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Generate impression based on medical findings. | History of tuberous sclerosis and seizures of increased frequency. There is an unchanged 7 mm wide avidly enhancing lesion at the grey-white matter junction along the anterior right superior frontal sulcus with associated surrounding T2 hyperintensity. There are postoperative findings in the right parietal lobe with unchanged associated scattered punctate foci of susceptibility effect and linear T2 signal abnormality surrounding the resection cavity, which likely represents gliosis and encephalomalacia. There is also unchanged linear T2 hyperintensity in the right forceps minor region. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged. | 1. Unchanged enhancing lesion in the right superior frontal sulcus grey-white matter junction, which may represent a hamartoma or perhaps less likely a neoplasm superimposed upon transmantle dysplasia.2. Unchanged postoperative findings in the right parietal lobe.3. Unchanged signal abnormality in the right right forceps minor region, which likely represents transmantle dysplasia with radial migration band. |
Generate impression based on medical findings. | Female, 66 years old, with confusion, left-sided weakness and vision changes. Assess for right occipital hemorrhage of unclear etiology in the setting of ALL. A hematoma is evident within the right occipital lobe measuring 27 x 18 x 16 mm. Internal signal characteristics are compatible with acute blood product (predominantly deoxyhemoglobin). Moderate vasogenic edema is seen surrounding the hematoma, which mildly effaces the right ventricular atrium, but without significant generalized mass effect. Trace subdural blood product is also seen along the right occipital and temporal lobes and along the right tentorium.Within the limits of this noncontrast examination, no definite underlying lesion can be seen in the vicinity of the hematoma. Elsewhere, patchy predominantly periventricular white matter T2 hyperintensity is seen without significant mass effect. No additional areas of intracranial hemorrhage are suspected. The ventricular system is otherwise within normal limits.On MRA imaging, no evidence of any vascular lesion is seen in the vicinity of the occipital lobe hematoma. No significant vascular stenosis or occlusion is suspected. No aneurysms are detected within the limitations of technique. Although a dedicated MRV could not be performed due to patient tolerance, the T2 flow voids of the dural venous sinuses appear to be preserved compatible with patency. | 1.An acute hematoma is evident within the right occipital lobe inducing moderate vasogenic edema but without significant generalized mass effect.2.No clear underlying etiology for the hematoma is identified on this examination, including no evidence of any vascular lesion on MRA imaging.3.The differential diagnosis would include hemorrhage related to coagulopathy. Less common etiologies would include vasculitis or intravascular involvement by leukemia which can produce vessel rupture. A leukemic parenchymal chloroma can also present with hemorrhage. Parenchymal hemorrhage has been reported as a rare complication of therapy. Finally, an invasive fungal infection such as aspergillus could produce a parenchymal hemorrhage. |
Generate impression based on medical findings. | Male, 61 years old. Limping MENISCI: There is diffusely abnormal signal within the posterior horn of the medial meniscus with a complex combination of vertical, horizontal, and radial tearing. The anterior horn of the medial meniscus and the lateral meniscus are normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage of the medial femoral condyle and the patella, without focal cartilage defects.LIGAMENTS: The collateral and cruciate ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1.Complex tear of the posterior horn of the medial meniscus.2.Generalized thinning of the articular cartilage of the medial femoral condyle and the patella, without focal cartilage defects.3.Small joint effusion. |
Generate impression based on medical findings. | Transphenoidal surgery for Cushing syndrome and foramen decompression for Chiari malformation. Pituitary: There has been expected interval evolution of postoperative findings related to transsphenoidal surgery. There is no definite evidence of a discrete pituitary mass. The remaining pituitary gland is not enlarged and there is no mass effect upon the optic apparatus. The infundibulum is intact and not significantly deviated. The cavernous sinuses are intact. Brain: There are stable postoperative findings related to Chiari decompression with an unchanged position and configuration of the cerebellar tonsils. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchymal signal appears unremarkable. The ventricles are stable in size and configuration, with asymmetric lateral ventricles in which the left is slightly smaller than the right. The major cerebral flow voids are intact. There is a small left maxillary sinus retention cyst. The skull and extracranial soft tissues are otherwise unremarkable. | 1. Postoperative findings related to transsphenoidal surgery without definite evidence of residual or recurrent pituitary tumor.2. Expected postoperative findings related to foramen magnum decompression for Chiari malformation. |
Generate impression based on medical findings. | 33-year-old female with worst headache of her life x 3 days There is no evidence of intracranial hemorrhage, mass or edema. A small focus of mildly increased attenuation in the posterior cranial fossa with possible slight effacement of the right posterior border of the fourth ventricle is seen on a single slice in multiple planes. The remainder of the ventricular system is normal. This is a nonspecific finding and may be artifactual. Recommend MRI if clinically indicated. Slight focal irregularity and waviness of the right lateral ventricle lateral border is nonspecific and may be artifactual or represent isolated remote ischemic event. The remainder of the periventricular white matter is normal. There is a well-demarcated expansile lesion in right supraorbital ridge measuring 2 x 1 x 1.7 cm with no cortical erosion and preservation of the adjacent soft tissue planes. This appearance favors a benign process such as a hemangioma or ossifying fibroma. Left maxillary sinus mucus rentention cyst measuring 1.5 x 1.5 cm is incompletely visualized. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1) No intracranial hemorrhage. 2) Foci of increased attenuation adjacent to the 4th ventricle may represent artifact. Recommend MRI if there is clinical suspicion for mass. 3) Right supraorbital expansile bone lesion, likely benign, such as a hemangioma or ossifying fibroma. |
Generate impression based on medical findings. | 42-year-old female strong family history of breast carcinoma. Family history of breast cancer in her mother diagnosed at age 37, and a maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Scattered high T2 signal cysts are present.Moderate to marked parenchymal enhancement is noted bilaterally. This is increased compared to prior studies and somewhat of a limitation. No suspicious enhancement is seen in either breast. The 8 mm inferior left breast mass is stable in size and typically benign in appearance, though less conspicuous today due to a relative increase in background enhancement. A few of the scattered enhancing foci in the right breast are more enhancing, though none uniquely suspicious. Their kinetic profiles are typically benign once slight motion is accounted for. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. Please schedule future MRI follow up studies during the 2nd week of the patient's menstrual cycle to limit the effect of background enhancement.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain mets (tonsil SCC) s/p resection, post-op SRS History: assess for EOD There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Focal high signal intensity on the left parietal lobe precuneus referred to prior resection of metastatic lesion on FLAIR imaging is still seen, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on ethmoid sinus, bilateral maxillary sinuses and frontal sinus with retention cyst is on the left maxillary sinus, grossly unchanged since prior scan. | Unchanged resection area focal FLAIR high signal intensity since prior scan.No evidence of new abnormal enhancement.No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on medical findings. | Proximal weakness There is moderate symmetric patchy diffusely-distributed increased T2 signal throughout all of the visualized musculature of the thighs bilaterally, compatible with myositis. No fatty atrophy is evident.The subcutaneous fat is normal in appearance, without masses or edema. The bone marrow signal is normal. Bilateral inguinal lymphadenopathy is noted. | Findings compatible with myositis, as described above. |
Generate impression based on medical findings. | 52-year-old male with biopsy proven prostate cancer. Evaluate extent of disease. PELVIS:PROSTATE:Prostate Size: 3.3 cm in AP, 4.5 cm in transverse, and 3.9 cm in critical diameter.Peripheral Zone: In the left apex, there is a 7 x 7 mm lesion that is hypointense on T2 and ADC (series 604 image 104).Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Dominant lesion in the left apex peripheral zone. |
Generate impression based on medical findings. | Female, 38 years old, with pain in the C7 distribution, mild slowing on EMG. Straightening of the cervical lordosis may be positional. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are normal. No concerning marrow replacement or evidence of marrow edema is seen.Visualized spinal cord shows normal signal intensity and morphology throughout.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild right foraminal narrowing secondary to slight uncovertebral and facet hypertrophy. No spinal canal stenosis. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc-osteophyte complex with a focal component in the right foraminal zone resulting in a severe right foraminal stenosis. The disc osteophyte slightly flattens the ventral cord, but no significant spinal canal stenosis is seen. C6-7: Uncovertebral hypertrophy resulting in mild to moderate bilateral foraminal stenosis. No spinal canal stenosis. C7-T1: Mild to moderate foraminal narrowing is seen largely due to facet hypertrophy. No significant spinal canal stenosis. A large and very heterogeneous lesion is evident within the left thyroid lobe. The right thyroid lobe contains smaller heterogeneous lesions as well. Corresponding lesions were noted on a prior ultrasound, though at least the left-sided lesion seems to have increased in size. | 1.Focal disc and osteophyte disease is seen within the right C5-6 foraminal zone result in a severe stenosis of the right C5-6 neural foramen.2.Scattered additional areas of mild to moderate foraminal narrowing are seen as detailed above.3.No areas of high-grade spinal canal stenosis are detected.4.Bilateral thyroid lesions are noted incidentally with some questionable increase in size on the left when compared to a thyroid ultrasound from 2005. |
Generate impression based on medical findings. | History of migraine, evaluate for structural abnormality. There are nonspecific scattered subcortical foci of FLAIR abnormality. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. | 1.Nonspecific scattered FLAIR white matter foci. Given the patient's history, etiology of migraine is considered most likely, with demyelination and other etiologies remaining in the differential.2.Partially empty sella with no specific MR imaging findings of benign intracranial hypertension. Clinical correlation is recommended. |
Generate impression based on medical findings. | Reason: left hand thumb deformity, assess for tendon involvement/tumor/old trauma History: as above LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL | Findings consistent with AVM of the thumb. |
Generate impression based on medical findings. | 47 year old female with ESRD on HD, HTN, heroine abuse on methadone, cardiomyopathy with concern for amyloid. Referred for cardiac MRI to assess for cardiac amyloid. Left VentricleThe left ventricle is mildly dilated with reduced systolic function. There is mild global decrease in function without any regional wall motion abnormalities. The overall LV ejection fraction is 47%. The LVEDV is 163 ml (normal range 109+/-23), LV end diastolic volume index is 112 ml/m2 (normal range: 65+/-11), LVESV is 87 ml (normal range 31+/-10), and LV end systolic volume index is 60 ml/m2 (normal range 18+/-5). The LV mass is 110 g (normal range 114+/-24) and the LV mass index is 76 g/m2 (normal range 67+/-11). The native T1 myocardial relaxation time is <950 ms not suggestive of underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RVEDV is 102 ml (normal range 110+/-24), the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVESV is 48 ml (normal range 35+/-13), and the RV end systolic volume index is 33 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsBilateral moderate pleural effusions . Associated passive bilateral lower lobe subsegmental atelectasis. Suggestion of persistent pulmonary edema. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1.Assessment for cardiac amyloidosis is limited in the absence of contrast; unable to assess for areas of myocardial late gadolinium enhancement. The native T1 myocardial relaxation time is <950 ms, not suggestive of underlying diffuse fibrosis or infiltration.2.The left ventricle is mildly dilated with mildly reduced systolic function. LVEF 47% stable from recent TTE. 3.The right ventricle is normal in size with normal systolic function. RVEF 53%.4.Mild mitral regurgitation and mild left atrial dilation.5.Small pericardial effusion.6.Bilateral moderate pleural effusions, multilobar passive atelectasis and suggestion of persistent pulmonary edema. |
Generate impression based on medical findings. | 66-year-old female with primary sclerosing cholangitis status post lobectomy revealing high-grade dysplasia. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of left lobectomy and hepaticojejunostomy. Prominent distal common bile duct is noted. There is mild right hepatic biliary ductal dilatation with evidence of mild stricturing in the proximal right hepatic biliary duct. Segment 6 perfusion abnormality at the site of the prior drain is again noted. Right biliary drain is present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Postoperative changes of left hepatic lobectomy with hepaticojejunostomy. 2.Mild right intrahepatic biliary ductal dilatation with evidence of mild stricturing compatible with history of primary sclerosing cholangitis. |
Generate impression based on medical findings. | Reason: left eye proptosis with hx of CNS lymphoma History: left eye proptosis and pain Exam is severely degraded by motion artifact.There is interval progression of the circumferential soft tissue thickening involving the left intraorbital optic nerve measuring up to 6-mm in thickness. There is also increase in T2 signal abnormality of this lesion. There is interval improvement of the previously seen pre-chiasmatic and chiasmatic component with mild residual enhancement of the right prechiasmatic optic nerve centered at the optic canal and left optic nerve just anterior to the chiasm and intracanalicular portion. There is worsening of left orbital proptosis. Additional lesions of the brain seen on prior studies are suboptimally evaluated on this study.There is moderate diffuse paranasal mucosal thickening, similar to prior study. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. | 1.Compared to MRI 2/11/2015, there is interval increase in circumferential soft tissue surrounding the left intraorbital optic nerve suspicious for some disease progression. There is worsening proptosis. 2.Limited exam from motion artifact. There is interval improvement of prechiasmatic and chiasmatic abnormal enhancement with residual disease as described above. Consider dedicated MRI of the brain with contrast to follow up intracranial extent of disease as clinically indicated.3.Moderate diffuse paranasal mucosal thickening similar to prior study. |
Generate impression based on medical findings. | Diagnosis: Altered mental status. Personal history of other disorders of nervous system and sense organsClinical question: unclear hx of seizure disorder, SDH, CVA, residual R hemiparesis Arm > LSigns and Symptoms: transferred from OSH for AMS There is encephalomalacia involving the left inferior frontal gyrus as well as portions of the left middle frontal gyrus and in the left pre and postcentral gyri and left insular cortex within the left middle cerebral artery territory. There is associated atrophy of the left cerebral peduncle with signal change compatible with Wallerian degeneration. There is associated susceptibility effect within the area of infarction. There is ex vacuo effect on the left lateral ventricle. There are associated flow voids within the left sylvian fissure middle cerebral artery vasculature.No foci of diffusion restriction are appreciated to suggest acute ischemic cerebral infarction.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal right 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 left internal carotid artery lumen has high signal within it at the petrous segment..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.Findings are suspicious for old infarction with encephalomalacia in the left middle cerebral artery territory as detailed above with associated Wallerian degeneration.2.Occlusion or near occlusion of the left internal carotid artery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific.4.There is no evidence for acute ischemic cerebral infarction. |
Generate impression based on medical findings. | Seven year old male evaluate for facial fracture/ICH CT of brain.No evidence of calvarial fracture is identified. Mastoid air cells and paranasal sinuses are unremarkable. No evidence of intracranial post traumatic finding. No evidence of edema, mass effect, hemorrhage, midline shift is detected. There is however a slight prominence of the lateral ventricles which although may be within normal limits possibility of hydrocephalus cannot be entirely ruled out an MRI examination is recommended.CT of the maxillofacial region.The paranasal sinuses are well pneumatized. The regional maxillofacial demonstrate no evidence of fracture. No definitive evidence of any soft tissue abnormality is detected. | 1.No evidence of maxillofacial fracture.2.No evidence of post traumatic findings on CT of brain.3.Slight prominence of lateral ventricles as detailed. |
Generate impression based on medical findings. | Clinical question: 49-year-old with cervical neck pain. Signs and symptoms: Tenderness in the spine especially with extension. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.There is unremarkable signal intensity of vertebral column.There is normal caliber and signal intensity of cervical and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate mild degenerative disc disease with mild loss of disc height. There is bilateral uncovertebral hypertrophy with resultant moderate right neural foraminal compromise and mild on the left. Mild central spinal stenosis is also suspected.C5-C6 demonstrate mild to moderate degenerative disc disease and mild loss of disc height without significant degenerative or hypertrophic changes of posterior elements. There is shallow broad-based bulging disc which is a slightly more prominent on the right compared to left. Osteophytes from uncovertebral hypertrophic changes are also present at this level and more prominent on the right. Constellation of changes at this level results in effacement of ventral subarachnoid space, subtle flattening and posterior displacement of the cord and mild central spinal stenosis. Moderate left neural foraminal compromise and mild right.C6-C7 demonstrate mild degenerative changes without central spinal stenosis. Mild left neural foraminal compromise is suspected.C7-T1 through T3-T4 levels are unremarkable. | 1.Degenerative changes at C5-C6 and to a lesser degree at C4-C5 results in mild central spinal stenosis and neural foraminal compromise as detailed above.2.Unremarkable images at other levels. Please review detailed report above.3.The caliber and signal intensity of the visualized cervical/upper thoracic cord remains within normal. |
Generate impression based on medical findings. | 50 year-old female with family history of breast cancer in her grandmother in her 40s. History of left benign biopsy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Reason: evaluation for thoracic mets History: breast cancer new diagnosis breast cancer MRI thoracic spine:There is diffuse marrow replacement present. Compression fractures are present at multiple levels including T6 were there is 40% loss of vertebral body height, and T8 were there is 40% loss of vertebral body height T11 where there is 25% loss of vertebral body height and L1 where there is 60% loss of vertebral body height. There is extraosseous extension into the spinal canal at L1 and T8 and T6. At L1 there is a mild degree of spinal stenosis, retropulsion of T12 on L1 and encroachment of the exiting nerve roots within the neural foramina.The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are bilateral pleural effusions present.There small enhancing nodules scattered in the peri-vertebral musculature and subcutaneous tissues behind the thoracic spine which could represent metastatic foci. One in the left peri-vertebral musculature at the T9 vertebral level measures 12mm x 5 mm sagittal dimensionsLumbar spine:Compression fracture is present at L1 where there is 60% loss of vertebral body height. There is extraosseous extension into the neural foramina and adjacent spinal canal at L1. There is a mild degree of spinal stenosis and retropulsion of T12 on L1 resulting in encroachment of the exiting nerve roots within the neural foramina.The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level. There is marked thickening of the right L5 pedicle as a result of tumor with some extension into the adjacent neural foramina without compromise to the exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.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.Diffuse osseous metastases throughout the visualized spine with multiple pathologic compression fractures at T6, T8, T11 and L1 but worse at L1. There is a small amount of epidural extension at T6, T8 and L1. There is some subluxation of T12 on L1 with encroachment of the exiting nerve roots within the neural foramina. There is mild spinal stenosis at L1 as a result of the compression fracture and retropulsion with minimal spinal canal narrowing contributed from the at the epidural extension.2.There are a few small scattered subcutaneous and perivertebral musculature nodules present which are suspicious for metastatic involvement.3.There are bilateral pleural effusions present. |
Generate impression based on medical findings. | 17-year-old male patient with medial knee pain and instability. Note that evaluation on several sequences is limited due to patient motion artifact.MENISCI: The lateral meniscus appears intact. There is linear obliquely oriented increased signal intensity within the peripheral fibers of the posterior horn of the medial meniscus extending to the tibial articular surface, suggesting a longitudinal undersurface tear. The body and anterior horn of the medial meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is edema type signal within the posterior aspect of the lateral tibial plateau as well as the anterior aspect of the lateral femoral condyle. There is slight flattening of the lateral femoral condyle overlying the contusion, indicating a mild impaction fracture. A small contusion is also noted in the far medial aspect of the medial tibial plateau. We see no fluid-filled articular cartilage defects.LIGAMENTS: There is a full-thickness midsubstance tear of the anterior cruciate ligament. The superficial band of the medial collateral ligament is intact. There is a curvilinear low signal intensity structure extending superiorly from the body of the medial meniscus between the medial femoral condyle in the superficial band of the MCL that is of uncertain clinical significance. While this could conceivably represent a meniscofemoral coronary ligament tear, this seems unusual in light of the intact superficial band of the medial collateral ligament. The posterior cruciate ligament, lateral collateral ligament complex, and patellar retinacula are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | Midsubstance rupture of the anterior cruciate ligament with bone contusions, medial meniscus tear, and other findings as described above. |
Generate impression based on medical findings. | The cerebellar tonsils are low-lying measuring up to 8 mm below the foramen magnum. There is however no significant crowding at the foramen magnum. CSF flow sequence was not obtained. The spinal cord is of normal caliber and signal without evidence of syrinx. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. LUMBAR SPINE | 1. Cerebellar tonsils measure up to 8 mm below the foramen magnum but with preservation of the subarachnoid spaces at the craniocervical junction. CSF flow sequence was not obtained and if clinically warranted, patient may return for this sequence without charge. 2. No evidence of syrinx in the cervical cord.3. Lumbar spine images demonstrate unchanged appearance of the low-lying spinal cord with suggestion of scarring at its distal aspect at the S2 level.4. Small extradural fluid collection posterior to the expanded dural sac at the S2-S3 levels measures 7 mm in the AP dimension and up to 2.7 cm in the craniocaudal dimensions which is increased since 7/21/2016 although smaller since 10/29/2015, suggesting a small persistent CSF leak. There is also small amount of fluid involving the superficial subcutaneous soft tissues at the S2 level which was also present on prior studies from 10/29/2015 and 7/21/2016, although demonstrates gradual decrease compared to the prior two studies. |
Generate impression based on medical findings. | 36-year-old male with left side and frontal headaches. The axial T2 FLAIR sequence is moderately degraded by motion artifact.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Normal noncontrast brain MR. |
Generate impression based on medical findings. | Male, 59 years old, with memory decline. Numerous scattered foci of T2 hyperintensity are seen within the white matter of the cerebral hemispheres. These are primarily juxtacortical, and to a lesser degree periventricular in distribution. No significant involvement of the basal ganglia, brainstem or cerebellum is seen.There is no evidence of restricted diffusion. No parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid collections are noted. The lateral ventricles may be slightly prominent. The cerebral sulci in general are of normal caliber, though the sylvian fissures appear mildly prominent. | 1.Numerous, likely chronic, scattered small white matter lesions are seen in the cerebral hemispheres, largely juxtacortical in location but with mild involvement of the periventricular regions as well. The basal ganglia, brainstem and cerebellum are spared. The distribution is somewhat atypical for small vessel ischemic disease though correlation with risk factors is suggested. Other considerations would include sequelae of prior inflammation, demyelination or vasculitis.2.No definite acute intracranial abnormality is seen nor are there any other specific findings which would account for the patient's memory decline. The lateral ventricles appear to be slightly prominent and there may be some prominence of the sylvian fissures suggesting a component of mild parenchymal volume loss. |
Generate impression based on medical findings. | Female, 72 years old, with aphasia and right facial droop, suspected left MCA syndrome.] For stroke. Gyriform restricted diffusion is evident within the lower left precentral gyrus and middle frontal gyrus. There may be a small focus of restricted diffusion within the left postcentral gyrus as well. Very mild patchy cortical restricted diffusion is also suspected along the left temporal and occipital junction.Sequelae of prior ischemia are seen within the left temporal and occipital lobes with associated gliosis and encephalomalacia. There is mild ex vacuo dilatation of the left ventricular atrium. Numerous scattered foci of periventricular white matter T2 hyperintensity are also seen compatible with chronic microvascular ischemic disease.No evidence of significant generalized mass effect is seen. No findings to suggest acute intracranial hemorrhage are noted. Several scattered foci of susceptibility are seen predominantly in the left cerebral hemisphere compatible with chronic microhemorrhage. Except as above, the ventricles are within normal limits. | 1.Acute ischemia involving the lower left precentral gyrus and part of the left middle frontal gyrus. There may be an additional small focus of acute ischemia within the left postcentral gyrus, and mild, perhaps subacute ischemia at the left temporal occipital junction.2.Sequelae of multiple prior territorial and small vessel ischemic lesions are seen. No evidence of significant intracranial hemorrhage or any generalized cerebral mass effect is seen. |
Generate impression based on medical findings. | 61-year-old female with bladder cancer, status post ileostomy. Fever and shock. Indiana pouch with ileostomy. Evaluate for GI source of infection. Pulmonary embolism CT scan examination was performed in conjunction with this study, but will be reported separately. ABDOMEN:LUNG BASES: CT scan of the thorax for pulmonary embolism was performed and will be reported separately.LIVER, BILIARY TRACT: There are multiple benign-appearing simple hepatic cysts, unchanged from the recent MRI examination. There is diffuse gallbladder wall thickening with mucosal enhancement suggesting cholecystitis.SPLEEN: There is a splenic hemangioma unchanged since the recent MRI examination.PANCREAS: No evidence of pancreatitis was found.KIDNEYS, URETERS: Mild left hydronephrosis is found, as expected in this patient who is status post Indiana pouch ilial conduit. There is a focal left mid pole cortical thinning, probably due to prior infarct. No acute changes are found and compared with the prior examination.ADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is focal fat stranding in the right or quadrant, especially axial image 81/162, adjacent to the ilial conduit and a drainage tubing at axial image 97 / 162.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a left lower quadrant ileostomy at axial image 91/ 158.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New gallbladder wall thickening suggests interval development of cholecystitis. Multiple postoperative changes. No abscess or ascites. Multiple additional findings, as described above. |
Generate impression based on medical findings. | LevocardiaNormal ventricular and atrial position.Interatrial and interventricular septa are intact; prior VSD patch noted. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 62 ml/m2 (normal range: 65+/-11), the LVEDV is 116 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). Abnormal septal motion of unclear significance. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is severely dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 146 ml/m2 (normal range 69+/-14, previously measured as 114 ml/m2 (2013)), the RVEDV is 276 ml (normal range 110+/-24), the RV end systolic volume index is 82 ml/m2 (normal range 22+/-8, previously measured as 60 ml/m2 (2013) ), and the RVESV is 154 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately enlarged. The IVC, SVC and CS all drain into the RA normally.Aortic ValveThe aortic valve appears bicuspid. The aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. The leaflets appear thickened and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is severe pulmonic regurgitation (regurgitant fraction = 57%, regurgitant volume = 60 ml).Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation .AortaThere is a left sided aortic arch. The aortic root is normal in size. There is an aberrant R SC artery arising from the distal aortic arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium and are of normal calibre.Pulmonary ArteryThe main pulmonary artery is moderately-severely dilated and there is marked infundibular enlargement. The RPA is severely dilated. The LPA was not well seen.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a persistent LSVC that drains into the RA directly (not the CS).PericardiumThere is no obvious pericardial effusion. Extracardiac FindingsThere is artefact from previous sternotomy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. LV size and systolic function are normal, LVEF 60%.2. RV is severely dilated with reduced systolic function, RVEF 44%. The RVEDV has increased from prior MRI (2013)3. Severe pulmonary regurgitation with regurgitant fraction 57% and regurgitant volume of 60 mL.4. Persistent LSVC to RA. 5. LPA not well seen. |
Generate impression based on medical findings. | Lower extremity wound Examination is limited by motion artifact on multiple sequences.There is a large ulceration of the anterolateral soft tissues of the leg at approximately the level of the junction between the upper and middle thirds. The ulceration extends into the tibialis anterior muscle and appears to disrupt the central tendon. There is edema and enhancement of the tibialis anterior muscle and adjacent soft tissues. The ulceration extends to within a couple of millimeters of the anterior tibial cortex where there is a small defect as seen on the recent radiographs. While this may represent an erosion related to the ulceration, there is no abnormal marrow signal intensity in the underlying bone to confirm osteomyelitis. This defect may be posttraumatic in nature.The fibula appears normal. There is subcutaneous edema extending laterally down the leg into the ankle. There are no additional fluid collections separate from the ulceration. Small foci of signal void along the margins of this ulceration may represent foci of gas or less likely tiny metallic foreign bodies. Subcutaneous edema is also noted along the medial ankle. | Soft tissue ulceration with extension into the tibialis anterior muscle and a small superficial cortically-based defect of the adjacent tibia. While this defect could represent erosion due to the ulceration, there is no abnormal signal intensity to confirm osteomyelitis and it is possible this defect is posttraumatic in nature. |
Generate impression based on medical findings. | Cerebral infarction, unspecified [I63.9] / Other specified soft tissue disorders [M79.89], Reason for Study: ^Reason: Evaluate etiology of comatose state History: comatose state Brain MRIMultifocal various sized restricted diffusion lesions on bilateral hemispheres including bilateral centrum semiovale, left temporo-occipital lobe, right side caudate nucleus, bilateral temporal lobes, bilateral basal ganglia, left cerebellar hemisphere and right middle cerebellar peduncle indicating acute ischemic infarctions.There is susceptibility lesion on the right temporal lobe indicating acute intracerebral hemorrhage, considering multifocal ischemic infarctions, this lesion could represent hemorrhagic transformation.There are also scattered susceptibility lesions on bilateral hemispheres indicating multiple petechial hemorrhages or multiple cavernous malformations or parenchymal calcifications.The ventricles, sulci and cisterns are symmetric and unremarkable. The mastoid air cells are clear.Mucosal thickening on bilateral ethmoid sinuses and right maxillary sinus. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Brain MRVThis is non diagnostic brain MRV. Thus, if clinically indicated, the exam needs to be repeated without additional charge.There is definitive evidence of major dural sinus occlusion. | 1. Multifocal various sized bihemispheric, supra and infratentorial acute ischemic infarctions with right temporal ICH. The ICH could represent hemorrhagic conversion.2. Normal brain MRA.3. Non diagnostic MRV but major dural sinuses appear to be patent. |
Generate impression based on medical findings. | History of metastatic GYN adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is susceptibility artifact within the bilateral basal ganglia, likely reflecting mineralization. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. Incidental note is made of cavum septum pellucidum and cavum vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild vessel thickening and fluid signal in bilateral mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. No evidence of intracranial mass.2. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on medical findings. | Reason: R/o TIA History: R-sided weakness with dizziness, transient The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These were present on the prior exam and are unchanged Incidental note is made of cavum septum pellucidum and cavum vergae.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening along the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The distance between the interzygomatic line and the is anterior aspect of the cornea and is 19 mm. | Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. These are somewhat atypical at this age group but not substantially different than on the prior exam They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. |
Generate impression based on medical findings. | History of left lumpectomy for invasive ductal carcinoma with lymphovascular invasion and associated DCIS 3/2014. Patient received chemotherapy and radiation therapy and is currently on letrozole. History of benign right breast biopsy. History of breast cancer in sister. Heterogeneous fibroglandular tissue is present bilaterally. Mild parenchymal enhancement is noted bilaterally.Left breast: There has been interval surgical excision of the mass at the 5 o'clock position of the left breast. A 4.2 x 2.8 x 3.3 cm (AP x LR x CC) fluid filled seroma cavity is present in the lumpectomy bed with thin enhancing wall. Overlying nonenhancing skin thickening is present. Susceptibility artifact from surgical clips are present in the lumpectomy bed. No abnormal enhancement is present in the left breast and no abnormal left axillary lymph nodes are present.Right breast: Previously described enhancing mass at the 12 o'clock position of the right breast is not seen on the current study. Susceptibility artifact at the 7 o'clock position from benign right breast biopsy is present without surrounding enhancement. No abnormal enhancing masses, non-mass enhancement or uniquely enhancing foci are present in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region. | Postsurgical changes of the left breast. Previously described enhancing mass in the 12 o'clock position of the right breast is not seen on the current study. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | Persistent left sciatica which has been increasing. Known spinal DJD. There is reversal of the lordosis with 3 mm of grade 1 retrolisthesis of L3 on L4 and 4 mm of retrolisthesis of L5 on S1. There is also levoscoliosis and moderate to severe degenerative disc narrowing at multiple levels. The bone marrow demonstrates a heterogeneous signal which is nonspecific. The spinal cord displays normal signal and morphology and terminates at the L1 level. The paravertebral soft tissues are unremarkable. T10-T11: On sagittal views, there is a small diffuse disc bulge but no significant central canal or neuroforaminal stenosis.T11-T12: A disc bulge is noted with facet hypertrophy and ligamentum flavum thickening. There is mild to moderate bilateral neural foraminal and mild to moderate central canal stenosis.T12-L1: There is a disc bulge with moderate facet hypertrophy and ligamentum flavum thickening which causes moderate bilateral neural foraminal stenosis and at most mild to moderate central canal stenosis.L1-L2: There is a disc bulge and left greater than right facet hypertrophy and ligamentum flavum thickening which causes mild right and moderate to severe left neuroforaminal stenosis and moderate central canal stenosis.L2-L3: There is a disc bulge with severe facet hypertrophy and ligamentum flavum thickening which causes minimal right and moderate to severe left neural foraminal stenosis as well as moderate central canal stenosis.L3-L4: A shallow left foraminal/far lateral disc protrusion is superimposed on the uncovering of the disc. There is also severe facet hypertrophy, right greater than left, and ligamentum flavum thickening which causes severe right and moderate to severe left neural foraminal stenosis. This also causes moderate to severe central canal stenosis with effacement of the right lateral recess.L4-5: A disc bulge is seen at this level with severe facet hypertrophy and ligamentum flavum thickening with moderate to severe bilateral neural foraminal stenosis and mild to moderate central canal stenosis.L5-S1: A disc bulge is noted with a superimposed left to right paracentral shallow disc protrusion with facet and ligamentum flavum hypertrophy. This causes left greater than right neural foraminal stenosis with effacement of the left lateral recess. There is also moderate central canal stenosis.A small rounded T2 hyperintense lesion is noted within the upper pole of the right kidney which is nonspecific but statistically most likely represents a renal cyst. | 1.Diffuse moderate to severe degenerative disease of the lower thoracic and lumbar spine with at most moderate-severe central spinal canal stenosis at L3-4 and multilevel neural foraminal stenosis, and multiple levels of moderate-severe to severe foraminal narrowing as detailed above.2.There is also lumbar levoscoliosis and degenerative grade 1 retrolisthesis of L3 on L4 and L5 on S1. |
Generate impression based on medical findings. | 77 year old female with right-sided weakness; evaluate for CVA There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift or edema. Areas of encephalomalacia are again seen in the right parietal lobe and left temporal pole appearing similar to the prior study. Basal ganglia hypodensities, likely representing lacunar infarcts, with associated ex vacuo dilatation of the lateral ventricles. Extensive confluent hypodensities are seen in the periventricular and subcortical white matter which are nonspecific, but likely represent small vessel ischemic disease of indeterminate age showing mild interval progression from the previous exam. An area of hypoattenuation appears to involve the left frontal white and possibly gray matter which is new from the previous exam and may represent a focus of previous infarction. If high clinical suspicion for acute nonhemorrhagic stroke, MRI may be performed for further evaluation.Prominence of the ventricles, sulci and basal cisterns likely representing age-related volume loss. Extensive atherosclerotic calcifications are seen in the distal internal carotid arteries and vertebro-basilar system.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA. 2. New left frontal focus of hypoattenuation appears to involve the gray and white matter and may represent a previous infarct. MRI may be performed if high clinical suspicion for acute nonhemorrhagic CVA. |
Generate impression based on medical findings. | The exam is markedly degraded by dental brace artifact. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute infarction in the areas that are not degraded by artifact. The paranasal sinuses and mastoid air cells are grossly unremarkable, within the limitations of artifact. | The exam is markedly degraded by dental brace artifact, but there is no gross intracranial mass. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | History of prematurity, global developmental delay, and chronic head banging. Evaluate for structural abnormality. No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. Myelination is within normal limits for age. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. | Normal unenhanced brain MR. |
Generate impression based on medical findings. | 70-year-old female with complaint of confusion, and aphasia. Patient on Coumadin. Rule out intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. Well-defined area of encephalomalacia involves the left occipitoparietal region consistent with previous ischemic event.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. | No acute intracranial abnormalities. Diffuse hypodensity and apparent low distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. |
Generate impression based on medical findings. | Reason: Soft tissue mass that is very painful and enlarging in plantar foot. characterize. There is no abnormal soft tissue mass identified. There is no abnormal enhancement. Bone marrow signal is within normal limits. There are no significant degenerative changes in the forefoot or midfoot. There is no soft tissue fluid collection or bursitis. There is trace fluid at the first MTP joint, likely within normal limits. The extensor and flexor tendons are intact without evidence of tenosynovitis. The intramuscular signal is normal. | Normal examination of the left forefoot. |
Generate impression based on medical findings. | Male 30 years old Reason: left and right knee avn History: left and right knee pain. MENISCI: The menisci are normal in signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is abnormal signal intensity with surrounding edema within the majority of the lateral femoral condyle consistent with AVN, extending to the subchondral bone plate. There is slight depression of the weight-bearing portion of the articular surface with a thin band of underlying signal abnormality consistent with a subchondral fracture. There is mild thinning and increased signal intensity of the overlying cartilage suggestive of mild degeneration but we see no full-thickness fluid-filled defect. AVN also affects the medial femoral condyle posteriorly but there is no evidence of subchondral fracture, articular surface collapse, or overlying cartilage abnormality. There is a small focus of osteonecrosis in the medial tibial condyle which does not contact the articular surface. There is mild increased signal intensity within the articular cartilage of the lateral facet of the patella, suggestive of mild chondromalacia/degeneration.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Osteonecrosis as described above. |
Generate impression based on medical findings. | Acute lymphoblastic leukemia, in relapse [C91.02] / Stiffness of unspecified joint, not elsewhere classified [M25.60], Reason for Study: ^Reason: 20 yo with history of relapsed ALL. Evaluate for intracranial hemorrhage, mass or infarct History: 30 minute episode of right-sided arm and neck stiffness, memory loss, headache. Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Previously seen bilateral (left greater than right) preseptal swelling appear to be improved. However, precise evaluation is challenging due to motion artifacts. There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. | 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Interval improvement of bilateral preseptal thickening since prior scan.3. Normal brain MRA |
Generate impression based on medical findings. | Repeat evaluation of pituitary: multiple myeloma with possible pituitary abnormality on MR. There is a persistent mild heterogeneous enhancement of the pituitary. Otherwise, there no evidence of a discrete pituitary mass or enlargement of the gland. The pituitary infundibulum is intact. The optic apparatus and cavernous sinuses are intact. | Persistent nonspecific mild heterogeneous appearance of the pituitary. |
Generate impression based on medical findings. | History of chronic suppurative otitis media now with dizziness and headaches in the setting of possible chronic Lyme disease. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right temporal lobe developmental venous anomaly. The brain parenchyma otherwise appears 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.Internal Auditory Canals: There is mild high T2 signal in the right mastoid air cells region. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. | 1. Mild scattered foci of T2 hyperintensity in the right mastoid air cells, which may represent a sequela of prior infection. However, assessment of the middle ear is limited on MRI and a temporal bone CT may be useful for further evaluation.2. Right temporal lobe developmental venous anomaly. |
Generate impression based on medical findings. | Spasticity, evaluate for cervical stenosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is osseous fusion involving the C3-C4 vertebral bodies and the C5-C6 vertebral bodies. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise grossly maintained. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No significant compromise to the spinal canal or left neural foramen.C3-4: There is a subligamentous disc extrusion with approximately 6 mm superior migration. There is at least moderate spinal canal stenosis at this level with complete effacement of the ventral and dorsal thecal sac and subtle impression on the cord. There is questionable subtle T2 hyperintensity within the cord at this level.C4-5: Fusion at the intervertebral discs level. There is a small dorsally projecting osteophyte which results in mild spinal canal stenosis at this level. Mild left and minimal right neural foraminal narrowing.C5-6: There is a disc osteophyte complex and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis at this level and deformity of the cord particularly in its right aspect. There is T2 hyperintensity in the cord and volume loss consistent with myomalacia. There is severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and to a lesser degree facet arthropathy.C6-7: Fusion at the intervertebral disc level. No significant spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis. C7-T1: There is a disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis at this level. There is mild to moderate bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. | 1. Postsurgical changes of remote anterior cervical fusion with solid osseous fusion evident at C4-C5 and C6-C7. 2. There is moderate to severe spinal canal stenosis at the C5-C6 level which is not fused. There is cord deformity at this level particularly on the right. There is also T2 hyperintensity and volume loss consistent with myelomalacia.3. There is also at least moderate stenosis at the C3-C4 level related to disc extrusion with superior migration. There is questionable subtle T2 signal abnormality at this level.4. Multilevel neural foraminal stenosis, worst at the C5-C6 level where there is severe right-sided neural foraminal stenosis. Additional levels as above. |
Generate impression based on medical findings. | Male 70 years old Reason: H/o IVC sarcoma, resected 10/8/14 on f/u MRI done 2/19/15, some enhancing tissue along right diaphragmatic crus. Needs to evaluate for change May, 2015. ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobe hemangioma is stable in size measuring 1.1 cm (series 4, image 11). Again seen is a small enhancing focus in segment 8 measuring 7 mm (series 1002, image 67). This is unchanged in size but remains nonspecific. The previously described segment 5 T2 hyperintensity is not well seen on today's study.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: Persistent focus of diffusion restriction along the crus of the right hemidiaphragm measures 0.9 x 0.9 cm (series 8, image 69) and is unchanged compared to prior study. There is persistent mildly enhancing soft tissue surrounding this focus of diffusion restriction, along the crus, which has decreased in size compared to prior study. Low-density focus along the right posterolateral margin of the IVC is nonenhancing and likely represents postsurgical fluid. This is unchanged.Subcentimeter nonspecific retrocrural and retroperitoneal lymph nodes. These are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall. | 1.Postsurgical changes related to IVC sarcoma resection, with mildly enhancing soft tissue along the right diaphragmatic crus with a small central focus of diffusion restriction. This has decreased in size compared to prior study.2.Nonenhancing collection along the right posterolateral margin of the IVC is unchanged and may represent postsurgical edema.3.Nonspecific arterially enhancing focus in segment 8 is unchanged. |
Generate impression based on medical findings. | 46-year-old woman with history of pancreatitis and choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is mild intrahepatic biliary duct dilatation. The gallbladder is distended and there are multiple layering stones. There is no gallbladder wall thickening or pericholecystic fluid. The common bile duct is dilated up to 9 mm and tiny stones are seen in the distal common bile duct (series 501, images 22/23). SPLEEN: The spleen appears normal.PANCREAS: There is mildly increased signal in the pancreatic parenchyma suggesting edema. The pancreatic duct is mildly prominent to the level of the ampulla.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A right upper pole parapelvic cyst is noted. The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted. Of note, a strut of the IVC filter is seen in the aorta.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Tiny gallstones in the distal common bile duct with mild intrahepatic and pancreatic duct dilatation.2.IVC filter strut in the aorta.3.Findings discussed with Dr. Chapman and Kathleen Tepe, PA by phone at 17:16 on 10/27/15. |
Generate impression based on medical findings. | Known left breast IDC post neoadjuvant chemotherapy presents for triple wire needle localization On review of the prior studies, significant reduction in size of the known mass in the left upper-outer quadrant is noted. A clip is identified along the posterior aspect of the mass. A vague band like focal asymmetry is located anterior and posterior to the clip. Recent MRI dated 9/22/2015 demonstrated area of non mass enhancement anterior and posterior to the clip spanning approximately 5.9 x 3.7 x 2.5 cm. Plan is to perform a triple wire needle localization targeting the posteriormost extent of focal asymmetry, the clip in the midportion and the anteriormost extent of the focal asymmetry. The procedure, risks including bleeding, mistargeting and infection, and benefits of triple needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 9 cm Kopans needle was placed posterior most extent of the focal asymmetry, 7 cm Kopans needle was placed at the clip in the midportion, and a 9 cm Kopans needle was placed at the anterior most extent of the focal asymmetry. On orthogonal mammography, adequate positioning of the needles was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the targets. The spring wires were deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Kulkarni performed the procedure and was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the 3 wires, one clip, focal asymmetry to be within the specimen. | Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | Diagnosis: Hereditary hemorrhagic telangiectasia. Other malformations of cerebral vesselsClinical question: 3T scanner, please evaluate for cerebral AVMsSigns and Symptoms: HHT MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm, arteriovenous malformation or cerebrovascular occlusion.The anterior communicating artery is identified and is intact. The posterior right communicating artery is intact. There is fetal origin of the left posterior cerebral artery with a hypoplastic left P1 segment. The vertebral arteries are similar in size. | There is no evidence for intracranial arteriovenous malformation. |
Generate impression based on medical findings. | Reason: evaluate for LESI, s/p lumbar surgery with continued LBP, right knee pain and left LE numbness History: evaluate for LESI, s/p lumbar surgery with continued LBP, right knee pain and left LE numbness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post laminectomy and posterior fusion with instrumentation at the L3-4 level. There is atrophy of the paraspinous musculature in the lower lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level right slightly more than left.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level associated with ligamentum flavum hypertrophy. The fat at the lateral recess these is not effaced. There is fluid present within the facet joints left more than right.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.Status post lumbar surgery at L3-4. 2.There are degenerative changes present in the lower lumbar spine without significant compromise to spinal canal or neural foramina. |
Generate impression based on medical findings. | 88-year-old male with pain with movement of the right shoulder. Suboptimal examination secondary to patient motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at its insertion on the greater tuberosity measuring 16 mm in the dimension. There is approximately 2 cm of retraction. There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is edema type signal abnormality within the supraspinatus muscle belly which may represent subacute denervation injury. No masses are identified in the suprascapular notch. There is mild fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus muscles. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneity and irregularity of the glenoid labrum, particularly along the posterior and inferior margins, consistent with degenerative tearing. There is increased bone marrow signal abnormality within the humeral head, likely degenerative in etiology.BICEPS TENDON: There is fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint ADDITIONAL | 1. Full-thickness rotator cuff tear as described above.2. Edema type signal abnormality within the supraspinatus muscle may represent subacute denervation injury. No masses are identified in the suprascapular notch.3. Other findings as described above. |
Generate impression based on medical findings. | 14-year-old female with pain. Evaluate for stress fracture. The distal tip of the second and third metatarsals are incompletely included in the field of viewTENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normalLIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. There are no findings to suggest stress reaction. No linear signal abnormality is identified to suggest a stress fracture.ADDITIONAL | Normal appearing MRI without findings to suggest stress reaction/fracture. |
Generate impression based on medical findings. | Female, 65 years old, history of small cell lung cancer with brain metastases status post radiation treatment. Most of the innumerable large enhancing lesions seen on the pretreatment examination remain significantly reduced in size or even undetectable with minimal if any enhancement above and beyond intrinsic T1 hyperintensity. Most of these prior lesions are hemosiderin stained. A formerly large extra-axial lesion along the right frontal lobe with a hemorrhagic component has been reduced to a small hemosiderin stained cystic space which has further decreased in size since the prior examination.However, a few enhancing lesions are now evident which were not seen on the prior examination or on the pretreatment exam. For example, there is a 4 mm lesion along the right superior frontal gyrus, a 6 mm lesion along the orbital gyrus of the right inferior frontal lobe, a 4 mm lesion within the left frontal operculum and a 5 mm lesion along the left precuneus. None of these lesions is associated with significant parenchymal edema or mass effect.Further interval progression of periventricular T2 hyperintensity is seen, particularly adjacent to the right frontal horn. The ventricles are stable in size relative to the prior examination but remain slightly larger than that seen on the pretreatment exam. | 1.Numerous formerly large enhancing lesions seen on the pretreatment examination remain under excellent control showing stable or reduced size and minimal if any enhancement, mass effect and edema.2.Since the prior examination, however, at least 4 subcentimeter enhancing lesions have developed which were not evident on the immediate prior or on the pretreatment examinations. These are concerning for progressive metastatic disease. |
Generate impression based on medical findings. | Reason: mass over anterior antecubital fossa-probable lipoma History: soft tissue mass The biceps tendon appears intact. There is minimal intermediate signal intensity within the brachialis tendon at the level of its insertion on the indicating mild tendinosis. There is subchondral signal abnormality within the ulna at the site of the brachialis tendon insertion. The triceps appears intact. There is nonspecific subcutaneous edema along the posterior aspect of the olecranon. There is prominence of the subcutaneous fat along the medial aspect of the distal humerus underlying a skin marker presumably corresponding to the patient's palpable area of concern, however, this is difficult to accurately measure or differentiate from the adjacent subcutaneous fat due to lack of inherent contrast. There is no significant enhancement on postcontrast sequences. No bone marrow signal abnormality is identified. | Prominence of the subcutaneous fat along the medial aspect of the distal humerus indicating lipoma formation. No enhancing mass lesions are identified. |
Generate impression based on medical findings. | 17-year-old male with history of germinoma status post chemotherapy and radiation therapy, off therapy since June 2014. As before, the pineal gland region appears unchanged. There are unchanged right transfrontal surgical tracks. There is no evidence of intracranial hemorrhage or acute infarct. The sella and suprasellar regions are unremarkable. The ventricles are not significantly changed in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits are grossly unremarkable. The paranasal sinuses and mastoid air cells are clear. | Unchanged treated pineal germinoma. |
Generate impression based on medical findings. | 48-year-old female patient with right tibial pain, medial and lateral joint line tenderness. MENISCI: The posterior horn of the medial meniscus is attenuated compared to that seen on the prior study which may represent progression of attritional tearing or interval partial meniscectomy. The attenuated posterior horn appears separate from the root of the posterior horn compatible with a full-thickness radial tear. There is medial extrusion of the body of the medial meniscus that appears more prominent on the current compared to the prior study. The anterior horn appears relatively intact.Best seen on the coronal sequences is an obliquely oriented tear that appears to transect the body of the lateral meniscus. There is blunting of the free edge of the posterior meniscus which may reflect prior meniscectomy.ARTICULAR CARTILAGE AND BONE: Foci of subchondral osteonecrosis in the lateral and medial femoral condyles posteriorly appears similar to the prior study. There is a small cyst in the tibial plateau near the attachment of the posterior cruciate ligament that is new compared to the prior study.There is moderate to severe degeneration of the cartilage along the medial facet of the patella, appearing similar to the prior study. There has been progression of cartilage degeneration along the weightbearing portion of the medial femoral condyle. Cartilage degeneration/osteophyte formation along the lateral femoral condyle anterior to the meniscus appears similar to the prior study.LIGAMENTS: The patient has undergone an ACL reconstruction. The intra-articular portion is markedly thinned compatible with interval tearing. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: There is thickening and increased signal intensity of the distal patellar tendon representing tendinosis with adjacent foci of metallic susceptibility artifact suggesting surgery at this site. There is a thin collection of heterogeneous signal intensity in the subcutaneous fat overlying the distal patellar tendon suggesting a bursitis.ADDITIONAL | 1. Medial and lateral meniscal tears.2. Progression of osteoarthritis as described above.3. Progressive thinning of the anterior cruciate ligament graft indicating interval attritional tearing.4. Distal patellar tendinosis with findings suggestive of chronic overlying bursitis.5. Joint effusion and small Baker's cyst. |
Generate impression based on medical findings. | History of pancreatic cancer status post 12 cycles of chemotherapy. Evaluate for response. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity.Cholelithiasis without acute cholecystitis. Normally distended gallbladder. Punctate segment 3 cystic focus is too small to characterize but is unchanged and likely a cyst (series 3 image 19)No suspicious liver lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Poorly defined pancreatic uncinate process soft tissue measures approximately 1.8 x 1.7 cm (series 12/35). The soft tissue encases the adjacent SMA and moderately narrows the SMV portal vein confluence. The portal vein is patent. There is pancreatic atrophy distally. Adjacent to the pancreatic tail there is an unchanged soft tissue nodule measuring approximately 1 cm (series 12/62).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and too small to characterize hyperintensities.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. | Mild interval decrease in the pancreatic head lesion and nodule near the pancreatic tail. The difference in size likely represents a combination of treatment response and modality technical differences. No new sites of disease. |
Generate impression based on medical findings. | 45-year-old female with metastatic breast cancer and weakness, rule out cord compression Vertebral body heights are intact. Nonenhancing foci of increased signal within the L1 vertebral body likely represents focal fat. No osseous enhancing lesions. Alignment is anatomic. Normal signal within the distal cord, which ends at L1. Mild multilevel facet arthropathy.Multiple enhancing intrathecal nodules are present, the largest at L1-L2 measuring 1.5 x 1.6 cm (1001/27), likely representing metastases. This lesion causes moderate to severe central canal narrowing, compressing the cauda equina and extending into the right lateral recess of L3-L4 along the nerve root. Several additional smaller nodules are also evident along the conus and nerve roots of the cauda equina. In addition, there is diffuse mild thickening and enhancement cauda equina, indicating diffuse leptomeningeal spread of tumor.T12-L1: No central or neuroforaminal stenosis.L1-L2: No central or neuroforaminal stenosis. L2-L3: Large aforementioned metastatic deposit in the right lateral recess causing moderate to severe central canal narrowing. L3-L4: Large enhancing lesion extends inferiorly into the L3-L4 nerve root on the right. No central canal or neural foramina stenosis.L4-L5: Small enhancing lesion in the left lateral recess along L4. No central or neuroforaminal stenosis.L5-S1: No central or neuroforaminal stenosis. | Extensive intrathecal metastatic disease with gross nodules, including a 1.6-cm nodule at L1-L2 causing moderate to severe compression of the canal, as well as a finer leptomeningeal pattern disease. |
Generate impression based on medical findings. | No evidence of epidural hematoma. Alignment is anatomic. Vertebral body heights are normal. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Mild disc dessication at L4/5 and L5/S1 levels with mild disk bulges; no significant spinal canal or neural foraminal stenosis. The visualized intra-abdominal and paraspinal contents are unremarkable. | No epidural hematoma. Minimal disc bulges at L4-5 and L5-S1 without significant spinal canal or neural foraminal stenosis.Findings discussed with Dr. Deshmukr on 3/25/2015 at 4:45PM. |
Generate impression based on medical findings. | Knee pain MENISCI: There is abnormal increased linear signal intensity within the body of the lateral meniscus indicating tearing which extends from the tibial articular surface through the peripheral fibers. There is a small associated parameniscal cyst and lateral extrusion of the body of the meniscus. The tear also propagates into the anterior horn where it appears to contact the femoral articular surface. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the lateral tibial plateau along the intercondylar eminence. There is also superficial degeneration of the articular cartilage of the adjacent lateral femoral condyle. The articular cartilage of the medial compartment is intact. There is mild heterogeneous signal of the articular cartilage of the medial patellar facet which may reflect mild focal degeneration. The articular cartilage of the lateral patellar facet and femoral trochlear is intact. Residual red marrow is noted within the distal femur, proximal tibia, and proximal fibula. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1. Lateral meniscal tear as detailed above. The medial meniscus is intact.2. Cartilage loss of the lateral compartment with additional findings described above. |
Generate impression based on medical findings. | Clinical question: evaluate interval change. Signs and symptoms: Same. Unenhanced head CT:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Previously noted multiple foci of low attenuation of the cortex of bilateral posterior frontal lobes, bilateral basal ganglia are poorly visualized. There is only very subtle mass effect of the left high convexity posterior frontal area of cortical/subcortical edema. This is similar to prior MRI exam from 8 -- 4 -- 11. The ventricular system remain within normal range of size and unchanged since prior exam. | 1.No evidence of an acute new findings on this nonfused portable head CT.2.Bilateral hemispheric foci of high signal intensity noted on prior MRI appear as foci of low-attenuation on CT and without any definitive appreciable interval change. |
Generate impression based on medical findings. | Congenital talipes equinovarus. Evaluate for cord tethering, syrinx or Chiari malformation. Brain:The cerebral white-matter appears decreased in volume, especially centrally. There is asymmetric expansion of the posterior left lateral ventricle, which may reflect more pronounced white-matter volume loss or might be in part relate to normal variation. Anterior subarachnoid space prominence and ventricular prominence also in part likely relate to benign enlargement of subarachnoid spaces of infancy. Myelination is delayed for age. Otherwise, there is no definite parenchymal signal abnormality but there is diffuse thinning of the corpus callosum. There is no Chiari malformation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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.Complete spine: The study is limited by motion artifact. Mild broad-based rightward convex spinal curvature might be positional. Sagittal alignment is preserved. Note, the S1 is partially lumbarized which is a common variation. The vertebral bodies and intervertebral discs are unremarkable there is no significant narrowing of the spinal canal or the neural foramina. The spinal cord is of normal shape and signal, without a syrinx. The conus medullaris is normal in morphology and its tip lies at L2-L3 level which is normal. In prone positioning, there is appropriate ventral displacement of the nerve roots. Focal T2-hypointensity projecting anterior to the tip of the conus medullaris on axial T2-weighted imaging (image #14 of series #2801) with no definite abnormality on sagittal imaging or the other sequences is likely artifactual. There is no fat signal intensity in the distal thecal sac.The vitamin E capsule marker overlies the intergluteal cleft at S1-S2 level with no definite underlying soft tissue abnormality or posterior osseous defect. While the right testicle is in the scrotum, the left one is not, and might be undescended. | 1.Cerebral white-matter volume is decreased along with findings of delayed myelination or hypomyelination, which are nonspecific findings.2.No Chiari malformation.3.Spine imaging shows no abnormality but is limited by motion artifact. There is no MR suggestion of cord tethering. Of note, S1 is partially lumbarized; if surgery is to be contemplated, correlation with imaging of the entire spine is recommended.4.Suggestion of undescended left testicle. Correlation with scrotal ultrasound is recommended. |
Generate impression based on medical findings. | 46 years, Female, Reason: h/o Acinic cell carcinoma of the parotid and chemoradiation Again seen are postoperative findings related to right parotidectomy. Interval postsurgical changes of partial mastoidectomy are seen with mild increase in surrounding enhancement which may reflect granulation tissue. No significant change in the remainder of the ill-defined heterogeneously enhancing mass that involves the right basiocciput, petrous ridge, mastoid portions of the right temporal bone, and condylar and lateral squamous portions of the occipital bone. The central areas of non-enhancement within the mass likely represent necrosis and are not significantly changed. The mass still abuts the right ICA and encases the right internal jugular vein. There is also unchanged abnormal enhancement within the lateral mass of the C1 vertebra. Diffuse heterogeneity of the bone marrow signal in the remainder of the calvarium is similar to prior and nonspecific.There is no evidence of intracranial hemorrhage or acute infarct. There is no appreciable mass effect upon the cerebellum or brainstem. There are a few unchanged nonspecific foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. The remaining salivary glands are unremarkable. | Compared to 4/29/2015 interval postsurgical changes of partial mastoidectomy for debridement related to osteoradionecrosis is seen. There is mild increased surrounding enhancement likely reflecting postsurgical change/granulation tissue. Otherwise there is no significant change in appearance of the heterogeneously enhancing necrotic mass centered at the right lateral skull base and craniocervical junction consistent with treated tumor. |
Generate impression based on medical findings. | Reason: right hip avn History: right hip pain There is increased signal abnormality within the anterior superior labrum likely representing a combination of degeneration and degenerative tearing. There is curvilinear signal abnormality within the right femoral head indicating avascular necrosis. There is flattening of the superior femoral head indicating subchondral collapse/fracture. There is bone marrow signal abnormality within the superior and medial right acetabulum which may be degenerative in etiology, although this could also represent additional foci of avascular necrosis. There is also a small focus of signal abnormality within the superomedial left femoral head also likely representing avascular necrosis. There is no evidence of subchondral collapse affecting the left hip. The alignment is anatomic. No additional bone marrow signal abnormality is identified. There is a small right hip joint effusion likely related to the aforementioned avascular necrosis of the right femoral head. There is fatty atrophy of the imaged musculature of the right hip. Severe degenerative disc disease affects image lower lumbar spine. | Findings indicating bilateral femoral head avascular necrosis, right greater than left. There is deformity of the right femoral head indicating subchondral collapse/fracture. Other findings as described above. |
Generate impression based on medical findings. | 56-year-old female with pain. Evaluate for cuff tear after fall. ROTATOR CUFF: There is mild tendinosis of the supraspinatus tendon. There is also a small 2 to 3 mm focus of relatively increased signal intensity within the supraspinatus tendon at its insertion, likely representing a concealed insertional tear. There is also mild irregularity of the bursal surface of the tendon suggesting fraying. There are small cysts in the humeral head at the insertion of the infraspinatus tendon, but the tendon and muscle itself appear normal. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. No fluid is identified within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is minimal increased signal intensity within the superior labrum which may reflect degeneration, but we see no evidence of a labral tear, given the limitations of a non arthrogram study. There is no glenohumeral joint effusion.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint. ADDITIONAL | Mild supraspinatus tendinosis and bursal surface fraying and probable concealed insertional tear with other findings as described above. |
Generate impression based on medical findings. | 43 years Female (DOB:5/17/1973)Reason: demyelinating lesion? History: weakness, hx ms PROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a T2 signal hyperintense focus present along the right posterior lateral aspect of the spinal cord at the C3-4 vertebral level. This was also present on the 9/21/2015 exam. There is no associated mass effect. This does not enhance following gadolinium administration.There is a T2 hyperintense lesion present along the left posterior lateral aspect of the spinal cord at the C2-3 disc space level. This was also present on the prior exam. There is no mass effect associated with it. This does not enhance following gadolinium administration.There is a punctate size T2 hyperintense focus at the right lateral aspect of the spinal cord at the C4 vertebral body level which is also unchanged. This does not enhance following gadolinium administration. This does not enhance following gadolinium administration.There is a T2 hyperintense ill-defined focus present at the left hemicord at the C6 vertebral body level. There is some vague contrast enhancement associated with this. This was not clearly present on the prior exam.There is a T2 hyperintense enhancing lesion present at the right hemicord at the C7-T1 disc space level . This was not clearly present on the prior exam.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated bilateral uncovertebral osteophytes and mild narrowing of the neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is small.MRI thoracic spine:There is a contrast enhancing lesion present within the posterior midline aspect of the spinal cord at the T6-7 disc space level. This is associated with T2 signal hyperintensity and mild mass effect. Additional lesions are present in the thoracic spinal cord at the T5-6 level along the anterior and right side of the peripheral spinal cord, at the T5 vertebral level along the left posterior lateral hemicord at the right posterior lateral aspect of the spinal cord with some punctate enhancement, at the T3 vertebral level at the right hemicord where there is some contrast enhancement and at the C7-T1 level there is also some contrast enhancementNonenhancing lesions are also present in the lower thoracic spinal cord at T8-9 level, T9-10 level and T10 level which are not associated with the mass effect or contrast enhancement..The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. | 1.Since the prior exam patient has accumulated new lesions in the lower cervical spinal cord which display contrast enhancement suggestive of active plaque formation. 2.There are multiple lesions throughout the thoracic spinal cord which are compatible with demyelinating disorder some of which display contrast enhancement at C7-T1, T3 and T6-7. Additional nonenhancing lesions suggestive of nonacute plaque are present elsewhere in the thoracic spinal cord. |
Generate impression based on medical findings. | Pain, unspecified [R52] / Slow transit constipation [K59.01] / Urgency of urination [R39.15] / Multiple sclerosis [G35], Reason for Study: ^Reason: thoracic cord mass? History: has MS New R T10 pain and UTI and ascending slowly progressing sensory loss of right leg. There is no evidence of abnormal signal intensity on thoracic spinal cord.The extruded T10-T11 disc central to left and inferior direction compresses thecal sac and spinal cord. However, there is no evidence of spinal cord signal changes.Comparing to prior scan, the extent of disc extrusion and the degree of thecal sac compression do not show any significant interval change. At the level of T9-T10, there is focal disc protrusion which abuts thecal sac, unchanged since prior scan.At the level of L23, there is diffuse bulging of disc which abuts thecal sac. No evidence of spinal stenosis is seen, unchanged since prior scan.There is normal thoracic kyphosis. 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. | 1. No evidence of abnormal signal intensity on spinal cord.2. Left paracentral disc extrusion at the level of T10-11 which compresses thecal sac and spinal cord, unchanged since prior scan.3. Degenerative changes of T9-10 and L23, unchanged since prior scan. |
Generate impression based on medical findings. | Chiari , headaches, neck pain, numbness tingling both hands and arms: 3 month follow up. Brain: There are stable postoperative findings related to Chiari decompression and fourth ventricular stenting. The cerebellum displays an unchanged morphology and signal characteristics. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.Spine: There is a posterior disc-osteophyte complex that indents the spinal cord and results in mild bilateral neural foramen stenosis. Otherwise, there is no evidence of spinal cord signal abnormality or syrinx. There is no significant neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unchanged. | 1. Stable postoperative findings related to Chiari decompression and fourth ventricular stenting without evidence of syringohydromyelia or ventriculomegaly.2. A posterior disc-osteophyte complex at C6-7 indents the spinal cord and results in mild bilateral neural foramen stenosis. |
Generate impression based on medical findings. | 11-year-old male with tuberous sclerosis.EXAMINATION: MR Kidneys without and with IV contrast 12/27/2016 ABDOMEN:LUNG BASES: Bibasilar subsegmental atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis. No fat-containing lesions or cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Normal examination. The angiomyolipomas seen on sonogram are punctate and thus unlikely to be seen by MRI. |
Generate impression based on medical findings. | History of recurrent squamous cell carcinoma of the right face involving the parotid gland. There are postoperative findings related to right parotidectomy with flap reconstruction. There is tumor along the right trigeminal nerve in the parapharyngeal space. The tumor measures up to approximately 30 mm in length and 7 mm in width. The tumor extends towards the foramen ovale, but there is no definite intracranial extension. There are denervation changes in the right masticator muscles. There are bilateral lens implants. There is no evidence of significant cervical lymphadenopathy. There is a chronic left basal ganglia infarct. | Postoperative findings related to right parotidectomy with flap reconstruction with evidence of perineural tumor spread along the right trigeminal nerve into foramen ovale and associated right masseter muscle denervation. However, characterization is limited due to the lack of intravenous contrast. |
Generate impression based on medical findings. | 6 years Female (DOB:4/7/2010)Reason: 5yo patient, STEALTH MRI prior to surgery (surgery will be in CCD with peds anesthesia). Please page neurosurgery resident to place fiducials. History: Pre-op STEALTH MRI prior to craniotomy for cavernous malformation resection in CCDPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD 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 cerebral cavernous malformation centered in the posterior pons and exophytic into the fourth ventricle measuring 12 x 13 mm axial dimensions There is an associated developmental venous anomaly in the left cerebellar hemisphere. It is stable compared to the prior exam.The visualized portions of the paranasal sinuses are partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | There is a cerebral cavernous malformation involving the posterior pons ventricle is associated with a developmental venous anomaly. Please note that this exam was performed for the purpose of stereotactic guidance during surgery. |
Generate impression based on medical findings. | 19-year-old male presents with left shoulder pain. ROTATOR CUFF: The rotator cuff is normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. No fluid or gadolinium is present in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: No gadolinium enters the superior labrum; however, there is intermediate signal intensity partially separating the superior labrum from the adjacent glenoid. While this is suspicious for a SLAP tear, it is possible that it could simply represent cartilage undercutting or a sublabral sulcus. There is a small cleft separating the posterior inferior labrum from the adjacent underlying articular cartilage, which may represent a small partial thickness tear, but this is also equivocal. The glenohumeral joint alignment is normal. The articular cartilage is normal.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL | 1. Small cleft partially separating the posterior labrum from the adjacent articular cartilage may represent a small partial thickness tear, but this is equivocal.2. Findings suspicious for a SLAP tear, as described above. |
Generate impression based on medical findings. | Reason: eval for labral tear History: shoulder pain and instability with throwing for over a year ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The teres minor tendon is poorly visualized, but the normal muscular attachment is seen inserting on the greater tuberosity. This may represent a normal variant. The subscapularis muscle and tendon appear intact. There is a small cyst within the underlying humeral head.SUPRASPINATUS OUTLET: The distal end of the clavicle is slightly high riding with respect to the acromion process, but we suspect this is a normal variation. There is no fluid or gadolinium within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of a relatively capacious glenohumeral joint. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. | Somewhat capacious glenohumeral joint, but no labral tear is evident. |
Generate impression based on medical findings. | Intractable headaches and vertigo, new onset. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There appears to be a small amount of fluid within the right mastoid air cells. | 1. No evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. No evidence of inner ear or retrocochlear lesions.3. Apparent nonspecific small amount of fluid within the right mastoid air cells. |
Generate impression based on medical findings. | Male, 29 years old, with intractable epilepsy, fMRI needed for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the junction of the frontal and parietal lobes, functionally defining the pre- and post-central gyri which are otherwise somewhat anatomically ambiguous. Passive visual stimulation produces cortical activation as expected along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant but with significant contributions from the right hemisphere on certain paradigms. For example, prominent Wernicke's area activity is seen on the right with the word generation paradigm. Cortical activation correlating to the putative Broca's area is seen on all paradigms localizing to the inferior left frontal gyrus, primarily the pars triangularis and pars orbitalis. Cortical activation correlating to the putative Wernicke's area is seen best on word generation and verb generation paradigms localizing along the posterior aspect of the superior temporal sulcus. | Sensorimotor cortical activation related to hand, foot and face/tongue motion is seen bilaterally, functionally defining the somewhat anatomically ambiguous pre- and post-central gyri. Visual cortical stimulation induces cortical activation along the calcarine sulci bilaterally.Language is left dominant, though there are significant contributions from the right hemisphere which vary depending on the language task performed. Broca's and Wernicke's areas localize to their expected locations as above. |
Generate impression based on medical findings. | Female 55 years old Reason: History of right forearm AVM, tx with laser therapy, now with pain and decreased strength to area History: Pain and muscle weakness to right forearm Within the subcutaneous tissues along the lateral aspect of the proximal forearm at the level of the radial head/neck is a vascular malformation. A questionable feeding vessel appears to arise from the proximal radial artery immediately distal to the bifurcation of the brachial artery. The venous drainage follows deep perforators which eventually drain into the cephalic vein. There is no adjacent edema. The visualized muscles and bones are unremarkable. No mass lesions are identified. | Vascular malformation in the superficial proximal lateral forearm as described. It is uncertain whether this is arterial or venous in etiology, however there is a possible feeding artery arising proximal radial artery. A diagnostic angiogram can be considered for further evaluation. |
Generate impression based on medical findings. | Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild patchy bilateral cerebral white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the inferior left cerebellar hemisphere and right middle frontal gyrus cortex. There is diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The distal basilar artery flow void appears to be diminutive. The other major cerebral flow voids are grossly intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant. There is a partially imaged nodule in the subcutaneous tissues of the left upper lateral neck. | 1. Mild cerebral white matter small vessel ischemic disease and a punctate inferior left cerebellar chronic and right middle frontal gyrus cortical infarcts, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal lobes can be a manifestation of Alzheimer dementia. |
Generate impression based on medical findings. | There is no abnormal intracerebral enhancement to suggest metastatic disease. There is an enhancement in the right side of the soft palate extended to the right side of oropharynx due to post surgical changes. No significant interval change since prior Neck CT scan performed on Sep 4 2015.There is chronic infarction of the right middle frontal gyrus and the left superior parietal lobe. There are foci of T2/FLAIR hyperintensities in the subcortical and the periventricular white matter, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There is no susceptibility or diffusion abnormalities.There is age related volume loss. The ventricles and the sulci are prominent. There is no midline shift. Basal cisterns are patent.Fluid is seen in the right mastoid air cells. | 1. There is no intracerebral metastatic lesions.2.There is chronic infarction of the right middle frontal gyrus and the left superior parietal lobe. 3. Chronic small vessel ischemic changes. 4. Age-related volume loss. |
Generate impression based on medical findings. | 62-year-old female with history of IPMN. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: A few scattered subcentimeter hepatic cysts are unchanged. No suspicious enhancing hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is been no significant interval change in several small cystic lesions seen throughout the pancreas, most consistent with small intraductal papillary mucinous neoplasms. The largest of these in the pancreatic head measures 1.2 x 1.0 cm (series 3, image 25), previously measuring 1.2 x 1.1 cm. There is no discrete enhancement of these lesions. The pancreatic duct is normal in caliber.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: Stable nonspecific focal enhancement in the L1 vertebral body which may be degenerative in etiology. OTHER: No significant abnormality noted. | 1.Stable pancreatic cystic lesions most consistent with branch type intraductal papillary mucinous neoplasms.2.Stable nonspecific focal enhancement in L1 vertebral body which may be degenerative in etiology. |
Generate impression based on medical findings. | BRAIN: There are multiple foci of susceptibility effect within the midbrain and pons with an associated developmental venous anomaly. There are additional dominant foci of susceptibility effect within the right frontal and left occipital white matter and innumerable punctate foci of susceptibility effect throughout the brain. These are all unchanged compared with the prior exam without surrounding edema to suggest recent hemorrhage. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the sphenoid sinuses.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. There is an unchanged 2 mm outpouching at the proximal A2 segment of the right anterior cerebral artery. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. | 1.Innumerable unchanged cavernous malformations most prominent in the pons where there is an associated developmental venous anomaly. 2.Unchanged 2 mm outpouching at the A2 segment of the right anterior cerebral artery may represent an aneurysm or an infundibulum. |
Generate impression based on medical findings. | Male 83 years old Reason: r/o osteonecrosis History: left lateral foot ulcer; h/o diabetes The patient has undergone resection of the fifth ray through the fifth metatarsal diaphysis. There is a small focus of heterotopic ossification seen in the soft tissues distal to the remaining fifth metatarsal. There is ulceration of the lateral soft tissues just distal to the remaining fifth metatarsal. There is adjacent low T1 signal suggesting scarring. We see no abnormality of the bone marrow to indicate osteomyelitis. There is also scarring of the subcutaneous fat adjacent to the base of the fifth metatarsal.Patient also has amputation of the second toe and distal phalanx of the first toe. Mild deformity of the head of the second metatarsal, but we see no features of osteomyelitis. Mild osteoarthritis affects the first metatarsophalangeal joint. Mild to moderate osteoarthritis affects the midfoot. Small collection of fluid within the flexor hallux longus tendon sheath at the knot of Henry may represent a focal tenosynovitis, but is not necessarily of any clinical significance. | Soft tissue ulcer and other findings as above, but we see no evidence of osteomyelitis. |
Generate impression based on medical findings. | Pain prostate pain. Status post RT to prostate with progressive lower pelvic pain. PELVIS:PROSTATE:Prostate Size: 2.1 x 3.2 x 2.6 cm.Peripheral Zone: Diffusely decreased T2 signal intensity, likely related to post-radiation change. No suspicious lesions are identified.Central Gland: No significant abnormality. noted. Seminal Vesicles: No invasion identified.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific findings to explain the patient's pelvic pain. Post-radiation changes of the prostate with no suspicious focal lesions identified. |
Generate impression based on medical findings. | Female, 69 years old, with remote history of parapharyngeal space cancer (1995), disease free until 04-2015 when a second primary left tonsillar cancer was detected (tentative staging T4N2c), status post induction chemotherapy. Assess for response. Evidence of prior left neck surgery is demonstrated. Soft tissue thickening with ill-defined associated enhancement within the left parapharyngeal space has not significantly changed even when comparison is made to an MRI from 2009.The immediate prior MRI examination dated 4/15/2015 contains limited sequences and as such an accurate comparison can only be made on the basis of fat-suppressed T2-weighted images. Given this limitation, a mild interval decrease in the thickness of the left oropharyngeal mucosa is seen. A reference measurement on today's examination yields 2 mm (image 15 series 9), while the same area on the prior examination measured proximally 5 mm in thickness. Mucosal thickening extending across the midline to the right has also improved to a similar degree.T2 hyperintensity involving the left pterygoid muscles and the left longus coli muscle is unchanged.A left level II lymph node, immediately subjacent to the region of prior mucoasal thickening, measures 6 mm short axis (image 14 series 9), stable dating back to 2009. Subcentimeter level Ia and Ib lymph nodes also show no significant interval change.No concerning mass or pathologic adenopathy is evident elsewhere in the neck. Bone marrow signal characteristics are within normal limits allowing for cervical spondylosis. T2 hyperintensity filling the left mastoid air cells and middle ear cavity is unchanged. | Comparison with the prior MRI examination dated 4/15/2015 is limited to fat suppressed T2-weighted images. Given this limitation, there seems to have been an interval reduction in thickness of the left oro-pharyngeal mucosa.Soft tissue thickening and ill-defined enhancement within the adjacent left parapharyngeal space shows little if any significant change dating back to 2009 and may be related to the patient's remote history of cancer. T2 hyperintensity involving the left pterygoid and longus coli muscles is unchanged compared to the immediate prior examination and nonspecific, possibly related to ongoing therapy.No definite evidence of pathologic adenopathy is detected in the neck. |
Generate impression based on medical findings. | 45-year-old woman with chronic left shoulder pain following an injury in January 2010. She has undergone numerous orthopedic surgeries at outside hospitals. Multiple foci of signal void within the shoulder represent metallic susceptibility artifact related to prior orthopedic surgery. Tubular foci of intermediate to low signal intensity in the humeral head presumably represent suture anchor tracks. ROTATOR CUFF: Evaluation of the rotator cuff is limited due to the lack of fat-suppressed fluid-sensitive sequences. There is moderate to severe fatty atrophy of the supraspinatus muscle. We see no fluid signal intensity traversing the supraspinatus tendon to confirm a full thickness tear. However, there is intermediate signal intensity within the distal 2 cm of the tendon, which could either represent tendinosis or granulation tissue. There is moderate to severe fatty atrophy of the infraspinatus. We see no fluid signal intensity traversing the infraspinatus tendon to confirm a full thickness tear. There is intermediate signal intensity within the distal fibers of the tendon which could represent tendinosis or granulation tissue. The teres minor muscle and tendon appear intact. There is moderate fatty atrophy of the superior portion of the subscapularis muscle with mild thickening and increased signal of the tendon distally suggesting tendinosis but we see no discrete tear. SUPRASPINATUS OUTLET: Mild deformity of the acromion process presumably represents previous surgery. There is mild hypertrophy of the capsular structures of the acromioclavicular joint. We see no frank fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. We see no joint effusion. The inferior joint capsule subjectively appears slightly thickened. Increased signal within the superior labrum suggests degeneration/degenerative tearing. BICEPS TENDON: The extraarticular portion of the tendon of the long head of the biceps appears intact. The intraarticular portion is not well visualized due to lack of fat-suppressed sequences. ADDITIONAL | 1.Limited evaluation of the right shoulder as described above. The patient was contacted on the day of the examination and was asked to return, but was unable to do so. She will reschedule for a repeat study at a later date. 2.Surgical changes as described above.3.Rotator cuff muscle atrophy as described above. Although we see no fluid-filled rotator cuff tear, intermediate signal intensity within the cuff suggests tendinosis and/or granulation tissue. 4.Osteoarthritis and other findings as above. |
Generate impression based on medical findings. | Grade II glioma status post treatment. There are postoperative findings related to right frontal craniotomy. There is unchanged confluent T2 hyperintensity in along the margins of the right frontal lobe resection cavity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. In particular, there is no elevated perfusion or enhancement within the treatment bed. 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. | Stable post-treatment findings in the right frontal lobe region, without evidence of tumor progression. |
Generate impression based on medical findings. | Evaluate etiology of headache, positional component: history of right mastoidectomy, lumbar drain. MRI: There are postoperative findings related to right mastoid obliteration with fat graft. There is fluid within the remaining pneumatized portions of the right temporal bone. 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. There appears to be mild prominence of the bilateral optic nerve sheath cerebrospinal fluid.MRV: There is constriction of the bilateral transverse sinuses. There is otherwise no evidence of | 1. Postoperative findings related to right mastoid obliteration with fat graft. There is fluid within the remaining pneumatized portions of the right temporal bone, which may represent persistent cerebrospinal fluid leakage or effusions. 2. A partially empty sella, mild prominence of the bilateral optic nerve sheath cerebrospinal fluid, and constriction of the bilateral transverse sinuses are suggestive of pseudotumor cerebri. |
Generate impression based on medical findings. | Clinical question: Status post pericardial window POD #1. Now with new facial droop. Evaluate for acute stroke, intracranial hemorrhage. Signs and symptoms: Left facial droop, right pronator drift. CT of brain without infusion:Images through posterior fossa demonstrate minimal prominence of the fourth of the cerebellum and vermis and are otherwise unremarkable.Images through supratentorial space demonstrate an area of low attenuation involving the subcortical white matter of right frontal lobe. This appears to apply mass effect on the adjacent cortical sulci and is highly suspected for an acute stroke. If clinically is desired an MRI can further evaluate this area of stroke. There is no evidence of hemorrhage, ventriculomegaly or midline shift. Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable. | 1.Focal area of edema in subcortical right frontal lobe suspected for an acute/subacute stroke considering patients provided clinical data.2.No evidence of hemorrhage, hydrocephalus or midline shift. |
Generate impression based on medical findings. | 51-year-old female with IVC filter placement and status post attempts unsuccessful retrieval of the IVC filter with placement of an additional IVC filter. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: An IVC filter is placed within the intrahepatic IVC. 15 x 15 mm hypodense lesion in the left lobe of the liver best seen image number 45 of series number 3 is nonspecific in appearance. If clinically indicated, dedicated liver MRI or CT may be helpful for further evaluation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 14 mm in diameter. Its CT appearance is nonspecific on this single phase post contrast CT.KIDNEYS, URETERS: Subcentimeter hypodense lesions in both kidneys which are too small to characterize with atelectasis.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter is tilted. Please refer to the interventional radiology procedure note on 12/10/2009 for better description.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia. Nodular density in the anterior abdominal wall likely secondary to injections.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Two IVC filters are in place. Inferiorly placed IVC filter is tilted. Please refer to the interventional radiology procedure report on 12/10/2009.Indeterminant hypodensities in the liver. If clinically indicated further evaluation with dedicated liver MRI or CT is recommended.Indeterminant left adrenal nodule. |
Generate impression based on medical findings. | 72-year-old female with leg pain. Evaluate for osteomyelitis versus fasciitis of the right leg. Degenerative changes affect the right knee. Vascular calcifications and phleboliths are identified in the overlying soft tissues. Note is made of diffuse soft tissue swelling about the leg. There is apparent periosteal reaction along the lateral aspect of the proximal fibula. No definite osteolysis, sinus tract or foci of deep subcutaneous gas density are identified to suggest acute osteomyelitis. If strong clinical concern for osteomyelitis, further evaluation with MRI could be considered. | Extensive soft tissue swelling and apparent periosteal reaction along the lateral aspect of the proximal fibula which is nonspecific. Chronic osteomyelitis cannot be excluded. If strong clinical concern for osteomyelitis, further evaluation with MRI could be considered. |
Generate impression based on medical findings. | Meningioma resection surveillance. There are postoperative findings related to right parafalcine meningioma resection with unchanged encephalomalacia in the underlying right parietal lobe. However, there is interval increase in size of a nodular enhancement in the surgical bed along the right aspect of the posterior superior sagittal sinus, which measures 16 x 18 mm in axial cross-section, previously 12 x 13 mm. The tumor protrudes in to the subgaleal space through th calvarial defect. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged patchy nonspecific scattered cerebral white matter T2 hyperintensity beyond the region of the surgical bed. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus. | Postoperative findings related to right parafalcine meningioma resection with interval increase in size of residual tumor. |
Generate impression based on medical findings. | History of right nipple discharge. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.A small amount of high T1 signal fluid is seen within ducts in the immediate retroareolar region. There is minimal enhancement within the inverted right nipple that does not meet threshold for kinetic analysis, and no enhancing mass is seen within the nipple. No suspicious enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Ectatic ascending aorta measures up to 4.2 cm on this non-dedicated exam of that region. A few high T2 liver lesions are present, including an approximately 5 cm right hepatic lobe lesion that has previously been characterized on dedicated body MRI as a hemangioma. | 1. Minimal enhancement in the inverted right nipple, not suspicious in appearance. No suspicious enhancing mass or non-mass like enhancement in either breast. 2. Ectatic ascending aorta measures up to 4.2 cm. Correlation with any previous cardiac imaging or, if performed, an outside institution chest CT to evaluate stability is suggested. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | 43 year old female with left breast 12-1 o'clock cancer with focus seen inferiorly on MRI, possible satellite. A targeted left ultrasound was performed for the MRI area of concern. 1 o'clock index lesion is re-identified. There is no definite solid or cystic mass identified in the expected area of the MRI abnormality in the 2-3 o'clock position. | No definite sonographic correlate found for MRI enhancing focus in the left breast. MRI guided biopsy is recommended. Results and recommendation discussed with the patient and Dr. Jaskowiak.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | Clinical question: Patient with radiculopathy persistent despite physical therapy. Evaluate for pathology. Signs and symptoms: Neck and scapular pain. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column.There is mild generalized smaller than expected caliber of spinal canal which is believed to be at least partially secondary to congenitally short pedicles.Foramen magnum is unremarkable.C2-C3 demonstrate a tiny central disc protrusion best appreciated on axial T2 series 902 image 27. Mild central spinal stenosis and no convincing evidence of neural foraminal compromise.C3-C4 demonstrate mild disc desiccation and loss of disc height and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and bilateral neural foraminal compromise.C4-C5 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and facet disease. There is mild central spinal stenosis and left neural foraminal compromise. There is a tiny focus of increased T2 STIR signal intensity projecting lateral to the left articulating facet suspicious for focus of effusion or a tiny synovial cyst.C5-C6 demonstrate mild degenerative disc disease with shadow bilateral (right greater than left) uncovertebral hypertrophic changes is noted. Mild central spinal stenosis, moderate left and mild right neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophic changes. There is a right-sided disc-osteophyte complex at this level with resultant significant right neural foraminal compromise. Mild central spinal stenosis and moderate to severe left neural foraminal compromise is also present.C7-T1 demonstrates significant asymmetric left-sided facet and ligamentum flavum hypertrophic changes without spinal stenosis or neural foraminal compromise.Examination also demonstrates patchy foci of T2 hyperintensity within the cervical cord which is best appreciated on sagittal images and centered primarily at C5 and C6 levels. Findings are believed to represent myelitis secondary to degenerative disease. | 1.Uniform generalized smaller caliber of the spinal canal believed to represent congenitally small canal.2.Multilevel mild degenerative changes in combination with congenitally small canal results in multilevel mild central spinal stenosis.3.There is a left-sided disc/osteophyte at C6-C7 level with resultant significant neural foraminal compromise.4.Multilevel neural foraminal compromise as detailed per level above.5.T2 hyperintensity of the cervical cord at C5 and C6 levels concerning for myositis secondary to degenerative disease. |
Generate impression based on medical findings. | Female, 72 years old, with new right lower extremity weakness. Assess for etiology. A subcentimeter focus of diffusion restriction is seen within the left corona radiata immediately adjacent to the body of the left lateral ventricle. Correlating ADC abnormality has nearly resolved. This lesion is associated with corresponding T2 hyperintensity. Also noted is T2 hyperintensity just below within the posterior limb of the left internal capsule.Numerous patchy areas of T2 hyperintensity are seen within the periventricular white matter bilaterally. No significant parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles and sulci are mildly prominent compatible with underlying parenchymal volume loss. | 1.Small area of ischemia within the left corona radiata, likely late subacute, potentially affecting the left corticospinal tract. No significant associated edema or hemorrhage is detected. Findings were discussed with Dr. Hong at approximately 3:00 PM on 10/26/2015.2.Evidence of moderately extensive chronic small vessel ischemic disease. |
Generate impression based on medical findings. | Reason: to r/o vp shunt malfunctioning History: pineal tumor, progressing, vp shunt in situ Suboccipital midline craniectomy is redemonstrated. Extensive bilateral cerebellar and left occipital cortical calcification is again identified and with no interval change. Finding are secondary to post therapy changes.There is filling of the subarachnoid space in the posterior fossa with high attenuation material which extends into the basal cistern. This is noted in the subarachnoid space at the level of foramen magnum, ambient cistern, prepontine cistern, and cerebellar pontine angles. These findings are believed to represent worsening of previously noted extensive pachymeningitis and possible carcinomatosis. There is suggestion of mass effect on the medulla secondary to above findings. Further follow-up with a dedicated MRI examination will significantly better characterize the above findings.Unchanged course and position of right lateral ventricular catheter. The shunt appears to partially traverse the right lateral ventricle. No change in the normal size of ventricular system since prior study. Diffuse low attenuation of the bilateral hemispheric white matter is stable since prior exam. This finding is believed to represent post therapy changes and surgical intervention for placement of multiple prior ventricular catheter placement.There is no hemorrhage, edema, mass effect or midline shift. The calvarium and soft tissues of the scalp are within normal limits. Air-fluid levels within the maxillary sinuses bilaterally. The mastoid air cells are clear. | 1.High attenuation content within the subarachnoid space in the posterior cranial fossa with extension into the suprasellar cistern. Findings are believed to represent interval worsening of patient's known extensive pachymeningitis and possible carcinomatosis.2.Further evaluation with an infused MRI examination is recommended.3.Stable size of shunted supratentorial ventricular system.4.Stable extensive bihemispheric white matter low-attenuation believed to represent post therapy changes.5.Therapy related calcification within the cerebellum bilaterally and left occipital cortex with minimal interval worsening. |
Generate impression based on medical findings. | Dysarthria. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white matter T2 hyperintensity. There is diffuse cerebral volume loss, which is most pronounced in the medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. Nonspecific mild scattered foci of cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute infarction.2. Diffuse cerebral volume loss, which is most pronounced in the medial temporal lobes, which may represent Alzheimer disease in the appropriate clinical setting. |
Generate impression based on medical findings. | Reason: polycytic astrocytoma , brain tumor, resection, yearly follow up for growth or changes History: yearly follow up brain tumor Redemonstrated is a left parietal lobe resection cavity, which has not substantially changed. Minimal T2/FLAIR hyperintensity surrounding the resection cavity similar to the prior exam. No suspicious enhancement is seen within or around the resection cavity.No acute intracranial hemorrhage is identified. No abnormal diffusion restriction. No new mass or midline shift. No extra-axial fluid collections. Stable ex vacuo dilatation of the atrium and occipital horn of the left lateral ventricle. Gray-white matter differentiation is preserved. Scattered ethmoid air cell and maxillary mild mucosal thickening is noted. The imaged orbits are intact. Postsurgical changes of left parietal craniotomy. | Stable postsurgical change without evidence of residual or recurrent tumor. |
Generate impression based on medical findings. | Prior intrathecal MTX: gait difficulty and cognitive symptoms. There appears to be mild disproportionate enlargement of the lateral and third ventricles, as well as a prominent cerebrospinal fluid flow jet in the third ventricle. There is diffuse patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. | 1. Findings suggestive of normal pressure hydrocephalus.2. Diffuse white matter abnormality may represent sequela of chemotherapy versus chronic small vessel ischemic disease. |
Generate impression based on medical findings. | Chronic pain wakes up from sleep Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is mild motion degradation.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with mild bulge. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.There is also mild facet arthropathy throughout the lumbar spine, relatively worse at the L3-L4 and L4-L5 levels. Paraspinous soft tissues are within normal limits. | Mild multilevel degenerative changes in the lumbar spine as described above. There is no significant disc herniation or spinal canal or neural foraminal stenosis at any level.Mild multilevel facet arthropathy, relatively worse at the L3-L4 and L4-L5 levels, which may be contributing to patient's low back pain. |
Generate impression based on medical findings. | 33 year old male with history of ventriculoperitoneal shunt placement; please evaluate. Enlarged supratentorial ventricular system with a right-sided ventricular catheter with its tip abutting the septum pellucidum. The size of the lateral ventricles remain similar to prior MRI examination from 11 -- 26 -- 2008.The cortical sulci, basal cisterns remain within normal limits. No evidence of hemorrhage, edema, mass-effect or midline shift is detected. | 1.No evidence of acute intracranial findings.2.Stable size of ventricular system since prior MRI from November of 2008.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Clinical question: History of lung cancer, compared to prior exam. Signs and symptoms: None. Nonenhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates interval improvement of postoperative changes of right frontal lobe tumor resection. There is interval decreased size of the small hematoma adjacent to the surgical cavity since prior study. Remaining hematoma on coronal T2 weighted images measures approximately 7.7 x 4-mm in size compared to prior study measurement of approximately 5.8 x 8-mm.there is also interval decreased size of surgical cavity demonstrating hemosiderin deposition along its wall since prior study. The surgical cavity measures approximately 6.7 x 8.7 mm in transaxial dimensions compared to prior study measurements of approximately 10 x 11 mm.Surrounding white matter T2 hyperintensity in the pattern of vasogenic edema all of without associated mass effect demonstrates subtle interval decrease extension.Extensive periventricular and pontine and to a lesser degree subcortical foci of flair hyperintensity suggestive of chronic nonhemorrhagic small vessel ischemic strokes are again noted. There are small foci of flair hyperintensity in the right inferior cerebellum consistent with chronic right cerebellar ischemic strokes without change. Ventricular system remain within normal size and it maintained midline. | 1.Interval improvement of postoperative changes of right frontal surgery and hemorrhage as detailed/measured above.2.No evidence of any new foci of edema or mass effect.3.Findings suggestive of chronic small vessel ischemic strokes grossly similar to prior study.4.Right cerebellar chronic ischemic strokes without change since prior exam. Diffusion-weighted images remain negative. |
Generate impression based on medical findings. | Syncope and collapse [R55], Reason for Study: ^Reason: rule out structural lesion History: syncope No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Normal brain MRI |