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Generate impression based on medical findings. | Female, 82 years old, status post fall with unsteady gait and trouble with speech. Corresponding to the CT finding of hyperattenuation at the left parieto-occipital junction, the parenchyma demonstrates ill-defined T2 hyperintensity suggesting edema and a prominent clustering of susceptibility foci along with one subcentimeter focus of intrinsic T1 hyperintensity. There is some very questionable mild diffusion restriction corresponding to this general location.Elsewhere in the brain, numerous scattered foci of susceptibility are seen within both cerebral hemispheres sparing the cerebellum. Also noted is extensive patchy periventricular T2 hyperintensity. No other areas of significant parenchymal edema are detected. No large extra-axial fluid collections are seen. No definite pathologic enhancement is evident. The ventricles are normal in size and morphology.The bone marrow signal characteristics are within normal limits. Mucous retention cysts are seen in the left maxillary and right sphenoid sinus. A small amount of layering secretions are seen in the right maxillary sinus. | 1.Parenchymal edema is seen at the left parieto-occipital junction with clustered foci of susceptibility likely representing blood product. One of these foci demonstrates intrinsic T1 hyperintensity suggesting subacute blood. There may be very vague associated restricted diffusion, but this is equivocal. Findings could represent petechial hemorrhage in the context of a resolving late subacute infarct or simply hemorrhage and associated edema.2.The large number of scattered foci of susceptibility elsewhere in the brain raises the possibility of amyloid angiopathy. In addition, there is evidence of fairly extensive chronic microvascular ischemic disease. |
Generate impression based on medical findings. | Metastatic small cell lung cancer treated with WBRT on 9/27/16. There are postoperative findings related to right frontal craniotomy, with underlying confluent high T2 signal with encephalomalacia and susceptibility effect in the right frontal lobe, and an unchanged subcentimeter area of enhancement. Otherwise, there are multiple supratentorial and infratentorial lesions, some of which have not significantly changed or are smaller, while some are larger. For example, a left middle frontal gyrus lesion measures up to 9 mm in diameter, previously 5 mm, and displays increased vasogenic edema, a right perirolandic lesion measures 17 mm, previously 12mm, and displays increased vasogenic edema, a left cerebellar lesion measures up to 7 mm, previously 10 mm, and displays less enhancement, a left thalamus lesion measures up to 5 mm, previously 9 mm, and a posterior medulla lesion measures approximately 5 mm in diameter, previously also 5 mm. In addition, there is a new punctate left posterior cingulate gyrus lesion. Many of the lesions contain hemorrhagic components with high T1 signal. There is no evidence of acute territorial 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. | 1. Findings suggestive of mixed response of the multiple intracranial metastases.2. Postoperative findings related to right frontal craniotomy, with an unchanged nonspecific subcentimeter area of enhancement. |
Generate impression based on medical findings. | 17-year-old female with VP shunt, hydrocephalus, myelomeningocele, syrinx, yearly follow up. Brain MRI:The examination again demonstrates stable appearing ectopia of the cerebellar tonsils with associated deformity of the inferior poles of the tonsils. Findings of Chiari II malformation as well as corpus callosal dysgenesis are again seen. There is no evidence of hydrocephalus and shunt catheter terminating in the right lateral ventricle shows no interval change. Expansion of the tip of the left temporal horn is unchanged. No new hemorrhage, infarct, intracranial mass or mass effect.MRI complete spine:Examination redemonstrates stable segmentation anomaly of C2 and C3 level with fusion. There is effacement of ventral and dorsal subarachnoid space at the level of foramen magnum secondary to herniation of cerebellar tonsils and slight posterior projection of the dens. At the mid C2 level, anterior CSF space is reconstituted however there remains loss of the posterior CSF space. An expansile syrinx of cervical cord extends from C4 level inferiorly to T4 level, with a less expanded syrinx portion extending from T4 inferiorly to the T8 level on the left aspect of the cord, not significant changed since prior. Diffuse volume loss involving the cord appears similar to prior.The cord terminates at the approximate L5/S1 level level with a small covered meningomyelocele extending posteriorly through midline dysraphism of L5 and S1 level. Again seen is extensive scoliosis of the upper thoracic spine and levoscoliosis with apex at the thoracolumbar junction as well as exaggerated lumbar lordosis. | 1.Compared to 9/11/2014, there is no significant change in brain MRI findings including Chiari malformation with tonsillar ectopia and dysgenesis of the corpus callosum. Stable caliber of the shunted ventricular system which remains decompressed.2.No significant change in size and extent of expansile syrinx of the cervical cord which extends from C4 level inferiorly to the T4 level as well as a less expanded syrinx portion extending from T4 inferiorly to the T8 level.3.No significant change in volume loss involving the spinal cord which terminates at the L5-S1 level and findings of myelomeningocele. |
Generate impression based on medical findings. | MRI BREAST BILAT CAD WWO, 4/14/2015 6:14 PMREASON FOR STUDY: Screening, genetic/family history There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Susceptibility artifact from biopsy marker clip is identified in the left central breast, from prior benign breast biopsy. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | Female, 11 years old, with papilledema. Evaluate for mass, tumor. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected. | Unremarkable evaluation with no evidence of tumor, mass effect or other specific findings to account for the patient's symptoms. |
Generate impression based on medical findings. | Optic neuritis. Evaluate for cervical spine demyelinating lesions. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild reversal of cervical lordosis which may be in part positional. Bone marrow signal is benign including small focus of T1 hyperintensity involving the posterior aspect of the C5 vertebral body most consistent with a small hemangioma..The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancement.Mild degenerative changes are seen in the cervical spine with small disc osteophyte complexes at the C3-C4, C4-C5, and C5-C6 levels with partial effacement of the ventral thecal sac but overall no significant spinal canal stenosis. Additional details as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Mild narrowing of the left neural foramen related to uncovertebral hypertrophy. Otherwise no significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. | 1. No evidence of demyelinating disease in the cervical spinal cord.2. Mild multilevel degenerative changes as described above. |
Generate impression based on medical findings. | New neuro deficits in patient with history of right basal ganglia and thalamic hyperintense signals, status post brain biopsy, now with new unequal pupils and diplopia (partial Parinaud syndrome). There are postoperative findings related to prior right transfrontal biopsy. There is decreased T2 hyperintensity in the right basal ganglia, cerebral peduncle, and pon. However, there is a new, mildly expansile, infiltrative, T2 hyperintense lesion involving the left posterior limb of the internal capsule and midbrain with patchy enhancement, which resembles the previous lesion in this region. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. | Interval decrease in size of the lesion involving the right basal ganglia, cerebral peduncle, and pons, but new left internal capsule and midbrain lesion with patchy enhancement. The constellation of findings may represent an inflammatory process or perhaps an atypical infectious encephalitis. Although potentially nonspecific, MR spectroscopy may provide additional insights. |
Generate impression based on medical findings. | 62-year-old female with bradycardia, slurred speech, and right facial droop. Please evaluate for intracranial process. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Small osseous deformity at the right lamina papyracea is likely from old trauma and appears similar to prior studies from 2009. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Normal brain CT. |
Generate impression based on medical findings. | 50-year-old female with history of head and neck cancer and chemoradiation with right hepatic lobe lesion found on CT 11/20/2015. Evaluate liver lesion. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter segment 8 T2 hyperintense nonenhancing focus compatible with a cyst. Segment 6 T2 hyperintense focus with internal enhance septations; this lesion measures 1.1 x 1.1 cm (series 3, image 26).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.Segment 6 hepatic lesion as detailed above may represent benign complex cyst versus benign atypical hemangioma.2.Segment 8 subcentimeter hepatic cyst. |
Generate impression based on medical findings. | MRI BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with marked chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.MRA HEAD: There is a 3.1 mm aneurysm projecting off the A2 segment of the right ACA and is directed towards the left. The distal right vertebral artery is hypoplastic and terminates into the right PICA. There is is otherwise dolichoectasia of the vertebrobasilar system. The left PCOM is small is size. The intracranial internal carotid arteries are normal in course and caliber. The middle, anterior and posterior cerebral arteries are otherwise unremarkable. There is no evidence of flow-limiting stenosis. | 1. periventricular white matter changes are present which are nonspecific and are more than expected at this age. Etiology is uncertain.2. 3 mm right A2 aneurysm projecting towards the left. 3. No evidence for intracranial cerebrovascular stenosis. |
Generate impression based on medical findings. | Reason: mycosis fungoides with new onset chest pain History: pleuritic chest pain LUNGS AND PLEURA: Mild streaky basilar opacities compatible with subsegmental atelectasis. The examination was not optimized for evaluation of pulmonary medicine. However at least one subsegmental filling defect is visible in the right lower lobe on the source images and other questionable very small defects are visible in left lower lobe arteries. In the presence of chest pain and unexplained basilar atelectasis this is suspicious for pulmonary embolism. A text page was sent to Dr. Sadiq at the time of interpretation.MEDIASTINUM AND HILA: Multiple small collateral vessels are present.No significant lymphadenopathy.CHEST WALL: Decrease in the size of an enlarged left axillary node which now measures 16 x 14 mm.Obstruction of the left axillary and subclavian veins of uncertain etiology with extensive collateral formation suggesting chronicity.New focal area of sclerosis or contrast pooling in the posterior T2 vertebral body, not visible on the recent CT of 11/3/2010, all of uncertain significance. If clinically indicated this could be further evaluated by MRI.UPPER ABDOMEN: Very limited evaluation with no gross abnormalities. | 1. Subsegmental right lower lobe pulmonary embolus and possibly additional small emboli in the left lower lobe. A repeat examination could be performed with CTA technique for more optimal evaluation if clinically indicated.2. Focal area of sclerosis or contrast pooling in the posterior T2 vertebral body of uncertain significance. |
Generate impression based on medical findings. | 33 year old male with IBS, palpitations, PVCs and recent fatigue and RV dysfunction. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVESV is 70 ml (normal range 47+/-19) and the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9). The LV mass is 96 g (normal range 164+/-36) and the LV mass index is 56 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%. The RVEDV is 144 ml (normal range 142+/-31), RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVESV is 72 ml (normal range 54+/-17), and the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9). No focal RV aneurysm or wall motion abnormality. No evidence of fibro-fatty infiltration. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically imaging indicated, a separate dedicated evaluation should be considered. | 1. Normal left ventricular size with mildly reduced systolic function (LVEF 48%). No evidence of underlying myocardial fibrosis inflammation or infiltration.2. Normal right ventricular size and systolic function (RVEF 50%) without evidence focal aneurysm or wall motion abnormality. No evidence of underlying right ventricular fibrofatty infiltration. No CMR evidence of arrhythmogenic right ventricular dysplasia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 12 years, Female, seizure. Brain parenchyma appears within normal limits. No intracranial mass or mass effect. No appreciable cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. Bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. No evidence of infarct or hemorrhage. Ventricles and sulci are within normal limits. Calvarium and extracranial soft tissues are grossly unremarkable. | Examination appears within normal limits. No findings to suggest seizure focus are appreciated. |
Generate impression based on medical findings. | 48 years Female (DOB:10/9/1967)Reason: assess for stroke History: right sided weakness and numbnessPROVIDER/ATTENDING NAME: DAVID HOWES RAYMOND ROOS MRA brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam periventricular white matter signal hyperintensity on FLAIR and T2 imaging has regressed but not completely resolved.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are serpiginous flow-voids in the right parietal lobe on susceptibility imaging and on FLAIR MRI which are suggestive of a developmental venous anomaly in the right parietal lobe. This appearance has not changed compared to the prior examNormal 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.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is some thickening of the posterior longitudinal ligament present. There is some straightening of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level is desiccation and narrowing of the left neural foramen with encroachment of the left-sided exiting nerve roots..At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There is some encroachment of the right-sided exiting nerve roots within the neural foramen and result material and osteophytes..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. | 1.There is no evidence for acute ischemic cerebral infarction.2.Some ill-defined periventricular white matter lesions are less conspicuous on the current exam compared to the prior. They're nonspecific.3.A subtle lesion in the right parietal lobe is suggested to be a developmental venous anomaly. The appearance has not changed since the prior exam from 2008. Developmental venous anomaly can be confirmed with post contrast imaging if felt to be clinically appropriate.4.There are degenerative changes present in the cervical spine with encroachment of left-sided exiting nerve roots at C2-3 and right-sided exiting nerve roots at C4-5. |
Generate impression based on medical findings. | Female, 53 years old, with sharp shooting pains and paresthesias. Brain:At most, there may be trace nonspecific T2 hyperintense signal along the left frontal horn. No other focal signal abnormality is detected. No edema or mass effect is observed. Diffusion-weighted images are within normal limits. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.C-spine:Alinement is anatomic. Vertebral body heights are preserved. No concerning areas of marrow replacement or marrow edema are seen.The visualized spinal cord shows normal signal characteristics throughout. No focal lesions are seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate right and mild left foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Severe left and moderate right foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate right foraminal narrowing. C6-7: Loss of disc height with mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. | 1.No specific findings are seen in the brain or cervical spine to account for the patient's symptoms.2.Relatively mild multilevel cervical spondylosis is evident but without high-grade spinal canal stenosis. |
Generate impression based on medical findings. | Vascular and nutrition access needed, evaluate vasculature in the neck and chest CHEST: LUNGS AND PLEURA: Large left pleural effusion with collapse of the left lung. Small right pleural effusion.MEDIASTINUM AND HILA: NG tube in the stomach.VASCULATURE: The left internal jugular vein is patent with a focus of ectasia just superior to its confluence with the subclavian vein (series 601, image 17). The right internal jugular vein is not visualized. The SVC appears small in caliber but patent proximally on postcontrast imaging. The distal SVC is not well visualized on postcontrast imaging, but appears patent on the coronal FIESTA sequence. There is a three-vessel aortic arch with a typical configuration of the major branch vessels. CHEST WALL: No significant abnormality noted. | 1. Small caliber SVC with findings suggestive of patency on this limited exam.2. Patent left internal jugular vein. Nonvisualization of the right internal jugular vein.3. Large left pleural effusion with collapse of the left lung. Small right pleural effusion. |
Generate impression based on medical findings. | Reason: rule out RTC tear History: pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No fluid-filled labral tear is evident within the limitations of this non arthrogram study.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect a mild tenosynovitis. There is minimal intermediate signal intensity within the intra-articular portion of the long head of the biceps which may reflect a mild tendinosis, however, the tendon itself appears intact.ADDITIONAL | 1. Findings suggestive of a mild tenosynovitis and tendinosis of the long head of the biceps. No evidence of a full-thickness rotator cuff tear or retraction.2. Mild osteoarthritis of the acromioclavicular joint. |
Generate impression based on medical findings. | Male 23 years old Reason: evaluation of angiomyolipomas on Afinitor History: tuberous sclerosis EXAMINATION: MR renal protocol with and without contrast. ABDOMEN:LIVER, BILIARY TRACT: Gallbladder stones without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Reference exophytic lesion in the left mid kidney (series 501 image 16) currently measures 1.76 x 1.31 cm, previously 17.8 x 1.7 cm with same T2 hypointensity signal compared to 11/06/2015. This lesion does not demonstrate enhancement or fat on in and out of phase images.The lesion in the mid/inferior pole of the left kidney again demonstrates fat on in and out of phase imaging and currently measures 1.46 x 10.2 cm (series 501 image 19) slightly decrease in size when compared with 11/06/2015.Again multiple T1 and T2 hypointense lesions are noted in the kidneys bilaterally, which may represent hemorrhagic cysts, also T2 hyperintense renal cysts are noted bilaterally, measuring up to 2.43 cm in the inferior pole of the right kidney, unchanged.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.Exophytic lesion in the mid left kidney minimally decreased in size compared to prior examination and does not contain fat. Recommend continued follow up of this lesion.2.Angiomyolipoma in the mid/inferior pole of the left kidney also decreased in size.3.Numerous bilateral renal cysts.4.Cholelithiasis. |
Generate impression based on medical findings. | 65 year old male with presumed ischemic cardiomyopathy, hypertension, hyperlipidemia admitted for acute decompensated heart failure. MEDICATIONS: Outpatient medications: Aspirin, Atorvastatin, Carvediolol, Furosemide, and Lisinopril. First Pass PerfusionDuring hyperemia, there is a subtle perfusion defect of the mid lateral wall noted. There is dark rim artifact also noted. Viability/ Myocardial ScarThere is subendocardial late gadolinium enhancement noted of the apical to mid anterior and inferior walls suggesting prior myocardial infarction. This territory has intermediate probability of viability. There is near full-thickness (>75%) to full-thickness late gadolinium enhancement of the anterolateral and inferolateral walls (apex to basal) and basal anterior wall. This territory is unlikely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 144 ml/m2 (normal range: 74+/-15), the LVEDV is 279 ml (normal range 142+/-34), the LV end systolic volume index is 110 ml/m2 (normal range 25+/-9), the LVESV is 212 ml (normal range 47+/-19), the LV mass index is 66 g/m2, and the LV mass is 128 g. There are several wall motion abnormalities present. The apical to mid anterior, anterolateral, and lateral walls are hypokinetic/akinetic. The inferolateral and inferior walls are also akinetic. Additionally there is hypokinesis of the mid anteroseptum. Pre-contrast, native myocardial T1 relaxation time is normal (1010 ms) at the level of the septum. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly-moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 74 ml/m2 (normal range 31+/-9), and the RVESV is 142 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Incompletely assessed mild focal thickening may relate to leaflet calcification.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 at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings 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. During hyperemia, there is a subtle perfusion defect of the mid lateral wall noted. There is dark rim artifact also noted. 2. There is subendocardial late gadolinium enhancement noted of the apical to mid anterior and inferior walls suggesting prior myocardial infarction. This territory has intermediate probability of viability. There is near full-thickness (>75%) to full-thickness late gadolinium enhancement of the anterolateral and inferolateral walls (apex to basal) and basal anterior wall. This territory is unlikely to be viable. 3. The left ventricle is severely dilated with severely reduced systolic function (LVEF 24%). 4. There are several wall motion abnormalities present. The apical to mid anterior, anterolateral, and lateral walls are hypokinetic/akinetic. The inferolateral and inferior walls are also akinetic. Additionally there is hypokinesis of the mid anteroseptum. 5. The right ventricle is mildly dilated with mildly-moderately reduced systolic function (RVEF 38%).6. Mild mitral/tricuspid regurgitation.7. Moderate biatrial enlargement. |
Generate impression based on medical findings. | 58 year-old woman with history of breast cancer. Now with headache Low attenuation area identified in the left parietal area (image 20, series 514) at the level of the corona radiata is identified. An additional low density lesion is identified in the deep white matter in the posterior frontal area in the region of the precentral gyrus is seen. Given patient's history, metastases does remain a possibility and follow-up MRI is recommended.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. | Two areas of low attenuation in the left parietal area and in the deep white matter of the precentral gyrus. Given the patient's clinical history the findings may represent metastatic disease. Follow up MRI with contrast is recommended as clincally indicated. |
Generate impression based on medical findings. | Female 52 years old Reason: evaluate for lymphatic disease History: rectal cancer Pathology states that a proximal rectal lesion from recent colonoscopy is compatible with invasive well-differentiated rectal adenocarcinoma. The lesion on colonoscopy report was described as diffuse flat and multilobulated. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: 3.2 x 1.7 cm ovoid lesion in the left lateral pelvis (801:47) is felt to represent an ovary, however, the right ovary is not well seen. Patients uterus is atrophic/surgically absent.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 7 mm, anterior to the rectosigmoid colon (801:46). Other tiny nodes are also seen. For example a 5 mm node (801:45) right posterior lateral to the rectosigmoid colon.Lymph nodes outside the mesorectal fascia: Subcentimeter left internal iliac node (801:58) is nonspecific.BOWEL, MESENTERY: No discrete identifiable tumor is seen. Majority of the rectosigmoid colons dark serosal signal is preserved. A small 7 mm T2 gray gently lobulated lesion is seen along the left posterior lateral aspect on axial T2 oblique images (1001:37). This may represent a small focus of T3 tumor, but is very small accurately characterize. There is a denuded appearance of the visualized rectosigmoid colon with hypervascularity and enhancement suggestive of a chronic colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.MRI findings suggestive of chronic colitis, likely ulcerative. 2.No definitive identifiable tumor is seen. A 7 mm lesion described above could represent T3 tumor but is very small accurately characterize. Several lymph nodes are seen, with a few described above. These are indeterminate as to whether they're related to ulcerative colitis or tumor. |
Generate impression based on medical findings. | Reason: pain and swelling History: pain Again seen is bipartite patella similar to prior study. Tiny patellofemoral osteophytes. Probable small joint effusion. We otherwise see no specific findings to account for patient's pain. | Bipartite patella. Mild osteoarthritis of the knee. Small joint effusion. |
Generate impression based on medical findings. | Left lower extremity weakness. There is linear restricted diffusion and T2 hyperintensity in the right thalamocapsular junction/posterior limb of the internal capsule, as well as what appear to be punctate foci of restricted diffusion and T2 hyperintensity in the left posterior periventricular white matter and right parietal lobe subcortical white matter. There are also mild No change from CT ANG HEAD AND NECK WWO with report dated 6/29/2015 7:52 AM.scattered areas of T2 hyperintensity in the cerebral and pontine white matter, including what appears to be a punctate chronic infarct in the right aspect of the corpus callosum. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. A 3 mm right paraophthalmic aneurysm is better depicted on the recent CTA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid signal in the right mastoid air cells. | 1. Acute infarction involving the right thalamocapsular junction/posterior limb of the internal capsule and left posterior periventricular white matter, as well as probable punctate acute infarcts involving the right parietal lobe subcortical white matter without evidence of hemorrhagic transformation, superimposed upon a background of chronic probable small vessel ischemic disease and chronic right corpus callosum infarct.2. A 3 mm right paraophthalmic aneurysm is better depicted on the recent CTA.Discussed with Dr. Javed at 10:30 AM on 6/29/15. |
Generate impression based on medical findings. | Reason: RCT? History: pain ROTATOR CUFF: Note is made of a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 13 mm in AP dimension. There is approximately 1 cm of retraction of the proximal tendon fragment. There is mild fatty atrophy of the supraspinatus along the myotendinous junction. There is thickening and intermediate signal intensity of the infraspinatus indicating tendinosis. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. The infraspinous muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa confirming a full-thickness tear. Mild to moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The glenohumeral joint alignment is anatomic. There is heterogeneity of the anterior and inferior glenoid labrum which may reflect degeneration and degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of fluid within the tendon sheath which may reflect fluid extending from the glenohumeral joint.ADDITIONAL | 1. Full-thickness rotator cuff tear with retraction as described above. Rotator cuff tendinosis.2. Osteoarthritis of the shoulder. Other findings as described above. |
Generate impression based on medical findings. | 63-year-old female with history of nasopharyngeal carcinoma and liver lesion, history of chemoradiation ABDOMEN:LIVER, BILIARY TRACT: Interval resection of the left lateral segment of the liver. No suspicious liver lesion is evident. The remainder hepatic vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelves. Subcortical right renal cortical cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Tarlov cyst in the sacrum. T2 hyperintense lesion demonstrating fat saturation in the T12 vertebral body, unchanged, likely represents a hemangioma. OTHER: No significant abnormality noted. | 1.Interval resection of left lateral segment of the liver. No suspicious liver lesion is evident on the current study. |
Generate impression based on medical findings. | Redemonstrated is an intra-axial, predominately cystic lesion in the right frontal lobe measuring approximately 6.5 AP x 5.8 ML x 5.2 CC cm with surrounding confluent T2 signal abnormality. There is substantial mass effect on the right lateral ventricle with partial effacement, and 8mm midline shift to the left. There is mild left lateral ventricular dilatation compatible with entrapment. The lesion is dominated by two large cystic components. Anteromedial to them, there is an elongated ovoid region of near CSF signal intensity through which it appears that small vessels may pass and which may also be a part of the lesion. The walls of the cystic components enhance, as does the solid nodular portion which is located more laterally. The solid portions of the lesion demonstrate mildly increased diffusion signal and subtle susceptibility effect suggesting hemorrhage and/or mineralization. The solid nodular portions of this tumor are inseparable from the right frontal opercular gyri which are thickened and heterogeneous, further supporting that the mass is intra-axial, and possibly originating from the cortex. The internal cystic components show no restricted diffusion. | Stable, large intra-axial cystic and solid mass with enhancing nodular components in the right frontal region with extensive mass effect, and midline shift as described above. |
Generate impression based on medical findings. | Somnolence [R40.0], Reason for Study: ^Reason: evaluation of white matter abnormality History: AMS There are bihemispheric periventricular white matter confluent high signal intensity lesions on FLAIR/T2 weighted images or on the posterior aspect without evidence of restricted diffusion or associated edema. The high signal intensity lesions are extended toward right cerebral peduncle, pons and medullar. Differential diagnosis include HIV encephalopathy and the differential diagnosis include PML.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, 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. | Constellation of above MR findings with clinical history indicate possible diagnosis of HIV encephalopathy and the differential diagnosis include PML. |
Generate impression based on medical findings. | Clinical question: Headaches. Signs and symptoms: Postoperative hemorrhage? Nonenhanced CT of brain:Expected postoperative changes of right-sided suboccipital craniotomy. Residual air within the subarachnoid space in the posterior fossa, soft tissues of the scalp.Four ventricle remains within normal size and in the midline. No hemorrhage within the posterior fossa. Small foci of increased density in the right cerebellopontine angle is believed to be a post operative replaced center thick material for treatment of trigeminal neuralgia (microvascular decompression).Images through supratentorial space demonstrate mild bifurcation of lateral ventricles which appears similar to prior MRI examination from 6 -- 1 -- 2010 | Expected postoperative changes of right suboccipital craniotomy as detailed. |
Generate impression based on medical findings. | Recent brain cyst removal w/ NSG 11/11, now with post op seizure. There are postoperative findings of left frontal craniotomy for resection of previous identified third ventricular cystic lesion. There is gliosis and a small amount of enhancement along the surgical tract in the left frontal lobe with a small amount of residual enhancement involving the anterior body of the corpus callosum. There is an evolving infarct with enhancement involving the genu of the right internal capsule extending inferiorly to the level of the hypothalamus. Blood products with prominent associated susceptibility are again demonstrated within the surgical bed involving the body of the corpus callosum. There are additional blood products within the ventricles, especially along the left side casting the choroid plexus. There is a small area of diffusion restriction within the surgical bed, decreased since prior examination. No acute intracranial hemorrhage is identified. There is no midline shift appreciated. | 1. Expected evolution of postoperative changes related to the lateral ventricular mass resection are again identified.2. Blood products with small area of diffusion restriction is again seen in the surgical bed involving the body of the corpus callosum.3. Evolving infarct with enhancement is again seen involving the genu of the right internal capsule, extending inferiorly to the level of the hypothalamus. |
Generate impression based on medical findings. | History of metastatic medullary thyroid cancer, compare to previous. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates decreased signal on out of phase images compatible with hepatic steatosis. There is redemonstration of numerous, scattered ill-defined enhancing foci throughout the liver compatible with hypervascular metastases. In general, the lesions demonstrate high T2 signal, restricted diffusion, and arterial enhancement. For future comparison, an example reference lesion in the inferior most aspect of the right hepatic lobe (series 7, image 146) measures 1.4 x 1.7 cm. The hepatic vasculature appears patent. There is cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous renal simple cysts are present bilaterally. No hydronephrosis.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. | Ill-defined enhancing lesions throughout the liver suspicious for hypervascular metastases. Reference lesion for future comparison is provided. |
Generate impression based on medical findings. | Dizziness and giddiness [R42], Reason for Study: ^Reason: eval lesion seen on CT History: dizziness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.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. Retention cysts on the left maxillary sinus.Brain MRA3D time in a MRI of the axial diffusion 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.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. | 1. Normal brain MRI.2. Normal brain MRA3. Normal Neck MRA |
Generate impression based on medical findings. | Ms. Diaz is a 35 year old female with a strong family history of breast cancer (mother diagnosed at the age of 32 and three maternal aunts). Personal history of benign right breast biopsy in 2010. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Artifact from the right central breast biopsy clip is again noted.No abnormal axillary 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. | 8-week-old female status post ECMO found to have subdural hemorrhage on MRI. Please evaluate interval change. Again seen are subdural fluid collections overlying the right frontal, temporal, and occipital regions and interhemispheric fissure as seen on recent MRI, grossly unchanged. No high density material is seen to suggest acute hemorrhage. The underlying cerebral and cerebellar hemispheres are unchanged in appearance. The ventricles are midline, with normal morphology and volume.Extensive soft tissue edema is seen about the skull. There is opacification of several ethmoid air cells. No definite skull fracture is evident. | Stable subdural hematomas and extensive soft tissue edema, with no evidence of acute hemorrhage. |
Generate impression based on medical findings. | Female, 54 years old, with history of longitudinally extensive cervical transverse myelitis presenting with new weakness and pain. Cervical:Volume loss of the mid cervical spinal cord is seen along with patchy central cord T2 hyperintensity most conspicuous between C2-3 and C4-5. No pathologic intramedullary or leptomeningeal enhancement is seen. No areas of cord edema are detected on this examination.Straightening of the cervical lordosis is demonstrated. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are within normal limits.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with slight flattening of the right ventral cord. No significant generalized spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation with left paracentral/foraminal focality. Effacement of the ventral thecal sac with flattening of the left ventral cord. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. C5-6: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing.C6-7: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. Thoracic:The spinal cord is free of signal abnormality. No evidence of intramedullary or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable.Facet arthropathy is demonstrated at T5-6. A small left paracentral disc protrusion is seen at T6-7. Facet arthropathy and ligamentum flavum thickening are demonstrated on the right at T10-11. No areas of significant spinal canal or foraminal stenosis are identified. | 1.Evidence of myelomalacia is seen in the mid cervical spinal cord which would correlate with the history of prior transverse myelitis.2.No evidence of cord edema or pathologic cord or leptomeningeal enhancement is seen in either the cervical or thoracic regions to suggest active inflammation.3.Scattered cervical spondylosis is demonstrated. Although no significant generalized spinal canal stenosis is seen, disc osteophytes do contact the spinal cord at several levels as above.4.Minimal spondylosis is seen in the thoracic spine without evidence of cord impingement or significant stenosis of the spinal canal or neural foramina. |
Generate impression based on medical findings. | 4 years, Male, partial seizures, intractable epilepsy, status post resection of left-sided seizure focus area.. Interval postsurgical changes of left temporoparietal craniotomy are seen with blood products/fluid containing resection cavity involving the left parietal lobe, left posterior temporal lobe including the hippocampus, as well as the lingual gyrus of the left occipital lobe. Expected postsurgical changes include restricted diffusion along the surgical cavity margin compatible with cytotoxic edema. There is small extra-axial collection on the left. There is a left-sided drainage catheter. Unchanged nodular focus of T2 hyperintensity involving the right frontal corona radiata. No large infarct, large hemorrhage, or significant mass effect is appreciated. No midline shift or herniation. No hydrocephalus. There is partial opacification of the left mastoid air cells. | Expected postsurgical changes of epilepsy surgery with partial resection of the left temporal, parietal, and occipital lobes. |
Generate impression based on medical findings. | Ms. Mitchuson is a 38 year old female with biopsy-proven malignancy of the left superior breast. Recent diagnostic workup revealed an incompletely characterized focal asymmetry seen 1.0 cm anterior to the biopsy-proven malignancy. She presents today for MR evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Bilateral retropectoral saline implants are identified. LEFT BREAST: In the left superior breast, mid depth, there is an irregular enhancing mass identified measuring 1.6 x 2.0 x 2.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen centrally within this lesion, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement seen in the left breast. Specifically, no abnormal enhancement is seen corresponding to the mammographically detected focal asymmetry seen anterior to the biopsy proven malignancy.RIGHT BREAST: There is no abnormal enhancement seen in the right breast.No abnormal axillary lymph nodes are identified in either axillary region. | (1) Unifocal biopsy-proven malignancy of the left superior breast. Continued surgical management is recommended at this time.(2) No abnormal MR enhancement seen to correspond to the mammographically detected focal asymmetry anterior to the biopsy proven malignancy in the left breast. No additional workup necessary at this time.(3) No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | There are multiple nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter and the centrum semiovale due to chronic small vessel ischemic changes. There is encephalomalacia seen in the right parieto-occipital lobe. There is volume loss with prominence of the ventricles and sulci. There is no midline shift. There is no evidence of hemorrhage or mass effect. There is no diffusion or susceptibility abnormalities. There is no abnormal enhancement. There is dolichoectasia of intracranial arterial system indicating atherosclerotic changes. | 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. 2. Periventricular and subcortical white matter chronic ischemic changes.3. Encephalomalacia in the right parieto-occipital lobe.4. Atherosclerotic changes of intracranial arterial system. |
Generate impression based on medical findings. | Female, 78 years old, with metastatic melanoma, screening examination for brain metastases. A 2 mm focus of enhancement is seen within the left inferior cerebellum. There is no associated T2 signal abnormality or edema.A small developmental venous anomaly is evident within the right postcentral gyrus. No additional pathologic intracranial enhancement is observed.No restricted diffusion is seen. Numerous scattered foci of periventricular and subcortical FLAIR hyperintensity are demonstrated without edema or mass effect.No findings are seen to suggest intracranial hemorrhage or any abnormal extra axial fluid collections. The ventricles are normal in size and morphology.Opacification of the sphenoid sinuses is demonstrated. | 1.A 2 mm focus of enhancement is evident within the left inferior cerebellum. As this is the only pathologic intracranial enhancement detected, the finding is nonspecific but metastatic disease would be in the differential diagnosis. Close interval follow-up should be considered.2.Evidence of chronic microvascular ischemia is seen. |
Generate impression based on medical findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (11/24/15, 6/10/16), ultrasound images of right breast (11/24/2015, 6/10/2016), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (6/21/2016), breast MRI (6/23/2016) performed at outside institution. For comparison, digital mammographic images (11/24/2014), ultrasound images (11/24/2014) are available. DIGITAL MAMMOGRAPHIC IMAGES OF BOTH BREASTS AND ULTRASOUND IMAGES OF RIGHT BREAST (11/24/15):The breast parenchyma is extremely dense (BiRADS Density Category D), unchanged in pattern and distribution. A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump. There is a partially circumscribed mass at the site of the BB marker. This mass is confirmed to be a simple cyst on ultrasound at 10:00 position in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST AND ULTRASOUND IMAGES OF RIGHT BREAST (6/10/2016):The breast parenchyma is extremely dense (BiRADS Density Category D), unchanged in pattern and distribution. A BB marker is placed at 12 o'clock position of right breast, denoting the area of palpable lump. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted at the area of palpable concern or elsewhere in right breast.On ultrasound, there is an ill-defined hypoechoic mass measuring 27 x 13 mm at 10:00 position in the right breast. Increased blood flow is observed in this area. Interval decrease of the simple cyst at 10:00 position in the right breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (6/21/2016):Ultrasound guided biopsy was performed for the abnormal hypoechoic masses at 12:00 position and 9:00 position of the right breast. The masses in the right breast appear more discontiguous than that seen in the prior study. The mass at 12:00 position was sampled by use of 11-gauge vacuum assisted needle, and the mass at 9:00 position was sampled with 14-gauge biopsy needle, with appropriate needle placement. Postprocedural right mammographic images show a marker clips at 12:00 position, and upper outer quadrant in the right breast, respectively. Distance between 2 clips is 32 mm on CC view. Per outside radiology report, pathology result for both sites was malignant.BREAST MRI (6/23/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Diffuse suspicious non-mass enhancement is seen at upper outer and upper inner quadrant in the right breast measuring 65 x 54 x 65 mm (AP x LR x CC). Simple cyst is seen at 10:00 position in the right breast.There are scattered enhancing foci, but no abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region. | 1. Biopsy proven malignancy in the right breast at 2 sites (12:00 and 9:00 position). Breast MRI demonstrated diffuse suspicious non-mass enhancement within upper outer and upper inner quadrant in the right breast, suggesting diffuse disease.2. No MRI evidence of malignancy in the left breast or either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | Loose body on radiograph. History of patellar dislocation medial sided knee pain. MENISCI: Adjacent to the anterior horn of the lateral meniscus there is a parameniscal cyst. The menisci are otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: There is focal thinning of the patellar cartilage at the lateral facet, with a subchondral cyst identified in the lateral patella. There is mild bone marrow edema at the lateral femoral condyle.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1. Loose body within the anteromedial aspect of the joint, with moderate effusion.2. Thinning of the cartilage of the lateral patella with a patellar subchondral cyst and adjacent anterior parameniscal cyst. |
Generate impression based on medical findings. | 77-year-old male status post fall. Question bleed question fracture. Review of prior studies indicates the patient has metastatic melanoma. Numerous brain masses are present. A prominent high attenuation mass in the high convexity of the right frontal lobe (series 6900 image 30) measures 1.1 x 0.9 cm. This lesion was not visualized on the MRI dated 3/2/2009. A high attenuation lesion in the right parietal lobe (series 6900 image 22) is also not clearly visualized on the previous MRI. Two high attenuation lesions in the right cerebellar hemisphere are faintly visible on post contrast images of the the study dated 3/2/2009. The large lesion seen in the left temporal lobe on the previous MRI is not well visualized on today's study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. No CT evidence of traumatic hemorrhage or fracture.2. Numerous high attenuation lesions scattered throughout the cerebral hemispheres and cerebellum -- consistent with hemorrhagic metastases from the patient's known melanoma. |
Generate impression based on medical findings. | Neck pain and bilateral upper extremity numbness and tingling. Evaluate for cervical stenosis. Low back pain and radiculopathy. History of previous lumbar surgery. Evaluate for scar tissue. CERVICAL SPINE:There is reversal of the normal cervical lordosis, which may be in part positional. The vertebral bodies are preserved in height. There is degenerative marrow signal subjacent to the endplates at C5-C6 and C6-C7, where degenerative disc-osteophyte complexes cause mild-to-moderate spinal canal stenosis as described below. Small anterior osteophytes are also present at these levels. Accounting for that and a hemangioma in C3 vertebral body, there is no significant marrow abnormality. The cervical spinal cord is normal in signal and shape. Included posterior fossa structures and upper thoracic spinal cord are unremarkable as well.C2-C3: There is no spinal canal or neural foraminal stenosis.C3-C4: Minimal disc-osteophyte complex barely indents the ventral thecal sac. Uncovertebral and facet arthropathy cause moderate right and mild left neural foraminal stenoses.C4-C5 and C5-C6: Disc-osteophyte complex causes mild central/left paracentral spinal canal stenosis. Facet and uncovertebral arthropathy causes moderate left C5-C6 and mild right C5-C6 and mild left C4-C5 neuroforaminal stenoses.C6-C7: The disc-osteophyte complex on this level causes mild-to-moderate spinal canal stenosis. Facet and uncovertebral arthropathy causes mild neuroforaminal stenoses.C7-T1: There is no spinal canal or neural foraminal stenosis.The internal carotid arteries show medial, retro-/parapharyngeal course, which is a normal variation. A partially empty sella is probably an incidental finding.LUMBAR SPINE:There are 5 lumbar-type, nonrib-bearing vertebrae. The last well-formed disc is at L5-S1.Sagittal alignment is notable for minimal degenerative anterior subluxation of L4 on L5 and L5 relative to S1, associated with desiccation of the respective discs. The vertebral bodies are preserved in height. There is degenerative marrow signal subjacent to the endplates at L5-S1. The spinal canal is narrowed at L5-S1 as described below. The tip of the conus medullaris lies at the lower L1 level. The conus medullaris and the included caudal part of the spinal cord show normal signal and shape.There are changes of previous posterior decompressive surgeries at L4-L5 and L5-S1 levels, where there are changes of bilateral laminotomies at both levels. Contrast-enhancing tissue is present at the surgery site and extending into the posterior and lateral epidural spaces at both levels. At L4-L5, there has been resection of the thickened ligamenta flava with resolved central and paracentral spinal canal stenosis. Minimal disc bulge and uncovering remain unchanged. The contrast-enhancing scar tissue extends into the posteromedial inferior aspect of the neural foramina without displacing or encasing the nerve roots. Neural foraminal stenoses remain mild-to-moderate, worse on the right. At L5-S1, the thecal sac is congenitally small with superimposed minimal anterior subluxation of L5 on S1. Prior laminectomy and partial facetectomies. There is prominent scar tissue abutting the bilateral S1 nerve roots.L1-L2, L2-L3, L3-L4 and L4-L5: There is no significant disc herniation and there is no spinal canal or foraminal stenosis. There is mild facet arthropathy and mild-to-moderate ligamenta flava thickening, which are worse in the lower levels.There are mild degenerative changes at the sacroiliac joints. Tiny sclerotic focus in the right iliac bone may represent a bone island. T1-hypointense, T2-hyperintense, and contrast-enhancing lesions in the kidneys likely represent cysts. | 1.Mid cervical degenerative disease results in mild-to-moderate C6-C7 and mild C4-C5 and C5-C6 spinal canal stenosis. No high-grade cervical spinal canal stenosis. Neural foraminal stenosis is moderate on the right at C3-C4 as well as on the left at C5-C6 and mild at other levels as described above.2.Resolved spinal canal stenosis at L4-L5 following posterior decompression as described above. Thecal sac remains diminutive at the L5-S1 level which is likely combination of congenital narrowing, epidural fat, minimal anterolisthesis, and epidural scar tissue. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Male, 7 years old. Pain, wounds. Evaluate for osteomyelitis. There is a skin defect along the lateral aspect of the right forearm with a tract extending from the skin, through the soft tissues, and to the site of a fracture in the mid-distal radial diaphysis. There is extensive edema and enhancement of the soft tissues and abnormal bone marrow signal in this region, compatible with cellulitis and osteomyelitis. No evidence of discrete fluid collection, sequestrum, or involucrum.Question of nonunion of the fracture line.A metal rod traverses the length of the ulna, markedly limiting evaluation. | Osteomyelitis of the radial diaphysis associated with a tract extending from the skin to a radial fracture. |
Generate impression based on medical findings. | The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate for age. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. | Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI evident manifestations of tuberous sclerosis. |
Generate impression based on medical findings. | History of cholecystitis status post drain placement, now with altered mental status ABDOMEN:LIVER, BILIARY TRACT: Abnormal diffuse T2 hypointense signal throughout the liver, likely reflecting iron deposition. Partially imaged cholecystostomy drain. Thick-walled gallbladder containing foci of signal void consistent with cholelithiasis, small pericholecystic edema. No intrahepatic or extra hepatic biliary duct dilatation visualized.SPLEEN: Abnormal diffuse T2 hypointense signal throughout spleen, likely reflecting iron deposition.PANCREAS: Focally prominent pancreatic duct at level of head measuring up to 4 mm, however tapering suggested distally. No pancreas divisum.ADRENAL GLANDS: Stable mild adrenal thickening.KIDNEYS, URETERS: Kidneys decreased in longitudinal dimension and renal parenchyma essentially replaced by innumerable small homogeneously T2 hyperintense simple cysts as well as additional rounded lesions demonstrating low T2 signal, may reflect cyst containing proteinaceous material or hemorrhage but these are incompletely assessed on this truncated study.RETROPERITONEUM, LYMPH NODES: Aortoiliac ectasia.BOWEL, MESENTERY: No gross abnormality noted.BONES, SOFT TISSUES: Decreased T2 bone marrow signal, likely reflecting sequela of iron deposition/renal osteodystrophy, L4 compression deformity unchanged from earlier CT imaging. Scoliosis seen.OTHER: Cardiomegaly. | 1. Incomplete exam secondary to patient's combative behavior and inability to follow commands. Study is also suboptimal secondary to extensive motion and respiratory artifact. Reassessment with CT imaging may be of use and should be pursued as clinically indicated. 2. Thick-walled gallbladder containing foci of signal void consistent with cholelithiasis, small pericholecystic edema, appearance consistent with patient's reported history of cholecystitis. 3. Sequela of medical renal disease including atrophic kidneys with parenchyma essentially replaced by innumerable cysts, simple as well as complex (latter incompletely assessed on this truncated study), and renal osteodystrophy, unchanged L4 compression deformity. Evidence of iron deposition as above. |
Generate impression based on medical findings. | There are scattered punctate foci of T2 hyperintensity in supratentorial white matter, primarily in subcortical white matter locations, without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions within the posterior fossa. There is a small area of T2 hyperintensity involving the medial-most aspect of the right caudate head with associated focal ex vacuo dilatation of the lateral wall of the right lateral ventricle. Overall lateral ventricular asymmetry is the within acceptable limits of anatomic variation. There are no findings of hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. | 1.There are scattered punctate foci of T2 hyperintensity in supratentorial white matter, primarily in subcortical white matter locations. Lesional morphology, locations, and distributions are not typical for migraine sequela, residua from prior trauma, or demyelination. Thus, this most likely represents mild chronic small vessel ischemic disease.2.There is a small focal area of gliosis and encephalomalacia involving the medial-most aspect of the right caudate head. |
Generate impression based on medical findings. | Reason: 63 yo male with hx of PJS (Peutz Jeghers Syndrome) please evaluate for any abnormalities History: PJS. History of distal pancreatectomy for intraductal papillary mucinous carcinoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS:Postsurgical changes of distal pancreatectomy. A nonenhancing T1 hyperintense lesion in the pancreatic tail is unchanged in size measuring 1.4 x 1.1 cm (4/29), possibly an old hematoma. Small fluid collection along the anterior aspect of the pancreatic body is no longer evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small subcentimeter bilateral renal cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small umbilical hernia containing a loop of bowel without evidence of obstruction. Diverticulosis without evidence of diverticulitis.Evaluation of the small bowel is limited due to poor distention. There are a few soft tissue nodules within the small bowel which may represent polyps. For example, there are soft tissue nodules in the right lower quadrant ileal loops measuring 1.0 x 1.3 cm (15/60) and 15 x 11 cm (15/38). There is also a possible lesion within jejunal loops in the left mid upper abdomen measuring 1.2 x 1.1 cm (15/48).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Resolution of cystic lesion along the anterior pancreatic body.2.No evidence of intra-abdominal neoplasm.3.A few enhancing nodules within ileal and jejunal small bowel loops may represent polyps. |
Generate impression based on medical findings. | Female, 59 years old, with medically intractable epilepsy. Presurgical evaluation. Sensorimotor cortical activation of the hand and face maps as expected along the pre- and post-central gyri. Reliable sensorimotor cortical activation of the foot could not be achieved despite repeat attempts. Passive visual simulation elicits primary visual cortical activation along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation and sentence completion paradigms. Language is left dominant. Broca's area, which is visualized on both paradigms, maps to the pars opercularis of the left inferior frontal gyrus. Wernicke's area, which is visualized on the sentence completion paradigm, maps along the posterior aspect of the left superior temporal sulcus. | The sensorimotor cortex for hand and face is well delineated. Sensorimotor cortex for the foot could not be reliably visualized.The primary visual cortex is identified as expected along the bilateral calcarine sulci.Language is left dominant. Broca's and Wernicke's areas are identified in their customary locations. |
Generate impression based on medical findings. | Female, 56 years old. Reason: Evaluate for R ischial tuberosity bony abnormality vs hamstring origin tendonitis History: R ischial tuberosity pain associated with some R heel numbness. Otherwise healthy. BONE MARROW: The visualized bones have normal signal.SOFT TISSUES: The visualized musculature appears normal. JOINTS: The imaged joints appear normal.ADDITIONAL | Evidence of mild tendinitis at the bilateral hamstrings tendon insertions, right slightly greater than left. No other acute abnormality. The bones and muscles appear normal. |
Generate impression based on medical findings. | Ms. Brown is a 45-year-old female with a strong family history of breast cancer in her mother, sister, and maternal grandmother. She presents today for MR imaging as part of her high risk protocol. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable enhancing mass in the left central breast, present on mammograms dating back to 2012. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Trace right pleural effusion present. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | THORACIC SPINE: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There is evidence of metastatic disease throughout the thoracic spine with relatively large lesions at T10, T11 and T12 as described below:-There is a well-circumscribed lesion along the posterior aspect of the T10 vertebral body on the right extending to the right pedicle which demonstrates decreased signal on T1-weighted images with corresponding increasing signal on T2-weighted images and marked enhancement. -There is diffuse marrow infiltration at T11 which is increased since prior MRI study on 9/10/2014. Within this process there is a well-circumscribed lesion demonstrating marked enhancement along the posterior aspect of the vertebral body on the left and extending to the left pedicle. There is associated minimal loss of vertebral body height with no evidence of intervertebral disc retropulsion or significant spinal canal stenosis, however this appears worse since the prior study. -There is a small well-circumscribed lesion within the T12 vertebral body posteriorly and to the right which demonstrates decreased T1 and T2 signal intensity with suggestion of subtle enhancement. This small lesion appears slightly larger compared to prior study measuring 7.4 mm in craniocaudal dimension, previously 5.5 mm. At T2 and T3 there are nonspecific T1 hypointense lesions abutting the posterior inferior endplate without enhancement and appear unchanged from prior study. At T11-T12 there is mild narrowing of the thecal sac as well as moderate narrowing of the left neural foramen. There is no abnormal signal within the spinal cord.At T12-L1 there is moderate left neural foraminal narrowing related to facet arthropathy and disc bulge. No significant spinal canal stenosis is noted.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis throughout the remaining thoracic spine. The spinal cord is of normal caliber and signal with no abnormal leptomeningeal, epidural, or intramedullary enhancement.LUMBAR SPINE: The lumbar spine is in grossly normal alignment, with mild levocurvature and mild left lateral L4 on L5 subluxation. There is loss of height involving the left aspect of the L5 vertebral body similar to prior and possibly on a benign basis with no large underlying lesion appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the T12-L1 level.There is evidence of metastatic disease throughout the lumbar spine with relatively large lesions at L1 and L2 as described below:-There is a well-circumscribed lesion along the anterior aspect of the L1 vertebral body which demonstrates decreased T1 signal with heterogeneous increased signal on T2 as well as heterogeneous enhancement.-A similar lesion affects the L2 vertebral body.-There is extensive signal abnormality involving the lateral aspect of L5 and S1 vertebral bodies on the left.There are advanced degenerative changes seen as described below which overall appear similar to prior study: At L1-L2 there is effacement of the left lateral recess without central canal stenosis. There is moderate left and mild right neural foraminal narrowing.At L2-L3 there is moderate spinal canal stenosis. There is moderate right and mild left neural foraminal narrowing.At L3-L4 there is severe spinal canal stenosis. There is moderate right and mild left neural foraminal narrowing.At L4-L5 there is moderate spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal narrowing.At L5-S1 there is mild spinal canal stenosis including effacement of the lateral recesses. There is moderate right and severe left neural foraminal narrowing. OTHER:There are multiple lesions in the sacrum including a partially imaged left S3 lesion which was present before.There is a well-circumscribed lesion of the right iliac wing with abnormal T1 and T2 signal and demonstrates marked enhancement. This small lesion appears slightly larger compared to prior study, measuring 17 mm in AP dimension, previously 13 mm. There are innumerable enhancing lesions within the partially imaged lungs compatible with metastatic disease which are better evaluated on recent CT study. There are bilateral renal cysts. | 1. Multilevel metastatic disease throughout the thoracic and lumbar spine with mild progression as described above. T11 vertebral body lesion again seen with more diffuse marrow signal abnormality and minimal pathologic compression deformity appearing worse from prior study. Mild compression deformity involving the left aspect of the L5 vertebral body appears similar to prior and possibly on a degenerative basis. Otherwise no significant pathologic compression deformities in the thoracic or lumbar spine. No evidence of epidural tumor or leptomeningeal disease.2. Advanced degenerative changes in the lumbar spine with severe spinal canal stenosis at L3-4 and moderate at L2-3 and L4-5. There is also moderate to severe neural foraminal narrowing at multiple levels as detailed above.3. Innumerable pulmonary metastatic disease which is better evaluated on recent CT study. |
Generate impression based on medical findings. | 39-year-old female with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. There is focal low attenuation in the left basal ganglia, which may represent a prior lacunar infarction or perivascular space. Further evaluation with MRI may be considered if clinically indicated. There is diffuse parenchymal volume loss.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. | Focal low attenuation in the left basal ganglia may represent prior lacunar infarction or perivascular space. If stroke is clinically suspected, MRI may be considered for further evaluation. |
Generate impression based on medical findings. | History of prostate cancer. 5/21/2013 TRUS biopsy showed 3+3 disease in the left medial base. PELVIS:PROSTATE:Prostate Size: 4.8 x 6.0 x 6.9 cmPeripheral Zone: Demonstrated again are to punctate suspicious foci in the mid posterior peripheral zone. The more superior lesion measures approximately 5 mm (series 801/20). The more inferior lesion measures approximately 4 mm (series 801/17). These are both associated with restricted diffusion and are unchanged when compared to the prior study.Central Gland: Significantly enlarged transition zone consistent with benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Mild nonspecific dilatation of the partially imaged right distal ureter.OTHER: No significant abnormality noted. | Two subcentimeter foci suspicious for prostatic adenocarcinoma in the mid posterior peripheral zone are unchanged. No evidence of extraprostatic extension or pelvic lymphadenopathy. |
Generate impression based on medical findings. | History brain metastasis. Possible diskitis at T7-T8. Back pain. Alignment of the thoracic spine is anatomical. This compression deformity of T8, choroid compression fractures seen on the prior MRI study. No severe retropulsion is seen. The spinal canal and neural foramina remain patent. His face. There is noted at T8. The T9 level. A small sclerotic focus in T2 vertebra is nonspecific, but is compatible with enostosis.In L4 vertebra, there is sclerotic lesion with depression of end plate superiorly. Imaging findings is not significantly changed compared to the prior MRI study. There is no evidence of epidural lesion.There are degenerative changes in the thoracic and lumbar spine, which are better visualized on the prior MRI study.An IVC filter is noted. There is increased interstitial densities in bilateral lungs, greater on the left. | 1. No significant interval change in the compression deformity of T8 and sclerotic lesion of L4. Diskitis at T7-T8 cannot be excluded based on CT findings. Lesion at L4 can represent chronic compression injury but sclerotic metastasis can have similar appearance. Continuing followup and correlation with clinical findings are recommended.2. Please refer to dedicated chest study for additional findings of the lungs. |
Generate impression based on medical findings. | Female, 77 years old, with lung cancer, stage III, not yet on therapy. Initial staging head CT showed an abnormal finding. The lesion identified on prior CT within the right frontal white matter is demonstrated as an area of mild susceptibility artifact and mild ill-defined FLAIR hyperintensity. This lesion shows no detectable enhancement on the early postcontrast images, and on the later postcontrast images shows only a faint rim of enhancement (image 106 series 1201). The high attenuation of this lesion seen on CT may therefore have represented mineralization. The lesion causes no significant edema or mass effect.No evidence of any other definite pathologic intracranial enhancement is seen. A small ill-defined blush of enhancement within the right precuneus is favored to represent a developmental venous anomaly. No parenchymal edema or mass effect is noted. There are several scattered small foci of T2 hyperintensity within the periventricular white matter which are nonspecific but likely reflective of chronic microvascular ischemic disease. No restricted diffusion is seen.There is no evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection. In addition to the susceptibility noted above, a 2 mm focus of susceptibility is also noted adjacent to the right frontal horn suggesting chronic microhemorrhage. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss, but are otherwise unremarkable.No definite marrow signal abnormality is seen. Thinning of the bilateral parietal bones is an age-related anatomic variant. The odontoid process appears somewhat angulated and/or retroflexed. This may be congenital or reflective of remote trauma. The posterior arch of C1 is not clearly visualized in its entirety. | The lesion identified on prior CT within the right frontal lobe is identified on today's examination as an area of either mineralization or hemosiderin staining with minimal rim enhancement and no significant associated edema or mass effect.The etiology for this lesion is not entirely clear. While metastatic disease cannot be entirely excluded, the presentation is rather atypical. Benign etiologies would also be in the differential including sequelae of prior injury or inflammation. Given the uncertainty, a short-term follow-up examination, perhaps in one to two months, can be considered. |
Generate impression based on medical findings. | Clinical question: History of lung cancer, evaluate for eye pain. Signs and symptoms: Left eye pain. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Changes consistent with mild chronic nonhemorrhagic small vessel ischemic strokes primarily in bilateral cerebral hemispheres demonstrate no interval change since prior study.Mildly prominent supratentorial ventricular system and the cortical sulci similar to prior exam. This finding although could be at the upper limits of normal for patient's stated age possibility of mild underlying parenchymal volume loss should also be considered.Post contrast images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable images through the orbits and including 3 mm thin axial fat sat post enhanced series.The signal intensity of the calvarium is within normal and without detectable abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement. | 1.No acute intracranial process and no convincing evidence of new finding since prior MRI from February 2015.2.Stable mild chronic nonhemorrhagic small vessel ischemic strokes.3.Stable mildly prominent cortical sulci and supratentorial ventricular system.4.Negative images through the orbits and including thin axial post enhanced fat sat series.5.Calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells are unremarkable. |
Generate impression based on medical findings. | There is a disc-osteophyte complex and uncovertebral hypertrophy at C5-6 with moderate left and mild right neural foraminal narrowing, but no significant spinal canal stenosis. There is also an eccentric left disc-osteophyte and uncovertebral joint hypertrophy at C6-7 with moderate left neural foraminal stenosis, but no significant right neural foraminal or spinal canal narrowing. There is a trace posterior disc osteophyte complex at C4-5, but no significant spinal canal or neural foraminal stenosis at this level. There is no significant degenerative spondylosis at C2-3, C3-4 or C7-T1. There is straightening of the cervical spine alignment in the sagittal plane. There is a degenerative bone marrow signal alteration at C5 and C6, but no evidence of marrow infiltration processes. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The imaged intracranial structures are unremarkable. | Degenerative spondylosis with moderate left and mild right neural foraminal narrowing, but no significant spinal canal stenosis. There is also an eccentric left disc-osteophyte and uncovertebral joint hypertrophy at C6-7 with moderate left neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | 19 year old female with radial wrist pain. Evaluate for scapholunate tear. LIGAMENTS: The lunotriquetral ligament appears intact. The scapholunate ligament appears intact. No intra-articular gadolinium is identified within the radiocarpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL | The scapholunate and lunotriquetral ligaments appear intact. |
Generate impression based on medical findings. | There is a redemonstration of a right frontal burr hole.There are FLAIR/T2 hyperintensities in the subcortical and the periventricular white matter, and the right centrum semiovale, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There are a few foci of dark susceptibility signal in the left parietal, bilateral basal ganglia, and the temporal lobes, consistent with blood products from old microhemorrhages.There is no evidence of acute hemorrhage, mass effect, or edema. The ventricular system is stable.Findings are seen compatible with prior transsphenoidal pituitary surgery. Irregular enhancing tissue within the sella and perhaps also the right cavernous sinus appears similar to prior exams.An oval nodule is again seen within the right parotid gland without change. The extracranial tissues are otherwise unremarkable.There is hypoplastic right maxillary sinus. | 1. No evidence to suggest recurrent primary CNS lymphoma.2. Stable appearance of the postoperative sella.3. Stable nonspecific right parotid nodule. |
Generate impression based on medical findings. | 64 year old male with prostate cancer PELVIS:PROSTATE:Prostate Size: 3.7 x 4.1 x 4.6 cmPeripheral Zone: There is a focus of T2 hypointensity in the right base peripheral zone measuring 10 x 12 mm with possible corresponding diffusion restriction. There is suggestion of neurovascular bundle involvement as evidenced by slight retraction of the capsule and probable extracapsular extension.Central Gland: Moderate benign prostate hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Probable extracapsular extension in the right peripheral zone base.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Right peripheral gland base lesion with probable neurovascular bundle involvement as described above. |
Generate impression based on medical findings. | Female 74 years old Reason: NSCLC History: headache. There are multiple foci of T2 hyperintensity in the periventricular and subcortical white matter. There is a prominent left inferior basal ganglia perivascular space. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary and sphenoid sinuses. | 1. No evidence of enhancing intracranial metastases.2. Probable chronic small vessel white matter ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis at any level. The spinal cord displays normal signal and morphology with no evidence of cord compression. The paravertebral soft tissues are unremarkable. | Normal MRI of the cervical spine with no evidence of spinal stenosis. |
Generate impression based on medical findings. | Reason: abnormality leading to acute loss of LLE function/sensation History: LLE paralysis, anesthesia. Please note the purposes of numbering, there is transitional anatomy with 6 lumbar vertebral bodies identified as seen on recent CT. Vertebral body heights and disc spaces are intact. Alignment is anatomic. 6 lumbar vertebral bodies are identified with partial sacralization of right L6. There is no significant disc disease with minimal disc bulges at L4-L5 and L5-L6. There is no significant spinal canal or neural foraminal stenosis at any level. There is no abnormal enhancement in the lumbar spine. Paraspinal soft tissues are unremarkable. | No significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. No findings to suggest metastatic disease in the lumbar spine. |
Generate impression based on medical findings. | Neurosarcoidosis with intermittent right arm and leg numbness. There are postoperative findings related to right frontal craniotomy. There is unchanged encephalomalacia and distortion of the right inferior temporal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative findings related to endoscopic sinus surgery and persistent bilateral maxillary sinus retention cysts. | 1. Unchanged postoperative findings with encephalomalacia in the right temporal lobe, but no evidence of recurrent neurosarcoidosis.2. Postoperative findings related to endoscopic sinus surgery and persistent bilateral maxillary sinus retention cysts. |
Generate impression based on medical findings. | Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: AMS (decreased alertness/responsiveness, non-verbal) w/ hx of SDH s/p crani and evacuation w/ new hypernatremia and UTI. CT head w/o acute change. History: Please see above Post left fronto parietal cranioplasty status follow up.There is no evidence of acute ischemic or hemorrhagic lesion.There is high signal intensity of the left frontal and parietal lobes underneath of the cranioplasty site which may indicate parenchymal edema. There is thin layer of extra axial fluid collections with evidence hemosiderin indicating blood products. There is 22.5mm x 36mm sized left parietal subgaleal fluid collection overlying the cranioplasty site.Underlying brain shows bilateral patchy high signal intensity lesions on periventricular white matter indicating non specific small vessel ischemic disease. Multifocal lacunar infarctions including right external capsule and left thalamiThe ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Post left fronto-parietal cranioplasty status with thin extra axial fluid collections without evidence of mass effects against underlying brain parenchyma.2. The left fronto-parietal lobe high signal intensity on T2/FALIR images were again seen which may indicate reactive changes after extra axial fluid evacuation.3. No evidence of acute ischemic or hemorrhagic lesion.4. Subgaleal fluid collections on the cranioplasty site.5. Non specific small vessel ischemic disease and multifocal lacunar infarctions. |
Generate impression based on medical findings. | Newly diagnosed tongue mass, eval extent of lesion. There is a heterogeneously enhancing mass in the right floor of mouth with possible involvement of the overlying right mylohyoid muscle and oral tongue. The tumor extends across the midline measures up to approximately 35 mm. In addition, there is surrounding ill-defined T2 hyperintensity and enhancement that extends towards the tongue base, which also appears diffusely enlarged. However, the overlying mandible appears to be intact. Although not particularly enlarged based on size criteria, right level 1B and 2B lymph nodes appear hyperenhancing. There is a heterogeneous right level 3 lymph node that measures 11 x 13 mm. There is also a prominent left level 1B lymph node that measures 12 x 15 mm in axial cross section. The thyroid and salivary glands appear to be intact. The larynx appears to be unremarkable. The orbits and intracranial structures are grossly unremarkable. There is multilevel degenerative spondylosis of the cervical spine, including a disc-osteophyte complex at C5-6 that mildly impinges upon the spinal cord. | 1. A heterogeneously enhancing mass in the right floor of mouth and oral tongue with extension across the midline measures up to 35 mm likely represents a squamous cell carcinoma. Ill-defined enhancement that extends towards a prominent, likely hyperplastic lingual tonsil may represent peritumoral inflammation rather than tumor infiltration.2. Bilateral cervical lymphadenopathy likely, at least in part, represents metastatic disease. |
Generate impression based on medical findings. | 88-year-old female with cellulitis about the dorsum of the foot extending to the mid shin. There is mild soft tissue infiltration visualized about the dorsum of the forefoot that is continuous with mild soft tissue infiltration within the anterior ankle/distal tibia-fibula. This edema extends circumferentially and involves the posterior aspects of the ankle. No fluid collections to suggest abscess.TENDONS: The tendons of the ankle appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the midfoot, though this findings is essentially normal for age. ADDITIONAL | Findings compatible with cellulitis of the ankle and dorsum of the forefoot, however no evidence suggest osteomyelitis. |
Generate impression based on medical findings. | 16 year old male with pain. Evaluate for osteochondral lesion. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of a 2.1 x 2.3 cm osteochondral defect along the weightbearing surface of the lateral aspect of the medial femoral condyle. There is increased signal abnormality along the superior margins of the defect consistent with an unstable lesion. No definite bony bridging is identified. LIGAMENTS: The cruciate collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | Findings consistent with an unstable osteochondral defect along the lateral aspect of the medial femoral condyle as described above. Large joint effusion. |
Generate impression based on medical findings. | 20-year-old male with pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the lateral tibial plateau and lateral femoral condyle. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: Multiple lobulated foci of fluid signal abnormality along the posterior aspect of the proximal fibers of the ACL may represent ganglion formation versus mucoid degeneration. There is partial thickness tearing of the MCL.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Near full thickness tearing of the MCL with associated bone contusions affecting the lateral tibial plateau and lateral femoral condyle.2. Multiple lobulated foci of fluid signal abnormality along the posterior aspect of the proximal fibers of the ACL may represent ganglion formation. 3. Small joint effusion. |
Generate impression based on medical findings. | Bilateral shoulder pain. Right hip pain. Right shoulder:Moderate to severe osteoarthritis with bulky osteophytes, sclerosis, and subchondral cysts.Left shoulder:Osteoarthritic changes appear mildly progressed with new chondrocalcinosis.Right hip:Moderate to pronounced osteoarthritic changes. The femoral head shape is preserved. | 1. Moderate to severe bilateral shoulder osteoarthritis.2. Moderate to pronounced osteoarthritic changes of the right hip. |
Generate impression based on medical findings. | 63-year-old female with left knee pain, evaluate for re-tear of meniscus MENISCI: The posterior horn of the medial meniscus contains mixed signal and is blunted compatible with tearing. The body of the medial meniscus is near completely extruded medially. There is linear signal extending towards the articular edge of the medial meniscus at the body compatible with tearing. There is blunting of the posterior horn of the lateral meniscus compatible with a tear. Mild intrasubstance signal within the lateral meniscus compatible with intrasubstance degeneration. ARTICULAR CARTILAGE AND BONE: The articular surfaces of the medial tibiofemoral compartment are near completely devoid of articular cartilage. Abnormal marrow signal within the medial femoral condyle and tibial spine. There is severe thinning of the articular cartilage of the lateral tibiofemoral compartment.There are focal near full-thickness articular cartilage defects at the medial and lateral facets of the patella. Focal cartilage defect also seen within the intratrochanteric cartilage of the femur.LIGAMENTS: The cruciate and collateral ligaments are within normal limits.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.Complex tearing of the posterior horn of the medial meniscus with near complete extrusion of the body of the medial meniscus. Peripheral tear within the body of the medial meniscus. 2.Blunting of the posterior horn of the lateral meniscus may represent a radial tear. 3.Severe osteoarthritis affects the knee, worst at the medial tibiofemoral compartment. 4.Articular cartilage defects, particularly at the patella as described above. |
Generate impression based on medical findings. | Male 70 years old with recurrent cirrhosis status post OLT 4/05 for HCC and HCV cirrhosis. Evaluate for lesions, assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: The transplanted liver has a nodular contour and heterogeneous signal intensity consistent with chronic liver disease as seen on the previous exam. Perfusion artifact is noted at the periphery of the liver. A serpentine focus of enhancement in hepatic segment 7 is consistent with a portal venous to hepatic venous shunt (series 19/45). No suspicious arterial enhancing liver lesions are identified. The hepatic vasculature is patent.There is mild narrowing of the common bile duct at the expected location of the anastomosis but no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys contain multiple cysts. There is no hydronephrosis within the partially visualized right iliac fossa transplant kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the imaged spine.OTHER: No significant abnormality noted. | 1.Allograft liver with findings of chronic liver disease. No suspicious liver lesion.2.Patent hepatic vasculature.3.Mild narrowing at the common duct anastomosis without significant intra or extrahepatic biliary ductal dilatation. |
Generate impression based on medical findings. | 40 year old female with clicking on range of motion. Evaluate for loose bodies. LIGAMENTS: There is linear intermediate signal intensity partially separating the distal fibers of the ulnar collateral ligament from the sublime tubercle of the coronoid process which may represent a partial undersurface tear of uncertain current clinical significance. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is thickening and heterogeneity of signal of the common flexor tendon at its origin compatible with chronic tendinosis, but we see no fluid signal intensity within the tendon to indicate a tear. There are small foci of signal void adjacent to the tendon as well as bandlike scarring in the overlying subcutaneous fat, suggesting prior surgery to this area. The common extensor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: There is edema type signal abnormality within the distal humerus concentrated in the capitellum. There is curvilinear subchondral fluid signal intensity within the anterior margin of the capitellum indicating a subchondral fracture. The articular surface fracture fragment is in near-anatomic alignment at this time. There is low signal intensity of the bone underneath the subchondral fracture which likely represents sclerosis. These findings are compatible with osteonecrosis.ADDITIONAL | 1. Avascular necrosis of the capitellum of the distal humerus with large subchondral fracture. The articular surface fragment is in near-anatomic alignment at this time.2. Moderate-sized elbow joint effusion. Although we see no definite loose body within the joint, we cannot completely exclude the possibility of a cartilaginous loose body adherent to the capsule as described above.3. Postoperative changes of prior ulnar nerve transposition.4. Tendinosis of the common flexor tendon.5. Partial undersurface tear of the ulnar collateral ligament as described above, of questionable clinical significance. |
Generate impression based on medical findings. | Medial knee pain MENISCI: The menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: Mild bone marrow edema type signal is seen in the posterior aspect of the lateral tibial plateau, likely representing a contusion.LIGAMENTS: There is mild increased T2 signal about the MCL without ligament thickening, suggestive of a mild sprain. No MCL tear is seen. The LCL complex appears normal. The cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Lateral tibial plateau bone contusion with findings suggestive of a mild MCL sprain. |
Generate impression based on medical findings. | Ms. Kendall submitted outside studies for review.Submitted for review are:-Screening mammogram dated 8/27/2016 performed at Palos Diagnostic and Women's Health Center-Left breast diagnostic mammogram dated 9/12/2016 performed at Palos Diagnostic and Women's Health Center-Post procedure left breast mammograms and specimen radiograph dated 9/15/2016 performed at Palos Diagnostic and Women's Health Center-Bilateral breast MRI dated 9/26/2016 performed at Palos Diagnostic and Women's Health Center-Right breast ultrasound dated 9/28/2016 performed at Palos Diagnostic and Women's Health CenterFor comparison, diagnostic right breast mammogram and images from ultrasound-guided right breast cyst aspiration dated 9/8/2015 are available. SCREENING MAMMOGRAM:Bilateral CC and MLO views, CC view of the left breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses.There are suspicious pleomorphic calcifications in the central lower left breast at anterior to mid depth. No dominant mass, suspicious microcalcifications, or architectural distortion in the right breast. Benign appearing lymph nodes are projected over both axillae.LEFT BREAST DIAGNOSTIC MAMMOGRAMAn ML and two spot magnification views of the left breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses. Again seen are suspicious pleomorphic calcifications in the central lower left breast at anterior to mid depth, spanning approximately 2.1 x 1.6 cm (AP x TV). No new mass or architectural distortion in the left breast.LEFT BREAST POSTPROCEDURE MAMMOGRAM AND SPECIMEN RADIOGRAPH:Postprocedure CC and MLO views of the left breast and specimen radiograph are submitted.Radiograph of the specimen cores demonstrates calcifications. Postprocedure mammograms demonstrate a lock-shaped clip in the central lower left breast at mid depth. There are residual calcifications extending 2.4 cm anterior to the biopsy marking clip.BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement bilaterally.There are postbiopsy changes in the central lower left breast at mid depth. There is focal nonmass enhancement along the anterior aspect of the biopsy cavity, measuring approximately 2.5 x 1.4 x 0.8 cm, likely corresponding to residual calcifications seen on mammogram. There are additional scattered enhancing foci in the left breast, compatible with background parenchymal enhancement.There is an indeterminate 8 x 5 x 10 mm enhancing mass in the retroareolar right breast. No additional enhancing foci or masses in the right breast.No axillary or internal mammary lymphadenopathy.RIGHT BREAST ULTRASOUND:Images from MR guided right breast ultrasound are submitted.Targeted right breast ultrasound images at the 12:00 position and retroareolar region demonstrate no sonographic correlate for the previously described MR finding in the right breast.OUTSIDE PATHOLOGY (per report):1. Left breast needle biopsy with calcifications:-Ductal carcinoma in situ, solid type with necrosis (comedocarcinoma) high nuclear grade.Estrogen receptor: Positive moderate nuclear staining 66%Progesterone receptor: Negative2. Left breast needle biopsy without calcifications: Negative for tumor. | 1. Biopsy proven left breast DCIS. There is nonmass enhancement anterior to the biopsy site on MRI, corresponding to residual calcifications seen on mammogram. If breast conservation is desired, bracketed wire localization of the clip and residual calcifications can be performed. Continued surgical management is recommended.2. Indeterminate 10 mm enhancing mass in the retroareolar right breast. Repeat MR-directed right breast ultrasound is recommended. If no ultrasound correlate is identified, follow-up bilateral breast MRI in 6 months is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | Headaches and hypertension. MRI: 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant intracranial steno-occlusive lesions or cerebral aneurysms. | 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant intracranial steno-occlusive lesions. |
Generate impression based on medical findings. | Reason: h/o oral cancer now with recurrence, FNA right masticator space, Dr Christoforidis to perform History: facial nerve paralysis Serial CT images obtained during the aspiration and biopsy procedure for the infratemporal fossa mass demonstrate the needle placement within the infratemporal fossa lesion. Following needle removal images obtained demonstrate no complications.Whereas the foramen ovale on the prior exam measured 10x14mm it now measures 28x17 mm axial dimension suggesting significant interval enlargement of the right infratemporal fossa mass extending to the right middle cranial fossa.Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the chin lesion. | 1.Significant interval enlargement of the right infratemporal fossa mass extending to the right middle cranial fossa.2.Infratemporal fossa lesion aspiration under CT guidance.3.Infratemporal fossa lesion biopsy under CT guidance.4.Chin lesion aspiration under CT guidance. |
Generate impression based on medical findings. | Pain in knee popping. Check for ligamentous injury MENISCI: The lateral meniscus is intact and unremarkable. The medial meniscus however demonstrates pronounced globular signal and loss with mild extrusion of the body of the meniscus extending into the posterior horn. Relative preservation of the anterior horn/aspect. Although there is no definite distinct linear component, a somewhat more oblique tear through the body extending to the inferior articular surface is suggested. Both menisci remain well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Moderate osteophytic changes with small subchondral cysts and osteophytes involving both medial and lateral compartments, with underlying mild edema. Minimal thinning of the lateral compartment, however near complete cartilaginous loss in the medial compartment, specifically overlying the condylar surface with underlying changes. Or mild to moderate changes are also observed in the patellofemoral compartment with a small fissural shallow cleft observed in the lateral facet (image 22 series 1301).LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Medial meniscal tear and destruction with underlying moderate to marked osteoarthritic changes, as described. |
Generate impression based on medical findings. | 31-year-old female. Right dorsal hand cellulitis failed PO antibiotics, evaluate for abscess. Again seen is edema within the dorsal soft tissues of the wrist and hand which enhances and extends into the fingers, compatible with cellulitis. There is also a nonenhancing collection of fluid signal intensity within the soft tissues dorsal to the third, fourth, and fifth metacarpals with perhaps a thin rim of enhancement. The collection surrounds the third and fourth extensor tendons although there does not appear to be fluid within the tendon sheaths themselves. Part of the collection lies deep to the third and fourth extensor tendons suggesting involvement of the subaponeurotic space. The fluid extends into the bases of the third, fourth, and fifth fingers dorsal to the extensor tendons. The overall size of this collection is approximately 1 cm in AP dimension, 5 cm in radioulnar dimension, and approximately 5 cm in longitudinal dimension. Edema and enhancing tissue extends into the palmar soft tissues along the head and neck of the fourth metacarpal. There may be mild synovitis of the fourth MCP joint. We see no fluid in the flexor tendon apparatus. We see no fluid collections or significant edema within the musculature of the hand. A small focus of signal abnormality in the third metacarpal head may represent a cyst, unchanged from prior study. | Cellulitis with findings suggestive of a dorsal soft tissue abscess, as described above. |
Generate impression based on medical findings. | 26 years Male (DOB:1/21/1990)Reason: Pain History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a right paramedian disc protrusion present at this level which mildly encroaches on the nerve roots of the right lateral recess, however, there is some spinal fluid surrounding the nerve roots at the right lateral recess. There is a punctate T2 signal hyperintensity present along the annulus at the disc protrusion at this level. There is mild loss of disc space height and disc desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a small left paramedian broad-based disc protrusion present at this level. There is some encroachment of the nerve roots of the left lateral recess at this level, however, there is some spinal fluid surrounding the nerve roots at the left lateral recess. There is mild loss of disc space height and disc desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There is a left paramedian disc protrusion present at L4-5 and a right paramedian disc protrusion at L5-S1 with only mild encroachment of the nerve roots at the associated lateral recesses. |
Generate impression based on medical findings. | History of supraglottic laryngeal cancer. Status post chemo/RT ending on 2 -- 8 -- 08. CT of the soft tissues of the neck with infusion:Images through the skull base and including cavernous sinuses remain normal. Paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrate extensive post therapy changes. Soft tissue thickening (right greater than left) is again identified with no interval change since prior exam as well as a study from 2 -- 3 -- 2009.Significant soft tissue thickening at the level of left cuneiforms sinus with mass effect is again identified. This finding is similar in appearance to the immediate prior study from 7 -- 5 -- 2009 as well as to -- 3 -- 2009. No distinct measurable tumor is identified however possibility of residual tumor within these regions cannot be entirely ruled out. Stable appearance of this findings on two prior consecutive studies is not suggestive of recurrence of tumor. Two entirely exclude recurrence of disease in this case an MRI is recommended.There is no evidence of any pathologic adenopathy in the neck. Limited images through the apices of the lungs and mediastinum are negative. No evidence of osseous metastatic lesions.CT of brain with infusionNo evidence of metastatic disease to the brain or the leptomeninges. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium is intact. 80 cc of Omnipaque 350 was utilized for the above studies. | 1.Negative CT of brain and calvarium for metastatic disease. Normal CT of brain.2.Extensive post therapy changes. Soft tissue thickening in the supraglottic/glottic regions remains stable since prior two studies. Further follow-up with an MRI is recommended to entirely exclude possibly two of residual tumor.3.No evidence of pathologic adenopathy in the neck. |
Generate impression based on medical findings. | Evaluate shunt/hydrocephalus. History of VA shunt, hydrocephalus, slit ventricular syndrome. Developmental delay, seizure. Nonenhanced head CT:There is no areas of parenchymal hemorrhage, edema or mass effect.There redemonstration of agenesis of corpus callosum and interdigitation of interhemispheric fissure.There is mild dilatation of the supratentorial ventricular system which appears identical to the study from 11 -- 23 -- 2008. There is no evidence of slit like ventricular system.A right-sided ventricular catheter enters from a right posterior parietal, traverses the brain parenchyma and with the tip in the midline at the expected level of the third ventricle.No evidence of hemorrhage or edema in the brain parenchyma. Subtle low-attenuation of periventricular white matter is again identified and may represent periventricular leukomalacia. This findings are noted on prior head CT and MRI studies. There is no evidence of midline shift. Images through posterior fossa are unremarkable. | 1.Mildly dilated and shunted supratentorial ventricular system. This findings are identical to prior examination from 2008.2.Agenesis of corpus callosum.3.No evidence of acute intracranial finding. |
Generate impression based on medical findings. | 64-year-old male with elevated alkaline phosphatase, mild transaminase elevation ABDOMEN:LIVER, BILIARY TRACT: Normal liver contour. Peripherally calcified lesion measuring 2.1 x 1.7 cm in the dome of the right lobe of the liver, segment eight is unchanged from exam dated 4/26/2014. Mild intrahepatic biliary ductal dilatation. Common bile duct measures 6 mm. Distended gallbladder and cholelithiasis without evidence of cholecystitis. There are two small apparent filling defects in the distal common bile duct (series 8, image 82; series 9, image 4). SPLEEN: Trace fluid around the spleen. PANCREAS: Thinning of the pancreatic parenchyma at the proximal body may reflect focal atrophy versus normal variant. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst it is unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. T2 hyperintense lesion adjacent to a loop of small bowel may represent a fluid filled diverticulum versus enteric duplication cyst. No evidence of complication. BONES, SOFT TISSUES: Compression deformity of the T12 vertebral body with greater than 50% loss of height anteriorly. Grade 1 anterolisthesis of L4 on L5. Mild superior endplate compression deformity of the L5 vertebral body.OTHER: No significant abnormality noted. | 1.Mild intrahepatic biliary ductal dilation. Two small apparent filling defects in the distal common bile duct are inconclusive although tiny nonobstructing stones not entirely extruded. No CBD dilation. 2.Cholelithiasis without evidence of cholecystitis. |
Generate impression based on medical findings. | Nasopharyngeal carcinoma status post treatment. Brain: There is no measurable nasopharyngeal tumor. There is persistent diffuse enhancement in the central skull base and pterygopalatine fossae, which is likely treatment related. There are effusions within the bilateral mastoid air cells. There is no evidence of tumor in the cavernous sinuses. There is pansinus mucosal thickening and there are scattered secretions. There are unchanged mild scattered cerebral white matter T2 hyperintense lesions. There is no abnormal intraparenchymal enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction.Orbits: The bilateral orbits are intact, without evidence of tumors or optic nerve enhancement. | 1. Post-treatment findings without evidence of measurable nasopharyngeal tumor.2. Unchanged mild scattered cerebral white matter T2 hyperintense lesions may represent chronic small vessel ischemic disease. 3. Bilateral tympanomastoid opacification may be attributable to Eustachian tube dysfunction.4. Diffuse paranasal sinus inflammation.5. The orbits are unremarkable. |
Generate impression based on medical findings. | 35-year-old woman with history of pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: Decreased signal in the liver is suggestive of iron deposition. Gallbladder wall is thickened, however there are no stones in the lumen is nondistended.SPLEEN: Spleen is slightly low in signal, suggestive of iron deposition. No focal lesion identified.PANCREAS: Multiple cystic lesions are again seen in the pancreas and communicate with the pancreatic duct. The pancreatic head lesion (series 701, image 7) measures 11 x 10 mm, previously 10 mm. The pancreatic tail lesion (series 701, image 14) measures 16 x 13 mm, previously 16 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large amount ascites. The heart is enlarged. | 1.Unchanged multiple sidebranch IPMNs.2.Hemosiderosis and large volume of ascites. |
Generate impression based on medical findings. | Lower extremity weakness and numbness. Assess for worsening stenosis. Cervical spine: There is reversal of the usual cervical lordosis. The vertebral bodies are preserved in height. There is mild disc height loss at C3-C4 through C6-C7 with loss of T2 signal. There is mild degenerative marrow endplate signal alteration at C6-C7. Otherwise, there is no significant vertebral bone marrow abnormality. There is no abnormal spinal cord signal. The imaged portions of the brainstem and upper thoracic spinal cord are unremarkable.C2-C3: There is mild right neural foraminal stenosis by facet arthropathy. There is no spinal canal or left neural foraminal stenosis.C3-C4: There is a disc-osteophyte complex that results in moderate spinal canal stenosis, indenting the ventral aspect of the spinal cord. In addition, uncovertebral arthropathy causes severe foraminal stenoses bilaterally.C4-C5: There is a disc-osteophyte complex that causes mild spinal canal stenosis. In addition, uncovertebral and facet arthropathy result in severe foraminal stenoses bilaterally.C5-C6: There is a disc-osteophyte complex that results in moderate-to-severe spinal canal stenosis. In addition, right greater than left uncovertebral and facet arthropathy results in severe foraminal stenoses.C6-C7: There is a disc-osteophyte complex and ligamenta flava thickening result in mild spinal canal stenosis. Left more than right uncovertebral and facet arthropathy result in severe left and moderate right foraminal stenoses bilaterally.Lumbar spine: The lumbar spine alignment is anatomic. The vertebral bodies are preserved in height. There is mild loss of disc height and T2 signal at L2-L3 through L5-S1. There is an inferior L4 endplate Schmorl node. There is abnormal contrast enhancement involving the L3-L4 facets, worse on the right, also degenerative in nature. The conus medullaris has its tip at the upper L2 level. The conus medullaris and included caudal part of the spinal cord display normal signal and morphology. There are degenerative changes involving the sacroiliac joints, as manifested by bridging osteophytes. There are multiple bilateral renal cysts.T12-L1: There is no significant disc herniation, spinal canal stenosis or foraminal stenosis.L1-L2: There is no significant spinal canal or foraminal stenosis.L2-L3: There is a disc bulge, mild ligamentum flavum thickening, and facet arthropathy, without significant spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with a small right paracentral protrusion, ligamentum flavum thickening, and facet arthropathy, which result in moderate central and right paracentral spinal canal stenosis, as well as mild bilateral neural foraminal stenoses.L4-L5: There is a disc bulge that is eccentric to the left, which along with ligamentum flavum thickening and facet arthropathy results in mild bilateral neural foraminal stenoses, but no significant spinal canal stenosis. There is a small posterior left facet joint synovial cyst.L5-S1: There is central disc bulge and bilateral facet arthropathy associated with mild foraminal stenoses bilaterally, but no significant spinal canal stenosis. | 1. Degenerative cervical spondylosis at C3-4 through C5-6 with associated mild indentation of the spinal cord and extensive bilateral neural foraminal stenoses. 2. Multilevel degenerative lumbar spondylosis consists of moderate spinal canal stenosis at L3-4, as well as mild bilateral neural foraminal stenoses at L3-4 though L5-S1. |
Generate impression based on medical findings. | Glioblastoma. Status post surgery followed by concomitant chemoradiation treatment and subsequent adjuvant chemotherapy. Now off treatment. There are postoperative changes from previous left parietotemporal tumor resection. The irregular contrast enhancement in the treatment bed is largely similar to prior allowing for slight differences in technique/reduced contrast dose. There is however contrast enhancement along the lining of the occipital horn of the left lateral ventricle which is minimally increased compared to the two previous examinations. The extensive T2-hyperintensity involving a significant part of the left cerebral hemisphere remains unchanged as well as the more widespread, nonspecific scattered foci of T2 FLAIR hyperintensity in the periventricular white matter. Numerous foci of susceptibility in the treatment bed related to chronic blood products remains unchanged. There is unchanged mild mass-effect surrounding the treatment bed while the remainder of the brain shows moderate brain volume loss. There is no new mass effect or new foci of abnormal enhancement aside from the left occipital horn. The presence of susceptibility effect in the treatment bed limits the value of the dynamic MR perfusion study.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a partially empty sella. The orbits are grossly unremarkable. | Posttreatment changes with irregular enhancement in the left parietal and temporal lobes is largely similar to prior study. There is however mild interval increase in enhancement along the ependymal surface of the left occipital horn compared to 1/28/2016 and 11/25/2015 which is suspicious for subtle tumor progression. Suggest close attention on follow-up. No abnormal enhancement involving the ventricular wall remote from this region or abnormal leptomeningeal enhancement to suggest CSF dissemination. Extent of FLAIR signal abnormality is not significant changed. |
Generate impression based on medical findings. | Diagnosis: Benign intracranial hypertension Arnold-Chiari syndrome without spina bifida or hydrocephalus. Other disorders of meninges, not elsewhere classifiedClinical question: Chiari malformation, 4th ventricle stent, pseudomeningocele, please do with CSF flow studySigns and Symptoms: headaches, neck pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniotomy and resection of the posterior arch of C1. There is a fluid collection present behind the C1 arch measuring approximately 33 x 12 mm axial dimensions which are stable compared to the prior exam. There is redemonstration of stent coursing through the foramen Magendie and into the fourth ventricle with tip at the top of the fourth ventricle. It is unchanged in positionCSF flow study indicates biphasic flow without any convincing evidence for obstruction at the level of the foramen magnum. Flow is also identified through the shunt tubing.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence for syrinx.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. | 1.Status post surgery for Chiari malformation with shunt placement. There is no evidence for obstruction to CSF flow. The postoperative findings including a small fluid collection overlying the dura are stable.2.There is no evidence for ventriculomegaly or syrinx. |
Generate impression based on medical findings. | Evaluate for focus of seizures, pre-MRI for surgical candidacy: periventricular heterotopia and left temporal lobe seizures. There are numerous bilateral periventricular nodules with signal characteristics of grey matter. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The lateral ventricles are enlarged and dysmorphic and there is deficiency of the septum pellucidum. There is a retrocerebellar arachnoid cyst that measures up to 25 mm in width. 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. | Extensive bilateral periventricular heterotopia and enlarged lateral ventricles. |
Generate impression based on medical findings. | Male 71 years old Reason: Evaluate recurrent rotator cuff tear History: pain and weakness ROTATOR CUFF: The supraspinatus muscle is atrophic. There is increased signal in the supraspinatus tendon at the insertion compatible with severe tendinopathy. No discrete tear is identified.SUPRASPINATUS OUTLET: Severe degenerative changes about the acromioclavicular joint. Small amount of fluid is noted in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Periarticular cyst adjacent to the superior glenohumeral joint has homogeneous T2 intense signal and is multilobulated. The glenoid labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | Severe supraspinatus tendinopathy with no discrete rotator cuff tear. Supraspinatus muscle atrophy. Severe degenerative changes of the AC joint. |
Generate impression based on medical findings. | Female; 61 years old. Reason: 61 yo with cirrhosis please screen for HCC ABDOMEN:LIVER, BILIARY TRACT: Diffuse nodular surface contour, compatible with cirrhosis. No suspicious hepatic lesions. No biliary ductal dilatation. Hepatic and portal veins are patent.SPLEEN: Splenomegaly. Thin, curvilinear area of increased delayed enhancement at the anteroinferior aspect of the spleen (series 10/52) with no restricted diffusion, suggestive of benign etiology such as scar tissue and similar to prior studies dating back to 9/18/13.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left midpole renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Stable mild gastrohepatic lymphadenopathy, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominal ascites. | 1.Cirrhotic liver sequela of portal hypertension including splenomegaly and mild ascites. 2.No suspicious hepatic lesion. 3.Probable scar tissue adjacent to the spleen. |
Generate impression based on medical findings. | MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid, middle and anterior cerebral arteries are patent. The AComA is not well seen by MRI. The left PComA is small. The right PComA is medium sized. The right vertebral artery is bigger than the left but both are patent. The basilar artery and posterior cerebral arteries are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. The left vertebral artery is smaller than the right and arises from a common origin with the left subclavian artery from the aorta. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. MRI C-Spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. No significant compromise to the spinal canal or neural foramina. The paraspinous soft tissue structures appear within normal limits. | 1.No evidence of acute intracranial hemorrhage, mass or abnormal mass lesion.2.No evidence for cervicocerebral occlusive disease, including no evidence of vertebral or carotid artery dissection.3.No evidence for cervical spinal cord compression or cord signal abnormality. There is no significant compromise to cervical spinal canal or neural foramina4.Tonsilar ectopia which may represent an incidental finding. |
Generate impression based on medical findings. | 51-year-old female with right foot pain status post trauma. Assess for anterior process of calcaneus fracture.IMAGE ACQUISITIONS: CT examination of the right foot was performed without IV contrast. Transverse, coronal, and sagittal reformations were performed. Soft tissue and bone windows were reviewed. There is no evidence of fracture. Specifically, the anterior process of the calcaneus appears normal. Mild osteoarthritis affects the first metatarsophalangeal joint. A bipartite medial sesamoid is identified which is a normal variant. Tiny accessory navicular bones are identified which are of doubtful clinical significance.The visualized tendons and ligamentous structures of the ankle appear normal given the limitations of CT relative to MRI. Note is made of a low-lying soleus muscle.Nonspecific subcutaneous edema along the lateral aspect of the foot and ankle. | Mild lateral soft tissue swelling without evidence of fracture. |
Generate impression based on medical findings. | daily headache No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion on this scan.No abnormal enhancement.Normal brain MRI |
Generate impression based on medical findings. | Clinical question: Chiari malformation, decompression, syrinx, yearly follow-up, evaluate for change. Signs and symptoms: Neck pain and spasm post surgery. Nonenhanced cervical MRI:Examination demonstrates stable expected postoperative changes of Chiari decompression without change since prior exam.A minimally expansile syrinx of cervical cord extending from C2 to C7 demonstrate no convincing evidence of change in its size or extent. Signal intensity and the alignment of the vertebral column is unremarkable. There is no spinal stenosis or neural foraminal compromise at any level. | 1.No evidence of an acute or new findings since prior study.2.Stable postoperative changes of Chiari decompression with expansion of subarachnoid space.3.Stable minimally expansile single cervical cord from C2 to C7 since prior study. |
Generate impression based on medical findings. | Reason: acute left hip pain History: acute left hip pain There is mild edema and enhancement within the iliopsoas muscle extending from the level of the anterior inferior iliac spine to just proximal to the level of its insertion on the greater tuberosity suggesting a mild strain injury. The tendon of the rectus femoris as well as the rectus femoris muscle appear normal as does the remainder of the musculature of the left hip. There is a trace amount of fluid within the left hip, but no large effusion. Although this examination was not protocoled for detailed evaluation of the acetabular labrum, there is linear abnormal signal intensity traversing the anterior superior labrum suggesting a small tear which is perhaps partial thickness. We see no fluid-filled articular cartilage defects. We see no frank CAM deformity. The bone marrow signal intensity is normal. There is a small amount of free fluid within the pelvis as well as multiple left adnexal cysts which are likely physiologic. | 1. Mild edema of the iliopsoas suggesting a mild strain injury.2. Small anterior superior labral tear. |
Generate impression based on medical findings. | Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Non-enhanced CT brain:The examination is suboptimal due to fact that patient was unable to lie flat for study. The images are noisy and evaluation for subtle findings is not possible. Within this limitation however no definitive evidence of any abnormality is identified. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Recommend repeat CT or an MRI of brain if concern for stroke persist.Calvarium, paranasal sinuses and mastoid air cells are unremarkable. | Suboptimal exam due to difficulty positioning the patient within the gantry properly. No gross abnormalities detected. Follow up with repeat CT exam or an MRI is recommended if clinical concern for stroke persist. |
Generate impression based on medical findings. | 11-year-old female with blunt trauma and multiple thoracic spinal fractures on CT. Limited complete spine: There is increased T2 signal within the thoracic spinal cord from T8 to T10. There is redemonstration of numerous previously described acute thoracic spine fractures with associated bone marrow edema. Please see dedicated thoracic spine MRI findings below and CT of the entire spine reports for additional details. The vertebral bodies are otherwise appropriate in the overall alignment and height. The cervical and distal spinal cord has normal signal characteristics and overall morphology through the cervical and lumbar spine. Thoracic spine: There is a fracture through the anterior, middle and posterior columns of the T8 vertebra (Chance fracture) with approximately 8 mm distraction of the spinous process. There is a displaced cortical osseous fragment within the right T8-T9 neural foramen. There are mildly displaced comminuted fractures through the anterior, middle and posterior columns at T9 with approximately 50% compression and 3 mm of retropulsion. An associated moderate acute kyphosis is centered at the T8-T9 level with spinal canal stenosis and compression of the spinal cord. Abnormally increased T2 signal is present within the thoracic spinal cord from the level of T8 to T10. There is mild depression of the superior endplates of T3, T4, T6, T7, T10, and T11 with associated diffuse edema in these vertebrae. There is a minimally displaced fracture involving the right pedicle and transverse process of T10. There is edema and indistinctness of the cortex suggesting possible microfractures at the spinous processes of T3 and T4 and inferior facet articulation of T4. There is intermediate T1 signal and high T2 signal within the dorsal epidural space of the thoracic spine from the T1 level through approximately T11 with effacement of the ventral thecal sac and mild mass effect on the spinal cord. There are enlarging moderate bilateral pleural effusions. There is significant diffuse paravertebral soft tissue swelling or hemorrhage. There is also prominent soft tissue swelling in the posterior soft tissues of the upper back. | 1. Acute spinal canal stenosis at T8-T9 with compression of the spinal cord and spinal cord edema from T8 to T10 suggestive of traumatic spinal cord contusion and unstable fractures at T8 and T9, as well as a displaced cortical osseous fragment within the right T8-T9 neural foramen. Furthermore, mild depression of the superior endplates and what may represent diffuse bone contusion involving T3, T4, T6, T7, T10, and T11. Neurosurgical consultation was suggested.2. Acute posterior epidural hematoma from the level of T1 through likely T11 with mild mass effect on the spinal cord.3. Paravertebral and posterior paraspinal soft tissue swelling/hematomas.4. Enlarging moderate bilateral pleural effusions.5. No acute fracture or subluxation of the cervical spine.6. No acute fracture or subluxation of the lumbar spine.Dr. Masse discussed preliminary findings with Dr. Omar Usman of the emergency department on 9/25/2016 at 0130 hours. Dr. Sorensen discussed additional findings with Dr. Jason Choi of the neurosurgery service on 9/25/2016 at 0927 hours.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Ataxia and weakness. Rule out spinal tumor or involvement by multiple sclerosis. THORACIC SPINE:There is moderate-to-severe spinal canal stenosis in the lower cervical spine. Also, the thyroid gland is diffusely enlarged. Please refer to the report of the cervical spine MRI from the day prior for more details.Thoracic spinal alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is notable for fat-containing lesions in T7, T9 and T12 vertebral bodies and most probably represent intraosseous lipomas or hemangiomas. There is no suspicious marrow abnormality, otherwise. Right anterolateral bridging osteophytes are present at T7-T12, most pronounced at T9-T10. The intervertebral discs show variable loss of T2 signal and mild height loss but there is no significant disc pathology. The thoracic spinal canal is preserved. There is also no significant neuroforaminal stenosis. The thoracic spinal cord shows normal morphology and signal. There is no abnormal thoracic spinal cord, leptomeningeal or nerve root contrast enhancement. Paraspinal tissues are notable for a 4 mm T2-hyperintense, T1-hypointense, non-contrast enhancing lesion in the upper pole of the left kidney which is incompletely assessed though likely represents a cyst. There is also a dilatation of the included extrahepatic bile duct, up to 10 mm for the pancreatic segment of the common bile duct. The gallbladder is also partially visualized and not enlarged.LUMBAR SPINE:There are 5 lumbar type, ribless vertebrae. The last well-formed disc is at L5-S1. Lumbar spinal alignment is anatomic. The vertebral bodies are preserved in height. Fat-containing lesion in the first sacral segment is probably either intraosseous lipoma or a hemangioma. There is no suspicious marrow abnormality, otherwise. The intervertebral discs are preserved in height but show partial loss of the T2 signal, compatible with desiccation. The spinal canal is fairly preserved. The conus medullaris tip is at the lower L1 level. The conus shows normal morphology and signal characteristics. There is increased contrast enhancement and STIR signal in the interspinous ligament at L3-L4 and to a lesser extent L4-L5, which is associated with minimal dorsal indentations of the thecal sac. This compatible with Baastrup disease.T12-L1, L1-L2, L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild thickening of ligamenta flava.L3-4: Minimal disc bulge is present along with moderate ligamentum flavum thickening. There is no significant spinal canal or foraminal stenosis.L4-L5: Minimal disc bulge and moderate ligamentum flavum thickening present without significant spinal canal or foraminal stenoses.L5-S1: There is no significant spinal canal or foraminal stenosis. There is moderate right and mild left facet arthropathy associated with increased contrast enhancement.There are typical changes are present at the sacroiliac joints with subchondral sclerosis and articular surface irregularity as well as marginal osteophytes/syndesmophytes. There is T1 hypointensity with more linear configuration in the right sacral ala with surrounding ill-defined abnormal signal, which may reflect a nondisplaced insufficiency fracture. Similar change is present also in the adjacent right iliac bone. | 1.Bilateral sacroiliac joint osteoarthritic changes are present. Additional T1 hypointensity including in a more linear configuration in the right sacral ala and possible in adjacent right iliac bone which could reflect a nondisplaced insufficiency fracture. Please correlate clinically. MR of the sacrum could be obtained for further evaluation.2.There is no spinal cord abnormality to suggest demyelinating disease. No MR evidence of spinal tumor as clinically questioned.3.Reactive inflammatory change in the interspinous spaces of L3-L4 and L4-L5, which could indicate Baastrup disease. Inflammatory degenerative changes are also present at the L5-S1 facets, right more than left. These findings can contribute to back pain.4.Moderate-to-severe lower cervical spinal canal stenosis with mass-effect on the spinal cord. Please refer to the report on the cervical spine MRI from the day prior for more details.5.Incidental dilated extrahepatic bile ducts but no gallbladder dilatation. Please correlate with cholestatic laboratory parameters and potentially dedicated hepatobiliary imaging. |
Generate impression based on medical findings. | 48 year old female with a history of congenital pulmonary stenosis s/p PVR with pulmonic insufficiency and known pulmonary artery aneurysm. She is now referred for cardiac assessment and follow-up of pulmonary artery dimensions. Height: 170cmWt 113kgLeft VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 137g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 245 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 138 ml (normal range 35+/-13). Right AtriumThe right atrium is again dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and visually there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is moderate pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. Visually there is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated. Measurements using 3D volumetric data demonstrate the following:Proximal main PA: 32mm x 34mmDistal main PA: 49 x 51 mmLeft PA (proximal): 47 x 38 mmLeft PA (distal): 30 x 31 mmRight PA: 36 x 35 mmThese values are stable when compared to previously obtained measurements. Proximal main PA: 33x33mm Distal main PA: 45mmx43mm (remeasured using the same technique as above as 55 x 49 mm)Left PA (proximal): 35x44mm (remeasured using the same technique as above as 47 x 38 mm)Left PA (distal): 36x36mm (remeasured using the same technique as above as 31 x 30 mm).Right PA: 34x33mm (remeasured using the same technique as above as 34 x 37 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings 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. Normal left ventricular size and systolic function (LVEF 63%).2. Moderately dilated right ventricular size and low normal systolic function (RVEF 44%), slightly worse compared to last study.3. Moderate pulmonary valve regurgitation (visual estimate).4. Dilated right atrium, as before.5. Severe pulmonary arterial dilation, not substantially different compared to previous study. Quantitative differences in measurement are likely related to differences in technique.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |