instruction
stringclasses 1
value | input
stringlengths 15
6.12k
| output
stringlengths 3
2.67k
|
|---|---|---|
Generate impression based on medical findings. | 8 year-old former 32 week premie with significant developmental delays. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and 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, and scalp soft tissues are grossly unremarkable. There is moderate left maxillary sinus mucosal thickening. | No evidence of acute intracranial hemorrhage, mass, or infarction. |
Generate impression based on medical findings. | Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: metastatic NSCLC s/p resection of R sided metastasis and adjuvant WBRT; please evaluate for response/progress Previously seen right frontal operculum cystic lesion appears to be smaller in size (10.4mm x 16.1mm, previously 18mm x 12.2mm). In addition, the daughter nodules some are on the enhancing rim also appear to be smaller in size comparing to prior study. The extent of surrounding edema also appears to be lessen than prior scan.A small nodular enhancing lesion on the right middle frontal sulcus (series 11, image 117) is again shown, unchanged in its size and configuration since prior scan. No other abnormal enhancing lesion is seen.Scattered patchy FLAIR high signal intensity lesions on bilateral periventricular white matter are again seen, unchanged since prior scan.No evidence of acute ischemic lesion on this scan.Evidence of right fronto temporal craniotomy is seen, unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Fluid collections on the right mastoid air cells, unchanged. | 1. Interval decrease in size of right frontal operculum mass as well as daughter nodules since prior scan as described above.2. No evidence of new abnormal enhancement.3. No acute ischemic lesion.4. Unchanged non specific small vessel ischemic lesions and right middle frontal sulcus enhancing lesion since prior scan. |
Generate impression based on medical findings. | Shoulder pain The examination is significantly limited by motion artifact.ROTATOR CUFF: There is fluid signal in the area of the supraspinatus tendon suggesting full-thickness tearing with retraction to the level of the clinoid. The infraspinatus may also be involved however this is unclear given the motion artifact. The distal fibers of the supraspinatus tendon are also poorly visualized but again this may be technical in nature.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is age-related degeneration of the labrum with mild glenohumeral osteoarthritic change.BICEPS TENDON: The intra-articular aspect of the biceps tendon is poorly visualized which may be secondary to at least partial tearing.ADDITIONAL | 1. Significantly limited examination secondary to motion artifact.2. Within the limits, there is likely full-thickness tearing of the supra/infraspinatus tendons with retraction to the level of the glenoid. Evaluation of the subscapularis tendon is limited although there may be partial tearing of the distal superior fibers as well.3. Poor visualization of the intra-articular biceps tendon likely secondary to tearing. |
Generate impression based on medical findings. | There is a mild dextrothoracic and levolumbar S-shaped scoliosis. There is minimal retrolisthesis of L1 on L2, L2 on L3 and L3 on L4. There is mild anterior wedging of the T12 vertebra. There is loss of disc height at T11-T12. There are scattered punctate T1 hyperintense foci throughout the lumbar spine, which are nonspecific, but likely represent focal fatty replacement or fat containing hemangiomas. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild retrolisthesis of L1 on L2 with pseudo disc bulge and bilateral facet arthropathy, contributing to mild spinal canal stenosis and mild bilateral foraminal stenosis. L2-L3: Mild retrolisthesis of L2 on L3 with pseudo disc bulge and bilateral facet arthropathy, contributing to moderate spinal canal stenosis and severe right and mild left foraminal stenosis.L3-L4: Mild retrolisthesis of L3 on L4 with pseudo disc bulge and bilateral facet arthropathy, contributing to moderate spinal canal stenosis and severe right and moderate left foraminal stenosis.L4-L5: Disc bulge and bilateral facet arthropathy, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis.L5-S1: Disc bulge and bilateral facet arthropathy, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis. | S-shaped scoliosis with degenerative lumbar spondylosis, most prominent at the L2-L3 and L3-L4 levels, with moderate spinal canal stenosis and severe right and mild to moderate left foraminal stenoses. |
Generate impression based on medical findings. | 64-year-old female with diarrhea, nausea, vomiting and abdominal pain. History of see differential colitis with abnormal guaiac two days ago. Evaluate for colitis. Previous history of multiple myeloma. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic hypodensities in the right lobe at axial image 31/162 and 38/162 were present in 2005 and most likely represent benign cysts. However, the lesion at image 31/162 has a larger size and may be better characterized for staging, if needed, with dedicated CT or MRI. This lesion now measures 12 mm in diameter. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities are present compatible with simple cysts. These are stable since 2005. Punctate calcifications in the renal pelves are most likely vascular. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal right eighth anterior rib expansion at axial image 38/162 is stable since 2005 and most likely represents changes of multiple myeloma.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a 4-cm segment of thickened narrowed sigmoid colon at axial image 107/162 with sharp zones of transition has appearance consistent with colon cancer. The remainder of the colon wall thickness and lumen diameter are normal.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Multiple stable lesions in the pelvis and hip compatible with history of multiple myeloma. These are stable since 2/5.OTHER: No significant abnormality noted | 4 cm lesion in sigmoid with appearance suggesting colon cancer. Right hepatic lobe hypodensity was present in 2005, but appears larger. Bony changes compatible with stable multiple myeloma. |
Generate impression based on medical findings. | Questionable hemorrhage on CT status post fall. History of extra-axial mass likely meningioma. No evidence of acute traumatic intracranial hemorrhage. Focus of increased density in the left pons on CT therefore represents mineralization. Punctate focus of restricted diffusion in the right cerebellar vermis compatible with a small acute infarct. New focus of mild diffusion restriction in the right anterior frontal lobe white matter with mild increased T2 signal compatible with an acute to subacute infarct. There is a third focus of new T2 signal abnormality in the left frontal corona radiata with associated susceptibility which does not currently demonstrate diffusion restriction and is compatible with a subacute to chronic infarct with associated chronic microhemorrhage.There are additional foci of periventricular and subcortical white matter T2 signal abnormality that are similar to prior compatible with small vessel ischemic changes. Stable chronic lacunar infarct in the right caudate head.Redemonstration of an extra-axial mass centered along the right aspect of the prepontine cistern and extending down to the level the pontomedullary junction. Stable extension into an expanded right Meckel's cave and foramen ovale. The mass abuts the cavernous sinus anteriorly. There is significant mass effect on the right cerebral peduncle, pons, and the right middle cerebellar peduncle. Overall the mass is not significantly changed in size measuring 2.6 x 2.0 cm in maximum axial dimension, previously 2.9 x 1.8 cm. There is increased T2 signal in the adjacent pons which may reflect edema and/or gliosis and similar to prior.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. | 1. Punctate focus of acute infarct involving the right cerebellar vermis as well as an acute to subacute punctate infarct in the right frontal lobe. There is also a focus of microhemorrhage with associated gliosis in the left frontal corona radiata which appears chronic but is new since prior study from 8/18/2015.2. Stable appearance of extra-axial mass centered in the right prepontine cistern with extensive mass effect on the adjacent pons and extension into Meckel's most compatible with a schwannoma or meningioma.3. Minimal chronic small vessel ischemic changes in the cerebral white matter and a chronic right basal ganglia infarct.4. Punctate focus of hyperdensity in the left pons as seen on recent CT is consistent with calcification.Findings were discussed with Dr. Gulati in the emergency room at 13:51 |
Generate impression based on medical findings. | 52-year-old male. History prostate cancer. Patient scheduled for RALP. PELVIS:PROSTATE:Prostate Size: 3.5 x 3.9 x 4.5 cm. Peripheral Zone: In the apex, there is extension of tumor from the transitional zone into the medial left peripheral zone (series 801, image 11). 1.2 x 0.5 cm T2 hypointense lesion in the left base and a subcentimeter lesion in the medial right base, suspicious for additional tumor foci (series 801, image 16).Central Gland: Diffusion restricting, T2 hypointense lesion in the anterior and left transitional zone in the apex consistent with prostate cancer, measuring 1.9 x 1.1 cm (series 801, image 11). The anterior component of tumor measures 1.8 x 0.7 cm, with broad based extension to the fibromuscular stroma and is concerning for extracapsular extension (series 801, image 13).Seminal Vesicles: None.Extracapsular Extension: Findings suspicious for extracapsular extension at the anterior fibromuscular stroma, as described above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Multifocal prostate cancer with dominant lesion in the central to left TZ and medial left peripheral zone at the apex. Findings suspicious for extracapsular extension at the anterior fibromuscular stroma. |
Generate impression based on medical findings. | Reason: Evaluate lumbar pathology History: Low back pain radiating down right leg Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disk space height, disk desiccation and diffuse disk bulge as well as bilateral facet hypertrophy and a mild anterior subluxation of L5 on S1. There are bilateral pars interarticularis defects present at this level and the narrowing of the neural foramina bilaterally. There is effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally at this level. This appears to be worse on the right versus the left side.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge at this level and there is bilateral facet hypertrophy at the mild/moderate degree at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There are degenerative changes present in lumbar spine with spondylolysis with spondylolisthesis at L5-S1 where there is encroachment of the exiting nerve roots within the neural foramina bilaterally right worse than left. |
Generate impression based on medical findings. | Right neck mass status post biopsy on 5/2015 with pathology as cyst. There is a T2 hyperintense, enhancing, right palatine tonsillar mass measuring 3.9 x 3.4 x 2.7 cm with extension into the soft palate and mild oropharyngeal airway narrowing. There may also be slight extension of tumor across the glossotonsillar sulcus. There is right level 2 lymphadenopathy, including a diffusely enhancing lymph node that measures 2.0 x 1.2 cm. In addition, there is an adjacent cystic lesion with layering debris or hemorrhage measures 2.2 x 2.6 cm. The salivary glands are unremarkable. There are right temporomandibular joint degenerative changes with an associated small effusion and subluxation. There is mild scattered paranasal sinus mucosal thickening. There is mild scattered periventricular and subcortical white matter T2 hyperintensity compatible with chronic small vessel ischemic disease. There is multilevel degenerative cervical spondylosis. The orbits are unremarkable. | 1. A mass in the right palatine tonsil with extension into the soft palate likely represents a squamous cell carcinoma or minor salivary gland neoplasm.2. Right suprahyoid lymphadenopathy likely represents metastatic disease, juxtaposed to what may represent a branchial cleft cyst with prior hemorrhage and possible tumor encroachment.3. Advanced degenerative changes involving the right temporomandibular joint. |
Generate impression based on medical findings. | 3 month laser ablation follow up for seizure focus. There has been expected evolution of postoperative findings related to laser ablation of the left medial temporal lobe lesion, where there is volume loss. There is a small amount of susceptibility effect along the left frontal and temporal surgical tracks. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening and secretions. The skull and scalp soft tissues otherwise appear unchanged. | Expected evolution of postoperative findings related to laser ablation of the left medial temporal lobe lesion. |
Generate impression based on medical findings. | Status post right frontal craniotomy and mass resection. Again seen are expected postoperative changes related to right frontal craniotomy and mass resection, including pneumocephalus, a small amount of hemorrhage, and persistent vasogenic edema. There is a rim of restricted diffusion in the resection cavity, compatible with cytotoxic edema. There is persistent mild leftward midline shift and partial effacement of the right lateral ventricle, similar to recent CT. No uncal herniation.There is no definite evidence of residual tumor. However, there is minimal residual enhancement which is questioned along the medial aspect of the resection cavity.Normal vascular flow voids are present in the major intracranial vessels. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.Status post right frontal craniotomy and right frontal lobe mass resection with expected postsurgical changes, including a small amount of hemorrhage in the resection cavity. 2.Persistent vasogenic edema, regional mass effect, and mild leftward midline shift, not significantly changed from recent CT. 3.No definite evidence of residual tumor. There is question of minimal residual enhancement along the medial aspect of the resection cavity, which can be further assessed on follow-up imaging. |
Generate impression based on medical findings. | Redemonstrated are postoperative findings of the lumbosacral spine for tethered cord repair. There is unchanged appearance of fat signal intensity involving the tip of the conus extending from the L4-L5 level down to the lower S1 level and remains adherent to the dorsal dural margin. The spinal cord displays normal signal and appears to slightly shift anteriorly on prone imaging with respect to supine imaging. The tip of the conus remains approximately at the mid L4 level. There is apparent clumping and a peripheral distribution of the cauda equina nerve roots. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable, aside from the surgical alterations. | Postoperative findings in the lumbosacral spine with redemonstration of an intradural lipoma and low-lying conus medullaris. Apparent clumping of the cauda equina nerve roots may indicate arachnoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Cerebellar hemangioblastomatosis treated with surgery in 2002 and SRS in 2004: headache and gait difficulty. There are postoperative findings related to left suboccipital craniotomy. There has been interval increase in size of the left inferior cerebellar hemisphere enhancing lesions, which now measure up to 18 and 8 mm each, previously 15 and 5 mm, respectively. There is also increased associated vasogenic edema and susceptibility effect. There are unchanged nonspecific punctate foci of T2 hyperintensity in the supratentorial brain. There is no evidence of acute infarct. There is an enlarged partially-empty sella. The ventricles are stable in size and configuration. There is no midline shift or herniation. Thre is fluid within the right mastoid air cells. The extracranial soft tissues are unremarkable. There are bilateral lens implants. | Interval increase in size of the left inferior cerebellar hemisphere hemangioblastomas, along with increased associated vasogenic edema. |
Generate impression based on medical findings. | 46-year-old male with sensory level, evaluate spinal known thoracic lipoma. CERVICAL SPINE: The vertebral body heights and disc are normal. Straightening of the cervical spine, otherwise no abnormal alignment. No abnormal marrow signal or enhancement. There is mild edema within the lower cervical cord as described below. At C5-C6, there is mild left foramen disc osteophyte complex effacing the left lateral recess with associated mild left neural foramen narrowing and mild effacement of the left thecal sac. At C6-C7, there is mild disc osteophyte complex without significant spinal or neuroforamen stenosis. THORACIC SPINE: There is a nonenhancing intramedullary lesion with fat signal characteristics extending from the level of the inferior aspect of T1 to the superior aspect of T3, which measures 1.6 x 1.2 x 3.3 cm. There is expansion of the cord with edema at this level extending superiorly and inferiorly from the lesion. The central canal is mildly dilated superiorly. The alignment of the thoracic spine is normal and there is no significant spinal canal or neural foramen stenosis throughout the thoracic spine.LUMBAR SPINE: The alignment is anatomic and the vertebral body heights are intact. There is minimal disc desiccation of L3-L4 and L4-L5. No abnormal marrow signal. No abnormal signal within the cord or conus, and T12-L1. There is no significant herniation, or spinal canal or neural foramen stenosis throughout the lumbar spine. | 1. Intramedullary lipoma in the upper thoracic spinal cord with associated edema.2. Multilevel degenerative cervical spondylosis that is most pronounced at C5-C6 associated with mild left neural foramen and spinal canal narrowing. |
Generate impression based on medical findings. | Multiple sclerosis: paresthesias. There are scattered focal and confluent areas of T2 hyperintensity predominantly involving the periventricular white matter of the bilateral cerebral hemispheres. There also appears to be a T2 hyperintense lesion in the spinal cord at the C1-2 level. The lesions appear to be similar to prior scans. 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, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst. | Findings compatible with demyelinating lesions in the brain and in the upper spinal cord, which appear similar to prior scans, although comparison is limited by differences in the technical parameters of the scans. |
Generate impression based on medical findings. | 69-year-old female with shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus from its insertion on the greater tuberosity, with 1 cm or less of proximal retraction. This appears to be a complete or near-complete tear, possibly with a few intact articular surface fibers posteriorly. There is a 7 mm ossicle within the retracted end of the torn tendon corresponding to a small ossicle seen on prior radiographs from October 2014. There is slight loss of volume of the supraspinatus muscle with relatively minimal fatty infiltration. There is intermediate signal intensity within the anterior fibers of the infraspinatus tendon at its insertion suggesting tendinosis but we see no fluid-filled filled tear. There is mild volume loss of the infraspinatus muscle with minimal fatty infiltration. There is mild intermediate signal abnormality within the subscapularis tendon suggesting mild tendinosis. The subscapularis muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is spurring at the greater tuberosity representing chronic enthesopathic changes as seen on prior radiographs.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint and there is a small os acromiale. Additional small ossicles lateral to the acromion process likely represent chronic enthesopathic changes at the deltoid origin. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is perhaps mild fraying of the superior labrum, but we see no fluid-filled tear within the limitations of a non arthrogram study. The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no large effusion is evident.BICEPS TENDON: The tendon of the long head of biceps appears intact. | Rotator cuff tear, acromioclavicular joint osteoarthritis, and other findings as described above. |
Generate impression based on medical findings. | Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: Evidence of prior bilateral posterior parietal craniotomy.There is relatively well circumscribed homogeneously enhancing extra axial mass adjacent to the superior sagittal sinus around the area of the right parieto-occipital fissure. The lesion appears to be slightly increased in size comparing to prior scan (12.2mm x 13.4mm, was 9.4mm x 11/8mm).The superior sagittal sinus at the level of the mass appears to be a bit obliterated due to the mass but reconstituted at the level of occipital lobe area. There is no evidence of venous congestive encephalopathy.There is no evidence of prominent cortical veins indicating rerouting of venous flow. Redemonstration of right cuneus and precuneus encephalomalacia with a some susceptibility artifacts indicating postoperative changes, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Bilateral maxillary sinuses show mucosal thickenings. | 1. Interval increase in size of parasagittal, around the area of right parieto-occipital fissure, extra dural mass, likely representing residual meningioma since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Postoperative status with postoperative encephalomalacia of the right cuneus and precuneus, unchanged. |
Generate impression based on medical findings. | 56-year-old man with history of rectal cancer status post resection of left lobe hepatic metastasis, now with new lesions seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Patient is status post partial left hepatectomy. In comparison to 6/2016, there are two new hepatic parenchymal lesions identified. A segment 4 lesion (13/17) measures 17 x 13 mm, has increased peripheral T2 signal, and enhances. In segment 6 at the site of previously seen hypoattenuating liver lesion (13/30) there is a 19 x 13 mm subcapsular T2 hyperintense area which retracts the capsule and does not enhance. No additional focal hepatic lesions are identified.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Accessory splenule noted, the spleen is otherwise unremarkable.PANCREAS: A few punctate foci of T2 hyperintensity along the pancreatic duct probably represent small sidebranch IPMNs. The pancreatic parenchyma otherwise appears normal. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cysts, the kidneys are otherwise unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: Scarring in the right lower quadrant anterior abdominal soft tissues likely from prior ostomy.OTHER: Along the surgical margin (13/27) there is minimally increased, amorphous T2 and diffusion signal. There is no evidence of enhancement. | 1.Segment 4 lesion suspicious for metastasis.2.Segment 6 surgical defect without evidence of enhancing tumor.3.Signal along the left lobe resection margin nonspecific but may represent postoperative inflammation/scarring. |
Generate impression based on medical findings. | Female, 18 years old, with left palm and sole numbness. Assess for thalamic or sensory cortical abnormality. Assess for cervical spine intramedullary or extramedullary lesions. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. A chronic deformity of the right orbital floor is seen with some herniation of orbital fat towards the maxillary sinus.C-spine:Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic intraspinal enhancement is seen. The intervertebral disk spaces are preserved. No spinal canal or neuroforaminal stenosis is seen. | 1.Unremarkable evaluation of the brain with no specific findings to account for the patient's symptoms.2.Unremarkable evaluation of the cervical spine with no specific findings to account for the patient's symptoms. |
Generate impression based on medical findings. | Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius, and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The distal LAD is diminutive, the LV apex is supplied by RV acute marginal branches.Ramus intermedius: No significant stenoses.LCx: The left circumflex coronary artery is non-dominant and small. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery, giving rise to a large RV marginal branches (which supply the usual territory of the distal LAD, a second RV marginal branch that supplies the usual territory of the posterior descending artery), a diminutive PDA, and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left VentricleThe left ventricle is normal in size. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular VSD located in the apical septum. Both VSDs have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the "VSD" on the prior cardiac MRI.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated. Not well visualized on the recent cardiac MRI, it is apparent on this study that the RV was surgically foreshortened with a patch to exclude apical muscular septal defect.Right AtriumThe right atrium is mildly dilated dilated. The right atrial appendage is located in between the left atrium and the pulmonary and aortic roots. Aortic ValveThe aortic valve is superior, anterior and to the left of the pulmonary valve.Mitral ValveThe mitral valve has no calcification.Pulmonic ValveThe pulmonic valve is normal in caliber but located to the right and posterior to the aortic root; it arises from the basal anterior wall of the right ventricle, likely via a conduit. Tricuspid ValveThe tricuspid valve has no calcification.Great VesselsMain pulmonary artery trunk (and pulmonic valve) is located along the right inferior border of the aortic root. The pulmonary artery and pulmonic valve are attached via, what is presumed to be, a short conduit to the basal free wall of the right ventricle. The distal main pulmonary artery is mildly narrowed. There are mild stenoses of the proximal right and left pulmonary arteries. Distally, the right and left pulmonary arteries are each mildly dilated. The aortic root is rotated counter-clockwise, posteriorly, and superiorly. It is likely connected to the left ventricle via an intra-ventricular baffle. The aortic arch is right-sided. The left innominate artery originates most proximally, followed by the right carotid and then right subclavian arteries. Systemic Venous ReturnRight SVC and IVC normally drain into the right atrium. A persistent left SVC courses in between the left atrial appendage and left sided pulmonary veins ultimately draining into the right atrium via a dilated coronary sinus.Pulmonary Venous ReturnAll four pulmonary veins drain into the left atrium.PericardiumThere is no obvious pericardial disease. | 1.Double outlet right ventricle s/p repair. See above for details. 2.There is normal origin of the coronary arteries. There are no significant coronary artery stenoses present. The distal LAD is diminutive; however, the LV apex is supplied by large acute RV marginal branches.3. There are at least two anatomic (but not functional) ventricular septal defects. The first is located immediately proximal to the aortic valve in the usual location of the distal RVOT. The second is a muscular "VSD" located in the apical septum. Both "VSDs" have been isolated from the right ventricle by a VSD patch. There appears to be no contrast communicating between the isolated anatomical VSDs and the functional right ventricle. This explains why no turbulent jet was seen through the "VSD" on the prior cardiac MRI.4. Normal LV size.5. Moderate RV dilation.6. Persistent left sided SVC draining to coronary sinus.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is a small left frontal developmental venous anomaly. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable. | Unremarkable brain and cervical spine MRI. |
Generate impression based on medical findings. | 25-year-old female patient perirectal pain and drainage. Evaluate for perirectal abscess. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are scattered mildly enlarged perirectal lymph nodes. BOWEL, MESENTERY: Redemonstration of a fistula originating at the 11 o'clock position of the distal rectum (to the right), coursing anteroinferiorly, and terminating in the skin of the right labia. No evidence of associated abscess. A fistula originating at the 6 o'clock position of the distal rectum without definite fluid collection also appears similar to the prior study. There is bowel wall thickening, increased T2 signal, restricted diffusion, and enhancement of the rectum compatible with active disease. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a new small amount of presacral fluid. No perirectal abscess is identified. | 1.Rectal bowel wall thickening with signal abnormality and enhancement compatible with active disease. 2.New small amount of presacral fluid, but no definite perirectal abscess.3.Similar appearance of fistulae to prior exam. |
Generate impression based on medical findings. | 65 years, Female, multiple sclerosis, evaluate for progression. Brain: There are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology compatible with known demyelinating disease. Differences in technique limit comparison; there are few small lesions involving the bilateral frontal and parietal subcortical white matter which are present on current high-resolution study and not evident on prior MRI from 4/14/2012 and 11/8/2010. The relatively largest lesions involving the right periatrial white matter as well as the right posterior pericallosal lesions are again seen and demonstrate T1 hypointensity. No new large lesions are demonstrated. No infratentorial lesions are definitively appreciated. No lesions with enhancement to suggest active demyelination. A right frontal developmental venous anomaly is incidentally noted. Brain parenchymal volume is within normal limits for age. No intracranial mass effect. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues are unremarkable. Cervical: Again seen are multiple T2 hyperintense lesions in the cervical cord including the right lateral C2 level, dorsal C2-C3 level, and left dorsal lesion extending from the C5-C6 to the C7 level, which is also associated with focal volume loss. No associated enhancement is seen. No new lesion is seen. The previously seen lesion in the cord at T3 is again seen and partially imaged on the sagittal sequence.Vertebral body heights and alignment are maintained. Mild degenerative changes are again seen with small disc disc protrusions at the C3-C4 to C5-C6 levels without significant spinal canal or neural foraminal stenosis. Foci of T1 hyperintensity compatible with small hemangiomas or focal fat. No suspicious osseous lesions are evident. Paraspinous soft tissues are unremarkable. | 1. Multiple T2/FLAIR hyperintense lesions are compatible with known chronic demyelinating disease. Differences in technique with prior study from 4/14/2012 limited precise comparison; however, there are small lesions which are present on the current high-resolution study and not seen on prior. Comparison is technically better with MRI from 11/8/2010 with more definitive evidence of a few small lesions which are new since then. Overall there is minimal interval progression of disease in the brain. No new large lesions are evident.2. Unchanged multiple T2 hyperintense lesions in the cervical cord and upper thoracic cord compatible with chronic demyelinating disease. No new lesions. |
Generate impression based on medical findings. | 56 years, Male, Reason: Patient with hx of right tonsil cancer treated in 2012 with CRT. Now with new onset right horner' s, right hypoglossal weakness and dysphagia Brain: Please note lack of contrast limits evaluation for small metastatic lesions. Within this limitation no intracranial mass, mass effect, or evidence of edema to suggest metastatic disease is appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Major flow-voids are preserved.There is opacification of the bilateral ethmoid air cells, right sphenoid sinus, as well as mild mucosal thickening involving the maxillary sinuses, similar to prior CT from 9/13/2013. No destructive lesions within the calvarium.Neck: There are posttreatment changes in the neck including asymmetrically increased soft tissue thickening along the right carotid sheath, which was seen on prior CT as well. There is asymmetric volume loss involving the right aspect of the tongue with rightward deviation of the extrinsic tongue muscles. There is also posterior displacement of the right posterior tongue which may also be related to denervation. There is also increased volume loss involving the right sternocleidomastoid muscle and trapezius when compared to prior study from 9/13/2013. No obvious destructive mass at the right skull base or elsewhere in the neck is appreciated within the limitations of noncontrast MRI.No discrete neck mass or significant cervical lymphadenopathy is appreciated within the limitations of noncontrast MRI. | 1. Please note lack of contrast limits evaluation, especially for perineural tumor spread. There is soft tissue thickening in the right neck which is grossly similar to prior neck CT and favored to be related to posttreatment change. No discrete neck mass or significant cervical lymphadenopathy is appreciated. 2. Volume loss involving the right oral tongue, posterior displacement of the right posterior tongue, and volume loss involving the right trapezius and sternocleidomastoid muscles. These findings all appear progressed/new since prior CT from 9/13/2013 and most compatible with multiple lower cranial neuropathies. No discrete mass at the right skull base is appreciated within the limitations of noncontrast MRI. If patient is not on dialysis and GFR is greater than 30, consider postcontrast sequences with half dose gadolinium to better exclude the possibility of recurrent neoplasm.3. No intracranial mass, mass effect, or edema within the brain to suggest intracranial metastases is seen. |
Generate impression based on medical findings. | Encephalopathy: confusion, encephalopathy. Many of the sequences are degraded by patient motion. There is an area of encephalomalacia in the right thalamocapsular junction region with extension into the corona radiata and left frontal lobe white matter, as well as punctate foci of encephalomalacia in the bilateral frontal lobe subcortical white matter and left thalamus, superimposed upon a background of patchy cerebral white matter T2 hyperintensity. However, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. 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. | Scattered chronic infarcts and probable chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on medical findings. | 45-year-old male with diabetic ulcer and spiking fevers on antibiotics. Evaluate for osteomyelitis. Right foot: There is significant soft tissue edema within the midfoot and forefoot of the right foot particularly along the dorsal aspect. There is normal bone marrow signal present on all sequences. No evidence of osteomyelitis. Severe degenerative changes affect the interphalangeal joint of the first toe.Right tibia/fibula: There is diffuse intramuscular edema throughout the lower leg. There is normal bone marrow signal present within the tibia and fibula. No evidence of osteomyelitis. | No evidence of osteomyelitis. |
Generate impression based on medical findings. | Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: ischemic stroke History: ischemic stroke Brain MRIMotion artifacts degraded image quality.Previously seen left thalamic hemorrhage and IVH especially on the left lateral ventricle occipital horn are again demonstrated. Restricted diffusion seen on DWI of the thalamic lesion can be considered as usual characteristics of acute hemorrhage especially in early stage. Lack of susceptibility effects on gradient echo images indicate hemorrhagic conversion from acute ischemic lesion less likely but still is a possibility.Minimal mass effect is associated with the lesion, however, there is no identifiable midline shift.There is no other acute ischemic or hemorrhagic lesion on this scan.Encephalomalacia on the left inferior parietal lobule is seen indicating chronic ischemic lesion.Underlying brain shows patch high signal intensity lesions on bilateral centrum semiovale and periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The mastoid air cells are clear.There is opacification of the right maxillary sinus the subtle mass like effects. Differential diagnosis include intra sinus mass lesion including tumorous condition such as inverted papilloma, inflammatory polyp or fungal lesion. Dedicated imaging study can be considered for further imaging evaluation if clinically necessary.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) tandem stenosis of proximal basilar arteryand mid portion of the left MCA M1 segment where the left anterior temporal branch origin stenosis (about 30%). In addition, the left MCA angular branch appears to be diminutive indicating possible severe luminal stenosis or related to prior stroke.There is no evidence of intracranial arterial aneurysm.Above described findings are consistent with intracranial arterial atherosclerosis. | 1. Left thalamic ICH with IVH especially in the left lateral ventricle occipital horn,2. No evidence of other acute ischemic lesion.3. Intracranial atherosclerosis involving basilar artery and the left MCA as described above.4. Mass like lesion on the right maxillary sinus, dedicated imaging study can be considered if clinically indicated. |
Generate impression based on medical findings. | Pain, check for labral tear ROTATOR CUFF: Mild tendinopathy with diffuse increased signal and mild thickening of the supraspinatus, most pronounced underlying the acromion and AC joint. Specifically a definite partial and suspected full-thickness split tear is observed with supraspinatus intact fibers, given a small amount of subacromial fluid. The remainder of the rotator cuff is otherwise intactSUPRASPINATUS OUTLET: Mild narrowing with a borderline measurement of 7 mm. A downward sloping acromion is observed.GLENOHUMERAL JOINT AND GLENOID LABRUM: Liberal evaluation is limited without arthrogram augmentation. Within this limitation, the liver appears grossly intact without a definite acute focal abnormality. The superior aspect is small and demonstrates mild degenerative signal without a focal specific distinct tear. As well the inferior margin is also less discrete. Mild degenerative changes, including the AC joint, similar to the plain film evaluation. BICEPS TENDON: No significant abnormality noted and intact. ADDITIONAL | 1.Supraspinatus partial and possible full-thickness split tear, see description above. 2.Mildly degenerative labor without discrete focal abnormality |
Generate impression based on medical findings. | History of cholangiocarcinoma, presents for restaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is severe intrahepatic ductal dilatation which abruptly terminates at Klatskin's point (series 8/92), where there is a suspected mass lesion measuring 1.2 x 1.0 cm which progressively enhances (series 12/32), suspicious for cholangiocarcinoma. The more distal common bile duct appears normal in caliber.There is extensive intrahepatic bile duct wall thickening and postcontrast enhancement predominantly involving the right hepatic lobe which extends peripherally to several lobular mass lesions which demonstrate postcontrast heterogeneous and rim enhancement. Periductal hyperenhancement also seen. Right posterior portal vein not well seen, suspicious for thrombosis. The proximal right and common hepatic arteries are patent, the left hepatic artery is suboptimally visualized.The visualized hepatic veins are patent.Cholelithiasis within a normally distended gallbladder without specific evidence of acute inflammation.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. | Extensive intrahepatic ductal dilatation which tapers abruptly at Klatskin's point with focal lesion suspicious for cholangiocarcinoma. Extensive periductal enhancement and thickening predominantly involving the right hepatic lobe which extends to peripherally based heterogeneous enhancing/rim-enhancing lesions. The extent of periductal thickening and enhancement favors an infectious etiology, i.e., suppurative cholangitis with associated abscess formation. While an element of periductal infiltrating cholangiocarcinoma cannot be entirely excluded, considered less likely based on extent seen. Right posterior portal vein not well seen, suspicious for thrombosis. |
Generate impression based on medical findings. | Altered mental status and history of alcoholic cirrhosis of liver with ascites. Many of the images are degraded by patient motion. There is mild cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild T1 hyperintensity in the bilateral basal ganglia and pituitary gland. There is also diffuse nonspecific susceptibility effect within the bilateral basal ganglia and midbrain. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions that encompass the entire left maxillary sinus. | 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Diffuse cerebral and cerebellar volume loss is likely related to alcohol use.3. Findings suggestive of chronic hepatic encephalopathy. |
Generate impression based on medical findings. | 54-year-old female with right lower quadrant pain and fluid collection. Evaluate fluid.Per EPIC, patient with history of multiple abdominal surgeries. 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: There is a loculated T1 hypointense, T2 hyperintense, nonenhancing collection in the right lower quadrant measuring 5.5 x 9.6 cm; this fluid collection extends into the left pelvis.OTHER: Sacral decubitus ulcer is noted without evidence of signal abnormality in the underlying osseous structures. | 1.Findings most consistent with a right lower quadrant simple fluid collection measuring up to 10 cm.2.Sacral decubitus ulcer. |
Generate impression based on medical findings. | Known right triple negative cancer. Biopsy proven axillary metastasis. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right upper outer breast, there is an irregular enhancing mass identified measuring 3.0 x 2.5 x 2.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this proven malignancy.Again seen extending postero-inferiorly from the index malignancy are multiple additional enhancing masses. The largest extent of the index and satellite masses in an AP oblique projection is 6.3 cm. A hydromark clip is seen inferior and lateral to the index mass, from the prior benign biopsy. In the right axilla, there at least three abnormal morphology lymph nodes with eccentric cortical thickening , the largest of which measures approximately 1.7 cm. One hydromark clip is present within this largest node, and another clip is adjacent to the node.LEFT BREAST:In the left retroareolar region, an oval circumscribed mass with adjacent hydromark biopsy clip artifact and post biopsy changes is present. This area was benign at the outside hospital biopsy.No abnormal axillary lymph nodes are identified in the left axillary region. | Proven malignancy in the right breast and axilla with measurements given above. Numerous satellite lesions are again noted extending inferior and posterior to the index lesion and ultrasound guided biopsy of one of satellites furthest from the index can be performed if clinically indicated. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | Cervical lesion, 6 month follow-up Again seen is T1 shortening involving the C1-C3 vertebral bodies consistent with prior radiation therapy. There is been slight increase in STIR hyperintensity and enhancement involving the inferior aspect of the odontoid process. Again seen are multiple abnormal foci of enhancement and T2/STIR hyperintensity involving the C3, C4, C5, C6, C7, T1, T2, and T2 vertebral levels consistent with known metastatic disease. Compared to prior, some of these lesions appear minimally more confluent, which may also be in part related to differences in technique. However no major change is appreciated. A C7 transverse process lesion measuring approximately 15 x 14 mm, previously 13 x 11 mm.Vertebral body heights and alignment are grossly unchanged including straightening and minimal anterolisthesis at the C7-T1 level similar to prior. There remains at least moderate spinal canal stenosis at the C3-C4 level related to prominent disc osteophyte complex and ligamentum flavum thickening and not significantly changed. Minimal enhancement along the anterior dura at this level is likely degenerative in etiology. There is T2 hyperintensity and volume loss consistent with myelomalacia at the C3-C4 level also unchanged. Minimal spinal canal narrowing at the C7-T1 level related to disc bulge also appears similar.No evidence of epidural tumor. No abnormal leptomeningeal or intramedullary enhancement. | 1. Compared to 11/19/2015, there is stable to minimal worsening of diffuse metastatic disease involving the cervical and visualized upper thoracic spine. No evidence of pathologic fracture or epidural tumor.2. Moderate spinal canal stenosis at the C3-C4 level on a degenerative basis with cord myelomalacia is unchanged. |
Generate impression based on medical findings. | 28 year old male; evaluate for CVA. Subtle area of low attenuation within the brainstem likely represents artifact. A separate subtle area of low attenuation is noted in the right thalamus/posterior limb of the internal capsule; if acute infarct is suspected, recommend MRI or repeat examination to further evaluate.There is no evidence of intracranial hemorrhage, mass or edema. 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. | Subtle areas of low attenuation with the brainstem and right basal ganglia/posterior limb of internal capsule; recommend MRI or repeat CT if acute infarct is suspected. |
Generate impression based on medical findings. | Male, 31 years old, with oligodendroglioma, 1p19q co-deleted, surveillance imaging. A region of T2 hyperintense, nonenhancing parenchymal thickening is again seen involving the left superior and middle frontal gyri. Evidence of prior biopsy of this lesion is seen including visualization of the biopsy trajectory and placement of a titanium marker.There has been no significant interval change in the size or geographic extent of this lesion. As before, signal abnormality extends to the left body of the corpus callosum but does not cross to the contralateral side.No new parenchymal lesions are seen. No pathologic parenchymal or extra-axial enhancement is observed. The ventricular system is normal in size and morphology. A mucous retention cyst is unchanged in the left sphenoid sinus. | No significant progression of the left frontal lobe tumor. |
Generate impression based on medical findings. | Pain one month after fall MENISCI: There is extensive globular and branching signal abnormality throughout the posterior horn of the medial meniscus indicating extensive degeneration and complex tearing which propagates into the body of the medial meniscus as well. There is mild attenuation of the anterior horn of the medial meniscus which may reflect additional attritional tearing. There is horizontally oriented linear signal abnormality within the lateral meniscus which extends to both the tibial and femoral articular surfaces indicating horizontal tearing.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly affecting the patellofemoral joint, the lateral facets of which are devoid of articular cartilage. There is delamination of the articular cartilage along the weightbearing portion of the medial femoral condyle with additional full thickness degeneration of the articular cartilage along the posterior aspect of the condyle with underlying subchondral cyst formation. There is also focal full-thickness degeneration of the articular cartilage of the lateral femoral condyle just above the posterior horn of the lateral meniscus. There are multiple tricompartmental osteophytes. Aside from the subchondral cyst formation, the bone marrow signal intensity is within normal limits. We see no fracture.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is nonspecific edema along the anterior aspect of the patellar tendon.ADDITIONAL | Severe osteoarthritis of the right knee, particularly affecting the patellofemoral joint, with medial and lateral meniscal tears as well as other findings as described above. |
Generate impression based on medical findings. | TIA, migraines with odynophagia, persistent headaches (following a recent fall), and eye pain. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and 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. There is degenerative spondylosis of the upper cervical spine with reversal of the usual lordosis. | No evidence of acute intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on medical findings. | Reason: Assess for foot abscess, osteomyelitis, foot as source of possible bacteremia History: No ulcers/soft tissue defects of the foot; significant swelling and pain; evidence of Charcot arthropathy on XR As seen on the recent radiographs, there are findings compatible with a neuropathic arthropathy of the tarsometatarsal joints with cyst/erosions of the metatarsal bases, cuneiforms, and cuboid. There is also fluid within the Lisfranc joint and abnormal signal intensity within the adjacent bones representing edema associated with the arthropathy. The bone fragments within the adjacent soft tissues are better seen on the patient's recent radiographs. There is also a fluid collection along the lateral aspect of the talonavicular joint, perhaps arising from the sinus tarsus. There is diffuse edema particularly along the dorsum of the forefoot and midfoot. Although there is edema within the subcutaneous fat of the forefoot and midfoot, we see no soft tissue defect or sinus tract extending from the skin to the bone to suggest osteomyelitis. There is diffuse atrophy of the imaged musculature of the midfoot and forefoot as well. | Soft tissue edema and neuropathic arthropathy of the Lisfranc joint. There is also a small fluid collection along the lateral aspect of the talonavicular joint that may represent a synovial cyst or ganglion. While it is impossible to completely exclude infection, we see no soft tissue ulceration, sinus tracts, or other specific findings to support abscess formation or osteomyelitis. |
Generate impression based on medical findings. | 13 years Female (DOB:5/26/2002)Reason: Female, 13 years old, with seizures and mesial temporal abnormalities on prior imaging. re-evaluate temporal lobe History: encephalopathy w/ temporal lobe abnormalitiesPROVIDER/ATTENDING NAME: CHARLES J. MARCUCCILLI CHARLES J. MARCUCCILLI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of generalized brain atrophy present and a marked degree of atrophy of the right temporal lobe. There is atrophy of the right hippocampus.. It is stable compared to the prior examNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | The examination is stable. There is redemonstration of brain atrophy predominantly involving the right temporal lobe and especially the right hippocampus. |
Generate impression based on medical findings. | 16 year old female with sickle cell disease. Headache. There is no evidence of intracranial hemorrhage, mass or edema. Slight prominence of the sulci in the right frontoparietal region and small areas of hypoattenuation in the right centrum semiovale are consistent with known prior strokes in this region as visualized on the MRI dated 4/1/2009. As with all CT findings of prior stroke, superimposed acute stroke cannot be entirely excluded.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. | Sulcal prominence and white matter hypoattenuation in the right frontoparietal region consistent with known prior stroke as detailed above. |
Generate impression based on medical findings. | Reason: knee mass/pain History: pain The medial and lateral meniscus appear intact. No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen. The cruciate and collateral ligaments appear intact. The extensor mechanism appears intact. There is a small amount of fluid within the joint without evidence of a large effusion. There is a skin marker along the anteromedial aspect of the knee presumably corresponding to the patient's palpable area of concern. There is a 8.1 x 2.6 x 2.1 cm heterogenous mass/collection along the anteromedial aspect of the right knee situated along and abutting the medial retinacular structures which demonstrates irregular peripheral enhancement on post contrast sequences. There is subcutaneous edema in the surrounding area. | Enhancing heterogeneous mass/collection within the subcutaneous tissue along the anteromedial aspect of the medial retinacular structures is nonspecific and may be infectious, inflammatory, or neoplastic in etiology. |
Generate impression based on medical findings. | Evaluate for etiology of dizziness, nystagmus. History of diabetes and hypertension. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered foci of cerebral white matter T2 hyperintensity, most of which are attributable to prominent perivascular spaces. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Brain MRA: There is a fetal right posterior cerebral artery, which is an anatomic variant. There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck MRA: The bilateral internal carotid arteries are tortuous, with redundant looping of the right side. There is no evidence of significant steno-occlusive lesions. | 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive arterial lesions in the head and neck.3. The bilateral internal carotid arteries are tortuous, with redundant looping of the right side, which may be attributable to hypertension. |
Generate impression based on medical findings. | History of multiple endocrine neoplasia 1a with pancreatic lesions. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion, biliary ductal dilatation or vascular abnormality. Status post cholecystectomy. No extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates fatty atrophy with focal fat in the pancreatic head but is otherwise normal in morphology and signal intensity. The main pancreatic duct is normal in caliber.The very subtle T2 hyperintense lesion in the pancreatic tail measures 8 mm (series 5/17), not significantly changed from the prior study where it measured 9 mm.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: Partially imaged left basilar peripheral wedge-shaped signal intensity compatible with atelectasis/scarring as seen on 3/7/2015 CT. | Stable pancreatic tail subcentimeter lesion likely corresponding to the patient's previously sampled neuroendocrine tumor. |
Generate impression based on medical findings. | Female, 52 years old, with right leg subjective weakness, inability to walk. Cervical:The cervical lordosis is straightened but alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen.C2-3: Unremarkable. C3-4: Mild posterior disc-osteophyte complex formation which just contacts the ventral surface of the cord. No spinal canal or foraminal stenosis. C4-5: Unremarkable. C5-6: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C6-7: Unremarkable. C7-T1: Unremarkable. Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic intramedullary or leptomeningeal enhancement is detected.A tiny central disc protrusion is evident at T8-9. Otherwise, the intervertebral discs are preserved. No spinal canal or foraminal stenosis is seen. | No specific findings to account for the patient's symptoms. |
Generate impression based on medical findings. | 63 year old female with breast cancer s/p chemotherapy, hx of atrial flutter s/p ablation. Referred for MRI for assessment of function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%. The LVEDV is 129 ml (normal range 109+/-23), LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), LVESV is 49 ml (normal range 31+/-10), and LV end systolic volume index is 27 ml/m2 (normal range 18+/-5). The LV mass is 53 g (normal range 114+/-24) and the LV mass index is 29 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is within normal range. There is no LV thrombus. 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 55%. The RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. 3.There is no evidence of late gadolinium enhancement suggesting no fibrosis or inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 63-year-old female patient with pain in right knee. Question of right knee chondromalacia. MENISCI: There is increased signal within the posterior horn of the medial meniscus. Additionally, there is linear increased T2 signal within the body of the medial meniscus which may represent a horizontal cleavage tear (image 19, series 1301). The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness loss of the cartilage of the weightbearing portion of the medial femoral condyle. There are partial-thickness defects of the lateral and medial facets of the patella with a full-thickness fissure more superiorly within the medial facet with T2 signal abnormality within the underlying bone. There is mild thinning of the weightbearing portion of the articular cartilage of the lateral femoral condyle.A subcentimeter lesion within the proximal tibia with high T2 signal likely represents a benign enchondroma.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1. Chondromalacia of the right knee, most predominantly affecting the medial tibiofemoral compartment.2. Questioned horizontal cleavage tear of the body of the medial meniscus. |
Generate impression based on medical findings. | New left-sided 7th nerve palsy, history of DLBCL, melanoma, breast cancer. There is new diffuse left facial nerve enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few nonspecific punctate foci of T2 hyperintensity within 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. | New diffuse left facial nerve enhancement is suggestive of Bell's palsy rather than neoplastic involvement and there is otherwise no evidence of brain metastases. |
Generate impression based on medical findings. | 57 year old female with right upper extremity pain and pain in the shoulder for many months with decreased mobility of the joint. ROTATOR CUFF: Full thickness tear of the supraspinatus measuring approximately 9 mm in the AP dimension with minimal retraction. Fibers of the supraspinatus can be traced to their insertion on the greater tuberosity. There is extension of tearing along the articular surface of the supraspinatus tendon more proximally. Moderate tendinosis affects the supraspinatus. Mild tendinosis affects the infraspinatus tendon. There is minimal fatty atrophy at the level of the myotendinous junction of the supraspinatus and infraspinatus muscles. Teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | Full thickness rotator cuff tear as detailed above. |
Generate impression based on medical findings. | Worsening balance, endometrial cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific foci of high T2 signal in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. 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. | No evidence of intracranial metastases. |
Generate impression based on medical findings. | 66 years, Female, stroke, left-sided weakness sparing the face. Brain: There is restricted diffusion in the distal right anterior cerebral artery territory including the right paramedian frontal lobe extending into the paramedian parietal lobe with involvement primarily of the superior frontal gyrus and right paracentral lobule. There is associated T2/FLAIR hyperintensity without significant mass effect or evidence of hemorrhagic transformation. Additional punctate focus of diffusion hyperintensity in the right medial occipital cortex may be artifactual.There is an area of encephalomalacia involving the right anterior basal ganglia with susceptibility indicating chronic hemorrhage within this region. Additional chronic infarct involving the inferior medial aspect of the left cerebellar hemisphere is also noted. Foci of volume loss involving the anterior corpus callosum body and splenium are also evident. There is additional patchy T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with mild to moderate chronic small vessel ischemic disease. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. Major flow-voids are preserved. Calvarium and extracranial soft tissue structures are grossly unremarkable. There are bilateral lens implants. Mild opacification of the left posterior ethmoid air cells also noted.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis which may be partly positional. Alignment is otherwise maintained. Bone marrow signal is benign. Endplate edema on a degenerative basis is present at the C6-C7 level.Examination is motion degraded however no obvious cord signal abnormality is appreciated. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex. No significant compromise to the spinal canal. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Right neural foramen is patent.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy. There is mild to moderate right neural foraminal narrowing. Left neural foramen is patent.C5-6: No significant spinal canal stenosis. There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. There is minimal left neural foraminal narrowing related to facet arthropathy.C6-7: Small disc osteophyte complex with minimal left neural foraminal narrowing. Spinal canal and right neural foramen are patent. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. | 1. Acute infarct involving the right paramedian frontal and parietal lobes. No associated mass effect or hemorrhagic transformation.2. Chronic infarct with evidence of prior hemorrhage in the right anterior basal ganglia. Chronic left inferior cerebellar infarct also noted. There is also a background of mild to moderate chronic small vessel ischemic disease.3. Mild multilevel degenerative changes in the cervical spine without significant spinal canal stenosis at any level. No definite cord signal abnormality. Multilevel neural foraminal stenosis as described above without high-grade stenosis at any level.Findings were discussed with Dr. Fabiane at 1148 hours on 8/31/2016. |
Generate impression based on medical findings. | Reason: eval for labral tear History: shoulder pain for a year ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact. There are numerous foci of low signal intensity identified within the glenohumeral joint which extend into the subscapular recess likely representing a synovitis.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is low signal intensity debris within the tendon sheath of the long head of the biceps likely representing a tenosynovitis. ADDITIONAL | Findings indicating a synovitis of the glenohumeral joint and tenosynovitis involving the long head of the biceps tendon. The glenoid labrum appears intact. |
Generate impression based on medical findings. | Reason: 40yo F w/ foot swelling pain and concern for deep tissue infection History: as above There is thickening of the distal fibers of the posterior tibialis tendon which may reflect a mild tendinosis. There are lobulated foci of fluid signal intensity within the tendon sheath of the posterior tibialis tendon which demonstrate enhancement on postcontrast sequences likely representing a tenosynovitis. The peroneal tendons appear intact. There may be a small amount of enhancement along the peroneal longus tendon also likely representing a mild tenosynovitis. The Achilles tendon appears intact. The extensor tendons are normal in appearance There is a small amount of fluid about the subtalar joint and talonavicular articulation which demonstrates enhancement on postcontrast sequences likely representing a synovitis. There is also fluid identified about the first MTP joint which is incompletely imaged but also likely represents a synovitis. Mild osteoarthritis affects the talonavicular articulation. There is no bone marrow signal abnormality to suggest osteomyelitis. There are no focal fluid collections to suggest abscess formation. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. | Tendinosis and a mild tenosynovitis of the posterior tibialis tendon. Findings indicating a mild synovitis affecting the subtalar joint, talonavicular articulation, and first MTP joint. No evidence of osteomyelitis or focal fluid collection to suggest abscess formation. |
Generate impression based on medical findings. | History of C2-C4 ACDF presenting with C6 radiculopathy. There are postsurgical findings related to C3 through C5 anterior spinal fusion. There is diffuse loss of cervical lordosis. There is multilevel degenerative spondylosis. In particular, at C2-C3, there is a slight disc bulge and mild uncovertebral joint hypertrophy, with mild left neural foraminal stenosis, but no significant spinal canal or right neural foraminal stenosis. At C3-C4, there is considerable spinal canal narrowing due to the altered alignment of the vertebral bodies and what may be an underlying congenitally narrow spinal canal, but no disc-osteophyte complex is present. At C4-C5, facet hypertrophy results in moderate left and mild right neural foraminal stenosis and the altered alignment of the vertebral bodies and what may be an underlying congenitally narrow spinal canal results in considerable spinal canal stenosis. At C5-C6, a disc bulge asymmetric to the left and uncovertebral joint hypertrophy result in severe left and mild right neural foraminal stenosis, as well as compression of the spinal cord. At C6-C7, a disc bulge asymmetric to the left and uncovertebral joint hypertrophy results in severe left and mild right neural foraminal stenosis, as well as severe spinal canal stenosis. There is mild prominence of the central canal at the C7 and T1 levels. The vertebral body heights are intact. The vertebral bone marrow signal is unremarkable, aside from the postoperative alterations. The paraspinal soft tissues are unremarkable. | 1. Postoperative changes from C3 to C5 anterior spinal fusion with spondylitic changes at these level results in considerable spinal canal stenosis at these levels, with contribution from altered alignment and what represent an underlying congenitally narrow spinal canal.2. Spondylitic changes also result in severe spinal canal and neural foraminal stenoses on the left at the C5-6 and C6-7 levels, as well as a mild syrinx inferior to these levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Plantar soft tissue mass and Achilles tendon pain Note that the examination was tailored for the evaluation of the plantar soft tissues.TENDONS: Within the limits of the exam, there are no significant abnormalities. Specifically, the visualized portion the Achilles tendon appears normal.LIGAMENTS: Within the limits of the exam, there are no significant abnormalities.ARTICULAR SURFACES AND BONE: There is metallic susceptibility artifact within the head of the first metatarsal relating to an orthopedic screw. There is severe osteoarthritis of the first MTP joint. ADDITIONAL | 1. No evidence of plantar soft tissue mass or abnormal enhancement contrast demonstration.2. Surgical changes of the first MTP joint with osteoarthritis. |
Generate impression based on medical findings. | 51-year-old woman with history of cervical cancer. PELVIS:UTERUS, ADNEXA: There is abnormal intermediate T2 signal involving the left lateral cervix (501/40) with corresponding diffusion abnormality (806/328). This signal abnormality extends approximately 18 mm laterally into the parametrial fat beyond the ectocervix. Additionally, there is a small area of T2 signal abnormality along the right posterior cervix with loss of the ectocervical interface (601/30).Multiple uterine fibroids are noted.BLADDER: The bladder appears normal. There is no hydronephrosis.LYMPH NODES: No significant lymphadenopathy seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peritoneal dialysis catheter noted in the abdomen. | 1.Cervical carcinoma with parametrial extension, left greater than right, as detailed above.2.No regional lymphadenopathy or hydroureter. |
Generate impression based on medical findings. | Female, 40 years old, with numbness and tingling in the hands and feet, history of C5-6 transverse myelitis in October 2014. Assess for demyelination. A 5-mm round focus of T2 hyperintensity is evident just lateral to the corpus callosum in the right frontal lobe. No additional parenchymal lesions are seen.Diffusion weighted images are normal. No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. The ventricular system is normal in size and morphology. | A single 5-mm nonenhancing focus of signal abnormality is seen within the white matter lateral to the corpus callosum in the right frontal lobe. While such a lesion could represent demyelinating disease, in the absence of other lesions or more definitive findings, it is nonspecific. |
Generate impression based on medical findings. | 20 old female with with B cell lymphoma and known brain metastasis presents with headache and neck stiffness x 7 days. Interval resolution of the vasogenic edema within the left cerebral hemisphere. No definite evidence of the previously described mass on this study. High density material within the right transverse sinus which appears new when compared to the prior study.There is no evidence of intracranial hemorrhage or midline shift. 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. | 1. Interval resolution of the vasogenic edema involving the left hemisphere. No definite evidence of a mass within the limitations of this noncontrast study.2. High density material within the right transverse sinus possibly represents thrombosis. An MRI is recommended for further evaluation.These findings were discussed with Dr. Powell at the time of this dictation. |
Generate impression based on medical findings. | 13-year-old male with history of Rathke's cyst and pituitary cyst. Evaluate cystic structures. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Minimal diffuse paranasal sinus mucosal thickening. Mildly enlarged bilateral cervical lymph nodes are likely reactive in etiology. The AP dimension of the globes remain elongated but are unchanged.MRI Pituitary:Interval significant decrease in the size of the non-enhancing focal lesion between the anterior and posterior pituitary gland which now appears as a thin slitlike area of nonenhancement. The pituitary gland is otherwise within normal limits. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. | Interval significant decrease in the size of a likely Rathke's cleft cyst located between the anterior and posterior pituitary gland. |
Generate impression based on medical findings. | Reason: pannus History: inflammation c spine The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk desiccation presentThere is mild thickening of the cruciate ligaments which is nonspecific. There is heterogeneous signal on T1 and T2 imaging along the right lateral mass of C1.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 mild anterior subluxation of C2 on C3 associated with some facet hypertrophy predominantly on the left side. There are left-sided uncovertebral osteophytes present at this level which mildly narrow the left neural foramen.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is mild anterior subluxation of C7 on T1.The vertebral artery flow voids appear to be intact. | 1.The right lateral mass of C1 is somewhat heterogeneous and irregular. This is nonspecific. It is possible that this is related to degenerative change. A CT of the cervical spine may be helpful in further evaluating if clinically appropriate.2.There are some minor degenerative changes present in the cervical spine without significant compromise of spinal canal or exiting nerve roots.3.Some images are degraded by patient motion which may obscure more subtle anomalies can |
Generate impression based on medical findings. | 51 year old female with hypertension, hyperlipidemia, and chest pain with a history of LVH, abnormal stress test, and negative coronary angiogram. Referred for cardiac MRI. Left VentricleThere is mild qualitative thickening of the left ventricular apical walls. The left ventricle is normal in size and systolic function otherwise. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is transmural, diffuse late gadolinium enhancement in the anterior apex and apical walls that is atypical in pattern for infarction but may represent myocarditis or suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native T1 myocardial relaxation time is ~1050 ms (normal). There is no evidence of myocardial iron overload. Left AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 101 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 37 ml (normal range 35+/-13). Right AtriumThe right atrium is normal sized. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is normal in size and systolic function (LVEF 60%) except for wall thickening within the apical LV. There is transmural, diffuse late gadolinium enhancement in the anterior apex and apical walls that is atypical in pattern for infarction but may represent myocarditis or suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Recommend repeat cardiac MRI in 4-6 months or sooner if clinically warrented. 2. The right ventricle is normal in size and systolic function (RVEF 64%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Paraclinoid meningioma status post RT: surveillance MRI. There are postoperative findings related to left temporal craniotomy with a substantial defect in the anterior left temporal lobe and confluent T2 hyperintensity in the surrounding brain parenchyma, mainly related to encephalomalacia. The extra-axial enhancing tumor in the left paraclinoid region, appears to be slightly smaller, measuring up to 14 mm, previously 16 mm. The mass partially surrounds the internal carotid artery, without apparent significant narrowing of the flow void. The tumor also continues to abut the prechiasmatic segment of the left optic nerve. There are unchanged mild nonspecific foci of cerebral and brainstem white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged, including a left temporal scalp lipoma. | Apparent slight interval decrease in size of the treated residual left paraclinoid region meningioma. |
Generate impression based on medical findings. | 50 year-old male. Small bowel Crohn's. Evaluate extent of disease. Cramping. ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar homogeneously T2 hyperintense hepatic cysts, unchanged. Signal loss of the liver on out of phase images consistent with fatty infiltration. No biliary ductal dilatation.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: Approximately 12 cm long segment of most distal terminal ileum with submucosal fat deposition and cord like enhancement. This segment is persistently collapsed on all sequences with mild upstream bowel dilatation suggestive of fibrostenotic chronic inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Findings consistent with fibrostenotic chronic inflammatory bowel disease of approximately 12 cm of most distal terminal ileum. |
Generate impression based on medical findings. | 65 year old man with history of HTN, new LV dysfunction and rectal cancer referred for stress MR as part of ischemic evaluation.MEDICATIONS: carvedilol, lisinopril, aspirin, spironolactone First Pass PerfusionDuring hyperemia, there were no perfusion defects observed.Viability/ Myocardial ScarThere was a prominent mid-wall stripe pattern of late gadolinium enhancement which is atypical for previous myocardial infarction, seen in the basal to mid septum, and inferior wall. This has been described in dilated cardiomyopathy. No evidence for previous myocardial infarction.Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 147 ml/m2 (normal range: 74+/-15), the LVEDV is 238 ml (normal range 142+/-34), the LV end systolic volume index is 93 ml/m2 (normal range 25+/-9), the LVESV is 150 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 116 g. There is borderline LVH (wall thickness of 10-11mm). There is global hypokinesis with regional variation, but notable abnormalities in the regions associated with late gadolinium enhancement as above.Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 117 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely, is trileaflet, and there is qualitatively moderate aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered with thickening of the leaflet tips. There is mild mitral regurgitationPulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. No perfusion defects with stress.2. No prior myocardial infarction, however there is a prominent pattern of mid-wall late gadolinium enhancement throughout the basal-mid septum and basal-mid inferior wall with associated significant wall motion abnormalities. While this has been described in dilated cardiomyopathy, this could also suggest infiltrative, inflammatory or fibrotic disease. 3. Severely dilated LV size with moderate-severely reduced systolic function (LVEF 37%).4. Normal RV size and mildly reduced systolic function (RVEF 46%).5. At least moderate aortic regurgitation with a trileaflet aortic valve.6. Mitral valve tethering with mild mitral regurgitation.7. Biatrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 27-year-old female presents for evaluation of the right thigh mass. There is a large mass within the proximal thigh posteriorly that appears to arise from the sciatic nerve. It measures approximately 7 cm x 5.5 cm in the transaxial dimension and 8.5 cm in the cranial caudal dimension (measured approximately 6.5 cm x 5 cm x 8.2 cm on previous study). It is situated between the distal fibers of the gluteus maximus muscle and the hamstring musculature and extends posteriorly to just beneath the skin surface.It is isointense to skeletal muscle on isolated T1 images, heterogeneous on fat suppressed T2 images with components that are both isointense and hypointense to skeletal muscle, and there is diffuse heterogeneous enhancement following contrast administration. Small foci of signal void along the posterior margin of the mass suggest prior intervention (presumably a surgical biopsy). Additional smaller cutaneous and subcutaneous lesions in the thigh are noted. Similar to those seen on the prior study. The remainder of the musculature of the thigh appears normal and the bones appear normal. Small cutaneous neurofibromas are seen on the left thigh on the large field-of-view images. | Slight enlargement of peripheral nerve sheath tumor arising from the sciatic nerve as described above. While it is impossible to exclude a malignant peripheral nerve sheath tumor, the relatively slow growth as well as the similar signal characteristics to the prior study argue against malignant transformation. |
Generate impression based on medical findings. | Other specified postprocedural states [Z98.89], Reason for Study: ^Reason: s/p l4-5 microdisc History: same For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: There is evidence of left side laminectomy. There is non enhancing T1 and T2 low signal intensity lesion seems to be attached to remained L45 disc seen on the left side lateral recess. Considering this exam was obtained within 2-3months after microdiscectomy, the diagnostic possibility of this lesion include 1) residual or recurrent disc material or 2) postoperative blood products. The disc height has decreased, unchanged. L5-S1: no neuroforaminal narrowing or spinal stenosis. | 1. Post laminectomy and microdiscectomy status of L45 extruded disc.2. Non enhancing lesion located on the left side lateral recess of L45 disc space, diagnostic possibilities include 1) residual or recurrent disc material and 2) postoperative blood products. |
Generate impression based on medical findings. | There is a focus of restricted diffusion in the splenium of the corpus callosum with associated T2/FLAIR hyperintensity.Elsewhere there is no significant signal abnormality or evidence of edema or mass effect. The cerebellar tonsils remain above the foramen magnum. There is no grey matter heterotopia, cortical dysplasia or evidence of mesial temporal sclerosis. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. The cervical spine demonstrates slight enlargement of the central canal at the level of C5-C6 with a diameter of no more than 1 mm. Otherwise, the cervical and the thoracic spine is normal. In the lumbar spine there is a focus of high T1 signal from the level of L4 to the level of L5 at midline along the posterior thecal sac that could represent fibrofatty infiltration of the filum terminale. The conus medullaris ends at the level of L1. Normal marrow signal of the vertebral bodies. There are no structural abnormalities. | 1. Restricted diffusion in the splenium of the corpus callosum associated with T2/FLAIR hyperintensity. This likely represents cytotoxic edema related to seizure activity and/or the effect of anti-seizure medication.2. Findings suggestive of a short segment of fibrofatty infiltration of the filum terminale. In the absence of other findings of tethered cord, this can be an incidental finding. Correlation with clinical symptoms is suggested.3. The remained of the spine exam is within normal limits. |
Generate impression based on medical findings. | 75-year-old female patient with worsening right low back pain in past 3-4 months. Severe degenerative disc disease is noted throughout the lumbar spine with vacuum disc phenomenon at T12/L1, L1/L2, L4/L5, and L5/S1. There is a dextrorotoscoliosis and a slight anterolisthesis of L5 on S1. There is heavy atherosclerotic calcification of the abdominal aorta and its branches. | Severe degenerative disc disease of the lumbar spine. |
Generate impression based on medical findings. | Ms. Jonikaite is a 40 year old female with recent history of left breast lumpectomy for malignant phyllodes tumor in 12/2015 with multiple positive margins. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Expected postsurgical changes are identified in the left superior breast, at site of recent lumpectomy bed. There is architectural distortion and a nonenhancing seroma measuring 2.4 x 1.1 x 2.0 cm (AP times ML times SI). There is no gross abnormal enhancement seen surrounding the seroma cavity. However, extending inferomedially from this lumpectomy bed are three separate enhancing masses with suspicious MR appearance. The largest of these masses measures approximately 1.4 x 1.3 cm. The total span of these masses measures approximately 2.6 x 1.2 x 3.3 cm (AP x ML x SI). The AP oblique extent of these three masses combined measures approximately 3.9 cm. The closest of these masses is located approximately 0.5 cm medial to the lumpectomy site.In addition, there is an abnormal morphology left axillary lymph node measuring 1.8 cm.There are numerous T2 hyperintense lesions identified in both breasts, some of which enhance. These likely represent simple and complicated cysts in both breasts.There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in in the right axillary region. | (1) Expected postsurgical changes from recent left breast lumpectomy with three suspicious enhancing masses extending inferomedial from the lumpectomy bed. Total AP extent of these masses measures approximately 3.9 cm in the AP dimension. (2) Abnormal morphology left axillary lymph node. (3) No MR evidence of malignancy in the right breast.Of note, patient presented for an MR directed ultrasound shortly after the MRI. The findings and final recommendations from this MR directed ultrasound will be detailed in a separate report.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 40-year-old male patient with history of liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no intra or extrahepatic biliary ductal dilatation. Redemonstration of multiple hypointense lesions within the right hepatic lobe, which are best seen on postcontrast imaging. There is no associated arterial enhancement, restricted diffusion, or T2-weighted signal abnormality. There is the suggestion of signal loss on out of phase imaging of some lesions. A reference lesion within segment six of the liver measures approximately 1.4 x 1.3 cm, previously 1.3 x 1.2 cm (image 42, series 1603). No new lesions are identified.The portal and hepatic veins are prominent in size, but patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact related to a median sternotomy.OTHER: No significant abnormality noted. | Relatively stable appearance of multiple non-specific hypointense lesions within the liver. |
Generate impression based on medical findings. | Left shoulder pain ROTATOR CUFF: There is increased intermediate signal intensity and thickening of the supraspinatus and infraspinatus tendons, indicating moderate tendinosis. The increased signal intensity within the supraspinatus tendon extends to the articular surface fibers, suggesting undersurface fraying but we see no discrete tear. There is a small focus of signal abnormality in the underlying humeral head. The supraspinatus and infraspinatus muscles appear normal. The teres minor muscle and tendon appear normal. There is focal increased signal within the undersurface of the subscapularis tendon at its insertion, likely representing tendinosis with a small focus of signal abnormality of the underlying humeral head but we see no discrete tear.SUPRASPINATUS OUTLET: There is an os acromiale. The acromioclavicular joint appears otherwise normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is a small amount of fluid in the joint but there is no large effusion. There is perhaps mild fraying of the superior glenoid labrum, however we see no discrete tear.BICEPS TENDON: There is a small amount of fluid within the biceps tendon sheath, raising the possibility of mild tenosynovitis. On the axial sequences there appears to be a longitudinal split in the superior fibers of the biceps tendon but the true clinical significance of this is uncertain. | 1. Rotator cuff tendinosis and possible undersurface fraying of the labrum without discrete rotator cuff tear.2. Os acromiale.3. Findings suggestive of a longitudinal split tear of the biceps tendon at its transition from the bicipital groove to the rotator interval.3. Other findings as above. |
Generate impression based on medical findings. | Male, 56 years old, with history of disseminated Nocardia. Multiple small edema-inducing lesions are seen within both cerebral hemispheres. The most conspicuous is a ringlike lesion within the right occipital lobe measuring up to 8 mm in diameter. Additional smaller lesions are seen at the gray-white junction of the left superior frontal gyrus, and within the right periventricular white matter. The lesions in the right occipital lobe and in the right periventricular white matter demonstrate some degree of diffusion restriction.Numerous additional small foci of non-edematous white matter T2 hyperintensity are seen in both cerebral hemispheres but these are nonspecific. There is ill-defined T2 hyperintensity within the dorsal medulla of uncertain etiology. No significant generalized mass effect is detected. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are seen. The ventricular system remains within normal limits. Patchy opacification of the ethmoid air cells is noted. | Multiple intracranial lesions are identified ranging in size up to 8 mm. These lesions induce mild local edema but no significant generalized mass effect. The examination is limited without postcontrast images, but given the history, these lesions would be compatible with a Nocardia infection of the brain. |
Generate impression based on medical findings. | The study is motion degraded and nearly nondiagnostic. Given this caveat:Soft tissue edema with ill-defined enhancement is noted involving the soft tissues overlying the right posterior sacral region and sagittal STIR images fail to demonstrate osseous edema, thus there is no gross evidence of osteomyelitis.Redemonstrated are small disc bulges at L4/5 and L5/S1 with mild to at most moderate facet hypertrophy from L3/4 through L5/S1. There is no gross central or neural foraminal stenosis. The cauda equina is grossly unremarkable and terminates at an appropriate level. | The study is motion degraded and nearly nondiagnostic. Given this caveat, no gross evidence for osteomyelitis. Soft tissue edema with ill-defined enhancement is noted involving the soft tissues overlying the right posterior sacral region and sagittal STIR images fail to demonstrate osseous edema. |
Generate impression based on medical findings. | Reason: evaluate for renal recurrence/metastasis History: Hx of renal cell ca, sp left partial nephrectomy. ABDOMEN: Limited examination without the administration of intravenous contrast.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: 1.4 cm cystic lesion in the pancreatic head likely represents a pancreatic cyst or IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of a partial left nephrectomy. Multiple bilateral renal cysts, some of which demonstrate increase intrinsic T1 signal compatible with hemorrhagic or proteinaceous material. Right renal cyst demonstrates T1/T2 hypointense rim compatible with hemosiderin. Previously noted left renal mass with enhancing nodule on CT has slightly increased in size in its distal component, it solid component remains stable in size. Limited examination of the cysts without contrast.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Significant extra scoliosis and associated degenerative changes.OTHER: Small amount of ascites. | Significantly limited examination without contrast. Multiple bilateral renal cysts some of which are proteinaceous or hemorrhagic. Left renal cyst has increased in size in its cystic component, with its solid component (which enhanced on prior CT) stable, remaining suspicious renal malignancy. |
Generate impression based on medical findings. | 79-year-old woman with history of chronic pancreatitis, questionable stone and ventral duct which could not be removed during ERCP on 9/21/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intrahepatic biliary duct dilatation. The gallbladder and common bile ducts appear normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreatic parenchyma is mildly atrophic. No solid masses are identified. Segments of the pancreatic duct are irregularly dilated measuring up to 7 mm in the body. A 20 x 9mm cystic lesion in the pancreatic head (series 8, image 19) appears to communicate with the pancreatic duct. Additionally, there are additional small foci of increased T2 signal which communicated with the pancreatic duct (series 4, images 19 and 20). No pancreatic duct stone is identified.After administration of secretin, a bolus is seen filling the duodenum, however the pancreatic duct does not changed in size.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci in the kidneys bilaterally are likely cysts. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon appear normal.BONES, SOFT TISSUES: Bilateral Tarlov cysts noted.OTHER: No significant abnormality noted. | 1.Irregular pancreatic duct dilatation compatible with given history of chronic pancreatitis.2.Preserved exocrine function but decreased pancreatic duct compliance also compatible with chronic peritonitis.3.Probable side branch IPMN documented in the pancreatic head without suspicious features.4.No obstructing mass or stone identified. |
Generate impression based on medical findings. | 70-year-old man with history of multiple myeloma status post stem cell transplant with new onset back pain. The examination is somewhat limited without intravenous contrast. There are numerous low T1 and high T2 signal lesions throughout the axial skeleton, consistent with multiple myeloma. In particular, there is a lesion involving the T9 vertebral body, which demonstrates at least 50% compression deformity with retropulsion of the posterior aspect of the vertebral body into the spinal canal causing severe spinal stenosis and cord compression at this level. There is diffuse edema involving the vertebral body on fluid sensitive sequences suggestive of subacute or acute abnormality. There is approximately 50% compression deformity of the T3 vertebral body without evidence for retropulsion or spinal or neuroforaminal stenosis at this level. There is a lesion within the T10 vertebra with minimal deformity of the superior endplate. There is a lesion with extraosseous soft tissue extension involving the right 10th rib. There is approximately 50% compression deformity of the T11 vertebral body, without evidence for retropulsion or spinal or neural foraminal stenosis. There are additional mild vertebral compression deformities at T3, T8, T10, and T12, without retropulsion. There is no evidence for compression deformity within the lumbar spine, but the L4 vertebral body demonstrates diffusely abnormal marrow signal with small amount of edema likely related to metastatic disease. There is multilevel posterior disc osteophyte complex formation within the cervical spine, worse at C3-C4 level, where there is associated hypertrophy of the ligamentum flavum causing moderate to severe spinal stenosis and moderate bilateral neuroforaminal narrowing. There are posterior disc osteophyte complex formation at C4-T1 levels, with mild indentation upon the spinal cord at C3 though C7 and variable degrees of neural foraminal stenosis. There is a mild diffuse disc bulge at L3-L4 causing mild effacement of the ventral thecal sac however without spinal stenosis or neural foraminal stenosis. There is a mild diffuse disc bulge at L4-L5 causing mild bilateral neural foraminal narrowing. There is a disc bulge at L5-S1, without significant spinal or neural foraminal stenosis at this level. There is no spondylolisthesis. Within the right L3-L4 paraspinal musculature there is a 4.8 x 2.7 cm lobulated low signal soft tissue lesion, which appears to involve the L4 spinous process. There is a 2.8 x 1.7 cm lesion involving the posterior left iliac bone and a 2.6 x 2.3 cm low signal lesion involving the midline occipital bone. There is an additional 3.6 x 1.9 cm lesion involving the right temporal bone. There is a trace amount of fluid in the mastoid air cells. There is a small right thyroid nodule. There is a 1.9 cm diameter right renal cyst. | 1. Widespread multiple myeloma throughout the axial skeleton, with a pathological fracture of the T9 vertebral body and retropulsion associated with spinal cord compression at this level. Additional multilevel vertebral compression deformities are not associated with spinal canal or neural foraminal stenosis.2. Multilevel degenerative spondylosis of the cervical spine and lower lumbar spine.Discussed with Dr. Zimmerman at 11: 15 AM on 7/9/16. |
Generate impression based on medical findings. | Reason: new lesion on MRI at T7-please bx-hx of head and neck ca History: as above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. | T7 vertebral bone biopsy under CT guidance. A total of eight samples were delivered to pathology for analysis. |
Generate impression based on medical findings. | Clinical question: Rule-out brain hemorrhage. Signs and symptoms: Fall and alteration of mental status. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass effect, mass, midline shift or hydrocephalus.There is a focus of low-attenuation in the left posterior temporal subcortical and periventricular white matter with no involvement of overlapping cortex. This finding demonstrates no mass effect on the adjacent parenchyma or the ventricle. The finding likely represents a focus of encephalomalacia. Two entirely evaluate this finding recommend follow-up with an MRI exam. This finding could represent an area of chronic ischemic stroke however further evaluation is recommended.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells and orbits are unremarkable. | 1.No acute intracranial findings. CT is insensitive for early detection of acute ischemic strokes.2.Focus of low attenuation in the left posterior temporal subcortical/periventricular white matter could represent a focus of encephalomalacia however follow-up with an MRI is highly recommended to exclude other possibilities. |
Generate impression based on medical findings. | Provided history of prostate cancer. No pathology results available. PELVIS:PROSTATE:Prostate Size: 3.5 x 5.8 x 5.1 cmPeripheral Zone: There is diffuse T1 weighted hyperintensity in the peripheral zone compatible with hemorrhage/proteinaceous material likely related to prior biopsy. This severely limits evaluation of the peripheral zone.Central Gland: Changes of benign prostatic hyperplasia. In the left apex adjacent to the urethra there is a 1.1 x 0.8 cm focus of intermediate T2-weighted signal intensity (series 601/16) associated with restricted diffusion (series 803/304) and suspected early arterial enhancement (series 1501/1211).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Partially distended urinary bladder with trabecular thickening may be seen in the setting of chronic bladder outlet obstruction.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No definite suspicious arterially enhancing bone lesion. The bone marrow has a mottled appearance.OTHER: No significant abnormality noted. | 1.Left apex periurethral central gland 1.1 cm lesion may represent a site of prostatic adenocarcinoma.2.The study is significantly limited by intrinsic T1 weighted hyperintensity in the peripheral zone related to recent biopsy.3.Changes of BPH.4.Mottled bone marrow signal intensity without a definite arterial enhancing bone lesion. |
Generate impression based on medical findings. | Reason: presence of small vessel ischemic disease History: transient aphasia MRI BRAIN: There is an area of restricted diffusion in the left thalamus, consistent with an acute infarct. Chronic infarcts are present in the right posterior frontal lobe extending to the operculum, left middle frontal gyrus and left inferior cerebellar hemisphere with associated areas of susceptibility, likely reflecting hemosiderin deposition. There are linear areas of mild diffusion hyperintensity just anterior to the infarct in the right frontal lobe without corresponding low signal on the ADC map, possibly representing subacute ischemia. T1 hyperintensity along the anterior aspect of the infarct in the right frontal lobe is consistent with laminar necrosis. Additional areas of encephalomalacia are noted in the right insular cortex in addition to the right anterior and posterior temporal lobe. There is no intracranial mass. There is global parenchymal volume loss. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. Partially empty sella is incidentally noted. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. There is partial opacification of the mastoid air cells, right greater than left. Bilateral lens implants are noted.MRA BRAIN: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are normal in course and caliber. The posterior cerebral arteries, vertebral arteries and basilar artery are patent. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: The left common carotid artery originates from the brachiocephalic artery, which is a normal variant. The common and cervical internal carotid arteries are normal in course and caliber. There is mild atherosclerotic plaque at the left internal carotid artery origin, but no significant stenosis. The vertebral artery origins are widely patent. There is no evidence of flow-limiting stenosis or aneurysm. | 1. Small focus of of restricted diffusion in the left thalamus is consistent with an acute infarct.2. Linear areas of mild diffusion hyperintensity just anterior to the chronic infarct in the right frontal lobe without corresponding low signal on the ADC map may represent subacute ischemia. 3. Multiple supra and infratentorial chronic infarcts.4. No evidence of flow-limiting stenosis or aneurysm.Findings communicated to Dr. Choudhury at time of dictation. |
Generate impression based on medical findings. | Clinical question: Based on the study. Signs and symptoms: Metastatic melanoma. Please measure. Enhanced CT of brain:The examination demonstrates no evidence of metastatic disease to the brain or leptomeninges.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No abnormal enhancement. Calvarium is intact, limited view of the orbits are unremarkable, mastoid air cells and middle ear cavities are unremarkable.There is complete opacification of the left chamber of the splenic sinus. This is associated with subtle thinning of the bone at the level of planum sphenoidale on the left. This finding is best appreciated on axial bone density (series 5) image 10, coronal reformatted bone density (series 8036) image 46, sagittal reformatted bone density image 28 through 30. There are also minimal increased density of the contents of the left chamber of the sphenoid sinus. Although all of the above findings could represent long-standing chronic sinus disease the associated bony changes are concerning and further follow-up or dedicated MRI exam is recommended to exclude the less likely possibility of a small metastatic bony lesion.120 cc of Omnipaque 350 was administered for the study. | 1.Negative enhanced CT of brain parenchyma and the leptomeninges.2.Complete opacification of the left chamber of the sphenoid sinus with some subtle bony thinning of planum sphenoidale which remotely could represent a bony metastatic disease considering provided clinical data. The findings could also represent changes related to long-standing chronic sinus disease or even a small fibrous dysplasia. Please see above comments for exact location of the lesion. Follow-up with an MRI is recommended. |
Generate impression based on medical findings. | 29-year-old female with history of trauma to the right knee with pain and swelling. MENISCI: Complete vertical tear of the posterior horn of the medial meniscus (series #2, image 22).ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact without significant abnormality.LIGAMENTS: There is diffuse signal abnormality within the anterior cruciate ligament with more focal horizontal appearing discontinuity indicative of significant tearing.EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall-Salvati index measures about 1.4, indicative of mild patella alta.ADDITIONAL | 1. Findings compatible with complete tear of the anterior cruciate ligament of the right knee.2. Complete vertical tear of the posterior horn of the medial meniscus. |
Generate impression based on medical findings. | 69-year-old female with a personal history of left breast lumpectomy in 2005 for DCIS followed by radiation and Arimidex therapy. Family history of breast cancer in her paternal cousin and ovarian cancer in her mother. She has no current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes from prior lumpectomy are noted in the left retroareolar region. Stable enhancing focus in the left lower outer breast.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a 1.2 x 1.1 cm area in the spleen which has high T2 signal intensity and has remained stable since 2013. This likely represents a benign etiology such as a cyst or hemangioma. | No MRI evidence for malignancy. Stable postsurgical change in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Impingement syndrome of left shoulder [M75.42] / Pain in thoracic spine [M54.6] / Low back pain [M54.5], Reason for Study: ^Reason: eval for disc herniation History: lbp 2011 with disc herniation; better now but recent strain of the back For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. 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: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication appears to be progressed since prior scan, there is broad based focal disc protrusion central to right which abuts thecal sac. Minimal narrowing of the right side neuroforamen is seen. No spinal stenosis. L5-S1: minimal bulging of disc, unchanged since prior scan, no neuroforaminal narrowing or spinal stenosis. | 1. Progressed disc dessication at the level of L45. Slightly changed disc protrusion from central to central to right side with minimal right side neuroforaminal stenosis at the level of L45.2. Unchanged minimal bulging of disc at L5S1 level. |
Generate impression based on medical findings. | 55-year-old female with left-sided neck pain with radicular pain down the left upper extremity. There are scattered patchy non-expansile T2/STIR spinal cord signal abnormalities located at the upper C2 level, centrally at the lower C2 level, posteriorly at the upper C3 level, along the right lateral aspect of the spinal cord at the C3-4 level and within the right lateral aspect of the spinal cord at C5 level.Similarly, there are at least two small focal T2/STIR lesions in the deep white matter of the left cerebellum and a single focus of signal abnormality in the left medial dorsal lower medulla.The cervical spine alignment is maintained. The cervical vertebral bodies are appropriate in height. There is mild loss of disc height at the C4-5 and C5-6 levels. The bone marrow signal is within normal limits. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant disc disease or compromise to the spinal canal or neural foramina.C3-4: Trace diffuse disc osteophyte complex with mild uncovertebral hypertrophy which causes mild bilateral neuroforaminal narrowing. No spinal canal stenosis.C4-5: Small diffuse disc osteophyte complex with mild uncovertebral hypertrophy which causes moderate bilateral neuroforaminal narrowing. There is minimal spinal canal stenosis. C5-6: Trace disc osteophyte complex and mild bilateral neuroforaminal narrowing. No spinal canal stenosis.C6-7: Small disc osteophyte complex with mild to moderate bilateral neuroforaminal stenosis and minimal spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.At the T1-T2 and T2-T3 levels, there is minimal disc disease but no significant neuroforaminal or spinal canal stenosis.The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits. There is partially visualized mucosal thickening involving the left maxillary sinus and an air-fluid level within the right maxillary sinus which could indicate sinusitis. | 1.Scattered patchy areas of T2/STIR signal abnormality in the posterior fossa and cervical spinal cord which are suspicious for a demyelinating process. MRI Brain with and without contrast is recommended for further evaluation.2.Mild spondylotic changes of the cervical spine with at most moderate bilateral neuroforaminal narrowing and minimal spinal canal stenosis at the C4-5 level.3.Maxillary sinus mucosal thickening with a air-fluid level within the right maxillary sinus which could indicate sinusitis. Please correlate clinically. |
Generate impression based on medical findings. | 65-year-old female with nonweightbearing for 5 weeks. Evaluate for fracture. ACETABULAR LABRUM: The labrum appears intact within the limits of a non arthrographic examination.ARTICULAR CARTILAGE AND BONE: Marrow signal appears within normal limits without evidence of fracture.SOFT TISSUES: The musculature of the left hip and pelvis appears within normal limits.ADDITIONAL | No evidence of fracture or other finding to account for the patient's symptoms. |
Generate impression based on medical findings. | Several sequences are limited by patient motion. There is redemonstration of asymmetric severe right and moderate left cerebellar atrophy associated extensive susceptibility along the residual right cerebellar parenchyma extending into the right pons and medulla which also demonstrate asymmetric volume loss. There is no significant associated FLAIR abnormality. Minimal areas of linear and somewhat ill-defined enhancement along the right cerebellar tissue without a masslike configuration. There is ex vacuo dilatation of the fourth ventricle, more prominent on the right side. There is no significant FLAIR abnormality. A focus of susceptibility is identified in the right lateral thalamus, corresponding to previously noted CT. Other punctate foci of calcifications seen along the right deep gray nuclei are not well appreciated on this MRI.The lateral and third ventricles are within normal limits. The cerebral sulci are mildly prominent, suggestive of mild global volume loss slightly greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are few scattered punctate foci of T2/FLAIR hyperintensity in subcortical white matter within the frontal lobes which are nonspecific. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The structures and craniocervical junction are within normal limits. There is mild mucosal thickening in all the paranasal sinuses bilaterally. Aerated secretions are seen in the right sphenoid sinus. | 1.Redemonstration of severe right and moderate left cerebellar atrophy with associated right pontine and medullary atrophy. Corresponding coarse calcifications on the right in the posterior fossa and along the brainstem, with minimal scant enhancement felt to relate to areas of scarring. Findings are suggestive of a chronic process with dystrophic calcifications, perhaps relating to sequela of previous infectious/inflammatory process such as cerebellitis or previous vascular insult. Neurodegenerative disorder remains within the differential and can be associated with autoimmune, para neoplastic, and toxic/metabolic abnormalities.2.No significant supratentorial abnormality aside from mild global volume loss, with a few scattered nonspecific punctate foci of T2/FLAIR hyperintensity no MR evidence of demyelinating disease as clinically questioned.3.Aerated secretions in the right sphenoid sinus. Please correlate clinically for acute sinusitis. |
Generate impression based on medical findings. | 42-year-old male with right frontal sinusitis. Complains of right pressure in forehead x 8 months. Patient has history of glioma right orbit/temporal. Extensive opacification of right frontal sinus is noted. Priors MRI examination of the brain from 4 -- 11 -- 07 as well as 9 -- 26 -- 06 were also reviewed which also demonstrated presence of inflammatory sinus disease in the right chamber of frontal sinus. Findings are believed to represent chronic sinusitis.The right chamber of the frontal sinus has a multi-loculated appearance due to septation. The rest of the paranasal sinuses demonstrates only minimal ethmoid sinus disease bilaterally. Maxillary sinuses remain unremarkable an osteomeatal units of the maxillary sinuses are patent. | 1.Extensive chronic sinusitis of right chamber of frontal sinus as detailed.2.Minimal bilateral ethmoid sinus disease.3.Unremarkable paranasal sinuses otherwise. |
Generate impression based on medical findings. | Pulsating left upper quadrant pain. History of drained right hepatic cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity. Several simple cysts. No suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size morphology, signal intensity and enhancement without a focal lesion. Small splenule anterior to the anterior splenic pole.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: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted. | No significant abnormality or specific findings to account for the patient's reported left upper quadrant pulsatile mass. |
Generate impression based on medical findings. | Pituitary lesion, on Cabergoline. There is an unchanged intrinsically T2 hyperintense punctate lesion situated between the adenohypophysis and neurohypophysis. There is also an unchanged subcentimeter slightly hypoenhancing lesion in the right lateral sella, with extension into the medial cavernous sinus. The infundibulum is intact. There is no mass effect upon the optic apparatus. The imaged portions of the brain are unremarkable. | 1. Unchanged subcentimeter lesion in the right lateral sella, with extension into the medial cavernous sinus, which may represent a microadenoma. 2. Unchanged punctate pituitary lesion situated between the adenohypophysis and neurohypophysis, which may represent a pars intermedia cyst. |
Generate impression based on medical findings. | 66-year-old male patient with epigastric abdominal pain, weight loss, pancreatitis, suspected pancreatic neoplasm status post EUS 6/29/2016 with a cystic lesion in pancreatic tail and diffuse echogenicity in pancreas. Study limited as multiple sequences are degraded by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent. There is mild intrahepatic biliary ductal dilatation which is presumably due to a postcholecystectomy state. No filling defects are identified within the common bile duct. No suspicious hepatic lesion is seen. The hepatic vasculature is patent. SPLEEN: No significant abnormality noted.PANCREAS: There are no signs of acute pancreatitis. No obvious pancreatic head lesion is seen. A lobulated cystic lesion in the pancreatic tail likely represents a sidebranch IPMN without complicated features. A few other scattered cystic lesions in the pancreas also likely represent punctate branch type cystic lesions. A 2.2 x 1.7 cm air and fluid containing structure near the ampulla is favored to represent an ampullary/duodenal diverticulum. 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: A subcutaneous cystic structure in the posterior right abdominal wall is again noted. There is thoracic lumbar orthopedic hardware.OTHER: No significant abnormality noted. | 1.No suspicious pancreatic head mass. A cystic lesion in the tail of the pancreas likely represents a lobulated sidebranch IPMN with other punctate cystic branch type lesions elsewhere.2.An air/fluid containing structure near the ampulla is favored to represent an ampullary/duodenal diverticulum. |
Generate impression based on medical findings. | Female, 19 years old. Knee pain. Evaluate for meniscus and ACL tear. MENISCI: The medial meniscus is intact. The body of the lateral meniscus is mildly extruded. The anterior horn of the lateral meniscus is small in size and displaced superiorly by underlying fluid, although a clear displaced fragment is not definitely identified.ARTICULAR CARTILAGE AND BONE: There is and approximately 1 cm full-thickness focal cartilage defect in the lateral femoral condyle with associated underlying bone marrow edema. There is also bone marrow edema in the posterior aspect of the lateral tibial plateau with mild overlying cartilage irregularity. There is slight thinning of the articular cartilage in the medial femoral condyle without focal defect. Patellofemoral cartilage is intact.LIGAMENTS: Abnormal intermediate and high signal in the region of the ACL indicates a complete tear. The PCL is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1.Complete tear of the ACL with associated bone marrow edema and focal cartilage loss involving the lateral compartment.2.Abnormal position and morphology of the anterior horn of the lateral meniscus suggests a tear, although the displaced fragment is not clearly identified. |
Generate impression based on medical findings. | Clinical question: Bleed/mass. Signs and symptoms: Headaches, nausea and vomiting. Nonenhanced CT of head:Images through posterior fossa demonstrate ectopia of cerebellar tonsils consistent with Chiari malformation. The inferior pole of cerebellar tonsils are beyond the field of study. There is complete effacement of subarachnoid space at the level of foramina magnum with deformity of cerebellar tonsils. Follow-up with an MRI is recommended.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci and ventricular system remain within normal limits.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. | 1.Chiari malformation with resultant deformity of cerebellar tonsils and total effacement of subarachnoid space at the level of foramen magnum . CT examination of brain is otherwise unremarkable.2.Recommend follow-up with an MRI examination of brain and including CSF flow study at the level of foramen magnum. |
Generate impression based on medical findings. | 58 years Female (DOB:12/17/1957)Reason: etiology of L sided weakness History: LUE and LLE weaknessPROVIDER/ATTENDING NAME: KOUROSH L REZANIA KOUROSH L REZANIA There is redemonstration of ventriculomegaly and confluent periventricular white matter signal hyperintensities extending to the subcortical white matter. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently 42 mm and previously was 40 mm. Third ventricular diameter at the level of the massa intermedia is 8 mm on the current exam and was 8 mm on the prior exam. Fourth ventricle also appears similar. Corpus callosum is thin.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is diffuse cerebral atrophy present and loss of white matter which has very subtly progressed since the prior exam. There is no evidence for acute cerebral ischemic infarction. Underlying etiology is uncertain. |
Generate impression based on medical findings. | 61-year-old male with history of renal cancer, concern for hepatic metastases. ABDOMEN:LIVER, BILIARY TRACT: There is no definite enhancing hepatic mass lesion identified. The large right renal mass causes extrinsic mass effect on the right hepatic lobe with adjacent heterogeneous enhancement in this region immediately adjacent to renal mass. The noncontrast coronal images suggest that the renal mass remains encapsulated and merely abutting liver but direct invasion cannot be excluded. There is a 1 cm flash filling hemangioma in segment II. There is no biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: There is normal signal intensity in the pelvis. No focal pancreas lesion is identified. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large, heterogeneous, enhancing mass extending from the right upper pole kidney which measures 6.6 x 6.4 x 7.4 cm, compatible with known renal malignancy. There is enhancing thrombus in the proximal right renal vein, concerning for direct invasion (series 803, image 194). This does not extend to the inferior vena cava. Left kidney is normal.RETROPERITONEUM, LYMPH NODES: No thrombus is identified in the IVC. There is no significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No discrete osseous lesion is identified.OTHER: No significant abnormality noted. | 1.No discrete intrahepatic mass is identified.2.Heterogeneous enhancement in the right hepatic lobe adjacent to extrinsic compression from large right renal mass --- favored to be compression effect alone, but direct invasion cannot be excluded.3.Large right renal mass with tumor thrombus in the right renal vein. |
Generate impression based on medical findings. | 61-year-old female with medial sided left knee pain. MENISCI: Mild intrasubstance degeneration of the posterior horn of the medial meniscus. No evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the cartilage along the anterior femoral head. There is no full-thickness tear. There is fissuring along the medial ridge of the patella. Full-thickness loss is present along the medial facet of the patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Synovitis with a moderate joint effusion and debris within the joint. This could represent synovial chondromatosis or less likely pigmented villonodular synovitis. |
Generate impression based on medical findings. | ORBITS: The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no restricted diffusion to suggest acute ischemic infarction. There is no evidence of intracranial hemorrhage. There are no areas of abnormal parenchymal signal or enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits. Incidental note is made of a small cystic structure within the posterior nasopharynx compatible with a normal variant Tornwaldt cyst. | 1.No evidence of acute ischemic infarction.2.Orbits and optic nerves unremarkable and without specific findings to account for patient's symptoms. |
Generate impression based on medical findings. | 56-year-old male with history AV malformation, seizure disorder who presents with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Vascular calcifications are noted. The region of encephalomalacia within the posterior temporal occipital region with high density clip/coils presumably from the prior AVM repair. No evidence of hemorrhage. Multiple patchy low low attenuation is nonspecific and likely represents small vessel disease, age determinate. If there is clinical concern for acute ischemia an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Chronic changes as described above. If there is clinical concern for acute ischemia, an MRI may be considered. |
Generate impression based on medical findings. | Back pain following motor vehicle accident On this limited study lateral view of the lumbosacral spine, there is a radiopaque density anteriorly adjacent to the superior aspect of the L4 vertebral body. While this very likely represents bowel contents superimposed over this region, in the setting of trauma additional views would ordinarily be indicated. If this patient is pregnant however a nonemergent, limited noncontrast enhanced ( sagital sequence) MRI can be obtained for complete evaluation. No other obvious acute abnormality is identified. | On this limited study lateral view of the lumbosacral spine, there is a radiopaque density anteriorly adjacent to the superior aspect of the L4 vertebral body. While this very likely represents bowel contents superimposed over this region, in the setting of trauma additional views would ordinarily be indicated. If this patient is pregnant however a nonemergent, limited noncontrast enhanced ( sagital sequence) MRI can be obtained for complete evaluation. No other obvious acute abnormality is identified. |
Generate impression based on medical findings. | 52 year old female; rule out intracranial hemorrhage. No abscess identified.Patchy low attenuation in the subcortical white matter compatible with small vessel disease of indeterminate age.More focal low attenuation in the right high parietal region represents edema given subsequent contrast enhanced examination that revealed a metastatic focus at this location. This lesion is visible on the MRI dated 3/29/2008.There is no evidence of intracranial hemorrhage. 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. | 1. No intracranial hemorrhage.2. Metastatic lesion with surrounding edema in the high right parietal region adjacent to the cerebral falx; please see recent contrast enhanced examination for further details. If further workup is necessary, recommend MRI. |
Generate impression based on medical findings. | 41 years, Female, Reason: Rule out biliary obstruction History: elevated bilirubin, hepatomegaly, fever, abdominal pain. ABDOMEN: Please note that there is significant artifact from Dobbhoff tube tip within the duodenum.LUNG BASES: Small bilateral pleural effusions, new from the prior CT.LIVER, BILIARY TRACT: Mild hepatomegaly. Gallbladder is mildly distended with adjacent fluid but no wall thickening or stones.Common bile duct is normal in caliber measuring 4 mm. No intrahepatic biliary ductal dilatation. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Small cystic foci adjacent to the main pancreatic duct within the head of the pancreas (401/12) and body of the pancreas (701/61) appear to communicate with the main pancreatic duct and likely represent small side branch IPMN's.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small broad-based fat containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Likely Tarlov cyst partially visualized. Mild scattered ascites. Anasarca. | 1.No evidence of biliary obstruction.2.Two small side branch IPMN's.3.Small bilateral pleural effusions and anasarca. |