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Generate impression based on findings. | 34 year old female with history of sickle cell disease status post right total shoulder. Evaluate for component placement The right total shoulder arthroplasty components are in anatomic alignment. There is no evidence of fracture or dislocation | Right total shoulder arthroplasty components in anatomic alignment |
Generate impression based on findings. | 34 year old female with history of sickle cell disease status post right total shoulder. Evaluate for component placement The right total shoulder arthroplasty components are in anatomic alignment. There is no evidence of fracture or dislocation | Right total shoulder arthroplasty components in anatomic alignment |
Generate impression based on findings. | 84-year-old female with low back pain Posterior stabilization rods with transpedicular screws extending into L4 and L5, without evidence of hardware complication. Status post L4-L5 laminectomy. Anterior osteophytes are noted along the lower thoracic and lumbar spine with mild intervertebral disk space narrowing. Vertebral body heights are maintained. | Posterior fixation of L4 and L5, appearing similar to the prior exam. |
Generate impression based on findings. | The colon is adequately cleansed and distended. There is a small to moderate amount of mostly well-tagged fluid and liquid stool. Few diminutive foci that are not tagged.No significant colonic polyps or masses identified.Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny polyps < 5 mm), the presence or absence of which will not change management of the patient.EXTRACOLONIC | No significant colonic polyps or masses identified. *OPTIONAL C-RADS CLASSIFICATION:C-1E-2*(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than three 6-9mm polyps or can't exclude >6mm in technically adequate study. Surveillance CTC or colonoscopy recommended.C3: Polyp, possibly advanced adenoma. (polyp >10mm or >three 6-9mm). Colonoscopy recommended.C4: Colonic mass, likely malignant. |
Generate impression based on findings. | Locally recurrent oral tongue squamous cell carcinoma referred here for consideration of clinical trial participation. There are post-treatment findings in the neck related to partial right glossectomy with mandibulectomy, flap reconstruction, and neck dissection. There is an infiltrative heterogeneous mass in the left masticator, parapharyngeal, and pharyngeal mucosal spaces, with associated left mandible, posterior maxillary sinus wall, and central skull base erosion and extension into the left middle cranial fossa. There is partial opacification of the bilateral maxillary sinuses and complete left tympanomastoid opacification. There is a cluster of prominent left level 6 lymph nodes. The thyroid gland appears unremarkable. The orbits are unremarkable. | 1. Postoperative findings with evidence of recurrent tumor in the left masticator, parapharyngeal, and pharyngeal mucosal spaces, with associated left mandible, posterior maxillary sinus wall, and central skull base erosion and extension into the left middle cranial fossa and overlying skin of the face.2. Prominent left level 6 lymph nodes may represent metastatic disease, but are nonspecific. |
Generate impression based on findings. | 64-year-old male with history of left humerus sarcoma removal. Assess for metastatic disease. LUNGS AND PLEURA: Scattered pulmonary micronodules, some which are calcified. No new suspicious lesions.MEDIASTINUM AND HILA: Heart size within normal limits, no pericardial effusion. Calcified mediastinal lymph nodes appear stable. No lymphadenopathy in the mediastinum or hila. No visible coronary artery calcifications. Atherosclerotic calcifications of the aorta and annulus. CHEST WALL: Degenerative changes affect the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Unchanged renal pelvis calcifications, may be arterial or represent nonobstructing stones. Cholelithiasis and small right hepatic lobe cyst, unchanged. | No evidence of metastatic disease. |
Generate impression based on findings. | Evaluate Dobbhoff tube placement Dobbhoff tube seen in gastric body. Lateralmost soft tissues in left pelvic area excluded. Nonobstructive bowel gas pattern. Rounded radiodensities in right lateral upper abdomen nonspecific and may be located in subcutaneous tissues. Postprocedural changes including sequela of coil embolization and endovascular stent placement seen in left iliac region. Multilevel degenerative changes of spine and hips, decreased osseous mineralization. Please refer to concomitant chest chest radiography from same day for additional findings. | Enteric tube as above. |
Generate impression based on findings. | Tachycardia, evaluate for free air Suboptimal exam due to technique/patient positioning and patient motion artifact. No gross free air delineated. Enteric tube seen coiled in mid to distal esophagus with tip located in distal esophagus, repositioning recommended, discussed with clinical service at 8:15 a.m. on January 1, 2015. Bowel gas pattern without significant change, large stool burden, nonspecific gaseous distention of portion of bowel again noted, primarily in left abdomen. Small radiodensity in pelvis unchanged, may be a colonic diverticulum or phlebolith or calcified node. Decreased osseous mineralization and degenerative disease of spine. Please refer to concomitant chest radiography from same day for additional findings. | Repositioning of enteric tube recommended. |
Generate impression based on findings. | Female, 57 years old, with subarachnoid hemorrhage. A large coil mass is redemonstrated in the region of the basilar tip which results in streak artifact obscuring some portion of the exam. A right frontal approach ventriculostomy catheter is in place. The catheter has been pulled back slightly and the tip now terminates in the right frontal horn.Subarachnoid and intraventricular hemorrhage is redemonstrated. The subarachnoid hemorrhage is less conspicuous than on the prior examination. The intraventricular hemorrhage may also be slightly reduced.Ventricular dilatation also seems to have improved. For example, the right frontal horn measures up to 11 mm in thickness, previously 15. The temporal horns are also notably reduced in caliber.Hypoattenuation in the periventricular tissues is redemonstrated similar to prior. | 1.Redemonstration of a large coil mass situated at the basilar tip.2.Interval retraction of the right frontal approach ventriculostomy catheter, the tip of which now sits in the right frontal horn.3.Slight interval decrease in the conspicuity of subarachnoid and intraventricular blood products. The caliber of the ventricular system has also improved. |
Generate impression based on findings. | Male, 66 years old, status post subdural hemorrhage evacuation. Findings are redemonstrated compatible with subdural hemorrhage evacuation. Two burr holes are present in the right parietal bone, the more posterior of which conveys a drainage catheter which enters the right-sided subdural collection in approximately stable position. One burr hole is evident in the left parietal bone. Pneumocephalus is compatible with recent instrumentation. Substantial scalp swelling and subgaleal fluid is again seen.The right-sided subdural collection is stable in thickness measuring up to 14 mm, previously 14 mm. The collection is largely hypoattenuating but there are small areas of hyperattenuating material along the catheter track, similar to the prior study.The subdural collection on the left is smaller than that on the right and has not substantially changed either measuring up to 7 mm in thickness, previously 7 mm.No evidence of new intracranial hemorrhage seen. There remains generalized midline shift to the left of approximately 6 mm which is unchanged. The right lateral ventricle is partially effaced. The left ventricular atrium is mildly prominent similar to priorPatchy periventricular hypoattenuation, as well as encephalomalacia involving the left cingulate gyrus, are unchanged. | No significant change in the size of bilateral subdural collections. Generalized mass effect with a midline shift to the left is also approximately unchanged. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is mild mucosal thickening of the bilateral ethmoid sinuses. There are mucus retention cysts of the bilateral maxillary sinuses. The visualized portions of the mastoids/middle ears are grossly clear. | No acute intracranial hemorrhage. |
Generate impression based on findings. | There is a very subtle focal hypoattenuating area in the low right precentral gyrus, which may be artifactual. However, given the clinical history, the possibility of a developing or resolving ischemic lesion cannot be excluded. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. No acute intracranial hemorrhage. 2. Very subtle focal hypoattenuation in the low right precentral gyrus, may be artifactual. However, the possibility of a developing or resolving ischemic lesion cannot be excluded, given clinical history. MRI of the brain may be considered if clinical concern warrants. |
Generate impression based on findings. | Male, 84 years old, status post subdural hemorrhage evacuation. Since the prior examination, two burr holes have been placed within the right parietal bone. The more posterior burr hole conveys a drainage catheter which enters the right-sided subdural space. Substantial right-sided scalp swelling and pneumocephalus are compatible with recent instrumentation.The previously seen isoattenuating right frontoparietal subdural collection has been partially evacuated. Air now fills a portion of the space formerly occupied by fluid. The fluid is more hypoattenuating than it had been previously. There is hyperattenuating fluid compatible with more acute blood product along the catheter tract. The quantity of extra-axial blood product has decreased overall from the prior examination, now measuring up to 13 mm in thickness, previously up to 25 mm.Mass-effect on the right cerebral hemisphere has improved. There is near complete reexpansion of the right lateral ventricle and only a trace midline shift to the left persists.No loss of gray-white distinction is seen to suggest ischemic injury. No new parenchymal abnormalities are detected. The ventricles are normal in size and morphology. | Expected findings status post evacuation of a right-sided subdural hematoma. The quantity of blood product is reduced, along with associated mass effect. There is some acute blood product along the drainage catheter tract for which continued follow-up is recommended. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is minimal mucosal thickening of the bilateral ethmoid sinus. There is a mucus retention cyst in the left maxillary sinus. The remaining visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There are dental caries and periapical lucency of the posterior maxillary molars. Multiple bilateral cervical lymph nodes are present, largest measuring up to 1.1 cm on the right. | 1. No acute intracranial abnormality.2. Dental caries and periapical lucency of the posterior maxillary molars. Please correlate with dental examination.3. Multiple bilateral cervical lymph nodes, largest measuring up to 1.1 cm on the right, likely reactive. |
Generate impression based on findings. | Female 24 years old; Reason: Evaluate for acute intraabdominal process History: pelvic pain x 1 week, dysfunctional uterine bleeding since June ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic subcentimeter hypoattenuating focus, too small to characterize, image 31 series 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal-sized appendix, image 100 series 3, no evidence of periappendiceal inflammation. Mild to moderate distention of stomach containing ingested material, may be due to timing of exam. Underdistended sigmoid colon, making evaluation for underlying wall thickening suboptimal. Small to moderate stool burden without evidence of bowel obstruction. PELVIS:UTERUS, ADNEXA: Bilateral adnexal prominence, may reflect ovaries containing small physiologic follicles. No significant pelvic free fluid. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Unremarkable exam.2. Normal appendix.3. If there is continued clinical concern for pelvic/gynecologic pathology, further evaluation with dedicated pelvic sonography recommended. |
Generate impression based on findings. | There is high signal in the right corona radiata on the diffusion sequence, without corresponding low signal on ADC map. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. High T2/FLAIR signal of the bilateral caudate and putamina, may also be related to small vessel ischemic changes. No extra-axial fluid collection is identified.There are scattered punctate foci of susceptibility artifact, representing hemosiderin staining. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1. Extensive chronic small vessel ischemic changes with superimposed lesion in the right corona radiata, which may represent a late subacute, resolving infarct. 2. Moderate age related parenchymal volume loss. |
Generate impression based on findings. | History of intussusception from outside hospitalVIEW: Chest AP and abdomen AP Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. Multiple dilated loops of bowel without pneumatosis or pneumoperitoneum. | Distal bowel obstruction without pneumoperitoneum. |
Generate impression based on findings. | Abdominal distentionVIEW: Abdomen AP 1/1/15 Multiple skeletal deformities again noted. G-tube in place. Multiple punctate calcifications in the right upper quadrant. Paucity of bowel gas within the abdomen unchanged. Patchy atelectasis left lower lobe. | Paucity of bowel gas within the abdomen unchanged. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The right anterior ethmoid air cells are clear. There is partial opacification of the left anterior ethmoid air cells, improved from prior study.Maxillary sinuses: There is mild mucosal thickening of the bilateral maxillary sinuses, unchanged. The right ostiomeatal unit is clear. There is mild narrowing of the left ostiomeatal unit from mucosal thickening.Posterior ethmoids: The right posterior ethmoid air cells are clear. There is residual scattered opacification of the left posterior ethmoid air cells, improved from prior study.Sphenoid sinus: There is improved mild mucosal thickening of the bilateral sphenoid sinus. The bilateral sphenoethmoidal recesses are clear. There is no significant nasal septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.Other: Bilateral mastoid air cells and middle ear cavities are clear. Minimal debris within the bilateral external auditory canals. Dental caries in a left posterior molar. | Mild interval improvement in extensive paranasal sinus disease. |
Generate impression based on findings. | Male 46 years old; Reason: evaluate for necrotizing fascitis of scrotum History: scrotal swelling CHEST:LUNGS AND PLEURA: Multifocal air space disease seen throughout both lungs, more pronounced on left side. Small left pleural effusion. MEDIASTINUM AND HILA: Multiple mildly prominent mediastinal lymph nodes, measuring up to 10 mm. Subcentimeter axillary lymph nodes. Trace pericardial effusion. CHEST WALL: Right-sided central venous catheter seen with tip in right atrium. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No secondary signs of acute cholecystitis. SPLEEN: 2-cm presumed splenule inferior to spleen, image 124 series 4.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Minimal atherosclerotic aortic calcification. Subcentimeter retroperitoneal and iliac lymph nodes.BOWEL, MESENTERY: Tiny hiatal hernia. Small presacral edema. Segmental distal transverse colon wall thickening, measuring approximately 8.5 cm in length, image 120 series 4. Mild upstream transverse colon dilatation visualized. Findings discussed with Dr. Corelli at 8:50 a.m. on 1/1/15. Small paracolic gutter edema. Underdistention of hepatic flexure ascending colon makes assessment for wall thickening suboptimal. Appendix borderline in size, no significant periappendiceal inflammation seen at this time.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Mild scrotal thickening/edema, no associated gaseous foci seen. Mild bilateral proximal lower extremity subcutaneous edema. Mild ventral abdominal subcutaneous nodularity, may reflect sequela from prior injections. Scattered subcentimeter sclerotic foci, most likely bone islands. Mild degenerative disease of spine. | 1. Segmental thickening of distal transverse colon with mild upstream dilatation visualized, appearance suspicious for acute colitis, correlation with patient's clinical history/physical exam and followup to resolution to exclude underlying neoplastic process recommended (although this is considered less likely due to length of involvement). 2. Multifocal pneumonia/infectious process as above with small left pleural effusion. 3. Mild scrotal thickening/edema, correlate clinically for underlying cellulitis. |
Generate impression based on findings. | RDS on HFOVVIEW: Chest AP 1/1/15 ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. Right upper extremity PICC with tip at the confluence of the brachiocephalic veins. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. | Diffuse atelectasis bilaterally not significantly changed. |
Generate impression based on findings. | Chest tube placementVIEW: Chest AP and abdomen AP 1/1/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left upper extremity PICC with tip in the left brachiocephalic vein. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally increased from prior study. There is a small left anterior pneumothorax. There are bilateral small pleural effusions. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. Again noted sclerosis involving the metaphysis of the left proximal humerus unchanged. | Diffuse atelectasis bilaterally increased from prior study. |
Generate impression based on findings. | Status post lobectomy of lungVIEW: Chest AP 1/1/15 Left Penrose drain and surgical sutures again noted. The left chest tube has been removed in the interval. There is a small pneumothorax at the left costophrenic angle. There is improved aeration within the left lung. Patchy atelectasis left lower lobe. The right lung is clear. Cardiothymic silhouette normal. | Interval improved aeration within the left lung with a small pneumothorax at the left costophrenic angle. |
Generate impression based on findings. | Left lower jaw swellingVIEWS: Mandible Panorex There is a nondisplaced fracture involving the angle of the left mandible and extending into the root canal of the last left molar tooth. | Nondisplaced fracture angle of the left mandible. |
Generate impression based on findings. | Female 72 years old; Reason: Hx of metastatic likely endometrial cancer. Need to assess for malignant pleural effusions, metastatic spread to abdomen/nodes, and exam for vesicovaginal fistula. History: SOB, tachycardia, leaking urine although Foley catheter in place. CHEST:LUNGS AND PLEURA: Increasing now moderate to large sized left pleural effusion. Right-sided chest tube present with small adjacent subcutaneous edema and emphysema. Compared to prior study, significant interval decrease in size of right pleural effusion with residual small effusion seen. Bilateral compressive atelectasis. Mild bilateral patchy air space disease, likely due in part to atelectasis.MEDIASTINUM AND HILA: Enlarging axillary lymph nodes, findings discussed with gynecologic team at 8:20 a.m. on 1/1/15. A reference lymph node on the left measures 1.4 x 1.4 cm, image 19 series 4, previously measured 1.2 x 1.1 cm. Mildly prominent mediastinal lymph nodes present. Heterogeneous thyroid gland, right lobe larger than left, with multiple bilateral coarse calcifications and hypoattenuating nodularity seen on right. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval worsening of now mild to moderate right sided hydronephroureter with ureteral dilatation extending to level of soft tissue attenuation in region of distal ureter and UVJ, image 166 series 4, suspicious for evolving neoplastic obstruction. RETROPERITONEUM, LYMPH NODES: Atherosclerotic abdominal aorta. IVC filter in place. Evaluation of venous structures not optimal due to timing of IV contrast bolus. Linear radiodensity seen along course of left common iliac, external iliac, and common femoral vein, correlation with procedural history recommended. BOWEL, MESENTERY: Moderate abdominopelvic ascites, without significant change. Diffuse mild bowel wall thickening nonspecific in setting of ascites. Subcentimeter mesenteric lymph nodes. Mild diffuse mesenteric edema. PELVIS:UTERUS, ADNEXA: Amorphous soft tissue attenuation seen in bilateral adnexal areas, for instance, image 145 series 4 on the right. Underlying metastatic disease/peritoneal carcinomatosis not entirely excluded. Heterogeneous uterus with soft tissue attenuation/complex fluid in expected area of endometrial canal, area measures up to 5.4 cm in transverse dimension, likely reflecting patient's known gynecologic malignancy. Sites of uterine dystrophic calcification and leiomyomatous changes also visualized. BLADDER: Foley catheter seen in underdistended bladder, making evaluation suboptimal. Ill-defined soft tissue attenuation about bladder again may reflect neoplastic involvement. Evaluation for vesicovaginal fistula suboptimal on this nondedicated study but no obvious fistula delineated. LYMPH NODES: Subcentimeter bilateral inguinal lymph nodes.BONES, SOFT TISSUES: Multilevel degenerative changes of spine and degenerative disease of hip and right acromioclavicular and sternoclavicular joints. Right humeral head subcentimeter sclerotic focus without significant change accounting for differences in technique, may be a bone island but nonspecific. Decreased osseous mineralization. Moderate to marked anasarca. | 1. Heterogeneous uterus with soft tissue attenuation/complex fluid in expected area of endometrial canal, likely reflecting patient's known gynecologic malignancy. Amorphous soft tissue attenuation seen in bilateral adnexal areas and moderate abdominopelvic ascites present, findings worrisome for underlying metastatic disease/peritoneal carcinomatosis. 2. Ill-defined soft tissue attenuation about bladder may reflect neoplastic involvement. Evaluation for vesicovaginal fistula suboptimal on this nondedicated study but no obvious fistula delineated. If there is continued clinical concern for underlying vesicovaginal fistula, this may be better assessed with cystography.3. Interval worsening of right-sided hydronephroureter, etiology of obstruction suspected to be neoplastic as soft tissue attenuation seen at and near level of ureterovesicular junction. Findings discussed with gynecologic team at 8:20 a.m. on 1/1/15.4. Enlarging axillary nodes, worrisome for metastatic disease. 5. Bilateral pleural effusions and moderate ascites. 6. Linear radiodensity seen along course of left common iliac, external iliac, and common femoral vein, correlation with procedural history recommended. |
Generate impression based on findings. | RDS evaluate lung expansionVIEW: Chest AP 1/1/15 ET tube tip below thoracic inlet and above the carina. NG tube tip at the GE junction. UVC tip in the IVC/RA junction. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe and left upper lobe in a background of PIE. There is hyperinflation of the right lower lobe unchanged. No pleural effusion or pneumothorax. Marked body wall edema. | Patchy atelectasis bilaterally in a background of PIE unchanged. |
Generate impression based on findings. | Cyanosis worsening saturationVIEW: Chest AP and abdomen AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. UVC tip in the IVC/RA junction. Cardiothymic silhouette normal. Patchy atelectasis in the right middle lobe and left upper lobe in a background PIE. There is hyperinflation of the right lower lobe. No pleural effusion or pneumothorax. There is a catheter projected over the lower pelvis in the midline and may represent a displaced urinary catheter. Absent bowel gas within the abdomen. Marked body wall edema. | Patchy atelectasis bilaterally in a background of PIE. Probable displaced urinary catheter as described above. |
Generate impression based on findings. | History or inguinal hernia repair, unable to tolerate solidsVIEWS: Abdomen AP and left lateral decubitus Moderate amount of fecal burden. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | There is interval development of extensive hypoattenuation with loss of gray-white matter differentiation involving the left frontal, temporal and parietal lobes, and left basal ganglia, consistent with recent infarction in the left anterior and middle cerebral artery distributions. There is mild mass effect on the left lateral ventricle with a 4 mm left to right midline shift. There are chronic lacunar infarcts in the bilateral basal ganglia.There is no intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are are nearly completely opacified. There is slightly improved extensive subcutaneous soft tissue edema.Metallic foreign bodies are again noted in the right occipital calvarium causing extensive streak artifact at that level. Left ocular enucleation, right lens implant and chronic right medial orbital wall fracture are again noted. The partially imaged residual left mandible again demonstrates a mildly expansile appearance with cortical thickening, which is better evaluated on the CT head and neck dated 6/14/2013. | 1. Extensive recent left ACA and MCA territory infarct with associated mild mass effect on the left lateral ventricle and a 4 mm left to right midline shift. No intracranial hemorrhage. Per admission note in EPIC, the neurology service is aware of this finding.2. Chronic lacunar infarcts in the bilateral basal ganglia. 3. Diffuse paranasal sinus disease. |
Generate impression based on findings. | Abdominal distentionVIEW: Chest AP and abdomen AP 1/1/15 ET tube tip below thoracic inlet and above the carina. Left central line in place. The feeding tube tip in the second portion of the duodenum. Right lower extremity central line and urinary catheter have been removed in the interval. The abdominal drain with tip in the right upper quadrant unchanged. The IVC stent is unchanged. The NG tube has been removed in the interval. Cardiothymic silhouette normal. There are new opacities in the right upper lobe and left lower lobe likely representing atelectasis without pleural effusion and pneumothorax. Disorganized nonobstructive bowel gas pattern. Multiple surgical sutures in the right upper quadrant. No pneumatosis or pneumoperitoneum. | Bilateral lung opacities likely atelectasis in the right upper lobe and left lower lobe. |
Generate impression based on findings. | HypoxiaVIEW: Chest AP Right upper extremity PICC with tip in the right subclavian vein. NG tube tip in the stomach. Cardiothymic silhouette normal. Patchy atelectasis in the left lower lobe. No pleural effusion or pneumothorax. | Patchy atelectasis in the left lower lobe. |
Generate impression based on findings. | Female 40 years old; Reason: Evaluate for stricturing Crohn's disease in pt with ileal Crohn's disease s/p resection in 2005 History: Abdominal pain, decreased appetite, nausea ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic steatosis suggested. 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: Right sided abdominal postsurgical sequela related to prior partial ileal resection. At level of postsurgical anastomosis, axial images 111 to 115 series 4/coronal image 58, mild to moderate distal ileal luminal narrowing and mild wall enhancement seen. However, no significant proximal bowel dilatation noted and appearance is not significantly changed from prior 2010 examination. May reflect underdistention or chronic changes/postsurgical sequela. Some areas of jejunum not well distended, making evaluation suboptimal. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia. Minimal fat stranding in ischioanal fossae alluded to on earlier exam without significant change. Visualized osseous structures without significant change. | 1. Status post partial ileal resection at at level of postsurgical anastomosis, mild wall enhancement and distal ileal luminal narrowing seen. However, no significant proximal bowel dilatation noted and appearance is not significantly changed from prior 2010 examination. Findings may reflect chronic disease/postsurgical sequela and may be due in part to underdistention. |
Generate impression based on findings. | Pain sickle cell diseaseVIEWS: Right shoulder internal and external rotation No acute fracture or dislocation. No evidence of AVN. | Normal examination. |
Generate impression based on findings. | Pain sickle cell diseaseVIEWS: Left shoulder internal and external rotation No acute fracture or dislocation. No evidence of AVN. Bony changes involving the thoracic spine representing sickle cell disease. | No acute fracture or dislocation. |
Generate impression based on findings. | Trauma ET tube placementVIEW: Chest AP 1/1/15 Placement of endotracheal tube with tip immediately above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Patchy atelectasis in the left perihilar region and left lower lobe. No pleural effusion or pneumothorax. | ET tube tip immediately above the carina. |
Generate impression based on findings. | Trauma gunshot woundVIEW: Abdomen AP 12/31/14 There is a metallic bullet fragment at the right lower quadrant. Mildly dilated small bowel loop in the left lower quadrant. Disorganized nonobstructive bowel gas pattern. No evidence of pneumoperitoneum. | Metallic bullet fragment at the right lower quadrant without pneumoperitoneum. |
Generate impression based on findings. | Male 62 years old; Hb drop of unknown source, evaluate for bleed ABDOMEN:LUNGS BASES: Beam hardening artifact from patient's cardiac assist device makes evaluation suboptimal. Status post sternotomy. Moderate to marked cardiomegaly. Small to moderate left and small right pleural effusions with underlying atelectasis.LIVER, BILIARY TRACT: Mildly heterogeneous liver parenchyma. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renocortical scarring present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticula, most pronounced in descending and sigmoid colon. Small-sized small bowel containing right inguinal hernia, no bowel obstruction. No hyperdense fluid collection/hematoma delineated. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. No soft tissue hyperattenuation or intraabdominopelvic hyperdense fluid collection/hematoma seen.2. Bilateral pleural effusions.3. Small inguinal hernia.4. Colonic diverticulosis. |
Generate impression based on findings. | Trauma gunshot wound rule out pneumothoraxVIEW: Chest AP 12/31/14 Cardiothymic silhouette normal. Cardiac apex, aortic arch and stomach left-sided. Minimal perihilar atelectasis without pleural effusion or pneumothorax. | Minimal perihilar atelectasis without pneumothorax. |
Generate impression based on findings. | The right masseter muscle is enlarged with a hematoma, which extends inferiorly along the angle and body of the mandible and into the right submandibular space. There is associated scattered punctate foci of air and infiltration of the surrounding fat. There is mild mass effect on the right oropharyngeal airway, but the airway is patent. There is no acute fracture. There are surgical screws at the bilateral anterior maxillary sinus walls and bilateral mandibular bodies. Please correlate with prior surgical details. The partially imaged brain is unremarkable. There is a 1.4 x 1.9 cm subcutaneous nodule in the posterior neck, likely representing a sebaceous cyst. | Right neck laceration, contusion and hematoma involving the right masseter muscle extending to the level of the right submandibular space. No underlying mandibular fracture. |
Generate impression based on findings. | Female 88 years old; Reason: Evaluate for SBO History: abdominal pain, vomiting ABDOMEN:LUNGS BASES: Small basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy and stable mild intrahepatic biliary duct prominence. Common bile duct normal in size. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renocortical thinning and nonobstructing intrarenal calcifications, ureters difficult to follow along their courses, subcentimeter calcification in right lower quadrant may be a pelvic phlebolith, image 76 series 4. No evidence of hydronephrosis. Symmetric renal parenchymal enhancement. Left-sided renal cysts. Additional smaller hypoattenuating renal foci seen bilaterally, too small to characterize.RETROPERITONEUM, LYMPH NODES: Atherosclerotic abdominal aorta.BOWEL, MESENTERY: Mild prominence of proximal small bowel loops with relative decrease in caliber with respect to small bowel distally, nonspecific. Air and fluid seen distally in colon. Distended stomach containing large amount of ingested material, may be related to timing of exam. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Decreased osseous mineralization. Mild degenerative disease of spine and moderate to marked degenerative disease of bilateral hips. | 1. Distended stomach (suggestive of delayed gastric emptying) and mild prominence of proximal small bowel loops with relative decrease in caliber with respect to small bowel distally, nonspecific. Air and fluid seen distally in colon. Findings may reflect a partial small bowel obstruction but diffuse ileus also a consideration, followup with radiography may be pursued. |
Generate impression based on findings. | Spine painVIEWS: Lumbar spine AP Within the limitation of this single radiograph, no acute fracture identified. Moderate amount of fecal burden. | Within the limitation of this single radiograph, no acute fracture identified. |
Generate impression based on findings. | Spine painVIEWS: Thoracic spine AP Within the limitation of this single radiograph, no acute fracture identified. | No acute fracture identified in this single radiograph of the thoracic spine. |
Generate impression based on findings. | Female 82 years old; Reason: bleeding from colostomy site History: dropping hemoglobin, requiring multiple transfusions ABDOMEN:LUNGS BASES: Small pleural effusions and underlying atelectasis. Relatively hypoattenuated appearance of intracardiac blood pool compatible with anemia. LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: Lobulated pancreatic tail cystic focus, measuring 1.7 x 1 .1 cm, image 48 series 7, unchanged from earlier study and may be a sidebranch intraductal papillary mucinous neoplasm. ADRENAL GLANDS: Stable indeterminate bilateral adrenal thickening. KIDNEYS, URETERS: Unchanged appearance of kidneys, small perinephric stranding. Stable1 cm exophytic right renal lesion, image 36 series 80288. Additional unchanged left-sided lesions present, for example, 1.5-cm exophytic lesion, image 55 series 80288. Renal lesions characterized on prior imaging as probable complex cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Questionable very small amount of layering intraluminal hyperdensity on postcontrast imaging in anteriorly located right upper quadrant small bowel loop, image 58 series 9. Prominence of gastric rugae, may be due in part to underdistention but correlation with patient's clinical history recommended to exclude underlying gastritis. Multiple midline skin staples. Status post subtotal colectomy with formation of an ileostomy, unchanged small parastomal hernia, small adjacent parastomal induration/edema. Small presacral edema. Small pelvic and perihepatic ascites and fluid in gastrohepatic area.PELVIS:Left hip arthroplasty device with associated beam hardening artifact, making assessment suboptimal. UTERUS, ADNEXA: Uterus not seen, presumably related to prior hysterectomy.BLADDER: Foley catheter in underdistended urinary bladder, small air in bladder likely related to placement of aforementioned catheter. LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures not significantly changed, for example, left iliac sclerotic focus and multilevel degenerative changes of spine seen, most pronounced at L3/4 level. Small anasarca. | 1. Questionable very small amount of layering intraluminal hyperdensity on postcontrast imaging in anteriorly located right upper quadrant small bowel loop, image 58 series 9. Please refer to subsequent angiographic exam for additional findings. 2. Prominence of gastric rugae, may be due in part to underdistention but correlation with patient's clinical history recommended to exclude underlying gastritis. 3. Renal lesions again seen, characterized on prior imaging as probable complex cysts.4. Small pleural effusions and ascites, similar to earlier exam. |
Generate impression based on findings. | Male, 51 years old, history of left masticator space abscess status post drainage x 2. Redemonstrated is a rim enhancing, centrally hypoattenuating collection within the left masticator space involving predominantly the lateral pterygoid muscle. This collection measures 28 x 22 mm transaxial (previously 27 x 16 mm) and 22 mm craniocaudal (previously 21 mm).Ill-defined enhancing tissue extends from this collection anteriorly to the partially eroded posterior wall of the left maxillary sinus. Enhancement extends superiorly along the pterygomaxillary fissure to involve the pterygopalatine fossa which is widened. The anterior wall of the pterygopalatine fossa is eroded as well. Soft tissue thickening from the pterygopalatine fossa is beginning to enter into the orbital apex (see image 22 of series 80281).Sost tissue thickening seems to extend posteriorly from the masticator space abscess to involve the mandibular fossa of the left TMJ.Significant mucosal thickening and/or secretions remain evident within the left maxillary sinus. The left sided ethmoid air cells are partially opacified. The left sphenoid sinus is also opacified and the anterior wall is deficient at the level of the pterygopalatine fossa. Mild mucosal thickening is seen within the right sphenoid sinus. | The left masticator space abscess persists. Ill-defined enhancement extends from the abscess cavity to the posterior wall of the maxillary sinus, which is eroded, and along the pterygomaxillary fissure into the pterygopalatine fossa, the walls of which are also eroded. The left TMJ is questionably involved as well.The inflammatory/infectious process is beginning to enter the orbital apex via the pterygopalatine fossa. There would also be a theoretical potential for spread to the middle cranial fossa via the foramen rotundum, though the present CT shows no clear evidence of this as yet. Close clinical and/or imaging observation is suggested.Findings were discussed with Dr. Yesensky at 10:50 AM on 1/1/15. |
Generate impression based on findings. | Shortness of breath and tachycardia. PULMONARY ARTERIES: No significant abnormality noted.LUNGS AND PLEURA: Minimal linear atelectasis or scarring at both lung bases.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted, however. | No evidence of pulmonary embolism or other significant cardiopulmonary abnormality to account for the patient's symptoms.PULMONARY EMBOLISM: PE: None.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable moderate chronic small vessel ischemic changes. There are also unchanged foci of hypoattenuation within the bilateral thalami and basal ganglia, consistent with chronic lacunar infarctions. There is no extraaxial fluid collection. There are atheroscleroticcalcifications of bilateral internal carotid arteries. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. No acute intracranial hemorrhage. 2. Stable moderate small vessel ischemic changes. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern, MRI of the brain is recommended. |
Generate impression based on findings. | FeverVIEW: Chest AP 1/1/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | There are postoperative findings related to a right parietal craniectomy and cranioplasty with mesh placement. There is extensive encephalomalacia of the right parietal lobe with ex vacuo dilatation of the adjacent right lateral ventricle. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No significant interval change. No acute findings. |
Generate impression based on findings. | Female 48 years old; Reason: Evaluate current status of cancer. History of stage IIC ovarian cancer. Please examine bladder for invasion into bladder. History: hematuria, history of suboptimal debulking 9/2014 ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephroureteral stents. Left upper pole renal cyst. Additional renal foci seen that are too small to characterize, e.g., exophytic focus extending from left renal lower pole (coronal image 45) and left renal focus on coronal image 39. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate to large stool burden. PELVIS:UTERUS, ADNEXA, BLADDER: Rounded soft tissue attenuation seen in the expected region of the cervix extending upward into uterus/uterine bed, gaseous foci seen in area as well, see images 104 to 125 series 3, measures approximately 3.8 x 3.8 cm on transaxial imaging. Assessment for associated bladder invasion suboptimal particularly given underdistended state of bladder but no definite associated invasion delineated, no gaseous foci seen within bladder. If there is continued clinical concern for this, further characterization with MRI recommended due to superior tissue differentiation capability. BONES, SOFT TISSUES: Mild ventral abdominal subcutaneous induration/nodularity, may reflect postsurgical sequela. | 1.Rounded soft tissue attenuation seen in the region of cervix extending upward as above, gaseous foci seen in area as well. Assessment for associated bladder invasion suboptimal particularly given underdistended state of bladder but no definite associated invasion delineated, no gaseous foci seen within bladder. If there is continued clinical concern for this, further characterization with MRI recommended due to superior tissue differentiation capability. |
Generate impression based on findings. | Male 36 years old; Reason: Metabolic lung disease with progressive SOB, hx of hepatic liver failure s/p transplant x2, c/b by persistent cholestasis and renal insufficiency on HD. CHEST:LUNGS AND PLEURA: Interval decrease in small right pleural effusion. Remainder of visualized lung fields without significant change. As seen on prior imaging, extensive cauliflower-appearing confluent areas of calcification seen in bilateral lungs, additional areas of pulmonary nodularity and scattered sites of bronchiolitis also visualized.MEDIASTINUM AND HILA: Unchanged mildly prominent mediastinal and axillary lymph nodes. Hypoattenuating intracardiac blood pool suggestive of underlying anemia. Mild cardiac enlargement.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical sequela related to prior liver transplantation present. IVC filter visualized. SPLEEN: Splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts, majority appear to measure simple fluid, hyperdense cyst seen in left lower renal pole (image 117 series 3, associated Hounsfield units of 86 seen).BOWEL, MESENTERY: Poor opacification of bowel with oral contrast, particularly colon. Small to moderate proximal gastric wall thickening versus underdistention. Multiple mildly prominent subcentimeter mesenteric lymph nodes, similar to 2009 exam, and mild diffuse mesenteric induration. Thick walled ascending colon and hepatic flexure versus underdistention. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. | 1. Suboptimal exam secondary to absence of IV contrast and poor opacification of bowel with oral contrast, particularly colon. 2. Underdistention versus thickening of gastric and right colon, correlation with patient's clinical history/laboratory values recommended to exclude underlying gastritis and/or colitis.3. Interval decrease in small right pleural effusion. Remainder of visualized lung fields without significant change as above. |
Generate impression based on findings. | Female 21 years old; Reason: History of ulcerative pancolitis c/b primary sclerosing cholangitis admitted for vasculitic type rash now with 9/10 sharp epigastric pain. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Beaded appearance and narrowing involving the biliary system better delineated on prior MRI. Mild intrahepatic biliary duct prominence, common bile duct measures up to 6 mm proximally. 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: Paucity of intraabdominal fat makes evaluation suboptimal. Multiple mildly prominent mesenteric lymph nodes, nonspecific.BOWEL, MESENTERY: Normal appendix.PELVIS:UTERUS, ADNEXA: Tampon in place. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Left inferolateral body/pelvis excluded. | 1. Beaded appearance and narrowing involving the biliary system better delineated on prior MRI. Mild intrahepatic biliary duct prominence, common bile duct measures up to 6 mm proximally. 2. Multiple mildly prominent mesenteric lymph nodes, nonspecific, paucity of intraabdominal fat makes evaluation suboptimal. |
Generate impression based on findings. | Female 48 years old; Reason: assess firm nontender mass near right side of periumbilical area History: mass palpated over abdomen, gastroenteritis, n/v/d, periumbilical abdominal pain ABDOMEN:LUNGS BASES: 3-mm perifissural right middle lobe nodular focus, image 5 series 55, may be a lung nodule or lymph node and nonspecific. Mild right inferior breast nodularity, nonspecific, image 16 series 4.LIVER, BILIARY TRACT: Subcentimeter hepatic hypoattenuating foci, too small to characterize. Cholelithiasis, no secondary signs of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 1.7 x 1.5 cm indeterminate left adrenal nodule, image 42 series 4.KIDNEYS, URETERS: Mild ureteral prominence, particularly on the left. Symmetric renal parenchymal enhancement.BOWEL, MESENTERY: No secondary signs of acute appendicitis.PELVIS:UTERUS, ADNEXA: Markedly enlarged fibroid uterus, measuring approximately 19.1 cm in transverse dimension (including a reference subserosal leiomyoma, measuring 6.1 x 5.4 cm in the coronal plane, coronal image 68) by 17.4 cm in craniocaudal dimension by 12.6 cm in AP dimension. Fibroids seen appear to be primarily intramural in location. Fibroids exert mass effect on endometrial stripe. Small air/fluid seen in region of the endocervical canal, correlation with menstrual history recommended. Follicles seen in both ovaries.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Foci of subcutaneous gas in right gluteal region presumably related to prior injection. | 1. Enlarged fibroid uterus as described. Small air/fluid seen in region of the endocervical canal, correlation with menstrual history recommended. 2. Indeterminate left adrenal nodule, further characterization with dedicated contrast enhanced CT imaging or MRI recommended. 3. Mild right inferior breast nodularity, nonspecific, may be correlated mammographically. |
Generate impression based on findings. | Male 74 years old; Reason: Evaluate for infection, mass History: abdominal pain, PMH of multiple cancers ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Extensive pancreatic parenchymal atrophy and dystrophic calcifications seen throughout, likely reflecting sequela of chronic calcific pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy tube seen. Large stool burden, particularly in the rectum, which is distended. While no definite surrounding inflammation or wall thickening seen at this level, patient at risk for the development of stercoral colitis.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Distended bladder also seen.BONES, SOFT TISSUES: Soft tissue induration seen in medial right gluteal and perianal regions as well as deep to the sacrum, uncertain whether due in part to adjacent external material such as diaper, correlation with patient's clinical history and physical exam recommended to exclude decubitus ulcers. Visualized osseous structures without significant change, diffuse osseous demineralization, degenerative disease of spine and right hip heterotopic bone formation. | 1. Large stool burden, particularly in the distended rectum. While no definite surrounding inflammation or wall thickening seen at this level, patient at risk for the development of stercoral colitis.2. Soft tissue induration seen in medial right gluteal and perianal regions as well as deep to the sacrum, uncertain whether due in part to adjacent external material such as diaper, correlation with patient's clinical history and physical exam recommended to exclude decubitus ulcers. |
Generate impression based on findings. | Male 27 years old; Reason: c/f post op infection History: s/p b/l inguinal hernia repair 12/26, p/w fevers and abdominal pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Status post bilateral inguinal hernia repair. Small to moderate amount of subcutaneous/soft tissue emphysema, some extending into right hemiscrotum. Scattered locules of pneumoperitoneum. No discrete abscess or drainable fluid collection delineated. Schmorl's node at L3/4 level. Pars defects seen at L5/S1 level. | 1. Postoperative sequela, including scattered locules of pneumoperitoneum and small to moderate amount of subcutaneous/soft tissue emphysema, some extending into right hemiscrotum. No discrete abscess or drainable fluid collection delineated. |
Generate impression based on findings. | Abdominal distention Moderate stool burden. Interval removal of previously visualized stent. Small bowel distention, measuring up to approximately 4.3 cm. Air seen distally in colon and appearance may reflect postoperative ileus, but continued follow up recommended to exclude developing small bowel obstruction. Pelvic drainage catheter. Multiple skin staples. Please refer to concomitant chest radiography from same day for additional findings. | Postoperative sequela including interval removal of previously seen stent and drain placement. Dilated small bowel with air seen distally in colon, appearance may reflect postoperative ileus but continued follow up recommended to exclude developing small bowel obstruction. |
Generate impression based on findings. | Constipation Presumed percutaneous gastrostomy tube. Additional findings including lines/catheters essentially stable from prior study. Bowel gas pattern and distribution of enteric contrast without significant change. Stable osseous structures. Please refer to concomitant chest radiography from same day for additional findings. | Bowel gas pattern unchanged. |
Generate impression based on findings. | Male, 28 years old, with VP shunt, and headache. Evidence of midline suboccipital craniectomy is seen similar to prior. The CSF space is well expanded at the level of the foramen magnum. A catheter is seen approaching the dura at the level of the foramen magnum, but the field-of-view does not permit visualization of the point of entry into the subarachnoid space. The visualized extracranial components of the catheter appear intact.Brain parenchyma morphology and attenuation are within normal limits. No edema, loss of gray-white distinction or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and shape.Aside from surgical defects, the bones of the calvarium and skull base are intact. The visualized paranasal sinuses and mastoid air cells are clear. | 1. Redemonstration of midline suboccipital craniectomy similar to prior.2. A catheter is partially visualized approaching the dura at the level of the foramen magnum. The subarachnoid component of this catheter is not seen due to field of view . The extracranial components seem to be intact.3. Unremarkable evaluation of the brain parenchyma. |
Generate impression based on findings. | Abdominal pain, possible constipation Minimal to no formed stool delineated, possible small amount in region of splenic flexure, no bowel obstruction. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Evaluate for free air Multiple overlying lines make evaluation suboptimal.Persistent intramural gas/pneumatosis in region of cecum with associated/adjacent luminal prominence. No definite free intraperitoneal air. Nonobstructive bowel gas pattern. Enteric tube unchanged in position with tip in proximal jejunal region.Incompletely imaged post sternotomy sequela with multiple fragmented sternal wires and staples seen. | No definite free air, free intraperitoneal air was better delineated on prior CT imaging. |
Generate impression based on findings. | Male, 38 years old, headache, altered mental status, with shunt. The right frontal approach ventricular catheter is in stable position, tip at the midline at the level of the frontal horns. The right parietal approach ventricular catheter is also in stable position terminating at the mid body of the right lateral ventricle. An orphaned left sided catheter is unchanged as well.Since the prior examination, the ventricular caliber has significantly increased. For example, the trans-frontal diameter now measures up to 49 mm and previously measured 40 mm. The left temporal horn measures up to 20 mm and previously measured 10 mm.No evidence of intracranial hemorrhage is seen. No loss of gray-white distinction is detected.Aside from surgical alteration, the bones of the calvarium and skull base are intact. The paranasal sinuses and mastoid air cells as visualized are clear. | Interval increase in ventricular caliber. No other acute findings. |
Generate impression based on findings. | Evaluate position of gastrostomy tube Percutaneous gastrostomy tube seen projecting over expected area of mid to distal gastric body. More precise evaluation of tube location may be achieved with repeat radiographic imaging status post instillation of contrast via gastrostomy tube. Residual contrast seen throughout colon, colonic diverticulosis. Extensive upper abdominal radiodensities correspond to coarse calcifications related to pancreas, sequela of chronic calcific pancreatitis. Incompletely imaged left hip post surgical hardware. Decreased osseous mineralization and degenerative changes of spine and right hip. | Percutaneous gastrostomy tube as above.Please note that patient's pulmonary nodularity seen on prior CT imaging not well visualized on current exam. |
Generate impression based on findings. | Male, 67 years old, left upper extremity weakness. No evidence of loss of gray-white distinction, parenchymal edema or mass effect is seen. A small region of encephalomalacia is evident along the right middle temporal gyrus. No intracranial hemorrhage or any abnormal extra-axial fluid is detected. The ventricles are normal in size and morphology.A concavity of the right parietal bone is seen without fracture or obvious surgical findings. Elsewhere, the osseous structures of the skull and skull base are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. No evidence of acute ischemia is seen, but please note that CT is insensitive in this regard and if clinical suspicion is high, further evaluation with MRI would be appropriate.2. Encephalomalacia involving a small region of the right temporal lobe may reflect a chronic stroke or sequelae of remote injury.3. Concavity of the right parietal bone without fracture or clear evidence of surgical findings is of uncertain etiology. |
Generate impression based on findings. | Enteric tube placement Enteric tube seen just beyond gastroesophageal junction and further advancing by approximately 8 cm recommended. Incompletely imaged diffuse mild small bowel dilatation. Please refer to concomitant chest radiography and CT abdominal imaging from same day for additional findings. | Further advancing of enteric tube recommended. Incompletely imaged mild diffuse small bowel dilatation, please refer to concomitant CT abdominal imaging from same day for additional findings. |
Generate impression based on findings. | Male, 64 years old, altered mental status. Patchy periventricular hypoattenuation is seen along with scattered additional areas of hypoattenuation in the basal ganglia. These findings are probably not significantly changed from the prior exam.No evidence of mass effect or parenchymal edema is seen. No loss of gray-white distinction is suspected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid. The ventricular system is stable and within normal limits for size.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear. | 1. Age indeterminate microvascular ischemic disease.2. No definite evidence of any acute intracranial abnormality. |
Generate impression based on findings. | Female, 78 years old, with left cerebellar signs on exam, unclear duration. A band of mild hypoattenuation traverses the superior aspect of the left cerebellar hemisphere.Supratentorially, patchy periventricular hypoattenuation is seen. No loss of gray-white distinction is suspected in the cerebral hemispheres. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricles are normal in size. Calcification of the intradural vertebral arteries is seen.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells as visualized are clear. | 1. Hypoattenuation within the superior left cerebellar hemisphere is compatible with a SCA distribution stroke. The age of this lesion cannot be determined with certainty, but the CT appearance would suggest acute to subacute. Discussed with Dr. Wynne at 12:20 PM on 1/1/15.2. Supratentorially there is evidence of age indeterminate microvascular ischemic disease. No intracranial hemorrhage or significant mass effect is detected. |
Generate impression based on findings. | Knee pain status post fall No acute fracture or malalignment is identified. | No acute fracture or malalignment. |
Generate impression based on findings. | Bite with pain of right second digit. No acute fracture or malalignment. No radiopaque foreign body. | No significant radiographic abnormality of the right hand. |
Generate impression based on findings. | Cat bites. Pain first and fifth digits. No fracture or malalignment. No radiopaque foreign body. | No significant radiographic abnormality of the left hand. |
Generate impression based on findings. | Hyperextension injury. History of osteoarthritis. No acute fracture or malalignment. Chronic postsurgical changes with osteoarthritis and heterotopic ossification again noted. Suprapatellar joint effusion is seen. | No acute fracture or malalignment. |
Generate impression based on findings. | Heel pain. Evaluate for osteomyelitis or other pathology. No acute fracture or malalignment. No osseous destruction or periostitis to indicate osteomyelitis. No calcaneal abnormality visualized through correlate with patient's pain. No radiopaque foreign body. | No significant radiographic abnormality of the right foot identified. |
Generate impression based on findings. | Spine tenderness after motor vehicle accident. No fracture or malalignment identified. | No fracture or malalignment. |
Generate impression based on findings. | Fall to ground with cut on glass and right hand laceration. No fracture or malalignment. No radiopaque foreign body identified. | No significant radiographic abnormality of the right hand. |
Generate impression based on findings. | Neck tightness status post MVC. No acute fracture or malalignment. Prevertebral soft tissues are within normal limits. Straightening of the cervical lordosis may be secondary to positioning or muscle spasm. | No acute fracture or malalignment. |
Generate impression based on findings. | Worsening right shoulder pain No evidence of acute fracture or malalignment. Patchy sclerosis of the right humeral head consistent with osteonecrosis is not significantly changed. No evidence of subchondral collapse. | Stable osteonecrosis of the right humeral head without acute interval change. |
Generate impression based on findings. | Male 72 years old; Reason: G-Tube fell out overnight, s/p 16FR catheter insertion into pt's g-tube site; check for position History: None Mild distention of small and large bowel which may represent a developing ileus. Catheter tube tip projects over the mid-abdomen. Dense calcifications are visualized in the pancreas representing chronic pancreatitis. Retained contrast is visualized in colon with innumerable diverticula. | Catheter tube tip projects over the mid-abdomen. |
Generate impression based on findings. | Male 54 years old; Reason: placement of new Dobbhoff History: placement of new Dobbhoff. Note that the pelvis was not included in the exam. The feeding tube tip projects over the antrum of the stomach. Nonobstructive bowel gas pattern. Central venous catheter terminates at the superior cavoatrial junction. | Dobbhoff tube tip in the antrum of the stomach. |
Generate impression based on findings. | Male 65 years old; Reason: eval for SBO History: see above Nonobstructive bowel gas pattern. Gastrostomy tube projects over the body of the stomach. Retained contrast in the colon. Large amount of stool, gas and retained contrast projects over the lower pelvis. Surgical clips are noted in the left upper quadrant. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 38 years old; Reason: r/o peritonitis, free air History: lactic acidosis Nonobstructive bowel gas pattern. Interval removal of the nasogastric tube. IVC filter projects over the T12-L1 level. No evidence of large pneumoperitoneum. Coiled catheter device projects over the pelvis. | No pneumoperitoneum within the limitations of a supine radiograph. Upright or lateral decubitus radiographs are recommended to evaluate free air in the abdomen. |
Generate impression based on findings. | 48 years old, Male, Reason: s/p total proctocolectomy with persistent abd pain History: pain ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Prominence of the collecting systems bilaterally with some perinephric stranding. This is nonspecific in the setting of recent abdominal surgery. Lack of IV contrast limits evaluation kidney parenchyma. Nonobstructing nephrolithiasis on the right.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes related to a total proctocolectomy with a right lower quadrant ostomy and partially dehisced abdominal wound. There is mildly heterogeneous fluid within the dependent portion of the pelvis likely postprocedural in etiology and reflecting an evolving hematoma. Several loops of dilated small bowel measuring up to 4.3 cm in maximum dimension are present in the left upper quadrant. There appears to be a multiple transition points consistent with multifocal partial obstruction, likely due to adhesions. The distal bowel is decompressed and contrast is not seen entering the distal bowel or into the ostomy. No evidence of pneumatosis There is a small fluid collection adjacent to a loop of bowel in the right lower quadrant measuring approximately (image 122, series 80212), which is nonspecific in the setting of recent surgery.BONES, SOFT TISSUES: Midline abdominal wound which appears partially dehisced.OTHER: Trace pneumoperitoneum is likely postprocedural in etiology.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air is seen within the urinary bladder, likely iatrogenic in etiology.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See abdomen section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Several loops of proximal dilated small bowel with multiple points of transition and bowel collapsed distally which is favored to represent multifocal partial bowel obstruction secondary to adhesions. |
Generate impression based on findings. | 63-year-old male with intracranial hemorrhage Redemonstrated are postsurgical changes of right parietal craniotomy for hematoma evacuation. Continued expected evolution of the patient's previously demonstrated right hemispheric hematoma is noted with decreasing density and developing encephalomalacia. Mass-effect is decreasing as well, with right to left midline shift measuring 3 mm (previously 5 mm). Blood products within the lateral ventricles has resolved. There are no findings of interval new hemorrhage.There is a focus of encephalomalacia involving the right inferior frontal lobe, presumably related to remote trauma. Mucosal thickening within the maxillary sinuses and ethmoid air cells as well as fluid in the sphenoid sinus, mastoid air cells, and middle ears has improved. | Continued expected evolution of the patient's previously demonstrated right hemispheric hematoma is noted with decreasing density and developing encephalomalacia. Mass-effect is decreasing as well, with right to left midline shift measuring 3 mm (previously 5 mm). There are no findings of interval new hemorrhage. |
Generate impression based on findings. | Male 52 years old; Reason: Evaluate for free air History: abdominal pain, pneumatosis Persistent intramural gas/pneumatosis in region of cecum with associated/adjacent luminal prominence appearing similar to previous exam. No definite free intraperitoneal air. Nonobstructive bowel gas pattern. Enteric tube unchanged in position with tip in proximal jejunal region. Incompletely imaged post sternotomy sequela with multiple fragmented sternal wires and staples seen. | Persistent pneumatosis without definite free air. |
Generate impression based on findings. | 37 year-old female with persistent sinus tachycardia. Rule out pulmonary embolus. PULMONARY ARTERIES: Technically adequate study without evidence of pulmonary embolus. No evidence of right heart strain.LUNGS AND PLEURA: Suboptimal evaluation of the lung bases secondary to respiratory motion. Right apical scarring/atelectasis. 4-mm nodule along the right major fissure. Most consistent with an intrapulmonary lymph node. No pleural effusion or pneumothorax. There is mild bibasilar bronchiectasis. MEDIASTINUM AND HILA: The upper thoracic esophagus is patulous and air-filled. No coronary artery calcifications are identified. CHEST WALL: Superior and inferior endplate irregularity of the midthoracic vertebral bodies, likely representing Schmorl's nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolus or other acute cardiopulmonary findings. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 48 year-old male status post orthotopic liver transplant x 2. CT concerning for proximal portal vein thrombus. This study is limited due to overlying surgical dressings. LIMITED ABDOMENLIVER: The liver parenchyma is minimally coarsened. No intrahepatic biliary ductal dilatation is evident. | 1. Difficult identification of the main portal vein with diminished hepatopetal flow in the main portal vein versus flow within a collateral vessel in the porta hepatis; findings compatible with evolving portal vein thrombus as suspected on CT. No evidence of cavernous transformation at this time. 2. Perihepatic/intra-abdominal fluid collections and right pleural effusion as better seen on CT. |
Generate impression based on findings. | 84-year-old male status post subdural hemorrhage evacuation experiencing altered mental status Redemonstrated are two burr holes within the right parietal bone for prior right hemispheric subdural evacuation. The more posterior burr hole conveys a drainage catheter which enters the right-sided subdural space, unchanged in position. Right-sided scalp swelling is compatible with recent instrumentation. Pneumocephalus has nearly resolved. Residual dense blood products are unchanged without evidence of interval rehemorrhage. Continued decreased density right hemispheric subdural fluid is again noted. Mass-effect on the right cerebral hemisphere has improved and only a trace midline shift to the left persists. No loss of gray-white distinction is seen to suggest ischemic injury. No new parenchymal abnormalities are detected. | Continued expected changes status post subdural evacuation with no evidence of rehemorrhage. |
Generate impression based on findings. | Male 62 years old; Reason: eval Dobbhoff placement History: Dobbhoff. Note that the pelvis was not included in this exam. Multiple nonspecific distended loops of bowel. Feeding tube terminates in the body of the stomach. Multiple densities likely represent retained contrast within diverticula. Postsurgical changes in the mediastinum, LVAD and AICD/pacer seen. Hepatomegaly and left retrocardiac opacity again seen. | Dobbhoff tube terminates in the body of the stomach.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | History of lower abdominal pain and leukocytosis, evaluate perisigmoid abscess. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation noted in the bowel in the abdomen. Please see pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is persistent wall thickening affecting the rectosigmoid colon with the previously described adjacent stranding appearing slightly improved compared with the prior exam. No drainable fluid collection is identified. There is no evidence of bowel obstruction or pneumoperitoneum. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Colitis of the rectosigmoid colon with slight interval improvement in surrounding inflammation and without abscess. |
Generate impression based on findings. | 57-year-old female with nonhealing wound of right foot, evaluate for osteomyelitis The bones are demineralized. There is ulceration along the dorsal soft tissues of the foot without specific radiographic features of osteomyelitis. Mild cortical irregularity of the head of the proximal phalanx of the great toe may reflect old trauma. Mild degenerative arthritic changes affect the foot. | Soft tissue ulceration without specific radiographic evidence of osteomyelitis. |
Generate impression based on findings. | 66-year-old female with right hip pain No fracture is evident. Mild osteoarthritis affects the right hip. There appears to be slight soft tissue thickening adjacent to the bones of the hip which may reflect mild synovitis. A focal defect within the anterior femoral head could represent a chronic erosion or simply a manifestation of the patient's underlying osteopenia, but this is unchanged from January 2014 Arterial calcifications are noted in the soft tissue. The rectum is distended with stool. Fibroid uterus. | Degenerative arthritic changes and other findings as above without fracture evident. If there is strong clinical concern for fracture, MRI may be considered. |
Generate impression based on findings. | Headache. Question of intracranial lesion. There is no evidence of acute intracranial hemorrhage. A previously described area of hypoattenuation within the left frontal lobe is slightly more defined compared to the prior exam and compatible with a chronic ischemic infarct. Mild periventricular white matter hypoattenuation is nonspecific but likely represents small vessel ischemic disease. The ventricles are stable in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. No acute intracranial hemorrhage.2. Chronic left frontal lobe ischemic infarct.3. Age-indeterminate small vessel ischemic disease. |
Generate impression based on findings. | Male 3 months old; Reason: evaluate for focal process History: increased work of breathing, desatsVIEW: Chest AP (one view) 1/2/15 0650 Enteric tube tip is at the GE junction.The mediastinum remains right shifted. Otherwise, the cardiothymic silhouette is normal.Coarse bilateral lung opacities with innumerable round lucencies persist. No focal lung opacities are present.Multiple healing rib fractures are again noted. | Unchanged PIE. |
Generate impression based on findings. | Female 42 years old; Reason: check ngt placement History: ngt placed Note that the pelvis was not included in this exam. Persistently dilated loops of bowel compatible with a ileus or obstruction. Nasogastric tube tip projects over the fundus of the stomach with the sidehole beyond the gastroesophageal junction. Skin staples are visualized along the left paramedian abdomen. | Nasogastric tube tip in the fundus of the stomach with the sidehole beyond the gastroesophageal junction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | History of hematemesis, evaluate for abdominal mass. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated compressive atelectasis.LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. High-density material within the gallbladder lumen may reflect vicariously excreted contrast material.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small/moderate ascites with associated diffuse mesenteric haziness. Metallic densities within the gastric fundus and cardia presumably postprocedural in etiology, although clinical correlation is recommended. Mild prominence of the small bowel without transition point consistent with mild ileus pattern.BONES, SOFT TISSUES: Moderate body wall edema.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter with tip in bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small/moderate ascites with associated diffuse mesenteric haziness. Mild prominence of the small bowel without transition point consistent with mild ileus pattern.BONES, SOFT TISSUES: Moderate body wall edema.OTHER: No significant abnormality noted | 1.Cirrhotic liver and small/moderate ascites.2.No discrete masses or acute abnormalities identified.3.Mild ileus pattern. |
Generate impression based on findings. | Reason: ESRD, RV dysfunction, question of PE History: SOB PULMONARY ARTERIES: Exam is technically limited to the segmental pulmonary arteries. Given this limitation, no pulmonary embolus is identified. The main pulmonary artery is enlarged, suggesting pulmonary arterial hypertension.LUNGS AND PLEURA: No significant consolidation or pleural effusions.Basilar atelectasis, which is likely accentuated given partial expiratory phase of imaging.MEDIASTINUM AND HILA: The heart is markedly enlarged, small pericardial effusion, increased compared to previous exam.Severe coronary artery calcifications. Reflux of contrast into the IVC suggests right heart insufficiency.Right paratracheal node measures 18 mm in short axis (series 11, image 71), nonspecific, likely reactive.Persistent loculated ascitic fluid along the right lateral esophagus.CHEST WALL: Gynecomastia.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Widening in the hepatic fissures and hypertrophy of the caudate suggests chronic liver disease. There is moderate volume ascites.Severely atrophic kidneys. Left adrenal nodule appears stable but is not fully characterized on this exam. Severe atherosclerotic calcification of the abdominal aorta and its branches. | 1. Technically limited study. Given the limitations, no pulmonary embolism to segmental level.2. Cardiomegaly and reflux of contrast into the IVC are compatible with CHF.3. Evidence of chronic liver disease and moderate volume ascites.4. Severe coronary artery calcifications and atherosclerotic disease of the aorta and its branches.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 3 months old; Reason: where is PCVC History: line dislodgment.VIEW: Chest AP and Abdomen AP (two views) 1/1/15, 1951 Enteric tube tip is at the GE junction. The right lower extremity PICC tip is in a right iliac vein.The mediastinum remains right shifted. Otherwise, the cardiothymic silhouette is normal.Coarse bilateral lung opacities with innumerable round lucencies persist. No focal lung opacities are present.Multiple healing rib fractures are again noted. The inguinal hernia is partially imaged.The bowel gas pattern is disorganized and nonobstructive. No pneumatosis, portal venous gas, or pneumoperitoneum is present. | Unchanged PIE. Retracted right PICC. |
Generate impression based on findings. | 43 year old female with right foot pain Orthopedic screws affix the first tarsometatarsal joint. The articulation remains visible. Mild first metatarsal head deformity is presumably postoperative. Transverse lucency through the base of second metatarsal could represent a fracture if there is pain at this site, and may be subacute in etiology. | Postoperative changes as above. Poorly defined lucency at the base of second metatarsal may reflect a fracture if there is pain at this site. |
Generate impression based on findings. | 63 year old female with history of alcohol intoxication and fall. Head: There is marked diffuse enlargement of the ventricles and basal cisterns which is out of proportion to the cortical sulcal prominence, appearing similar to prior. Additionally, there is diffuse confluent periventricular and subcortical white matter hypoattenuation compatible with chronic ischemic small vessel disease. There is no evidence of intracranial hemorrhage. No midline shift or mass effect. The right lamina papyracea is bowed medially likely compatible with chronic trauma. There is a chronic left nasal bridge fracture. The remaining visualized paranasal sinuses are unremarkable. The mastoid air cells are clear.Maxillofacial: There is no acute fracture or dislocation. There is a chronic left nasal bridge fracture. The right lamina papyracea is bowed medially compatible with chronic trauma. There is an S-shaped nasal septum. The patient is nearly completely edentulous with a single impacted right mandibular molar remaining.Cervical spine: There is no acute fracture or subluxation. There is straightening of the normal cervical lordosis which could be secondary to positioning or spasm. The visualized lung bases are unremarkable.C1-2: No significant abnormality noted. The neuroforamina are grossly patent.C2-3: No significant abnormality noted. The neuroforamina are grossly patent.C3-4: There is mild annular disk bulge causing mild spinal canal stenosis. The neural foramina are grossly patent.C4-5: There is mild annular disk bulge and disk space narrowing causing mild canal stenosis. The neural foramina are grossly patent.C5-6: There is severe degenerative disk disease with anterior and posterior osteophytes with moderate to severe narrowing of the spinal canal. The neuroforamina are grossly patent.C6-7: There is moderate disc space narrowing and mild annular disk bulge. The neuroforamina are grossly patent.C7-T1: There is no significant abnormality noted. The neuroforamina are patent. | 1.No evidence of intracranial hemorrhage.2.Chronic traumatic deformities of the right lamina papyracea and left nasal bridge. No acute fractures are identified.3.Diffuse enlargement of the ventricles as well as chronic small vessel ischemic disease appearing similar to prior. This pattern can be seen with normal pressure hydrocephalus.4.Degenerative disease of the cervical spine as above. |
Generate impression based on findings. | 45 year-old female with third and fourth toe pain post injury No fracture is evident. Tiny midfoot osteophytes reflect minimal osteoarthritis. | No fracture evident. |
Generate impression based on findings. | Male 48 years old; Reason: NGT replaced History: NGT replaced Note that the pelvis was not included in the exam. The nasogastric tube curls in the body of the stomach with the tip in the fundus. Multiple dilated loops of bowel are nonspecific but may represent an ileus or bowel obstruction. The central venous catheter tip projects over the right atrium. Surgical staples overlie the midline. Bibasilar pulmonary opacities. | Nasogastric tube tip in the fundus of the stomach.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 48 years old; Reason: NGT History: NGT Note that the pelvis was not included on this exam. Severely distended stomach and dilated loops of bowel compatible with obstruction or ileus. Nasogastric tube tip is in the body of the stomach but the sidehole is at or above the gastroesophageal junction. A central venous catheter tip projects over the right atrium. Skin staples overlie the midline. | Nasogastric tube with sidehole at or above the gastroesophageal junction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 26-year-old male with bilateral wrist pain post motor vehicle collision 5 days ago There is mild soft tissue swelling along the radial aspect of the wrist without evidence of fracture. | Soft tissue swelling without fracture evident. |
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