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Generate impression based on medical findings. | Male, 65 years old. Reason: Neutropenic fever- r/o opacity History: neutro fever Small focus of atelectasis or scarring again noted at the left lung base. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Left-sided PICC, unchanged. | No acute cardiopulmonary process on radiography. |
Generate impression based on medical findings. | 60-year-old female with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Large thick-walled cystic lesion centered within the pancreatic body measuring 6.7 x 6.6 cm with a moderate amount of debris layering within the dependent aspect of the lesion. There is no appreciable enhancement after contrast administration. There is no clear communication with the main pancreatic duct however significant mass effect is present with a dilated and tortuous distal pancreatic duct measuring up to 5 mm. There is significant mass effect on the adjacent gastric antrum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign appearing left superior pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Large cystic lesion arising from the pancreatic body which is favored to represent a pancreatic pseudocyst, however a mucinous neoplasm cannot be excluded. There is distal pancreatic ductal dilation as well as significant mass effect on the gastric antrum. |
Generate impression based on medical findings. | Reason: assess for interval resolution of pulmonary edema with diuresis History: as above Moderate cardiomegaly with bilateral interstitial and airspace opacity, not significantly changed.The patchy nature of the pulmonary opacities is more suggestive of infection/aspiration and pulmonary edema. | Patchy pulmonary opacities consistent with infection and aspiration, not significantly changed. |
Generate impression based on medical findings. | Female, 42 years old.Reason: post op History: post op Mild to moderate cardiomegaly.No specific evidence of infection or edema. | Mild to moderate cardiomegaly, otherwise unremarkable. |
Generate impression based on medical findings. | Male, 66 years old.Fevers history of SCT with MDS assess for infection or opacities. Lung volumes remain low. Interval development of moderate bronchial wall thickening, associated atelectasis and peribronchial airspace opacities, most pronounced in the left lower lobe. Possible small pleural effusions.Vertebroplasty cement in the lower thoracic and upper lumbar vertebrae noted. | Bronchial wall thickening, atelectasis and peribronchial opacity suspicious for infection. |
Generate impression based on medical findings. | Evaluate lines. Unchanged jugular venous catheters, endotracheal tube and ECMO cannulae.Diffuse pulmonary opacities with improved lung aeration compared to the prior study. The left upper lobe remains completely opacified. Peripheral opacity consistent with layering pleural fluid. There is a small remaining anterior pneumothorax on the left, not measurable. | Improved lung aeration. Tubes and lines unchanged in position. |
Generate impression based on medical findings. | Female, 33 years old.Reason: loculated pleural effusion History: loculated pleural effusion s/p drain placement. Interval placement of a right pleural pigtail catheter that terminates in the right perimediastinal location. The left port remains accessed.Large right loculated pleural effusion and pleural thickening not significantly changed. Multifocal patchy airspace opacities on the left slightly increased with a stable small left pleural effusion. No significant pneumothorax identified. The cardiac silhouette is obscured but does appear enlarged. | No significant change in the loculated large right pleural effusion following pigtail catheter placement. |
Generate impression based on medical findings. | 75-year-old female with history of lymphoma presents with right lower extremity swelling. Ultrasound negative for DVT. Concern for vascular compression by lymphadenopathy. CHEST:LUNGS AND PLEURA: Scattered parenchymal scarring, especially in the apices, remains. Small bilateral pleural effusions are again noted.An AVM (right lower lobar artery to right inferior pulmonary vein) is seen in the right lower lobe (series 3; image 52), unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes remain, unchanged. Reference 8 x 5 mm paratracheal lymph node (series 3; image 22), unchanged.Focal plaque affects the aortic arch, unchanged.CHEST WALL: Several subcentimeter right axillary lymph nodes are seen, not greatly changed.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal sinus cysts are again noted bilaterally. Subcentimeter hypodensities in both kidneys are too small to characterizeRETROPERITONEUM, LYMPH NODES: Numerous mildly enlarged retroperitoneal (periaortic, interaortocaval, paracaval) lymph nodes have developed. For reference, one of the interaortocaval nodes measures 17 x 14 mm (series 3; image 114), previously 8 x 8 mm.BOWEL, MESENTERY: Mild circumferential thickening affects the terminal ileum.BONES, SOFT TISSUES: Patchy bone density is identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged lymph nodes are seen along the common and external iliac chains bilaterally. For reference, a right external iliac lymph node measures approximately 2.4 x 1.5 cm (series 3; image 161), previously approximately 11 x 5 mmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy bone density is identified.OTHER: Narrowing of the right common and right external iliac veins is seen, at least partially due to adjacent adenopathy. Adjacent fat stranding is seen in this region.BILATERAL LOWER EXTREMITIES:The soft tissues of the right thigh are edematous with skin thickening. Lack of venous opacification limits evaluation for thrombosis. However, the caliber of the right lower extremity veins are similar to that of the left lower extremity veins. Varicosities are seen in the right thigh. | Progression of the disease in the form of lymphadenopathy.Narrowing of the right common/external iliac veins secondary to adjacent adenopathy. This is likely the cause of visualized edema affecting the right side.Development of mild wall thickening affecting the terminal ileum. Right lower lobe pulmonary AVM, unchanged. |
Generate impression based on medical findings. | Cough and elevated WBC, possible pneumonia. Opacities in the right lung on a background of emphysema and fibrosis have not resolved and are worse. Confluent opacities in the projection of the right upper lobe along the minor fissure as well as in the right middle lobe are new may represent infection or neoplasm.Unchanged cardiomediastinal silhouette.Degenerative changes of the spine. | Worsening opacities in the right lung which are now suspicious for neoplastic process, recommend thoracic CT. Dr. Elaine Worchester (4781) notified via Web exchange text page at 12:22 PM on 11/15/2016 in addition to an email. Superimposed indolent atypical infection such as MAI is also a possibility and is not excluded. |
Generate impression based on medical findings. | The exam is degraded by motion artifact.BRAIN: Foci of restricted diffusion are noted in the right dorsal putamen and right parietal periventricular white matter, consistent with acute infarction. Multiple chronic lacunar infarcts are again noted in the bilateral cerebellar hemispheres. FLAIR signal abnormality in the periventricular and subcortical white matter in addition to the pons is consistent with moderate chronic small vessel ischemic disease. Global parenchymal volume loss appears commensurate for the patient's age. There is a small extra-axial mass along the posterior surface of the petrous temporal bone, which has shown gradual growth since 2009 and most likely reflects a meningioma. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a chronic left lamina papyracea fracture. The skull and scalp soft tissues are unremarkable. There is partial opacification of the paranasal sinuses and right mastoid.MRA HEAD: There is no evidence of flow-limiting stenosis or aneurysm within the limitations of motion artifact. The left vertebral artery and A1 segment of the left anterior cerebral artery are diminutive. The left internal carotid artery is slightly smaller than the right. The middle cerebral arteries are unremarkable. The basilar artery is normal in course and caliber. There is a fetal origin of the right posterior cerebral artery. | 1. Small foci of restricted diffusion in the right dorsal putamen and right parietal periventricular white matter are consistent with acute infarction. 2. No significant stenosis in the major intracranial vasculature.3. Note examination is moderately motion degraded. |
Generate impression based on medical findings. | Female, 36 years old.Reason: chest pain, hx MI History: chest pain/back pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities. | No significant abnormality. |
Generate impression based on medical findings. | Knee instability MENISCI: There is mild irregularity of the free edge of the anterior horn of the medial meniscus with similar but more conspicuous findings noted in the anterior horn of the lateral meniscus near the root. This may reflect degeneration/degenerative tearing, but is of questionable significance.ARTICULAR CARTILAGE AND BONE: There is redemonstration of an oblique nondisplaced fracture through the patella that involves the underlying articular cartilage. Additionally, there is subchondral cystic change and focal full-thickness degenerative cartilage loss of the lateral tibial plateau.LIGAMENTS: No significant abnormality noted. Specifically, the anterior and posterior cruciate ligaments and the collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps tendon is normal. There is mild increased signal and thickening of the patellar tendon reflecting mild tendinosis.ADDITIONAL | 1. Redemonstration of nondisplaced patellar fracture.2. Intact cruciate and collateral ligaments.3. Additional findings described above. |
Generate impression based on medical findings. | Entire left sided numbness in the last 2 weeks which occurs daily usually when waking up. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is unchanged mild coaptation of the right frontal horn. The ventricular system is otherwise unremarkable. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. | 1. No evidence of acute infarct, acute intracranial hemorrhage, or mass.2. No evidence of significant steno-occlusive lesions in the major head and neck arteries. |
Generate impression based on medical findings. | Male, 73 years old.Reason: hx o/LLL abscess History: same Mild to moderate cardiomegaly.Streaky basilar opacities suggestive of atelectasis, but no evidence of pneumonia or prior lung abscess.Cervical spine stabilization hardware. | Cardiomegaly and streaky basilar atelectasis, otherwise unremarkable. |
Generate impression based on medical findings. | Male, 60 years old.Reason: R/o infiltrate History: chest discomfort No focal consolidation, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette. | No acute cardiopulmonary process. |
Generate impression based on medical findings. | Reason: s/p thyroidectomy, neck pain and dysphagia. Partial thyroidectomy in 1979 for a symptomatically large goiter. She reports benign pathology. She had a completion thyroidectomy in 12/2013, pathology report with colloid nodular disease. RIGHT LOBE: Homogenous, hypoechoic soft tissue in the right thyroid bed extending into the isthmus measures 1.9 x 2.9 x 0.9 cm and represents recurrent or residual thyroid tissue. No suspicious nodules or lesions in the thyroid bed.LEFT LOBE: Homogenous, hypoechoic soft tissue in the left thyroid bed measures 0.8 x 0.8 x 1.0 cm and represents recurrent or residual thyroid tissue. No suspicious nodules or lesions in the thyroid bed.ISTHMUS: Residual isthmic thyroid tissue as noted above without suspicious nodules or lesions.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted. | Findings consistent with residual or recurrent thyroid tissue in the thyroidectomy bed. No suspicious nodules or masses. |
Generate impression based on medical findings. | Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST: Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. | No significant extra cardiovascular abnormalities in the visualized portion of the thorax. |
Generate impression based on medical findings. | Cardiogenic shock, check Swan-Ganz Swan-Ganz minimally retracted, tip extends at the bifurcation of the right and left pulmonary artery. ICD-9 remaining underlying cardiopulmonary appearance is otherwise similar | Swan-Ganz minimally repositioned and mildly retracted |
Generate impression based on medical findings. | Female, 20 years old.Reason: ARDS? History: see above Line position stable. Support devices unchanged.Coarse bilateral interstitial and airspace opacities of ARDS, unchanged. No significant pneumothorax is visualized. Retrocardiac atelectasis increased, consider retained secretions or mucous plugging. | No interval change |
Generate impression based on medical findings. | Female, 64 years old.Reason: Lung Nodule History: Lung Nodule No lung nodule identified.A left pleural effusion is smaller than before with less adjacent atelectasis.Right lung unremarkable. | Improving left pleural effusion and basilar consolidation. No nodule identified. |
Generate impression based on medical findings. | Age: 67 yearsGender: MaleReason for Study: Reason: Recently admitted locally for pneumonia; repeat chest XR locally showed small pleural effusion to L side. Please evaluate progress of effusion. History: Previous SOB Left-sided ICD unchanged.Decreased lung volumes basilar atelectasis.No focal areas of consolidation.No large pleural effusions.Median sternotomy is intact. | Bilateral basilar subsegmental atelectasis. No specific evidence of infection or edema. |
Generate impression based on medical findings. | Reason: assess for thyroid nodules History: asymmetric thyroid on clinical exam RIGHT LOBE MEASUREMENTS: 1.8 x 1.8 x 6.7 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.5 x 5.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Hypoechoic, predominantly cystic nodule in the mid right thyroid measures 1.0 x 0.5 x 1.1 cm. A hyperechoic focus in the inferior right thyroid measures 0.5 x 0.2 x 0.6 cm, likely a focal calcification.LEFT LOBE: A hypoechoic, predominantly cystic nodule in the mid left thyroid measures 0.6 x 0.4 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted. | Multiple predominantly cystic thyroid nodules, probably benign. |
Generate impression based on medical findings. | Female, 13 years old. Anti NMDA Receptor Encephalitis, seizures. Evaluate for ovarian teratoma. PELVIS:UTERUS, ADNEXA: A 3.5 x 3.3 x 4.0 cm simple left ovarian cyst is noted. No associated solid component or abnormal enhancement. No other pelvic mass lesion is identified. The uterus is normal in appearance. Trace free pelvic fluid is likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No specific evidence of bowel obstruction.BONES, SOFT TISSUES: A subcentimeter lesion located eccentrically in the right proximal femur, peripherally T2 hyperintense, is not significantly changed from multiple prior studies and is of doubtful clinical significance.OTHER: No significant abnormality noted. | 1.A 4 mm left ovarian cystic lesion is compatible with a follicular cyst.2.No other mass is identified in the pelvis. |
Generate impression based on medical findings. | Male, 65 years old.Status post LVAD and chest tube taken out, assess for pneumothorax. Interval removal of one of the mediastinal drains, other hardware and devices unchanged. Small left pleural effusion similar to prior. No specific signs of pulmonary edema. No pneumothorax. | No pneumothorax. |
Generate impression based on medical findings. | Reason: assess for masses or abnormalities that may be causing lower abdominal pain. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed and is normal in size. Normal variant nabothian cysts are noted. There is poor definition of the endometrial-myometrial junction. The ovaries appear within normal limits including several small follicles and/or cysts, some of which may contain a small amount of hemorrhage. However there is no significant associated intrinsic T1 shortening to suggest endometriosis.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.Poor definition of the endometrial-myometrial junction which can be seen with adenomyosis.2.No abnormal mass lesions are identified within the pelvis to account for the patient's symptoms. |
Generate impression based on medical findings. | 42-year-old woman with history of chromophobe type renal cell carcinoma status post resection in 2008, subsequent hepatic metastasis ablation in 2015. ABDOMEN:LIVER, BILIARY TRACT: There is a new 8 mm T2 hyperintense round lesion in segment 7 at the dome (401/37). This lesion abuts the diaphragm, it is difficult to discern true enhancement. The previously seen segment 4A enhancing lesion is not visualized on today's study. There is no evidence of abnormal enhancement near the segment 6 resection cavity. There is no intra or extrahepatic biliary ductal dilatation. Gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Patient is status post left adrenalectomy.KIDNEYS, URETERS: Patient is status post left nephrectomy. No suspicious right renal lesion seen.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes without significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.New segment 7 lesion at the dome which abuts the diaphragm (making it difficult to discern enhancement) but is suspicious for a new hepatic metastasis.2.Hepatic ablation defect and left nephrectomy without evidence of local recurrence. |
Generate impression based on medical findings. | Age: 73 yearsGender: MaleReason for Study: Reason: evaluate L pleural effusion History: see above Decreased lung volumes.Bilateral pleural effusions mildly increased since the prior exam.Basilar edema/atelectasis again noted.No new focal pulmonary opacities. | Interval increase in pleural effusions |
Generate impression based on medical findings. | 19 years old male with history of craniopharyngioma now with increased headache, evaluate ventricular size. Patient is status post right frontal craniotomy, with placement of ventriculostomy catheter having tip in the third ventricle and small amount of encephalomalacia abutting the distal catheter; this is not significantly changed in appearance from the 2007 comparison study. Lateral and third ventricles are effaced secondary to decompression.Cystic focus with internal calcification in the interhemispheric fissure is unchanged in size from recent prior MRI study.There is no evdence of intracranial hemorrhage, mass or edema. The remaining ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | No hydrocephalus or change in ventriculostomy catheter position since 2007. |
Generate impression based on medical findings. | 79-year-old male with chronic kidney disease RIGHT KIDNEY: Measures 11.9 cm in length. Three right renal cysts measuring up to 5 cm in diameter without septation or nodular component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 12.3 cm in length. Two left renal cysts measuring up to 3.7 cm in diameter without septation or nodular component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted. | 1. Increased renal echogenicity consistent with medical renal disease and bilateral simple cysts as detailed above. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion. |
Generate impression based on medical findings. | Ms. Bray is a 46-year-old female presenting from outside hospital with two suspicious lesions identified in the left breast. These were biopsied and final pathology revealed atypia, but no malignancy. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, limiting the evaluation of MRI.In the left breast, far posterior depth, there is a lobulated T2 hyperintense lesion identified with associated enhancement. This lesion measures approximately 2.1 x 1.8 x 1.5 cm. Susceptibility artifact from biopsy marker clip is seen at the posterior aspect of this lesion, compatible with one of the biopsied lesions at outside hospital (labeled on outside images as left breast 2:00 location, approximately 7 cm from the nipple).In addition, in the left breast, mid depth, there is an additional lobulated T2 hyperintense lesion identified with associated enhancement. This lesion is slightly harder to measure due to its irregular margins, but approximately measures 2.8 x 1.4 x 1.6 cm. Susceptibility artifact from biopsy marker clip is seen at the lateral aspect of this lesion, compatible with the second of the biopsied lesions at outside hospital (labeled on other images as left breast 2:00 location, approximately 3 cm from the nipple). The two biopsy marker clips are separated by approximately 7 cm in the AP dimension. Of note, these two lesions were re-biopsied on the same day as the MRI, and the new biopsy marker Hydromark clips are separated by approximately 6 cm in the AP dimension on the ML view. Although there is significant background parenchymal enhancement identified in both breasts, there is no additional abnormal enhancement identified. No abnormal axillary lymph nodes are identified in either axillary region. | (1) Two enhancing lesions with T2 hyperintense signal (suggestive of mucin content) in the left breast, corresponding to the biopsied lesions at outside hospital. Repeat US guided biopsies of these two lesions was performed on same day as MR. Awaiting final pathology. (2) No additional MR evidence of malignancy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 35-year-old female with history of Hodgkin's disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right paratracheal adenopathy is unchanged measuring 16 x 9 mm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous enhancement of the liver is unchanged. Mild splenomegaly is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Myomatous uterus is stable.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. | Stable right paratracheal lymph node. No significant interval change. |
Generate impression based on medical findings. | Episodes of confusion since 2014. Epilepsy protocol. The bilateral hippocampal regions are symmetric. There is no evidence of gray matter heterotopia or cortical dysplasia. There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The sella appears to be partially empty, but this probably just represents a relatively U-shaped pituitary gland. The skull and extracranial soft tissues are unremarkable. | Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms. |
Generate impression based on medical findings. | Female, 47 years old.Reason: Reevaluate pulmonary edema History: SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. | Resolution of previously demonstrated pulmonary edema and pleural effusions. Decrease in heart size, now normal. |
Generate impression based on medical findings. | Female, 67 years old.Reason: eval for infection, infiltrate History: 6204 The cardiomediastinal silhouette is unremarkable.Lungs are clear.Mild left basilar atelectasis and possible small effusion. | No interval change |
Generate impression based on medical findings. | Altered mental status, evaluate for brain metastases. There is no restricted diffusion to suggest acute infarction. There are scattered foci of increased T2/FLAIR signal within the bilateral cerebral white matter which do not appear significantly changed compared to the 8/20/2016 examination allowing for differences in technique. Previously seen signal abnormality on 8/8/2016 exam predominantly involving the bilateral posterior cerebral hemispheres likely related to PRES no longer seen. There is no evidence of acute intracranial hemorrhage or mass. There is an unchanged punctate focus of susceptibility in the left frontal lobe, which is nonspecific, but likely related to trace mineralization or chronic hemosiderin. No pathologic enhancement is identified. The ventricles and sulci are unchanged including a normal variant cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffusely decreased T1 signal within the bone marrow with a few scattered areas of preserved increased T1 signal which is nonspecific and may be related to chronic anemia. | 1.No evidence of acute infarct or other acute intracranial abnormality.2.Few scattered areas of signal abnormality within the cerebral white matter which are nonspecific and not significantly changed compared to 8/20/2016. These may represent chronic small vessel ischemic changes or sequela of other injury.3.No evidence of intracranial metastases as questioned. |
Generate impression based on medical findings. | Male, 74 years old.Reason: evaluate Swan-Ganz catheter. Swan-Ganz catheter has been pulled back slightly terminating within the RPA. Unchanged port catheter. Increase in basilar opacities, likely atelectasis. Mild interstitial pulmonary edema. Small pleural effusions. Unchanged heart size. No pneumothorax. | Swan-Ganz catheter has been pulled back slightly terminating within the RPA. Unchanged port catheter. Increase in basilar opacities, likely atelectasis. Mild interstitial pulmonary edema. |
Generate impression based on medical findings. | 62 year old with a previously noted right middle lobe nodule. History of smoking LUNGS AND PLEURA: Redemonstration of a 4-mm micronodular right middle lobe, unchanged since the previous examination. No other pulmonary, pleural abnormalities can be identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative changes throughout the dorsal spine with accompanying scoliosisUPPER ABDOMEN: No significant abnormality noted. | Small stable micronodular right middle lobe without interval change over 6 months. In view of this patient's history of smoking a follow up examination in one year is recommended. |
Generate impression based on medical findings. | Male, 73 years old.Reason: PNA vs other lung infection History: prod cough Mild basilar interstitial opacities, which may be chronic as there is no other evidence of edema.Ill-defined left basilar nodular opacity, for which follow-up is recommended.Left subclavian catheter, tip in SVC. | No evidence of pneumonia. Left basilar nodule, follow-up radiograph or CT recommended. Chronic appearing basilar interstitial opacities noted. |
Generate impression based on medical findings. | 42 year-old female. 4-Cm bleeding gastric mass. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis or consolidation. No definite lung nodules.MEDIASTINUM AND HILA: ET tube. NG tube. No pathologic size nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube coiled in stomach. Patient's gastric mass corresponds to a hypodense lesion seen in the fundus of the stomach on coronal image 51/122 and on axial series 4 image 84/237 where it measures 3.8 x 2.1 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Numerous small noncalcified uterine masses. Correlate.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Gastric mass. No definite evidence of metastatic disease. Other findings as above. |
Generate impression based on medical findings. | 68 year old female status post fall 2 weeks ago, headache Low-attenuation in the right frontal and parietal region consistent with prior infarct. Additional subcortical and periventricular areas of patchy low attenuation consistent with small vessel ischemic disease of indeterminant age. There is no evidence of bleed or acute infarct. If evaluation for acute ischemia is clinically warranted, MRI is recommended.There is no evidence of intracranial hemorrhage or mass.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.There is soft tissue density superficial to the right parietal bone which may represent a hematoma in the setting of acute trauma. In the absence of acute trauma, infection should be considered. | Findings consistent with prior infarct in the right frontoparietal region. No evidence of acute ischemic process or hemorrhage. If evaluation for acute ischemia is clinically indicated, MRI is recommended. |
Generate impression based on medical findings. | 30 year old female with Cushing's disease. Now with bilateral ribs/chest pain. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heterogeneous enlargement of the right thyroid lobe with mixed calcific and low densities. No mediastinal or hilar adenopathy.CHEST WALL: Fractures of the left 9th and 10th ribs posteriorly, raising the question of direct trauma. Small amount of callus formation surrounding the 10th rib fracture suggests subacute injury.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Questionable enhancing small nodule in the left adrenal gland (series 3 image 87), however, this is equivocal.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Abundant amount of retroperitoneal fat deposition, compatible with Cushing's.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Presumed VP shunt catheter tubing courses down the anterior soft tissues of the chest/abdomen and courses anterolaterally in the left lower abdomen. | 1) Fractures of left 9th and 10th ribs posteriorly, raising the question of direct trauma.2) Heterogeneously enlarged right thyroid lobe.3) Questionable small enhancing left adrenal nodule.4) No intrapulmonary abnormalities. |
Generate impression based on medical findings. | Female, 73 years old.Coughing and short of breath evaluate for infection. Unchanged cardiomegaly. Sternotomy hardware appears intact. No focal airspace opacities, pleural fluid or pneumothorax. | No acute pulmonary abnormality. Specifically, no signs of pneumonia. |
Generate impression based on medical findings. | Female, 25 years old.Reason: ptx, pneumonia? History: chest pain No acute cardiopulmonary normality. | No acute cardiopulmonary abnormality. |
Generate impression based on medical findings. | 70 year-old male with metastatic gastric cancer with esophageal stricture. Evaluate GE junction prior to endoscopic stent placement for esophageal stricture. CHEST:LUNGS AND PLEURA: Interval development of small left pleural effusion with overlying atelectasis. Apical scarring. Scattered pleural nodular calcifications on the left side are unchanged. Scattered micronodules are also unchanged.MEDIASTINUM AND HILA: Previously measured cardiophrenic lymph node is slightly larger, measuring 14 x 7 mm (image 75 series 3), previously 6 x 5 mm image. Diffuse circumferential thickening of the distal esophagus is consistent with esophageal stricture (image 75 series 3).CHEST WALL: Degenerative changes in the spine without suspicious lesion.ABDOMEN: Streak artifact from residual high density barium limits evaluation of the abdomen.LIVER, BILIARY TRACT: Known hemangioma in the left lobe unchanged. Subcentimeter cysts in the left lobe unchanged. No focal lesions in the liver suspicious for metastatic disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal and perigastric adenopathy appears stable. Reference left para-aortic lymph node again measures 18 x 15 mm (image 114 series 3), unchanged. BOWEL, MESENTERY: Stable diffuse thickening of the gastric wall consistent with patient's known malignancy. Stable reference full-thickness of gastric wall at the site similar to previously measured is 3.2 cm (image 102 series 3), previously 3.1 cm.Previously mentioned nodular lesions in the peritoneum adjacent to stomach likely representing peritoneal carcinomatosis are less well visualized now. Reference lesion is not clearly visualized.Ascites has increased significantly increased compared to previous study. Nodular soft tissue density representing peritoneal carcinomatosis is stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Interval development of distal esophageal stricture. 2. Interval increase in cardiophrenic lymph node and ascites. 3. Otherwise, stable intraperitoneal disease. |
Generate impression based on medical findings. | Reason: HCV, eval for HCC History: HCV LIVER: The liver is mildly enlarged, measuring 17.6 cm in length. Normal echogenicity. No focal lesions. No intrahepatic dilation.BILIARY TRACT: No evidence of cholelithiasis. The gallbladder wall is not thickened, measuring 0.2 cm. There is no pericholecystic fluid. The common hepatic duct is not dilated, measuring 0.4 cm in caliber.PANCREAS: The visualized portions of the pancreas reveal no significant abnormality.SPLEEN: The size of the spleen is within normal limits, measuring 8.9 cm in length. Normal echogenicity. No focal lesions.KIDNEYS: The right kidney measures 11.6 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis.The left kidney measures 10.2 cm in length. Normal echogenicity. No focal lesions. No hydronephrosis. OTHER: The main portal vein is patent with hepatopetal flow and a normal waveform. | 1. The liver is mildly enlarged. There are no focal lesions visualized.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Male, 57 years old.Reason: Concern for pneumonia History: Febrile with recent surgery Subsegmental atelectasis of the right middle lobe. Blunting of the left costophrenic angle may represent a focus of aspiration or subsegmental atelectasis. Cardiac mediastinal silhouette is unremarkable. No evidence of pulmonary edema. | Opacities suspicious for subsegmental atelectasis. No specific evidence of pneumonia. |
Generate impression based on medical findings. | 45-year-old female patient with abdominal distention. Evaluate for cholecystitis. (Upon review of prior imaging, the patient has had a cholecystectomy). LIVER: The liver measures 22.1 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.8 cm in length. There is mild hydronephrosis.OTHER: The left kidney measures 12.4 cm in length. No evidence of hydronephrosis.The spleen measures 11.2 cm in length.There is mild ascites. | 1. Status post cholecystectomy as noted on prior CT.2. Hepatomegaly and mild ascites.3. Mild right hydronephrosis. |
Generate impression based on medical findings. | Female, 61 years old.Fever and tachycardia. Small fibrotic appearing lungs with interval increase in opacity diffusely but particularly in the right upper lobe since the prior study of 2014. Scattered solid appearing upper lobe nodular opacities bilaterally are of indeterminate etiology. Unchanged cardiomediastinal appearance. | Severe progressive pulmonary fibrosis with increased opacity in the right upper lobe and scattered solid appearing upper lobe nodular opacities. Recommend correlation with CT scan. Differential considerations include infection, acute exacerbation of interstitial lung disease, drug reaction or malignancy. |
Generate impression based on medical findings. | Male, 67 years old.Reason: chest pain History: chest pain, cough Left lung and chest wall mass unchanged, with underlying rib destruction.Mild interstitial opacities with septal lines could indicate edema although the heart is not large.Right apical scarring unchanged. | Large left lung and chest wall mass with rib destruction unchanged. |
Generate impression based on medical findings. | Congestive heart failure with ascites LIVER: Unremarkable parenchymal echogenicity without mass. Liver length 15.7 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.PANCREAS: 1.9 x 1.9 x 1.8 cm cystic lesion arising from the pancreatic body.RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 8.3 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 8 cm in length. Spleen 8.1 cm in length. Mild ascites. | Unremarkable hepatic parenchyma without mass or ductal dilatation. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstruction. Mild ascites.Pancreatic body cyst. |
Generate impression based on medical findings. | Male, 70 years old.Reason: s/p TECAB with ct removal History: S/p TECAB with CT removal Chest tubes removed with no pneumothorax.Increased basilar atelectasis may be from mucous plugging.Heart size remains normal.Right jugular catheter removed. | No pneumothorax following chest tube removal. Increased basilar atelectasis may be from mucous plugging. |
Generate impression based on medical findings. | Male, 48 years old.History bladder cancer status post radical cystectomy. Evaluate for metastatic disease. Soft tissue and bony structures are pertinent only for mild degenerative disk throughout the thoracic spine, unchanged. Cardiac and mediastinal silhouettes are normal in appearance. Lung parenchyma is normal without evidence of airspace disease or nodules to suggest metastatic disease. No pleural disease. | No acute cardiopulmonary disease and no evidence for metastatic disease. |
Generate impression based on medical findings. | Reason: eval for cause of chest pain History: chest pain Unremarkable cardiac and mediastinal silhouette. No significant pulmonary abnormalities on the chest radiograph though a subsequent CT scan shows multiple pulmonary nodules.Surgical clips in the neck. | No gross radiographic abnormalities but see subsequent CT scan report. |
Generate impression based on medical findings. | Male 71 years old Reason: Assess RUQ for gallbladder pathology given gallbladder wall thickening on CT History: Abdominal pain LIVER: Liver measures 16.6 cm in length. Main portal vein patent with normal directional flow, velocity measures 22 cm/s. BILIARY TRACT: Gallbladder contracted making evaluation for wall thickening suboptimal. No definite additional secondary signs of acute cholecystitis. Gallbladder did not have this appearance on October 2015 ultrasound exam. Per ultrasound technologist negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: Not well seen in entirety but visualized portions unremarkable.KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 10.1 cm. Heterogeneous rounded lesion involving lower pole of left kidney measuring approximately 3.9 x 3.8 cm. Lesion does not have the appearance of a simple cyst. No hydronephrosis.SPLEEN: The spleen measures 5.7 cm. in length. OTHER: Pleural effusions, evaluation for ascites suboptimal. | 1. Left lower pole solid appearing renal lesion measuring up to 3.9 cm suspicious for neoplasm.2. Contracted gallbladder making assessment for wall thickening suboptimal, differential considerations for appearance include hypoalbuminemia, recent meal and/or underlying chronic cholecystitis. No definite additional secondary signs of acute cholecystitis. |
Generate impression based on medical findings. | Evaluation for cardiopulmonary stability/line stability. IABP. IABP marker 4 cm below the top of the aortic arch. Right jugular Swan-Ganz catheter tip at the level of the pulmonary outflow tract near the main pulmonary artery. Mediastinal drains unchanged in position.Extensive edema-like opacities unchanged from earlier exam today but progressed compared to earlier studies. Mild right upper lobe volume loss. Right pleural fluid less well visualized. Trace, 3 mm left apical pneumothorax. | IABP marker 4 cm below the top of the aortic arch. Worsening pulmonary opacities. Trace left apical pneumothorax. |
Generate impression based on medical findings. | Female, 28 years old.Reason: sob History: sob Low lung volumes. No pleural effusion or pneumothorax. No focal pulmonary opacities. The cardiac mediastinal silhouette is within normal limits. | No acute cardiopulmonary abnormality. |
Generate impression based on medical findings. | Respiratory failure Tracheostomy tube, Dobbhoff, LVAD, right jugular dialysis catheter and ICD are all unchanged.Mild motion degrades sensitivity with persistent diffuse partial changes representing early edema with moderate effusions and a retrocardiac opacity likely atelectasis | LVAD unchanged |
Generate impression based on medical findings. | Female, 26 years old.Reason: r/o acute chest History: chest pain in patient with sickle cell crisis, new O2 requirement Heart size near upper normal.Linear basilar scarring.No evidence of infection or infarction.Skeletal abnormalities of sickle cell unchanged.Cholecystectomy clips noted. | Heart size upper normal with scarring but no acute pulmonary abnormality. |
Generate impression based on medical findings. | 68 year-old male with a history of cholestasis and TPN. LIVER: The liver parenchyma is mildly coarsened. It is normal in size, measuring 19 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: The gallbladder is distended and contains sludge and small gallstones. There is no wall thickening, pericholecystic fluid or focal tenderness. The common bile duct is normal in caliber at the pancreatic head, measuring 4 mm.PANCREAS: The visualized portions of the pancreatic head and body are normal.SPLEEN: The spleen measures 10.6 cm in length without a discrete lesion.RIGHT KIDNEY: The right kidney measures 12.6 cm in length without hydronephrosis or shadowing calculus. There is a lobulated multiseptated lower pole cystic lesion measuring 2.9 x 2.2 x 3.3 cm, as seen on the prior CT, likely a minimally complex cyst. OTHER: The patient is status post left nephrectomy. | Dilated gallbladder with cholelithiasis and biliary sludge without specific findings of acute cholecystitis. |
Generate impression based on medical findings. | Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0], Reason for Study: ^Reason: further eval findings on CT concerning for stroke History: CT findings concerning for stroke, s/p VA ECMO \T\ myocardial dysfunction Brain MRI:There are multifocal restricted diffusion lesions involving left basal ganglia, bilateral frontal lobe parietal lobe and occipital lobe with peripheral enhancement on gadolinium infusion indicating subacute/acute ischemic infarct. On gradient echo images, there are scattered susceptibility lesions on bilateral hemispheres indicating chronic petechial hemorrhage or parenchymal calcification. In particular, right parietal lobe susceptibility lesions which are associated with acute ischemic infarct represent possible hemorrhagic conversion.The lesions show gyriform high signal intensities on T1 weighted images indicating possible laminar necrosis. Ventricular system is slightly dilated otherwise unremarkable.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells show opacifications.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate extremely attenuated left cervical ICA upto the level of the left cavernous sinus segment. The left MCA and ACA appear to be reconstituted through the left Pcom and Acom arteries.Right ICA, MCAs and ACAs appear to be normal. Vertebrobasilar system appears to be normal.Pituitary MRIThe pituitary gland is normal in size, morphology, signal intensity and enhancement. There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable. | 1. Subacute/acute ischemic infarctions on bilateral hemispheres as described above with hemorrhagic conversion on the right parietal lobe lesion.2. Near complete occlusion of the cervical segment of the left ICA with reconstitution of the distal left ICA at the level of cavernous sinus segment.3. Normal pituitary gland MRI. |
Generate impression based on medical findings. | Metastatic small cell lung cancer, brain metastases, on chemotherapy. There are postoperative findings related to right frontal craniotomy, with underlying confluent high T2 signal with encephalomalacia and susceptibility effect in the right frontal lobe, with an unchanged subcentimeter area of enhancement. There are also multiple other supratentorial and infratentorial metastatic lesions, some of which are stable and some of which are smaller. For example, a left middle frontal gyrus lesion measures up to 6 mm in diameter, previously also 6 mm, and a posterior medullary lesion measures 5 mm in diameter, previously 10 mm. Many of the lesions contain hemorrhagic components levels, some of which have evolved. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. | Postoperative findings related to right frontal craniotomy, with an unchanged nonspecific subcentimeter area of enhancement. Multiple other supratentorial and infratentorial metastatic lesions are stable or smaller and many contain hemorrhagic components. |
Generate impression based on medical findings. | Female, 77 years old.Reason: f/u s/p rll History: f/u s/p rll Subtle right hemithorax volume loss from right lower lobectomy, with no evidence of metastases. What may be perceived as a nodule in the right lower lung zone is likely a vessel on end. Previously described left lower lung nodular opacity barely visible.No reliable evidence of tumor recurrence.Heart size normal.Large hiatal hernia. | No specific evidence of tumor recurrence following right lower lobectomy. Large hiatal hernia. |
Generate impression based on medical findings. | Male, 71 years old.Widened mediastinum with chest pain. Metallic bullet fragments project over the right posterior lateral chest wall.Chronic blunting of the right costophrenic angle. No pneumothorax or conclusive pleural fluid. No signs of pulmonary edema or pneumonia. Normal heart size. The thoracic aorta is slightly unfolded, but no signs of mediastinal hematoma are evident. Spinal osteophytes. | No specific signs of mediastinal hematoma. Normal heart size. |
Generate impression based on medical findings. | Cough No cardiopulmonary abnormality | Normal |
Generate impression based on medical findings. | 70-year-old male with history of prostate cancer. Left lateral base 3+4, left medial base 3+4. PELVIS:PROSTATE:Prostate Size: 4.8 x 2.7 cmPeripheral Zone: In the left lateral base there is a T2 hypointense lesion with restricted diffusion measuring 1.4 x 0.7 cm (image 27 of series 601). This lesion abuts the seminal vesicles.Central Gland: Mild BPHSeminal Vesicles: The seminal vesicles are abutted by the aforementioned left base lesion.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Left lateral peripheral base lesion compatible with patient's known prostate adenocarcinoma which abuts the seminal vesicles. |
Generate impression based on medical findings. | Age: 50 yearsGender: FemaleReason for Study: Reason: eval for infection History: sob, cough, weakness The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Moderate degenerative changes throughout the thoracic spine. | No acute cardiopulmonary abnormalities are identified. No specific evidence of infection or edema. |
Generate impression based on medical findings. | There is diffuse T2 signal hyperintensity in the left slightly greater than right periventricular white matter and appears similar to prior MRI in 2012; findings compatible with periventricular leukomalacia and encephalomalacia. Diffusely diminished supratentorial white matter volume as well as thinning of the corpus callosum compatible with Wallerian degeneration, not significantly changed. The ventricles are normal in size. Cystic foci adjacent to the frontal horns favored to represent cystic encephalomalacia, less likely connatal cysts given similar appearance posteriorly. The cisterns remain patent. There is no midline shift or mass effect. There are no other areas of abnormal signal or pathological enhancement. No evidence of heterotopia or migrational anomaly. Bilateral hippocampi are symmetric in size and signal characteristics. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. | 1.No significant change in extensive periventricular T2/FLAIR signal abnormality, periventricular cystic changes, and diminished supratentorial white matter volume. Findings are again consistent with periventricular leukomalacia/encephalomalacia related to remote injury.2.No intracranial mass, acute infarct, or hemorrhage. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | MS, follow-up progression. History of paresthesias. There are several punctate and curvilinear T2/flair hyperintensities demonstrated in the periventricular and subcortical white matter which are unchanged in size, appearance, and location compared to the prior MRI. A stable punctate T2/flair hyperintensity is noted within the left superior pons. No new lesions are identified. There is no evidence of intracranial hemorrhage or mass. The pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No significant interval change in size and number of scattered T2/FLAIR hyperintensities seen in the subcortical and periventricular distribution, compatible with history of demyelinating disease. |
Generate impression based on medical findings. | Male, 31 years old.Rule out acute chest in sickle cell patient, chest pain The lungs and pleural spaces are clear. There is mild cardiomegaly. No pneumothorax. | Cardiomegaly without consolidation or pleural effusion. |
Generate impression based on medical findings. | Female, 60 years old.Reason: 60F with neutropenic fever. History: neutropenic fever Increasing interstitial abnormality as well as consolidation in the right middle lobe which may be due to infection. There may be superimposed pulmonary edema. PICC tip in SVC | Increasing interstitial abnormality as well as consolidation in the right middle lobe which may be due to infection. There may be superimposed pulmonary edema. |
Generate impression based on medical findings. | Female, 64 years old.Reason: Left lobe decreased breath sounds History: as above Endotracheal tube tip 3-cm above the level of the carina. Nasogastric tube tip off the caudal margin of the film.Unchanged lobular cardiomegaly, enlargement of the central pulmonary vasculature and apparent pulmonary vascular redistribution. Vascular unsharpness suggestive of edema and atelectasis. Opacity in the right lower lobe consistent with atelectasis however superimposed aspiration or infection in this region cannot be ruled out. Probable small pleural effusions | No interval change |
Generate impression based on medical findings. | 60 -year-old female colon cancer status post resection. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Subcentimeter nodule in the right middle lobe measuring 5 .number 13, series number 5. Emphysema.MEDIASTINUM AND HILA: Cardiomegaly. Aortic valvular calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:The study is limited due to lack of IV contrast. Focal liver lesions cannot be excluded based on this noncontrast study.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: . Subtle hyperdense lesion in the right kidney which cannot be optimally evaluated due to lack of IV contrast the likely complex cyst.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes. A reference left aortic lymph node measures 15 x 12 mm in image number 122, series number 80372.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace amount of perihepatic ascites.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous fluid collection along the incision containing air and with a thin wall measuring 11 x 8 cm consistent with an abscess. Diffuse inflammation of the subcutaneous fat in the anterior abdominal wall likely representing cellulitis.OTHER: No significant abnormality noted. | Limited study due to lack of IV contrast.Trace amount of ascites.Ill-defined hyperdensity in the lower pole of the right kidney likely representing a complex cyst, however, lack of IV contrast precludes further evaluation. Large anterior abdominal wall abscess with diffuse cellulitis.Borderline enlarged retroperitoneal lymph nodes. Follow-up imaging is recommended.Dr. Sharma was notified at the time of dictation. |
Generate impression based on medical findings. | Male, 68 years old, with brain lesion for evaluation. The left basal ganglia ring enhancing lesion persists, with perhaps a mild interval decrease in size, now measuring up to 23 mm in diameter, previously up to 25 mm. Internal diffusion restriction seen on prior exams continues to diminish. Subtle developing peripheral T1 hyperintensity is seen aroung this lesion. Some progression of surrounging T2 signal abnormality is seen, particularly at the level of the left caudate body which now shows progressive cystic degeneration. Along the left ventricular atrium, T2 signal abnormality is improved. A separate 4 mm linear focus of enhancement along the left posterior limb of the internal capsule is unchaged. Scattered calcified lesions as represented by areas of T1 hyperintensity and/or susceptibility effect have not changed. Smooth dural thickening and enhancement along the left parietal convexity is also unchanged. No new lesions are seen. Numerous patchy areas of white matter T2 hyperintensity and cortical encephalomalacia are stable. Ventricular size and morphology are unchanged. | 1.Persistent ring enhancing lesion in the left basal ganglia with perhaps a mild interval decrease in size. A rim of T1 hyperintensity continues to development around this lesion. 2.Diffusion restriction internal to the above lesion is reduced. Some progression of surrounding T2 signal abnormality is seen, at least along the left caudate body which shows progressive cystic degeneration.3.A separate small enhancing focus in the posterior limb of the left internal capsule is stable. Numerous calcified lesions, and other areas of white matter and cortical injury, are stable. Dural thickening and enhancement along the left parietal convexity is unchaged as well.4.Although no real evidence of progression of the basal ganglia lesion is seen, and some findings would suggest evolution towards chronicity, the findings are still not sufficient to distinguish between infectious and neoplastic etiologies. |
Generate impression based on medical findings. | Right foot/ankle mass; chronic pain Ankle/hindfoot: There is slight prominence of the subcutaneous fatty tissue anterior to the lateral malleolus which could represent a lipoma but this is equivocal. There is otherwise no discrete mass identified. There is minimal edema of the subcutaneous fat about the ankle both medially and laterally. There is slight signal heterogeneity of the deep fibers of the deltoid ligament which may represent prior sprain. The remaining ligaments, tendons, and soft tissues are unremarkable.Midfoot/forefoot: Mild osteoarthritis affects the first MTP joint and there is a mild hallux valgus deformity. There is mild edema of the soft tissues at the bases of the first and second toes. A couple of small (less than 5 mm) foci of high signal intensity are seen lateral to the proximal phalanx of the second toe which are nonspecific in nature and may represent small ganglia or even nerve sheath tumors but are of questionable clinical significance. The location of these foci is slightly distal for the typical presentation of a Morton neuroma. The bone marrow signal intensity of the foot is normal. | 1. Mild nonspecific soft tissue edema of the foot and ankle as described above.2. Prominence of the subcutaneous fat anterior to the lateral malleolus may represent a lipoma but this is equivocal. There is otherwise no discrete mass identified.3. Small foci of increased signal intensity lateral to the proximal phalanx of the second toe which are of uncertain clinical significance and etiology but may represent ganglia or perhaps nerve sheath tumors. Morton neuroma is considered less likely given the relatively distal location. |
Generate impression based on medical findings. | Female, 37 years old. Pain. Evaluate for labral tear. ACETABULAR LABRUM: There is abnormal high signal within the anterior superior labrum, compatible with a tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL | Anterior superior labral tear. |
Generate impression based on medical findings. | Female, 71 years old.Reason: r/o pneumonia History: sob, tachycardia Stable cardiac enlargement with atherosclerotic changes of aorta and an aortic stent graft in place involving the descending thoracic aorta.Large lung volumes compatible with COPD.Interval removal of right central catheter.Interval increase in by a lateral pleural effusions, left greater than right. Left basilar opacity. Consider infection. | Interval removal of right central catheter with no pneumothorax.Interval increase in bilateral pleural effusions with left basilar opacity. Consider infection. |
Generate impression based on medical findings. | Age: 23 yearsGender: MaleReason for Study: Reason: chest tube History: chest tube Left-sided chest tube unchanged.No pneumothorax identified.Decreased lung volumes a stable cardiomediastinal silhouette.Minimal basilar atelectasis. | Left-sided chest tube unchanged. No evidence of a pneumothorax. |
Generate impression based on medical findings. | Female, 34 years old.Reason: eval for active tb with hx +PPD or + QuantiFeron History: eval for active tb with hx +PPD or + QuantiFeron Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB. | No significant abnormality. |
Generate impression based on medical findings. | Female, 56 years old.Reason: eval for infiltrate, PNA; hx of EtOH hepatitis History: abd pain, hypotension Right basilar subsegmental atelectasis and right pleural effusion are present.Heart size normal.No change. | Unchanged basilar atelectasis and pleural effusion |
Generate impression based on medical findings. | A 66 year old male with paroxysmal atrial fibrillation, increased CPK extra-cardiac sarcoidosis with suspected cardiac involvement from previous cardiac MRI in 2009. Referred now to cardiac MRI for follow up. Left VentricleThe left ventricle remains normal in size and systolic function. The overall LV ejection fraction is 58%. There are no regional wall motion abnormalities present. The previous left ventricular ejection fraction was 59%. There is mild progression of basal anteroseptal hypertrophy measuring up to 14 mm. The LV end diastolic volume index is 84 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 43 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). There is late gadolinium enhancement in the basal infero-lateral segment in a mid myocardial distribution, similar in extent to the cardiac MRI of 2009. The late gadolinium enhancement spares the endocardium. Given the clinical history, this is suggestive of myocardial sarcoidosis. No thrombus is present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 102 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild chordal systolic anterior motion during systole secondary to anterobasal septal hypertrophy.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation which visually appears mild. Dedicated imaging was not performed.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsMild bilateral hilar lymphadenopathy. | 1. Well-preserved left ventricular function with an LVEF of 58%.2. Enhancement at the basal infero-lateral segment similar to cardiac MRI of 2009. This spares the endocardium and is not likely to represent a prior myocardial infarction. Given the clinical history, this is suggestive of cardiac sarcoidosis. There is no significant changes compared to 2009.3. The right ventricle is normal in size and systolic function, the RVEF is 51%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Male, 53 years old.Sudden onset of chest pain evaluate mediastinum. Severe cardiomegaly. Thickening of the fissures and vascular unsharpness consistent with moderate to severe pulmonary edema. Moderate volume of pleural fluid bilaterally.Please note that chest radiograph has a limited sensitivity for detection of vascular pathology including but not limited to dissection. Within this limitation, the mediastinum is without suspicious widening. | Moderate to severe CHF. |
Generate impression based on medical findings. | Reason: ett tube History: intubation ET tube tip 8 cm above the carina.Severe emphysema and bilateral lower zone airspace opacity with several discrete nodules, not significantly changed since the previous radiograph.No new findings. | ET tube in acceptable position. |
Generate impression based on medical findings. | 61-year-old female with history of intubation. Evaluate ET tube placement. ET tube tip 2 cm above the carina. Feeding tube in the stomach with tip outside the field of view. Status post median sternotomy with fracture of the 3 inferior sternal wires. Coronary stents are seen.Low lung volumes. Chronic appearing interstitial opacities likely representing edema, not significantly changed. Probable small bilateral pleural effusions. | Endotracheal tube tip 2 cm above the carina, otherwise stable cardiopulmonary appearance. |
Generate impression based on medical findings. | Male, 83 years old.Reason: r/o worsening of fluid status or acute parenchymal changes History: acute SOB and worsening hypoxia Worsening perihilar interstitial and airspace opacitiesSuggestive of edema or aspiration, with persistent bilateral pleural effusions. Heart size normal.Right PICC, tip in axillary region. | Worsening perihilar opacities suggestive of worsening edema or aspiration. |
Generate impression based on medical findings. | Male, 60 years old.Swan placement. Cardiogenic shock. Right jugular catheter has been replaced. New right jugular Swan-Ganz catheter tip projects over the right main pulmonary artery. Unchanged cardiomegaly. Sternotomy hardware and a bioprosthetic aortic valve noted.Large right pleural fluid collection and a probable small left pleural fluid collection are unchanged. Compressive atelectasis in the posterior lung fields, possibly with mild superimposed edema on the right, unchanged.No pneumothorax. | Right jugular Swan-Ganz catheter projects over the right main pulmonary artery, no pneumothorax. No acute change in pulmonary or pleural abnormalities. |
Generate impression based on medical findings. | Male, 26 years old.Reason: infiltrates History: desaturation New complete whiteout of the left hemithorax, likely atelectasis. No new focal pleural parenchymal opacity in the right hemithorax. Heart size difficult to assess. No pneumothorax. Lines and tubes are unchanged. | New complete whiteout of the left hemithorax, likely atelectasis. |
Generate impression based on medical findings. | Male 61 years old with elevated PSA and 2 prior negative biopsies. PELVIS:PROSTATE:Prostate Size: 4.9 x 6.0 x 6.0 cmPeripheral Zone: There is a 9 x 6 mm lesion (series 301, image 64) in the left base and a 5 x 4 mm lesion (series 301, image 66) in the right base. These lesions are dark on T2 and ADC and demonstrate early contrast enhancement and are suspicious for prostate carcinoma.Central Gland: Multiple large BPH nodules are noted.Seminal Vesicles: The left seminal vesicle is collapsed. The right seminal vesicle is unremarkable.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Diffuse diverticulosis and wall thickening of the the sigmoid colon. | Small peripheral zone lesions in the prostate base bilaterally are suspicious for prostate carcinoma. |
Generate impression based on medical findings. | Male 65 years old Reason: Pt is a 65 yo male w/ hx of follicular lymphoma; pre-asct eval History: Pre-stem cell transplant evaluation. Cardiac mediastinal silhouette is within normal limits.No focal opacity, pneumothorax, pleural effusion is identified.No evidence of metastatic disease. | No acute cardiopulmonary abnormality. No specific evidence of metastatic disease. |
Generate impression based on medical findings. | Male, 57 years old.Reason: SOB, elevated CK History: r/o ILD Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities. | No significant abnormality. |
Generate impression based on medical findings. | 44-year-old female with cough x 9 months, chest pain tonight; tachycardic - hemoptysis two days ago. Query any respiratory infection, PE, or signs of CA. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries.LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema with an intrapulmonary cyst noted peripherally in the right upper lobe as well. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted. | 1. No evidence of PE.2. Mild upper lobe centrilobular emphysema. |
Generate impression based on medical findings. | 20-year-old female presents with right upper quadrant pain. Evaluate for cholelithiasis. LIVER:Measures 17.4 cm. Course, heterogenous echogenicity of the liver parenchyma. No focal masses, ascites, intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder was not able to be definitely visualized on this study.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 10.0 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 10.6 cm. Left kidney measures 10.7 cm. The cortices have normal echogenicity. No shadowing calculi, hydronephrosis, or focal masses. OTHER: There is a small fluid collection between the inferior vena cava and the liver with some internal echoes which could represent a decompressed gallbladder or a loop of bowel which is incompletely visualized on this study. | 1. Course, heterogenous echogenic texture of the liver parenchyma is with chronic liver disease/parenchyma dysfunction.2. Gallbladder was not fully visualized on this study. There is a small fluid collection between the inferior vena cava and the liver which could represent a decompressed gallbladder although this could also represent a loop of bowel. |
Generate impression based on medical findings. | Intubated evaluate ETT. ETT tip about 3 cm above the level of the carina. Right jugular catheter and presternal ICD again noted. Interval placement of an enteric tube which extends to the right of midline in the upper abdomen.Unchanged cardiomegaly and mild diffuse interstitial abnormality. Left costophrenic angle blunting could indicate pleural fluid. | ETT tip 3 cm above the level of the carina. |
Generate impression based on medical findings. | 30-year-old male with history of right testicular cancer. Surveillance imaging. Normal cardiomediastinal silhouette.No acute focal airspace opacity. No discrete pulmonary nodules.Pleural spaces are clear. | No acute cardiopulmonary abnormality. |
Generate impression based on medical findings. | Female 58 years old with left kidney cyst on prior CT, evaluate size and characterization RIGHT KIDNEY: The right kidney measures 10.0 cm in length and has normal corticomedullary differentiation. No shadowing calculi or hydronephrosis is present. Previously noted low-attenuation focus on CT abdomen dated 12/20/2014 is not visualized.LEFT KIDNEY: The left kidney measures 10.4 cm in length and has normal corticomedullary differentiation. No shadowing calculi or hydronephrosis is present. OTHER: No significant abnormalities noted. | Previously noted low attenuation indeterminate focus on CT abdomen dated 12/20/2014 is not visualized. Recommend dedicated cross-sectional imaging for further characterization of this lesion. |
Generate impression based on medical findings. | Right base of skull mass. MRI: There is an unchanged lesion with high T2 and low T1 signal involving the right petrous apex and basiclivus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged T2 hyperintense foci within the cerebral white matter and foci of susceptibility effect that may represent chronic microhemorrhages. There is also unchanged encephalomalacia with hemosiderin lining in the medial left temporal lobe. There is a partially-empty sella. 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 paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an unchanged left MCA bifurcation aneurysm measuring approximately 3 x 2 mm and a right PCOM aneurysm measuring approximately 3 x 2 mm. There are no new cerebral aneurysms or significant steno-occlusive lesions. | 1. Unchanged lesion within the right petrous apex and basiclivus for which the differential diagnosis includes trapped secretions and less likely neoplasm, such as low grade chondrosarcoma. 2. Unchanged subcentimeter cerebral aneurysms.3. Unchanged probable microangiopathic white matter disease and hypertensive microhemorrhages, as well as left medial temporal lobe encephalomalacia. |
Generate impression based on medical findings. | Reason: edema, PNA History: chest pain, Afib with RVR Small lung volumes with no gross cardiopulmonary abnormalities. | No acute abnormalities. |
Generate impression based on medical findings. | Female, 49 years old.Nocturnal emesis, worsening lung exam. Evaluate possible aspiration. Sternotomy hardware and an orphaned ICD coil fragment in the projection of the left brachiocephalic vein are unchanged. Linear scarring or atelectasis in the left upper lobe. No pneumothorax. No focal pulmonary opacities. | No signs of aspiration or other acute pulmonary abnormality. |
Generate impression based on medical findings. | Evaluate for growth of thyroid nodules or adenopathy RIGHT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.6 x 1.1 x 1.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous thyroid echotexture with mixed hyper and hypoechoic parenchyma typical for thyroiditis, increasing from the prior examination. Inferior nodule measures 0.9 x 0.3 x 0.6 cm. LEFT LOBE: Heterogeneous thyroid echotexture with mixed hyper and hypoechoic parenchyma typical for thyroiditis, increasing from the prior examination.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | Heterogeneous thyroid echotexture with mixed hyper and hypoechoic parenchyma typical for thyroiditis. Stable right inferior lobe nodule. |
Generate impression based on medical findings. | 61-year-old male with prostate cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Asymmetrically enlarged thyroid gland, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensities throughout the liver, which are too small to accurate characterize, are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Extensive, diffuse retroperitoneal adenopathy, smaller compared to previous study. Index left para-aortic lymph node at the level of the left renal vein now measures 22 x 22 mm image number 115, series number 3. This lesion was measuring 4.8 x 2.8 cm image number 113, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Please see the discussion under the pelvic sectionOTHER: No significant abnormality noted.PELVIS:PROSTATE: Enlarged prostateBLADDER: Thickwalled bladder unchanged.LYMPH NODES: Index left inguinal lymph node is smaller now measuring 23 x 15 millimeter on image number 119, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive bone metastases involving the entire skeleton and appear more sclerotic, with slight interval increase in the extent of disease.OTHER: No significant abnormality noted. | Interval decrease in the size of the retroperitoneal and pelvic enlarged lymph nodes.Slight interval increase in the extent and density of the sclerotic bone metastases. |
Generate impression based on medical findings. | Enteric tube placement Suboptimal study secondary to patient motion artifact. Enteric tube seen with side-port in gastric body. Nonobstructive bowel gas pattern. Presumed residual contrast in right renal collecting system. Vascular calcifications. | Enteric tube as above.Please see same day chest radiography for additional findings. |