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Generate impression based on findings. | Female, 45 years old. Fall, now with medial knee pain and instability MENISCI: The posterior horn of the medial meniscus shows intrasubstance intermediate signal compatible with degeneration, without discrete meniscal tear identified. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. No focal articular cartilage defects are identified.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Degeneration of the posterior horn of the medial meniscus without discrete meniscal tear identified. |
Generate impression based on findings. | 33-year-old male with ulcerative colitis and primary sclerosing cholangitis. Assess for stricturing or suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. Subcentimeter T2 hyperintense focus in hepatic segment one that begins to fill in on delayed postcontrast images compatible with slow filling hemangioma, unchanged. No focal suspicious hepatic lesion is identified. The gallbladder is normally distended without cholelithiasis.There is mild dilation of the intrahepatic bile ducts and the common duct. The common duct measures up to 11 mm with smooth tapering near the level of the ampulla suggestive of distal common bile duct stricture, unchanged. There is mild scattered intrahepatic biliary ductal dilatation and extensive areas of bleeding of the intrahepatic biliary ducts, configuration is not significantly changed since the previous exam. No abnormal biliary ductal enhancement.The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances normally. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Symmetric renal enhancement without focal lesion.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.Stable mild intrahepatic and common bile duct dilation with suggestion of stricture near the level of the ampulla.2.Areas of intrahepatic biliary beading the configuration of which is not significantly changed. |
Generate impression based on findings. | Compared to 12/10/2015, interval evolution of postoperative changes at the C1 and C2 levels related to tumor resection are seen. Postoperative epidural blood products and fluid collection have resolved with reexpansion of the thecal sac. Minimal residual intradural enhancement is seen without mass effect. Residual extradural tumor remains at these levels similar to prior without mass effect on the thecal sac. Increased enhancement is noted in the midline paraspinous soft tissues consistent with postoperative change.Enhancing mildly expansile masses are seen at all levels in the cervical neural foramina which are not significantly changed since prior and without significant intraspinal extension. The previously noted enhancing oval mass in the left posterior paraspinal soft tissues at C2 measures 30 x 18 mm x 30 which is not significantly changed for differences in measurement technique although gradually enlarged since study from 8/8/2013 when this mass measured approximately 19 x 14 x 24 mm.Enhancing mass involving the left upper thoracic neural foramen extending into the lung apex is partially imaged. No expansile intramedullary lesions are seen. There is T2 hyperintensity with significant volume loss involving the cervical cord at the C2 level consistent with myelomalacia. Kyphosis of the cervical spine with apex at C4 is again seen, not significantly changed. Vertebral body heights are maintained. No concerning marrow replacement is seen. Multiple prior cervical laminectomies are noted extending inferiorly to the C5 level. There is no significant spinal canal stenosis at any level. | 1. Compared to 12/10/2015, there has been evolution of postsurgical changes related to intradural and extradural tumor resection at C1 and C2. There has been resolution of the previously seen postoperative fluid and blood products which were previously effacing the thecal sac. There is no residual mass effect on the thecal sac. Noted is T2 hyperintensity and moderate focal volume loss involving the cervical cord at the C1-C2 level compatible with myelomalacia and presumably related to previous chronic compression. 2. Multiple additional neurofibromas involving the cervical spine and paraspinous soft tissues demonstrate no significant interval change. No findings to suggest intramedullary neoplasm.3. Left posterior paraspinous soft tissues lesion at the C2 level demonstrates enlargement compared to 2013. |
Generate impression based on findings. | Clinical question: Evaluate for low grade disseminated glial tumor. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Examination demonstrates extensive bilateral frontal white matter flair hyperintensity and with resultant ex vacuo dilatation of ventricles without evidence of appreciable interval change since prior exam. Extensive susceptibility signal changes primarily in the frontal horn of the left lateral ventricle remains similar to prior exam. Also similar to prior exam there is a thin fairly uniform band of enhancement along the ependymal lining of left frontal horn and body of lateral ventricle.Also stable since prior exam are additional nonenhancing patchy foci of flair hyperintensity in the periventricular white matter of the cerebral hemispheres as well as bilateral basal ganglia. There is no detectable new foci of flair hyperintensity or abnormal enhancement since prior study.Prominence of cortical sulci for patient's stated age of 51 similar to prior exam and suggestive of underlying parenchymal volume loss.Unremarkable calvarium and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhances.All visualized paranasal sinuses demonstrate normal pneumatization signal pattern. | 1.No evidence of an acute or new finding since prior study.2.Diffuse bilateral anterior frontal encephalomalacia, ex vacuo dilatation of the ventricles and a thin uniform enhancement along the ependymal lining of the left frontal horn remains similar to prior exam. |
Generate impression based on findings. | Multiple sclerosis: paresthesias. There is no significant interval change in the multiple white matter lesions that are predominantly in a periventricular distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No significant interval change in the intracranial demyelinating lesions. |
Generate impression based on findings. | MRI Brain: There is no diffusion abnormality. No intracranial mass or mass effect. There is scattered mild T2/Flair signal abnormality in the periventricular and subcortical regions which is nonspecific but likely from small vessel ischemic changes. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Incidental note is made of a mucous retention cyst or polyp in the right sphenoid sinus.MRA Head: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. The right AICA is not visualized. No evidence of aneurysms or vascular malformations. | 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Mild chronic small vessel ischemic changes.3.MRA of the brain within normal limits. |
Generate impression based on findings. | Bilateral upper extremity weakness and hyperreflexia, status post MVA Cervical: Craniovertebral junction appears within normal limits. There is evidence of osseous fusion involving the C5-C7 vertebral bodies which is postsurgical. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild loss of cervical lordosis. Bone marrow signal is benign with T1 hyperintense lesion involving the C7 vertebral body compatible with a hemangioma..The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No significant compromise to the spinal canal or left neural foramen.C4-5: Disc osteophyte complex and prominent uncovertebral hypertrophy on the left. There is partial effacement of the ventral thecal sac without significant spinal canal stenosis at this level overall. There is moderate left and mild right neural foraminal stenosis.C5-6: No significant compromise to the spinal canal or neural foramina. There is mild effacement of the ventral thecal sac.C6-7: No significant compromise to the spinal canal or neural foramina. There is mild effacement of the ventral thecal sac.C7-T1: There is mild left neural foraminal stenosis related to facet arthropathy. No significant compromise to the spinal canal or right neural foramen.Small perineural cysts incidentally noted at C6-C7 and C7-T1. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic: Thoracic vertebral body heights are maintained. Alignment is maintained. There is trace prominence of the central canal/tiny syrinx involving the lower thoracic cord, measures 1.3 mm in the AP dimension, and is of doubtful significance. Thoracic cord signal is otherwise unremarkable. Bone marrow signal is benign with no suspicious lesions. Scattered foci of T1 hyperintensity are compatible with hemangiomas and focal fat.No significant spinal canal stenosis is seen. Degenerative changes include partial effacement of the dorsal thecal sac at the T9-T10 level related to ligamentum flavum thickening and facet arthropathy. There is mild right T1-T2 neural foraminal stenosis. There is also mild neural foraminal stenosis at the T5-T6 and T6-7 levels. Small multiple Schmorl's nodes are noted in the lower thoracic spine.T2 hyperintense lesion is partially imaged involving the right hepatic lobe. Small left renal cyst is also noted. | 1. Evidence of remote anterior cervical fusion involving the C5 to C7 vertebral bodies. There is no evidence of high-grade spinal canal stenosis at any level in the cervical spine or evidence of cervical cord signal abnormality.2. Adjacent segment disease with degenerative changes at C4-C5, where there is moderate left and mild right neural foraminal stenosis. There is also partial effacement of the ventral thecal sac at the C4-C5, C5-C6, and C6-C7 levels. Additional levels as detailed above.3. Mild degenerative changes in the thoracic spine without significant spinal canal stenosis at any level. There is trace prominence of the central canal in the distal thoracic cord which is of doubtful clinical significance. Thoracic cord signal is otherwise unremarkable. |
Generate impression based on findings. | Male, 70 years old, with elevated protein in CSF, nuchal rigidity, status post OHT. Cervical:Within the limitations of a motion degraded exam, the following observations are made. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. Minimal disc osteophyte formation is seen without high-grade spinal canal stenosis. At most minimal scattered foraminal narrowing is demonstrated.Thoracic:Within the limitations of a motion degraded exam, the following observations are made. A mild scoliotic curvature is seen. Sagittal alignment is within normal limits. Mild anterior wedging of the T6 vertebral body is seen without marrow edema. The remaining vertebral bodies demonstrate preservation of height. No pathologic marrow replacement or edema is detected. The spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are seen. Mild scattered disc degeneration is seen without significant spinal canal or foraminal compromise. Small pleural effusions are seen bilaterally.Lumbar:Within the limitations of a motion degraded exam, the following observations are made. Grade 1 retrolisthesis of L2 relative to L3 and L3 relative to L4 is seen. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous with scattered Schmorl's node deformities. However, no pathologic marrow replacement or edema is detected.A fluid-fluid level is evident dependently within the sacral thecal sac. In addition, the distal cauda equina nerve roots are clumped and disorganized with intermixed T1 hyperintense strands. The distal spinal cord and conus are unremarkable. No epidural abnormalities are suspected.L1-2: Loss of disc T2 signal but no significant compromise of the spinal canal or neural foramina. L2-3: Loss of disc T2 signal and disc bulging with a left far lateral annular fissure. No significant compromise of the spinal canal. Mild narrowing of the neural foramina. L3-4: Loss of disc T2 signal. Mild disc bulging. Mild compromise of the spinal canal and neural foramina. L4-5: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild compromise of the neural foramina. L5-S1: Moderate facet arthropathy. Mild disc bulging. No significant compromise spinal canal. Mild narrowing of the left neural foramen. | 1.A fluid-fluid level is evident layering dependently within the sacral thecal sac along with clumping and disorganization of the nerve roots and intermixed T1 hyperintense strands. This is favored to represent blood degradation product with scattered blood clots. The possibility of infection is not excluded, and infection may certainly coexist with hemorrhage. However, meningitis on its own typically does not produce this amount of gross intrathecal debris.2.Very mild disc degeneration is seen in the cervical and thoracic spine with moderate degenerative findings in the lumbar spine. No areas of high-grade spinal canal stenosis are detected. |
Generate impression based on findings. | MRI CARDIAC W/FLOW W/STRESS WWO, 11/16/2016 8:15 AM First Pass PerfusionDuring hyperemia, no perfusion defects were present. Mild dark rim artifact is present. Viability/ Myocardial ScarThere is mid-myocardial late gadolinium enhancement of the septum from the mid wall to the base which represents an infiltrative process, inflammation, or fibrosis. The finding is not typical for prior myocardial infarction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 161 ml/m2 (normal range: 65+/-11), the LVEDV is 334 ml (normal range 109+/-23), the LV end systolic volume index is 133 ml/m2 (normal range 18+/-5), the LVESV is 277 ml (normal range 31+/-10), the LV mass index is 41 g/m2, and the LV mass is 69 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 17%, the RV end diastolic volume index is 117 ml/m2 (normal range 69+/-14), the RVEDV is 243 ml (normal range 110+/-24), the RV end systolic volume index is 97 ml/m2 (normal range 22+/-8), and the RVESV is 200 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is mildly dilated. 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 mildly dilatedVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions (right greater than left). 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. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of any vasodilator stress test is likely reduced in the face of severe LV dilation and dysfunction. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 17%). There is evidence of myocardial fibrosis involving the mid-myocardial layer of the basal septum. This finding is not typical for prior myocardial infarction and has been commonly described in non-ischemic/ dilated cardiomyopathy. 4. The right ventricle is severely dilated with severely reduced systolic function (RVEF 17%).5. At least moderate mitral regurgitation.6. Severe biatrial enlargement.7. Mild dilation of main pulmonary artery and aortic root. 8. Small pericardial and pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 75 year old female with a history of hepatic mass. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without evidence of cirrhosis. There is a 4.8 x 4.2 cm lobulated mass in segment 2/3 of the liver with associated central scar, slight increased T2 signal abnormality and homogeneous enhancement on postcontrast sequences, which persists on the two and half hour delayed contrast enhanced sequence. These findings are most consistent with a benign FNH in a non cirrhotic liver. There is no washout on delayed postcontrast sequences.Simple cyst in the right lobe of the liver. The gallbladder is filled with numerous gallstones without evidence of acute cholecystitis. No intra hepatic biliary ductal dilation is identified. There is dilation of the common duct measuring up to 9 mm in diameter. Note is made of numerous common duct stones measuring up to 3 mm in diameter, which appear similar to the prior study performed at an outside hospital.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of a 10.0 cm simple cyst in the interpolar region of the left kidney.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. | 1.4.8-cm mass in the left lobe of the liver with imaging characteristics most consistent with an benign FNH, as detailed above.2.Choledocholithiasis with slight dilation of the common bile duct.3.Innumerable gallstones without evidence of acute cholecystitis. |
Generate impression based on findings. | 71-year-old female with history of COPD, hundred pack year smoker infiltrate on CXR. Assess for infiltrate versus oncologic process. Limited examination due to lack of contrast. MRI may be considered for further evaluation.BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.NECK:Limited value of the exam due to lack of contrast. With this limitation, imaging through the skull base and the cavernous sinus is unremarkable. Examination demonstrates no evidence of mass or pathologic lymphadenopathy in the neck. The airway and vasculature are patent. The osseous structures are intact. Effacement of the pyriform sinus is stable when compared to previous examinations dating back as far as one year ago 05/20/07.Limited view of the chest shows bilateral apical scarring. | Stable examination without evidence of an oncologic process as clinically questioned. |
Generate impression based on findings. | 60-year-old female with popping, locking and catching. Mild osteoarthritis on recent radiographs. Evaluate medial meniscus. MENISCI: Note is made of increased branching linear signal abnormality within the posterior of the medial meniscus which extends to the tibial and femoral articular surface consistent with a complex tear with both a radial and horizontal component. There is also linear increased signal abnormality within the posterior horn and body of the medial meniscus which does not definitively extend to either articular surface. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow signal abnormality within the medial aspect of the tibial plateau and to a lesser degree within the medial femoral condyle consistent with bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified. There is a partial-thickness articular cartilage fissure along the lateral facet of the patella, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Tearing of the medial meniscus as described above.2. Partial-thickness articular cartilage fissure along the patella and bone contusions as described above. 3. Small joint effusion. Other findings as described above. |
Generate impression based on findings. | Known cavernoma: surveillance. There is a mass with circumferential susceptibility effect and internal high T1 and T2 signal components that measures 15 mm in diameter in the right inferior frontal lobe, adjacent to the basal ganglia. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of vasogenic edema 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, skull, and scalp soft tissues are grossly unremarkable. There are bilateral small maxillary sinus retention cysts. | A right inferior frontal lobe cavernous malformation measures 15 mm. |
Generate impression based on findings. | Clinical question: Arnold-Chiari evaluate for syrinx. Signs and symptoms: dysphagia. Unenhanced cervical spine MRI:There is herniation of cerebellar tonsils to the foramen magnum of approximately 8.5 mm and with subtle flattening deformity of the tonsil. Findings consistent with Chiari malformation.There is normal signal intensity and caliber the cervical cord and without evidence of syrinx.There is normal anatomical development of cervical vertebral column and no evidence of spinal canal or neural foraminal compromise.Nonenhanced thoracic spine MRI:There is normal anatomical development, alignment and signal intensity of the vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of spinal canal or neuroforaminal compromise.Nonenhanced lumbar spine MRI:There are 6 lumbar type vertebral bodies which is an anatomical variation. There is no detectable congenital malformation of the vertebral column.There is normal signal intensity of the conus and with termination of the cord at L1 -- L2 disk level.There is normal signal intensity and morphology of cauda equina and in particular there is no evidence of fatty filum or tethered cord.The perispinal soft tissues are unremarkable. | 1.MRI of the cervical spine demonstrate 8.5-mm herniation of cerebellar tonsils through the foramen magnum with mild flattening deformity. Unremarkable MRI of cervical spine otherwise in particular without evidence of syrinx.2.Nonenhanced MRI of thoracic spine is unremarkable.3.Nonenhanced MRI of the lumber spine demonstrates 6 lumbar type vertebrae which is a normal anatomical variation. There is normal signal intensity and morphology of the conus and cauda equina without evidence of abnormalities. There is termination of the cord at L1 -- L2 level. |
Generate impression based on findings. | Limited sagittal images of the entire spine do not demonstrate any evidence of acute cord compression. Vertebral body heights are grossly preserved. There is nonspecific, patchy increased STIR signal within the T3 vertebral body with corresponding decreased T1 signal. There is no associated apparent destruction of the T3 vertebral body. Soft tissue edema is present within the lumbar posterior subcutaneous soft tissues which is nonspecific. | 1.No evidence of acute cord compression. 2.Bone marrow signal abnormality within the T3 vertebral body is nonspecific and could be related to both benign or malignant etiologies. CT can be considered for further evaluation to assess bony integrity. Discussed with SANTOS DE LIMA, FABIANE. |
Generate impression based on findings. | Reason: Patient w/ R. Hip and groin pain X 1 wk, please evaluate for dislocation/ fracture History: As above On the AP view, there is a step-off of the cortex along the medial aspect of the femoral head/neck junction. The underlying trabeculae do not appear disrupted and this is not clearly evident on the frog-leg lateral view. We suspect this represents a peculiar osteophyte, but if there is strong clinical concern for an acute fracture, MRI could be considered. | Step-off of the cortex along the medial aspect of the femoral head/neck junction. While we suspect this represents a peculiar osteophyte, if there is strong clinical concern for an acute fracture, MRI could be considered. These findings were discussed with Dr. Soundarrajan by phone at 12:30 PM on 3/30/2016. |
Generate impression based on findings. | Radicular left leg pain and urinary retention Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Focus of T1 hyperintensity within the L5 vertebral body is compatible with small hemangioma or focus of fat. No suspicious osseous lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L4-L5: Disc desiccation with disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening result in mild spinal canal stenosis. There is mild effacement of the lateral recesses, left greater than right, which may be affecting the left descending L5 nerve root. There is also mild bilateral neural foraminal stenosis, left relatively greater than right. L5-S1: There is disc desiccation with mild height loss. There is also a disc bulge which contributes to mild effacement of the lateral recesses. No significant central canal stenosis. There is moderate bilateral facet arthropathy and ligamentum flavum thickening. There is moderate bilateral neural foraminal stenosis which may be affecting the exiting L5 nerve roots.Paraspinous soft tissues are within normal limits. | 1. Degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels. There is moderate bilateral neural foraminal stenosis at the L5-S1 levels where there may be impingement of the exiting L5 nerve roots. 2. Mild central spinal canal stenosis at the L4-L5 level. No high-grade spinal canal stenosis at any level. Please see additional details above. |
Generate impression based on findings. | Reason: 64 YO male with hx of pancreas mass; please evaluate for changes and or abnormalities History: pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: Complex multiloculated cystic lesion with enhancing septations in the pancreatic head measures approximately 3.8 x 2.3 cm (series 4 image 30), previously 3.6 x 1.7 cm. This lesion again communicates with the pancreatic duct, which is mildly dilated measuring 5 mm, previously 4 mm. No new lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 3.5 cm solid nonenhancing lesion within the gastric body which follows fat on all sequences and compatible with an intramural lipoma has slightly increased in size, previously measuring 2.8 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slight interval increase in size of multiloculated cystic lesion in the pancreatic head that communicates with the mildly dilated pancreatic duct, these characteristics suggestive of a mixed main duct and side branch IPMN. Gastric lipoma. |
Generate impression based on findings. | 55-year-old female with ESRD, diabetes, severe peripheral vascular disease, and hypertension with gangrenous toes of the right foot and sacrum decubitus ulcerIMAGE ACQUISITIONS: Pelvis CT after intravenous administration of 120 mL Omnipaque 350 There is soft tissue ulceration adjacent to the sacrum. Anteroverted coccyx bone is noted which could be posttraumatic. This bone is demineralized, and we cannot rule out infection. MRI is recommended if further imaging is indicated.L5-S1 degenerative changes with vacuum disk phenomenon.Calcified uterine fibroids are noted. | 1. Sacral soft tissue ulceration2. Anteroverted coccyx which is demineralized. Infection cannot be excluded. |
Generate impression based on findings. | Unspecified convulsions [R56.9], Reason for Study: ^Reason: r/o stroke vs mas lesion History: 1st onset seizure Motion artifacts degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion on the scan.On FLAIR images especially coronal scan, there are relatively diffuse high signal intensities on bilateral hippocampi (left side more prominent than right). However, on axial FLAIR images those increased signal intensities were not as conspicuous as those of coronal FLAIR images. In addition, there is no evidence of hippocampal volume loss or deformity. Thus, this finding may suggest possible post ictal status or artifacts. 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, 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 bilateral mastoid air cells show opacifications. Mucosal thickening on the left maxillary sinus. | 1. Diffuse bilateral hippocampal high signal intensity on FLAIR coronal images which may indicate acute post ictal status or artifact. Follow up scan can be considered for further imaging evaluation.2. No evidence of acute ischemic or hemorrhagic lesion. No mass lesion identified. |
Generate impression based on findings. | 28-year-old male with right lower extremity cellulitis involving the knee down, with concern for underlying osteomyelitis. Diffuse soft tissue edema about the lower extremity, with a prominent collection along the medial tibial plateau with foci of low signal intensity, likely gas, extending to the bone surface of the medial tibial plateau. There is minimal enhancement after contrast administration with no discrete rim-enhancing collection identified to suggest an abscess. There is a depressed medial tibial plateau fracture, better evaluated on subsequent CT study. There is abnormal bone marrow signal in the medial tibial plateau demonstrating low T1 and low T2 signal intensity however no findings to suggest bone marrow edema and there is no enhancement after contrast administration.There is edema type signal in the adjacent musculature. Bone marrow signal of the remaining tibia and fibula appear normal. | Diffuse soft tissue swelling with a more pronounced collection adjacent to the medial proximal tibia with soft tissue gas extending to the bone surface of the medial tibial plateau where there is a depressed fracture better evaluated on subsequent CT study. There is low T1, low T2 signal intensity of the bone marrow of the medial tibial plateau, however no evidence of bone marrow edema. Given the above findings however, osteomyelitis is not entirely excluded. |
Generate impression based on findings. | Status post prostatectomy in 2007. PSA now 0.8. Possible nodule on digital rectal exam. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy, with surgical clips noted. A 4 mm T2-hypointense diffusion-restricting enhancing nodule in the posterior surgical bed at midline (series 801, image 7) (series 604, image 144) is suspicious for recurrent/residual carcinoma.Seminal Vesicles: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 4 mm nodule in the posterior midline surgical bed suspicious for recurrent/residual carcinoma. |
Generate impression based on findings. | Peritoneal mesothelioma status post CRS/HIPEC. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Few subcentimeter hepatic cysts. No suspicious hepatic lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: Tiny T2 hyperintense posterior pancreatic head lesion, may represent side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple renal cysts, some of which contain layering hemorrhage. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are several sites of new peritoneal deposits including peripancreatic, along the left hepatic lobe and along the lesser curvature of the stomach. A representative left hepatic lobe peritoneal nodule measures 4.4 x 2.5 cm (series 4, image 16). Nonspecific anterior midline metallic artifact limits evaluation of the ventral abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple sites suspicious for recurrent abdominal peritoneal disease.2.Nonspecific oval nodularity between the rectum and seminal vesicles, stable since 3/18/2015. Attention on subsequent imaging. |
Generate impression based on findings. | 51 years Male (DOB: 5/20/1965)Reason: fall down flight of stairs following syncopal event, now with severe mid back pain (interscapularly) and low back pain with left leg numbness and pain, eval for fracture eval disk herniation History: severe mid back pain (interscapularly) and low back pain, left leg numbness, weakness and burning sensationPROVIDER NAME: KEVIN C CONCORDIA TIEN S DONG Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified in the thoracic spine.There are Schmorl's nodes present at the T7-T8 disc space level. At the T2-3 interspinous ligaments there is T2 signal hyperintensity present on the T2 STIR images. There is a small right paramedian disc protrusion at T6-7. Additional Schmorl's node is present at T10-T11. A sclerotic focus is present within the T12 vertebral body measuring approximately 5 mm in size. In isolation this is of unknown clinical significance.Lumbar spine: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. No abnormal lesions are identified in the lumbar spine. There is mild multilevel disc desiccation present. Some mild epidural lipomatosis present in the lower lumbar spine at the L5 level and the sacral level. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.There are mild degenerative changes present in the thoracic and lumbar spine without significant compromise to the spinal canal or exiting nerve roots.2.Findings raise the question of some ligamentous injury at the T2 -T3 interspinous ligament |
Generate impression based on 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 findings. | Redemonstrated are cystic structures within the right parietal white matter demonstrating CSF isointensity on all sequences without enhancement or adjacent parenchymal abnormality. When compared to the recent CT, there are more of these foci within this small cluster given the better soft tissue discrimination of MRI. These have no associated mass effect.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 mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There are no abnormal enhancing foci. | Redemonstrated are cystic structures within the right parietal white matter demonstrating CSF isointensity on all sequences without enhancement or adjacent parenchymal abnormality. This constellation of features is consistent with dilated perivascular spaces which have no clinical significance. |
Generate impression based on findings. | Reason: eval for progression of HCC History: mildly enlarging liver lesion. Limited exam without the use of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Stable ablation cavity in the right hepatic lobe with internal debris/hemorrhage. Enhancement cannot be assessed.Previously seen mildly T2 hyperintense arterial enhancing lesion in segment 3 is not visualized on the T2 sequences possibly due to slice selection.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septation, unchanged. Subcentimeter left renal cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Esophageal varices.BONES, SOFT TISSUES: Fat-containing ventral hernia. L1 and L2 vertebral body hemangiomas. OTHER: No significant abnormality noted. | 1.Previously seen subcentimeter T2 hyperintense arterial enhancing lesion is not identified on the T2 sequences, possibly due to slice selection. If continued follow up is required, recommend pre and post contrast MRI when patient's acute renal failure has resolved. 2.Stable right hepatic lobe ablation cavity. Recurrence cannot be assessed without contrast. |
Generate impression based on findings. | Female, 15 years old. Reason: Evaluate for TFCC tear History: ulnar sided pain LIGAMENTS: Scapholunate and lunate triquetral ligament appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Triangular fibrocartilage complex is grossly intact.TENDONS: No significant abnormality noted. BONES: Focus of decreased T1 signal in the proximal pole of the scaphoid likely represents a bone island. Bone marrow signal is normal.ADDITIONAL | Triangular fibrocartilage complex is grossly intact. This can be better visualized with MRI arthrogram if clinically warranted. |
Generate impression based on findings. | Benign neoplasm of cerebral meninges: left vision loss. There is an unchanged enhancing dural based lesion that measures 7 mm in width along the right inferior frontal gyrus. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged scattered areas of high T2 signal in the cerebral white matter. There are also unchanged nonsecpfic punctate foci of susceptibility effect in the cerebral hemisphere, which may represent chronic microhemorrhages. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus with associated secretions. | 1. Unchanged subcentimeter right frontal convexity probable meningioma.2. Unchanged scattered areas of high T2 signal in the cerebral white matter, which are nonspecific, but likely represent chronic small vessel ischemic disease. 3. Left maxillary sinusitis. |
Generate impression based on findings. | 70 year-old male presenting with transient alteration of awareness and ataxia, with likely TIA. Evaluate for bleed or other cause. There is no evidence of intracranial hemorrhage, mass or edema. Soft tissue mass extending from the sella is identified, incompletely evaluated without contrast administration, resulting in mass effect upon the suprasellar cistern. No internal calcifications or adjacent bone erosion is evident. Further evaluation with MRI is recommended. The ventricles are midline, and demonstrate normal volume and morphology.The calvaria and skull base are radiographically normal. Crescentic high density is noted in the subcutaneous tissues along the superior aspect of the left parietal lobe, which may represent hematoma. No underlying fracture is evident. Partial opacification of the maxillary and sphenoid sinuses and numerous ethmoid air cells is evident. | 1. Subcutaneous hematoma overlying the postero-superior left parietal bone, with no underlying fractures or intracranial hemorrhage. 2. Sellar mass as described above. Differential considerations include pituitary macroadenoma, among others. Further evaluation with MRI is recommended. 3. Sinus disease as described above. |
Generate impression based on findings. | History of prostate cancer status post prostatectomy. 4+3 disease. Extraprostatic extension and lymphovascular invasion was present. Positive margins and left seminal vesicle invasion. Negative lymph nodes. PELVIS:PROSTATE: Status post prostatectomy. No evidence of recurrent or residual tumor at the cystourethral anastomosis.BLADDER: No evidence of recurrent or residual tumor at the cystourethral anastomosis.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Small fat-containing inguinal hernias.OTHER: No significant abnormality noted. | No specific findings of residual or recurrent tumor. |
Generate impression based on findings. | Female, 23 years old, with headache and pseudotumor cerebri, question of left frontal encephalocele seen on outside sinus CT. The left frontal bone lesion in question correlates to a small CSF filled defect within the inner table of the frontal bone. A venous structure enters into this defect, but no involvement of the brain parenchyma is seen.The brain parenchyma as visualized on this examination is within normal limits. No pathologic enhancement is seen. Incidental note is made of a cavum vellum interpositum. The pituitary gland is slightly small in size for a patient of this age. | 1.The lesion in question within the left frontal bone most likely represents a small pacchionian granulation or some other small developmental osseous anomaly. No evidence of encephalocele is seen.2.The pituitary gland is slightly small for a patient of this age. Findings may reflect normal anatomic variation but they could also represent a secondary finding related to elevated intracranial pressure as the history of pseudotumor cerebri would suggest. |
Generate impression based on findings. | Evaluate for vascular formation of orbit, glaucoma: Sturge Weber with right sided eye pain/headache. Brain: There is diffuse leptomeningeal enhancement in the right parietal and occipital lobes, as well as a small portions of the posterior right temporal lobe. The brain parenchyma otherwise appears to be unremarkable. There is a 10 mm wide arachnoid cysts in the medial right middle cranial fossa. There is no evidence of 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 skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There appears to be thinning of the right temporal scalp.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions. | 1. Stigmata of Sturge Weber syndrome involving the posterior right cerebral hemisphere.2. No gross orbital lesions.3. Apparent thinning of the right temporal scalp may also be related to Sturge Weber syndrome or an injury. |
Generate impression based on findings. | 21-year-old male. Pain along the lateral joint line and anterior. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Small bone contusion of the anterior medial femoral condyle (series 501, image 13). Tibiofemoral and patellofemoral compartment cartilage is normal in thickness and signal.LIGAMENTS: ACL and PCL are intact.EXTENSOR MECHANISM: Intact.ADDITIONAL | 1. Fluid signal intensity collection mostly in the superficial lateral aspect of the knee consistent with a Morel-Lavelle lesion. 2. Small bone contusion of the medial femoral condyle. |
Generate impression based on findings. | 2-month-old male with a reported history of an enlarging perianal mass.EXAMINATION: MRI Pelvis without and with IV contrast 6/30/2016 8:39 Focus of high T2 signal (series 801, image 22) with an arrowhead configuration and several branching curvilinear tendrils arising from the 6:00 position of the anal verge. The focus measures approximately 1.5 cm in length, 0.3 cm in thickness, and demonstrates enhancement (series 1001, image 26). Bilateral hydroceles are noted. | Enhancing abnormal signal adjacent to the anal verge is favored to represent a vascular lesion. A sonogram is recommended for further characterization. |
Generate impression based on findings. | No evidence of acute infarct, intracranial mass or mass effect. There are mild patchy T2 hyperintense foci in the subcortical, periventricular and deep white matter which are nonspecific but compatible with mild chronic small vessel ischemic disease. No hydrocephalus or extra-axial collections. Small mild cystic changes are noted in the right greater than left hippocampi and choroidal fissures, likely of no clinical significance. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Normal flow-voids are demonstrated in the major intracranial vascular structures. Bone marrow signal is within normal limits. | 1. No evidence of acute infarct. No intracranial mass or mass effect.2. Mild chronic small vessel ischemic disease. |
Generate impression based on findings. | A 74 year old female with personal history of systemic hypertension, deep vein thrombosis, GERD, pancreatitis, gallstones and systemic sarcoidosis (skin and lung). Recently had a syncope, the ECG showed sinus rhythm RBBB, the echocardiography showed normal left and right ventricular function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 67 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma.No accelerated flow was seen in the LVOT. There is no thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is rounded atelectasis of the right lower lobe. Mild splenomegaly. There is a low signal focus in the area of the gallbladder; this finding was better characterized on previous CT studies. | 1. The left ventricle is normal in size and systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is a focal high signal at the mid-myocardium at the insertion point of the right ventricle into the interventricular septum. This finding has been described in the setting of pulmonary arterial hypertension. In the context of this patient with sarcoidosis, we cannot exclude a focus of granuloma. 3. The right ventricle is normal in size and systolic function, the RVEF is 52%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 42 year old with CHEK 2 mutation positive and strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Simple cysts in left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | 35 years, Female, Reason: 35 yo female with hx of desmoid tumor; please evaluate for recurrence and/or abnormalities History: desmoid tumor. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Visualized liver without significant change.Lobulated lesion in the left hepatic lobe with high T2 signal and progressive peripheral nodular enhancement is unchanged in size measuring 2.3 x 2.0 cm (8/14) and likely represents a hemangioma.Three adjacent lesions in the right hepatic lobe (8/7, 8/9, 8/10 also have signal characteristics suggestive of a hemangiomas. A few punctate cysts are unchanged as well.SPLEEN: Small splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the right rectus muscle. No evidence of local recurrence.OTHER: No significant abnormality noted. | 1.No evidence of local desmoid recurrence.2.Hemangiomas within the liver are unchanged. |
Generate impression based on findings. | Clinical question: History of cervical discectomy complains of neck pain. Findings and symptoms: Snoring snoring, neck pain, history of discectomy. Nonenhanced cervical MRI:Examination demonstrates expected chronic post operative changes of anterior approach spinal fusion at C5, C6 and C7 levels. There is an anterior metallic plate at these levels and with placement of fixating screws into the vertebral bodies of C5, C6 and C7. There is suggestion of fusion of the disc spaces at these levels and repeat maintained anatomical alignment similar to prior exam.The signal intensity of vertebral column is unremarkable other than findings related to prior surgery and degenerative changes.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative disc disease and small bilateral (L>R) uncovertebral hypertrophic spurs. No spinal stenosis however mild to moderate (R>L) bilateral neural foraminal compromise are detected. Degenerative changes at this level demonstrate no significant change since prior exam.C4-C5 demonstrates moderate disc disease and loss of disc height and mild facet hypertrophic changes with resultant moderate left neural foraminal compromise and unremarkable otherwise. Findings at this level remain fairly similar to prior study from February 2015.C5-C6 demonstrate postoperative changes, shallow right paramedian hypertrophic spur however without central spinal stenosis. Significant right and moderate left neural foraminal compromise similar to prior exam.C6-C7 demonstrate postoperative changes of prior fusion without spinal stenosis. There is redemonstration of bilateral uncovertebral hypertrophic changes with resultant moderate to severe bilateral neural foraminal compromise. Findings remain grossly similar to prior exam.C7-T1 demonstrate postop changes without central spinal stenosis. Trace anterolisthesis similar to prior exam. Severe left (sagittal T2 series 3 image 16 and 17) and mild to right neural foraminal compromise (sagittal T2 series 3 images and 7).The signal intensity and morphology of the cervical and upper most visualized thoracic cord remains feeding normal.On sagittal T2-weighted images there is suggestion of a small central disc protrusion at T2-T3 level with resultant effacement of subarachnoid space and contact with the cord. No axial images were acquired. There is no spinal stenosis or neural foraminal compromise at this level. | 1.No evidence of an acute or convincing evidence of a new finding since prior MRI exam from February 2015.2.Stable postoperative changes of an anterior spinal fusion at C5-C7 as detailed.3.No evidence of central spinal stenosis at any level.4.Multiple levels of neural foraminal compromise of varying degree secondary to degenerative disease as detailed per level above. |
Generate impression based on findings. | Male, 61 years old, history of stage IV lung adenocarcinoma, in need of brain MRI to complete staging. Fairly extensive patchy periventricular T2 hyperintensity seen. Notable T2 hyperintensity is also evident within the pons.Diffusion weighted images are normal. No evidence of parenchymal edema or mass effect is detected. On postcontrast images, a punctate, submillimeter focus of enhancement is seen within the right parietal white matter (image 254 series 12). Otherwise, no pathologic parenchymal or extra-axial enhancement is detected.Numerous scattered foci of susceptibility are seen, prominently clustered within the basal ganglia and thalami, but with a few scattered elsewhere including the left cerebellum. No evidence acute intracranial hemorrhage is seen. No pathologic extra-axial fluid collections are detected. The size and shape of the ventricles are within normal limits.Mucosal thickening and layering of secretions are evident in the right maxillary sinus and at the level of the right ethmoid air cells. | 1.Extensive periventricular white matter signal abnormality, with scattered corresponding foci of susceptibility, likely reflect sequelae of chronic microvascular ischemic disease.2.No definite evidence of intracranial metastatic disease is seen. A punctate submillimeter focus of enhancement within the right parietal white matter is nonspecific, but given the appearance of the background parenchyma, it may reflect a resolving or subacute microvascular event. A follow up examination should be considered to verify resolution. |
Generate impression based on findings. | There is extensive encephalomalacia within the bilateral anterior frontal lobes and to a lesser degree the bilateral anterior temporal lobes. There is a background of scattered patchy high T2 signal within the subcortical and periventricular white matter. There are scattered areas of susceptibility effect scattered along the bilateral cerebral convexities and a punctate focus of susceptibility effect in the left occipital horn of the left lateral ventricle. There is ex vacuo dilatation of the left greater than right frontal horns of the lateral ventricles as well as prominence of the cortical sulci and prominence of the ventricles compatible with moderate diffuse cerebral volume loss. There is no evidence of mass effect or midline shift. There are no areas of abnormal intracranial enhancement. There is trace mucosal thickening within the paranasal sinuses. There are bilateral lens implants. The skull and scalp soft tissues are unremarkable. | 1.Bilateral anterior frontal and temporal lobe encephalomalacia is compatible with remote traumatic brain injury.2.Scattered areas of hemosiderosis and a punctate focus of susceptibility effect in the left occipital horn of the left lateral ventricle indicate chronic hemorrhage.3.Scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease, but no evidence of acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 61 years, Female, right face weakness, central. Rule out stroke, metastasis.. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There appears to be symmetric enhancement of the bilateral facial nerves without nodules or masses.Partially empty sella incidentally noted, which may be normal variant. Small left maxillary sinus mucus retention cyst. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. | MRI of the brain is essentially unremarkable for patient's age. There are minimal chronic small vessel ischemic changes. No evidence of acute infarct or metastatic disease, as questioned. |
Generate impression based on findings. | Right knee pain. Check for meniscal tear MENISCI: The left meniscus is intact and unremarkable. The medial meniscus however demonstrates diffuse globular signal in the body with a complex stellate appearance posteriorly, however a more horizontal component extends and intersects the superior articular surface.ARTICULAR CARTILAGE AND BONE: Mild bone contusion is observed in the medial tibial plateau and medial femoral condyle. Mild diffuse thinning with more moderate thinning observed in the medial compartment and irregular surface and small punctate defects along the femoral condylar surface of the medial compartment (image 25 and image 26 series 2). Similar signal abnormality and irregularity with punctate defects observed in the patellar surface involving both the lateral and medial facets.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Extensive complex medial meniscal tear with more moderate to pronounced cartilaginous changes in the medial and patellofemoral compartments |
Generate impression based on findings. | Moderately extensive periventricular and subcortical white matter FLAIR lesions compatible with demyelinating disease. Prominence of the ventricles and sulci likely due to volume loss. There are no enhancing lesions or other findings to suggest acute demyelination. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Evidence of demyelinating disease with no enhancing lesions to suggest active demyelination. |
Generate impression based on findings. | There are no masses, mass effect or midline shift. 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. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses are clear. Endotracheal tube is present. Moderate opacification of the mastoid air cells bilaterally which may be related to intubation. | 1.No intracranial abnormality as clinically questioned. No specific findings to suggest PRES. 2.Moderate mastoid air cell opacification bilaterally may be related to intubation. |
Generate impression based on findings. | Medically intractable epilepsy and headaches, presurgical evaluation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is asymmetric T2 hyperintensity involving the right hippocampus with blurring of the internal architecture, but no appreciable swelling or volume loss. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions within the left petrous apex. There are bilateral maxillary sinus retention cysts, left larger than right. | Right hippocampal abnormality likely represents early medial temporal sclerosis. |
Generate impression based on findings. | 64-year-old female with history of cirrhosis who presents for HCC screening and monitoring of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. In the medial left hepatic lobe, there is arterial enhancement without definite washout peripheral to T1 and T2 hypointense, nonenhancing tubular focus. The portal and hepatic veins are patent.T2 hyperintense foci in segment 5 and 7 without contrast enhancement, most compatible with cysts.Cholelithiasis with mild gallbladder wall thickening, which may be secondary to chronic liver disease.SPLEEN: No significant abnormality noted.PANCREAS: Normal T1 intrinsic hyperintensity of the pancreatic parenchyma. Pancreatic duct is normal in caliber. Uncinate process branch type IPMN is not significantly changed, currently measuring 9 x 8 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is evidence of mesenteric edema/small volume ascites.BONES, SOFT TISSUES: Thoracic dextroscoliosis and lumbar levoscoliosis.OTHER: No significant abnormality noted. | 1.In the medial left hepatic lobe, there is arterial enhancement without definite washout peripheral to a T1 and T2 hypointense, nonenhancing tubular focus. Findings may represent a thrombosed vessel with associated perfusion defect versus a central occult lesion with focal biliary dilatation. Short-term follow-up in approximately 3 months is recommended.2. Cholelithiasis and gallbladder wall thickening, which is likely secondary to chronic liver disease. 3. Stable pancreatic IPMN. |
Generate impression based on findings. | Ms. Calomese is a 74 year old female presenting with newly diagnosed left breast DCIS. She presents for MRI staging evaluation. There is scattered fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.In the left inferior breast, far posterior depth, there is an area of linear nonmass enhancement identified measuring approximately 3.0 cm in AP dimension. Susceptibility artifact from biopsy marker clip is now seen at the antero-inferior aspect of this nonmass enhancement, compatible with biopsy-proven malignancy. The distribution and span of this nonmass enhancement approximates the mammographically detected calcifications, measuring slightly larger which is likely related to associated post-biopsy changes. There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. | (1) Unifocal malignancy of the left breast. A mammographically-guided bracketed wire localization can be performed for preoperative surgical guidance. (2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Clinical question: Rule out lacunar infarct, posterior circulation stroke. Signs and symptoms: Dysarthria, bilateral upper extremity weakness. Nonenhanced brain MRI:Examination is limited due to extensive motion artifact.No detectable acute intracranial process and in particular no evidence of acute ischemic or lacunar infarct as is questioned clinically.A single suboptimal axial T2 series is also acquired. The sequence demonstrates a few small foci of T2 hyperintensity within the pons without detectable change in size or morphology. Although nonspecific the appearance is suspicious for chronic lacunar infarcts.Small focus of left frontal subcortical T2 hyperintensity without associated mass effect is also suspected of chronic small vessel ischemic stroke.The cortical sulci and ventricular system are slightly prominent for stated age of 50. | 1.Limited suboptimal exam due to extensive motion artifact.2.No acute intracranial findings.3.Minimal chronic small vessel ischemic stroke is suspected as detailed above. |
Generate impression based on findings. | Metastatic renal cell carcinoma to bilateral femurs, status post ORIF of left femur. Evaluate for progression. Right femur: Lytic lesions noted in the distal diaphysis of femur also seen on prior MRI. Endosteal scalloping concerning for impending fracture.Left femur: Trochanteric femoral rod extending into distal diaphysis with additional screw in femoral head. Lesion in distal diaphysis that has been curettaged, packed with cement, and fixed with sideplate with multiple screws. | Lytic lesions in distal diaphysis of right femur with cortical thinning concerning for pending fracture. Trochanteric femoral rod in left femur with lesion in distal diaphysis that has been curettaged, packed with cement, and fixed with sideplate with multiple screws. |
Generate impression based on findings. | 82 years Female (DOB:12/25/1933)Reason: eval brain tumor and other causes of syncope History: syncopePROVIDER/ATTENDING NAME: KRISTINA K GALLOW EDWIN RAMOS There is a 42 x 39 mm axial dimension mass located in the trigone of the right lateral ventricle which has heterogeneous enhancement with any it is near signal void on T2 and FLAIR imaging and low signal on T1 imaging but heterogeneous. It is associated with enlargement of the adjacent lateral ventricle especially the occipital horn and some periventricular signal hyperintensity and subcortical signal hyperintensity in the adjacent right parietal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is a mass present within the trigone of the right lateral ventricle which appears to arise from the choroid plexus. It is associated with the adjacent periventricular edema. Based on its signal characteristics and intraventricular meningioma is suspected. Other differential considerations could potentially include choroid plexus papilloma, choroid plexus carcinoma, metastases, glial tumor and lymphoma. A CT scan may help assess for the presence of calcifications if clinically appropriate.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | There is a T2 hyperintense focus involving the right pedicle and immediately adjacent osseous structures of C6. This demonstrates minimal T1 hyperintensity, persistent T2 hyperintensity with STIR technique, and enhancement. This is not associated with medullary expansion or MRI evident cortical erosion. There is no adjacent soft tissue component. There is a similar-appearing focus within the left posterolateral vertebral body of C7.Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no significant degenerative disease, and there are no stenoses. | 1.There is a T2 hyperintense focus involving the right pedicle and immediately adjacent osseous structures of C6. This demonstrates minimal T1 hyperintensity, persistent T2 hyperintensity with STIR technique, and enhancement. This is not associated with medullary expansion or MRI evident cortical erosion. There is no adjacent soft tissue component. There is a similar-appearing focus within the left posterolateral vertebral body of C7. The constellation of these MRI features is most suggestive of the atypical appearance of a benign hemangioma. This could be confirmed with CT.2.Otherwise negative contrast enhanced cervical spine MRI. |
Generate impression based on findings. | Male, 66 years old, with dizziness. Evaluate for stroke. No restricted diffusion is seen. Scattered small foci of FLAIR hyperintensity are seen within the cerebral hemispheres, a nonspecific finding. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A normal variant cavum septum pellucidum is noted. Mucosal thickening is seen in the left maxillary sinus. | 1.No evidence of acute ischemia is seen.2.Findings are noted which may reflect mild chronic microvascular ischemic disease. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect, midline shift, or abnormal enhancement to suggest metastatic disease. Partially empty sella is noted. There is no evidence for intracranial hemorrhage or acute infarction. There are no extraaxial fluid collections or subdural hematomas. Minimal scattered foci of T2/FLAIR hyperintensity in the periventricular deep white matter is nonspecific. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Left lens implant is noted. | MRI of the brain is within normal limits for age. No evidence of intracranial metastatic disease. |
Generate impression based on findings. | Reason: knee pain, s/p patellar dislocation History: knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No full-thickness cartilaginous defect is identified. There may be partial thickness tearing of the articular cartilage along the inferior-most aspect of the lateral facet of the patella, although this is equivocal and may simply represent volume averaging with adjacent fluid in the joint.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1.Mild edema of the superolateral aspect of Hoffa's fat pad, which can be associated with patellofemoral instability, but we see no specific imaging findings of prior patellar dislocation.2.Equivocal partial thickness tearing of the articular cartilage along the inferior aspect of the lateral facet of the patella. Otherwise, normal exam. |
Generate impression based on findings. | Reserved for concepts with insufficient information to code with codable children [IMO0002], Reason for Study: ^Reason: evaluate for Right sided lumbar spine radiculopathy, History: Right LE pain and N/T into L4-S1 area For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: there is minimal bulging of disc central to slightly left without evidence of thecal sac or nerve root compression. No neuroforaminal narrowing or spinal stenosis. | Central to slightly left lateral minimal bulging of L5S1 disc.Otherwise unremarkable. |
Generate impression based on findings. | Altered mental status: recently diagnosed lung adenocarcinoma with brain mets s/p radiation and steroids. MRI: There are new areas of restricted diffusion and high T2 signal in the left insula, perirolandic region, parietal lobe, and medial occipital lobe superimposed upon pre-existing areas of restricted diffusion in the left basal ganglia and lateral occipital lobe. There are multiple areas of peripheral and gyriform enhancement in the left cerebral hemisphere with an overall background of decreased perfusion. The largest peripherally enhancing lesion of the left cerebral hemisphere is located in the paracentral lobe, measuring up to 15 mm. Some of the lesions demonstrate susceptibility effect and intrinsic T1 hyperintensity, particularly in the left basal ganglia and occipital lobe. There are also ring-enhancing lesions in the left cerebral hemisphere, which measure up to 5 mm. There are scattered nonspecific foci of T2 hyperintensity without restricted diffuse in the cerebral white matter. There is an enhancing pituitary mass with suprasellar extension and mass effect upon the optic apparatus that measures up to 3 cm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an abrupt cut-off of flow-related enhancement in a left M2 branch proximally. There is also an abrupt cut-off of flow-related enhancement in a left P2 segment. The rest of the major cerebral arteries appear to be intact otherwise. | 1. Acute upon subacute infarcts in the left middle and posterior cerebral artery territories associated with areas of microhemorrhage and enhancement. However, a portion of the enhancing lesions in the bilateral cerebral hemispheres likely represent underlying metastases.2. Abrupt cut-off of left M2 and P2 branches may be due to thromboembolic disease. Vascular imaging of the neck may be useful.3. A pituitary mass likely represents a macroadenoma.Discussed with Dr. GAJEWSKI at 3:15 PM on 7/10/15. |
Generate impression based on findings. | 82-year-old male with ischemic cardiac disease, hypertension, diabetes mellitus, history of colon cancer status post urosepsis and extubation with persistent tachycardia today. Evaluate for PE. Findings are limited by patient motion artifact.PULMONARY ARTERIES: No evidence of pulmonary embolus as clinically questioned.LUNGS AND PLEURA: Bilateral pleural effusions with adjacent compressive atelectasis. Multiple granulomas and scattered micronodules.MEDIASTINUM AND HILA: Thinning of the left ventricular apex is concerning for left ventricular aneurysmal dilatation and may be further evaluated with echocardiogram or cardiac MRI as clinically indicated. Mild pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: NG tube with distal portion in the stomach. | 1. No evidence of pulmonary embolus as clinically questioned.2. Persistent bilateral pleural effusions with adjacent compressive atelectasis.3. Left ventricular aneurysmal dilatation may be further evaluated with echocardiogram or cardiac MRI as clinically indicated. |
Generate impression based on findings. | Thoracic spine:Compared to the MRI performed 10 hours prior, there is new T2 hyperintensity in the left lateral aspect of the cord at the T5 level compatible with edema. In comparison with same day CT, the previously noted epidural abnormality corresponds at least predominantly to a bone fragment with minimal associated blood products. There is mild associated deformity of the left dorsal thecal sac at the T5 level, which is similar to prior.Stable height loss and STIR hyperintensity involving the T5 vertebral body. The remaining vertebral body heights are grossly preserved. Heterogeneous marrow signal is compatible with a history of multiple myeloma. Mild multilevel degenerative changes including mild spinal canal stenosis at T10-11 related to degenerative changes is unchanged. Additionally, there is mild facet arthropathy and ligamentum flavum calcification at T10-11. There is mild bilateral neural foraminal narrowing at T4-5 and T5-6, right greater than left. Paraspinal soft tissue edema is present which may be postprocedural.Lumbar spine:There is no evidence of epidural collection to suggest epidural hematoma.Alignment of the lumbar spine is within normal limits. The vertebral body heights are grossly preserved. The marrow signal abnormality has improved overall with less discrete osseous lesions compared to 4/22/2015. For example, the right iliac lesion has slightly decreased in size. There is no evidence of epidural tumor within the limits of noncontrast technique. Degenerative spondylosis affects the lumbar spine worst at L3-4, L4-5, and L4-5, at which levels there is disc desiccation. The distal cord and conus medullaris are normal in signal and caliber. The conus terminates at the L1-2 level. There is mild fatty atrophy of the paraspinal musculature. The visualized intra-abdominal contents are within normal limits.T12-L1: Minimal disc bulge without spinal canal stenosis or neural foraminal narrowing.L1-2: Minimal disc bulge without spinal canal stenosis or neural foraminal narrowing.L2-3: Minimal disc bulge, facet arthropathy, and ligamentum flavum thickening with mild spinal canal stenosis but no significant neural foraminal narrowing.L3-4: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening with mild spinal canal stenosis. Mild to moderate bilateral neural foraminal narrowing. L4-5: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening with mild spinal canal stenosis. Moderate bilateral neural foraminal narrowing. 11 x 9 mm T2 hyperintense focus compatible with a synovial cyst within the right neural foramen extends into the lateral recess, which appears slightly larger compared to the prior exam, and possibly impinges upon the exiting right L4 nerve root.L5-S1: Mild disc bulge and facet arthropathy without spinal canal stenosis. Minimal bilateral neural foraminal narrowing. | 1. Compared to the MRI performed 10 hours prior, there is new T2 hyperintensity in the left lateral aspect of the cord at the T5 level compatible with edema. In comparison with same day CT, the previously noted epidural abnormality corresponds at least predominantly to a bone fragment in the left dorsal epidural space with minimal associated blood products. There is mild associated deformity of the left dorsal thecal sac which is similar to prior.2. No evidence of epidural collection in the lumbar spine. |
Generate impression based on findings. | 15 year old female with a history of repaired Tetralogy of Fallot and a history of pulmonic regurgitation and mild pulmonic stenosis by echocardiography referred from cardiac MRI. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 60 g (normal range 114+/-24). There is evidence of a small ventricular septal defect adjacent to the VSD patch site. There are no regional wall motion abnormalities present. There is no left ventricular late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 103 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). There is late gadolinium enhancement of the RVOT outflow patch repair. Right AtriumThe right atrium is mildly dilated. 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 at least moderate pulmonic regurgitation (regurgitant volume 26ml, regurgitant fraction 33%). Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root mildly over-rides the interventricular septum. There is a right-sided aortic arch with a mirror image brachiocephalic branching pattern. The aortic root is normal in size (sinus of Valsalva 31x31x33mm). There is normal origin of the coronary arteries. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The LPA takes a sharp angle at its take off and is mildly stenosed. The measurements are:MPA= 19x20mmRPA= 15x16mmLPA= 11x12mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. Tetralogy of Fallot morphology s/p repair2. Normal left ventricular size and systolic function (LVEF 66%).3. Mild right ventricular dilation with normal systolic function (RVEF 55%) with evidence of RVOT patch repair.4. Small, residual, membranous ventricular septal defect.5. Mild right atrial dilation.6. At least moderate tricuspid valve regurgitation. 7. At least moderate pulmonic valve regurgitation.8. Mild stenosis of ostial left pulmonary artery. 9. Right-sided aortic arch with mirror image brachiocephalic branching. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male, 66 years old, with history of grade 2 astrocytoma status post RT + TMZ. Off of all treatment since a few years. Patchy, non-masslike T2/FLAIR hyperintensity is again seen within the pons and medulla showing no significant interval change in morphology or geographic extent. No associated enhancement is seen.A focus of susceptibility within the right posterior medulla, and a very small additional focus along the left posterior medulla, are unchanged, possibly representing foci of microhemorrhage or small cavernous malformations.Subcortical T2 hyperintensity within the right cuneus and in the right inferior frontal gyrus is unchanged. Likewise, scattered small foci of periventricular and subcortical white matter T2 hyperintensity are unchanged and nonspecific. No evidence of mass effect is seen. The ventricular system is stable in size and morphology. Prominence of the CSF space along the right cerebellar hemisphere is unchanged. | Compared to multiple recent examinations since 2/12/2015, there is no evidence of tumor recurrence or progression. Of note, signal abnormality in the brainstem is markedly improved since remote MRI from 8/2/2011. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (10/25/16, 11/9/2016), ultrasound images of left breast (11/9/2016), images from ultrasound guided biopsy of left breast with postprocedural left mammographic images (11/16/2016), breast MRI (12/7/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (10/25/16, 11/9/2016):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). There is a small focal asymmetry in the central aspect of the left breast.No other abnormal findings are present elsewhere in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (11/9/2016):There is a lobulated, hypoechoic mass measuring 5 x 2 mm at 3:00 position, 8 cm from the nipple in the left breast. Note is made that a later biopsy of this lesion proved that this lesion did not correspond to the focal asymmetry in the left breast seen on the mammogram. At least 2 normal-appearing lymph nodes are present in the left axilla.ULTRASOUND IMAGES OF LEFT BREAST (11/9/2016), IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (11/16/2016):Ultrasound guided biopsy of the lesion at 3:00 position of the left breast was performed with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip at 3:00 position in the left breast. The focal asymmetry at central aspect in the left breast appears unchanged. This marker clip is located approximately 38 mm lateral and anterior from the focal asymmetry in the left breast.Per outside radiology report, biopsy result was malignant; infiltrating ductal carcinoma, grade 3 with DCIS intermediate to high-grade.BREAST MRI (12/7/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.A metallic artifact is present at 3:00 position in the left breast, from the marker clip placed at the recent ultrasound guided biopsy.There is a linear non-mass enhancement extending posteriorly from the marker clip, measuring 17 mm.Small enhancing masses seen in the central aspect in the left breast, measuring 6 x 5 x 5 mm (AP x LR x CC), corresponding to the focal asymmetry.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region. | 1. Biopsy-proven invasive and in situ carcinoma in the left breast at 3:00 position. Breast MRI showed linear non-mass enhancement posteriorly from the marker clip for 17-mm. If lumpectomy is planned, posterior generous excision should be considered.2. A focal asymmetry in the left central breast, showing an enhancement on MRI. The lesion has not been biopsied. Stereotactic biopsy can be performed. Ultrasound study may be performed before a stereo biopsy to look for a target.3. No MRI or mammographic evidence of malignancy in right breast. 4. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male, 8 years old, with neurologic deterioration. Assess for cerebellar degeneration or cerebral atrophy. Diagnosis of hereditary ataxia, unspecified. Patchy areas of white matter T2 hyperintensity seen on prior examinations have essentially resolved. Perivascular spaces are noted within the periatrial regions but this is within normal limits. The pattern of white matter myelination is mature. No areas of parenchymal edema or mass effect are seen. No intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricles are normal in size and morphology. The cerebral sulci are questionably and subjectively more prominent than on prior examinations. The cerebellar fissures more clearly seem to show progressive widening when compared to the prior exams.Patchy mucosal thickening and/or secretions are noted within the paranasal sinuses. | 1.Mild interval progression in loss of cerebellar volume is seen.2.Questionable progressive prominence of the cerebral sulci could also indicate some very mild loss of cerebral volume, though this finding is equivocal.3.No acute intracranial abnormality. |
Generate impression based on findings. | Motion limits fine detail of some sequences. There is a small linear focus of nonspecific T2 hyperintensity in the right precentral gyrus (series 801, image 17), which does not enhance. There is questionable ill-defined enhancement in the distal fundus of the left internal auditory canal, as well as asymmetric enhancement questioned in the expected location of the left geniculate ganglion. There are no masses, mass effect or midline shift. There is no evidence of hemorrhage or infarction. Incidental note is made of a partially empty sella. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The major vessels are patent. The paranasal sinuses are clear. The mastoid air cells demonstrate minimal opacity. The orbital globes are small with heterogeneous appearing fluid suggestive of blood products, not significantly changed compared to prior exam. The calvarial marrow is unchanged in appearance with diffuse T1 hypointense marrow replacement. | 1. Questionable ill-defined enhancement in the distal fundus of the left internal auditory canal and in the expected location of the left geniculate ganglion. Patient will be recalled for dedicated internal auditory canal sequences.2. Nonspecific T2 hyperintensity in the right precentral gyrus which does not enhance.3. Diffuse marrow replacement is a nonspecific finding which can be seen with chronic disease, anemia, lymphoproliferative or myeloproliferative disorders.4. Phthisis bulbi with chronic intraocular hemorrhage. |
Generate impression based on findings. | 79 years, Female, chronic dysarthria, memory loss. Stroke? No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss which is appropriate for age. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic disease. There is susceptibility effect along the left lateral ventricle wall which may be related to chronic blood products versus mineralization. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable. | 1. No evidence of acute infarct.2. Mild to moderate chronic small vessel ischemic disease. No findings to suggest a chronic large vascular distribution infarct.3. Global parenchymal loss, which appears appropriate for patient's advanced age. |
Generate impression based on findings. | 8-year-old male with neurofibromatosis type I. Assess for change of known brainstem tumor or optic glioma. BRAIN:The ill-defined foci of T2-hyperintensity involving the globus pallidi and thalami are unchanged. Similar lesions involving the middle cerebellar peduncles, cerebellar deep gray nuclei/white-matter and pons are not significantly changed. These lesions are not associated with mass-effect, consistent with FASI of neurofibromatosis.The hypothalamic mass which abuts the posterior aspect of the optic chiasm and the anterior aspect of the mamillary bodies is not significantly changed since the previous examination, accounting for different slice selection. In the axial plane, it measures 15 mm x 10 mm. The optic nerves themselves are not affected apart from the abutment described.The T2-hyperintense, T1-hypointense lesion involving the lower medulla and upper cervical spine is improved since the previous examination as well as the associated expansion. The mass is difficult to measure given its infiltrative nature. On axial T2 weighted imaging, the abnormality measures 10 mm x 8 mm (series number 1801, image #27) compared to 18 mm x 9 mm (series #701, image #22) given near complete resolution of the T2-hyperintense component along the left posterolateral aspect of the signal abnormality. Contrast enhancement characteristics of the lesion cannot be assessed given the noncontrast enhanced nature of the examination as requested.The remainder of the brain shows no abnormality. The ventricles and CSF-containing spaces are normal in size. There is no midline shift. The major intracranial vascular flow voids are preserved. Minimal ethmoid and maxillary mucosal thickening is nonspecific. Enlargement of the adenoids is a common finding at this age group.ORBITS:The minimal, focal contrast enhancement within the hypothalamic mass just superior to the attachment of the pituitary infundibulum is improved compared to the previous examination but this is nonspecific. The 3-mm well-circumscribed, T2 hyperintense lesion just inferior to the left optic nerve in the region of the left orbital apex is unchanged to minimally smaller. It shows less pronounced contrast enhancement currently. Orbits and globes are otherwise unremarkable. The optic chiasm is normal. Optic tracts appear unremarkable. CERVICAL SPINE:Focal expansion and increased T2 signal involving the left C4 and C5 nerve roots extending to just outside the also mildly expanded neural foramina is unchanged since the previous examination. Left C5 nerve root involvement as associated with a small intradural component which mildly deforms the left side of the spinal cord, as before.Alignment of the cervical spine is normal for straightening which may reflect patient positioning. The vertebral bodies are preserved in height. There is no suspicious marrow signal abnormality. Disc T2 signal and heights are preserved. There is also preservation of the spinal canal. Other than involvement of the upper part of the cervical spinal cord by the cervicomedullary infiltrative, mildly expansile mass, the cervical spinal cord shows no significant abnormality.Minimal expansion of the upper thoracic spinal central canal is not entirely included but was present previously and appears grossly similar. | 1.The infiltrative mass at the cervicomedullary junction is slightly smaller, with reduced left posterolateral component. The interval decreased size is more conspicuous when compared to more remote prior exams.2.The hypothalamic mass is unchanged in size since the previous examination.3.FASI in the brain's deep gray nuclei and white-matter are unchanged.4.Expansion of the left C4 and C5 nerve roots is unchanged nor the associated mild mass-effect on the left lateral aspect of the spinal cord by the left C5 nerve root. 5.Mild expansion of the upper thoracic spinal central canal is only partially included but was present previously, grossly similar.6.Tiny, T2-hyperintense left orbital intraconal lesion is of uncertain etiology, although with decreased enhancement on current exam. |
Generate impression based on findings. | 9-year-old female with previous absent seizures. Off AEDs x 2 years now with convulsive seizures not responding to meds. No intracranial mass or mass effect. No appreciable evidence of cortical dysplasia, gray matter heterotopia, or other findings to suggest possible seizure focus. Bilateral hippocampi are symmetric in size and signal characteristics without evidence of mesial temporal sclerosis. No evidence of infarct or hemorrhage. No hydrocephalus or extra-axial collections. Major flow-voids are preserved indicating vascular patency. No abnormal parenchymal or meningeal enhancement is appreciated.There is moderate mucosal thickening involving the bilateral maxillary sinuses, left greater than right, as well as patchy opacification of the ethmoid air cells. | 1. No findings to suggest seizure focus. 2. Moderate mucosal thickening involving the maxillary sinuses and to a lesser degree the bilateral ethmoid air cells. |
Generate impression based on findings. | Male, 37 years old, with pituitary tumor. On this limited evaluation for surgical planning purposes, a large heterogeneously T2 hyperintense lesion is evident involving the sella and suprasellar cistern. The lesion appears to invade both the sphenoid bone and the cavernous sinuses. The lesion projects superiorly indenting the brain up to the level of the foramen of Monro. The lesion is centrally nonenhancing with a thin rim of faint enhancement and a small nodule of enhancement at its superior most margin. It is difficult to determine whether the optic nerves pass through or around the lesion, though the optic chiasm is not clearly visualized and may be engulfed. The ICAs pass along the margins of this tumor. The left ICA flow void is intact. The right ICA flow void is not well seen through the region of the cavernous sinuses, though the terminal ICA and MCA branches do show typical flow voids. No other enhancing lesions are seen. No significant parenchymal edema is detected. | A large mass is evident involving the sella and suprasellar cistern with encroachment into the sphenoid bone, cavernous sinuses, and the undersurface of the brain. The lesion demonstrates thin peripheral enhancement with a small nodule of enhancement at its superior most margin. |
Generate impression based on findings. | Female, 49 years old, with radiculopathy in the lumbar region. Evaluate for herniated disc. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural lesions are seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet arthropathy. No spinal canal or foraminal stenosis. L4-5: Facet arthropathy. No spinal canal or foraminal stenosis. L5-S1: Facet arthropathy. No spinal canal stenosis or foraminal narrowing. There is a perineural root sleeve cyst in the right lateral recess, likely an incidental finding. | Facet arthropathy is evident at lower lumbar levels. Otherwise, no significant degenerative findings are seen. Specifically, there is no evidence of any disc herniation or significant compromise of the spinal canal or neural foramina. |
Generate impression based on findings. | Female 73 years old Reason: r/o CVA History: hx of CVA , A.fib - a/w syncope. Multiple sequences are degraded by motion. There is however no evidence of acute infarct. There is periventricular white matter T2/FLAIR hyperintensity which is nonspecific but likely related to mild chronic small vessel ischemic disease. Extensive encephalomalacia related to chronic infarcts is present in the bilateral inferior cerebellar hemispheres. There is susceptibility associated with the infarct in the left cerebellar hemisphere reflecting hemosiderin deposition. There are additional smaller foci of encephalomalacia in the left occipital, left parietal, and left posterior frontal lobes. Unchanged mild global cerebral volume loss. There is no midline shift or herniation. No hydrocephalus. The skull is grossly unremarkable. Opacification of the right sphenoid sinus which was seen on the previous exam and mild mucosal thickening of anterior ethmoid air cells. There is borderline proptosis. There is unchanged soft tissue thickening in the suboccipital region, likely related to scarring. | 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Evidence of multiple chronic supra- and infratentorial infarcts as described above.3.Mild chronic small vessel ischemic disease. |
Generate impression based on findings. | Tinnitus left ear and headaches. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several unchanged non-enhancing scattered T2 hyperintense cerebral white matter lesions. 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. | 1. No evidence of retrocochlear or inner ear lesions. A head CTA and temporal bone CT may be useful for further evaluation.2. Unchanged cerebral white matter lesions, which may represent multiple sclerosis. |
Generate impression based on findings. | Clinical question: Stiff leg. Signs and symptoms: Lower extremity stiffness. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-- C3 demonstrate mild degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes with result in mild to moderate right neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate moderate degenerative disk and mild facet/ligamentum flavum hypertrophy without significant change since prior exam. There is no central spinal stenosis however moderate bilateral neural foraminal (right greater than left) compromise is present. No change since prior exam.C6 -- C7 demonstrate slight interval decreased size of a left lateral disk protrusion since prior exam. There is no central spinal stenosis. Mild left neural foraminal compromise is again noted without change.C7 -- T1 demonstrate asymmetric right-sided hypertrophic changes with resultant mild to moderate right neuroforaminal compromise.There is normal signal intensity and caliber all cervical and uppermost visualized thoracic cord similar to prior exam. | 1.Stable mild to moderate degenerative changes of cervical spine.2.No evidence of central spinal stenosis at any level.3.Interval decreased size of a left lateral disk protrusion at C6 -- C7 since prior exam.4.Multiple levels of mild to moderate neural foraminal compromise without significant change since prior exam as detailed per level above. |
Generate impression based on findings. | 22-year-old female with right upper quadrant ache, elevated LFTs, and dx of PSC. Assess for any stricturing/suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Irregularity of the intra and extrahepatic biliary ducts are compatible with history of primary sclerosing cholangitis. These findings are stable in appearance. The common bile duct measures up to 1.1 mm in diameter. No new dominant stricture or suspicious hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation or pancreatic mass.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.Stable biliary ductal irregularity and dilatation compatible with history of PSC. No dominant new stricture or suspicious hepatic lesion.2.No pancreatic ductal dilatation or pancreatic mass. |
Generate impression based on findings. | Alignment of the lumbar spine is anatomic. For numbering purposes, there are 5 lumbar-type vertebral bodies. The vertebral body heights are preserved. The bone marrow signal is within normal limits. Mild degenerative spondylosis affects the lumbar spine, most notably at L4-5 and L5-S1 where there is disc desiccation. The conus is normal in signal and morphology, terminating at the L1-L2 level. There is no abnormal leptomeningeal or epidural enhancement to suggest metastatic disease. An enlarged right retroperitoneal lymph node is present. T12/L1: No spinal canal stenosis or neural foraminal narrowing.L1/2: No spinal canal stenosis or neural foraminal narrowing.L2/3: No spinal canal stenosis or neural foraminal narrowing.L3/4: Mild disc bulge without spinal canal stenosis or neural foraminal narrowing.L4/5: Mild disc bulge without spinal canal stenosis. Minimal right neural foraminal narrowing and no significant left neural foraminal narrowing. Enhancement surrounding the facet joints is likely degenerative in etiology. A small posteriorly directly synovial cyst is present on the left.L5/S1:Mild disc bulge without spinal canal stenosis. Mild to moderate right neural foraminal narrowing and no significant right neural foraminal narrowing.Mild facet arthropathy is present throughout the lumbar spine. | 1. No evidence of metastatic disease to the lumbar spine.2. Mild degenerative changes as detailed above without spinal canal stenosis at any level in the lumbar spine. |
Generate impression based on findings. | evaluate osteochondritis dessicans lesion MENISCI: There is minimal fraying of the inner edge of the lateral meniscus without additional abnormality.ARTICULAR CARTILAGE AND BONE: The patient is status post osteochondral repair with bilateral screws in the medial femoral condyle of the right knee. There is surrounding edema and mild irregularity of the adjacent articular cartilage. Without prior for comparison, we cannot comment on interval change but it appears to be healingLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Status post osteochondral repair with signs of healing. |
Generate impression based on findings. | New diagnosis of lung cancer. Initial staging. There is no contrast enhancing or space-occupying brain lesion. There is no midline shift. There is no intracranial hemorrhage. The ventricles and sulci are mildly enlarged, compatible with volume loss. The dural venous sinuses and major intracranial arteries appear to be patent. There is no destructive skull lesion. The mastoid air cells are unremarkable. There is mild mucosal thickening in the paranasal sinuses. The lenses are replaced, bilaterally. | No evidence of intracranial metastasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Clinical question: 65 year-old female with left tonsillar squamous cell carcinoma. Now presenting with seizure episode. Rule out hemorrhagic CVA, etc. Signs and symptoms: Seizures Non-infused CT of brain:A new area of low-attenuation involving the cortex and subcortical white matter of the left frontal lobe (axial images 19 and 20) is noted. There is subtle mass effect with this finding. There is no evidence of hemorrhage associated with this finding. This finding is believed to represent a small acute cortical stroke. Considering patient's history possibility of a metastatic lesion should also be considered. Further study with an infused head CT or an MRI is recommended.No evidence of hemorrhage, mass effect, midline shift or hydrocephalus. Calvarium is intact. Very extensive degenerative changes of cervical spine at C1 -- C2 level is noted. | 1.New foci of low-attenuation in the left frontal lobe as detailed. Finding is concerning for ischemic stroke and considering patient's history possibility of a metastatic lesion cannot be entirely ruled out. Follow-up study would be effusion is recommended.2.No evidence of hemorrhage a standard but is questioned or any additional findings. |
Generate impression based on findings. | Cellulitis. Rule out "osteo" versus necrotizing cellulitis. The subcutaneous fat of the ankle is replaced with intermediate density compatible with edema that propagates through the subcutaneous fat along the dorsum of the foot. There is associated skin thickening, as well as blistering along the lateral aspect of the ankle and dorsal aspect of the forefoot. The musculature of the forefoot also appears edematous. Furthermore, there are multiple foci of gas density within the soft tissues surrounding the head of the second metatarsal and extending dorsal to the head of the first metatarsophalangeal joint and the proximal phalanx of the second toe, in close association with the extensor tendons of the 1st and 2nd rays. There is also a poorly defined collection of low density within the plantar musculature of the foot deep to the flexor tendons of the second ray beneath the second metatarsal diaphysis which could represent a developing abscess or septic tenosynovitis; small foci of gas are seen within this collection. I see no site of skin ulceration on this study to suggest a source for this gas, and therefore, I cannot exclude the possibility of a necrotizing infection. I see no specific imaging features of osteomyelitis. Osteoarthritis affects the first metatarsophalangeal joint and midfoot articulations. | Soft tissue infection of the foot as described above. |
Generate impression based on findings. | Cervical spine:There is slight reversal normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Redemonstrated is opacification of the rightSinus with mucosal thickening in the remaining visualized. As the sinuses. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is a small midline disc protrusion which indents the anterior midline cord, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy resulting in mild bilateral neural foraminal stenosis.C4/5: There is a left paracentral disc extrusion extending above and below the disc level causing anterior left hemicord flattening, without intrinsic cord signal abnormality. There is also left uncinate hypertrophy. There is focal leftward moderate central stenosis and mild left neural foraminal stenosis.C5/6: There is a tiny central disc protrusion without significant associated mass effect and no resulting stenosis.C6/7: UnremarkableC7/T1: UnremarkableThoracic spine:Sequences acquired towards the end of the thoracic exam are significantly motion degraded. Given this caveat:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The thoracic spinal cord is grossly unremarkable.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. | 1.Originally a complete MRI of the spine with and without contrast was ordered. Unfortunately, due to the patient's back pain, she was unable to tolerate the exam. Multiple sequences were repeated due to motion. Per nursing, no meds were available and the service was paged. The patient requested to complete the rest of exam as an outpatient. Sequences acquired towards the end of the thoracic exam are significantly motion degraded.2.No MRI evidence of cervical cord myelopathy. The thoracic cord is grossly unremarkable.3.C3/4: There is a small midline disc protrusion which indents the anterior midline cord, without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy resulting in mild bilateral neural foraminal stenosis.4.C4/5: There is a left paracentral disc extrusion extending above and below the disc level causing anterior left hemicord flattening, without intrinsic cord signal abnormality. There is focal leftward moderate central stenosis and mild left neural foraminal stenosis. |
Generate impression based on findings. | 27-year-old female with head injury No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.Images at the level of common magnum demonstrates crowding of brain parenchyma at the level of the foramina magnum with effacement of subarachnoid space. This is consistent with low position of cerebellar tonsils (Chiari malformation) which requires further evaluation with a dedicated MRI exam.Calvarium, mastoid air cells and very limited view of paranasal sinuses are unremarkable. | 1.No evidence of acute post traumatic findings.2.Findings consistent with Chiari malformation which requires further evaluation with an MRI. |
Generate impression based on findings. | 71-year-old male with history of lung cancer, status post chemo, new left scapular mass, evaluate disease status CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again identified. Reference left lower lobe nodule (image 66, series 4) measures 13 mm x 10 mm.Reference right middle lobe nodule (image number 52, series 4) measures 9 mm x 9 mm, previously, measuring 9 mm x 8 mm.Groundglass nodule (image 49, series 4) unchanged from the previous exam.Right subpleural upper lobe nodule (image 46, series 4) 9slightly increased in size, now measuring 12 mm, previously, measuring 10 mm.Volume loss on the left, compatible with a previous left lobectomy. Centrilobular and paraseptal emphysema. MEDIASTINUM AND HILA: Stable reference precarinal lymph node (image 43 series 3) measures 14 mm x 13 mm.Reference right hilar lymph node (image 45, series 3) is stable, measuring 10 mm x 13 mm.Makes size is normal. No evidence of pericardial effusion. There are coronary artery calcifications.Central venous catheter with its tip in the SVC.CHEST WALL: New partial collapse of the T7 vertebrae. No evidence of pathologic.ABDOMEN:LIVER, BILIARY TRACT: Stable multiple small hypodensities most likely representing cysts.SPLEEN: No significant abnormality notedADRENAL GLANDS: Stable small left adrenal nodule.KIDNEYS, URETERS: Bilateral renal cysts that are stablePANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left scapular lesion noted on recent MRI exam is not identified on this exam.OTHER: Atherosclerotic disease of the aorta. | 1.Multiple pulmonary nodules without significant interval change.2.Partial collapse of the T7 vertebrae. No definite evidence of metastatic involvement. |
Generate impression based on findings. | Images are motion degraded. Given this caveat:There is slight reversal of normal upper cervical curvature.. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: UnremarkableC3/4: Mild posterior osteophyte disc complex and bilateral uncinate hypertrophy without significant resulting stenosis.C4/5: Posterior osteophyte disc complex and left uncinate hypertrophy results in moderate left neural foraminal stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the right causes right anterior hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy (right greater than left). Overall there is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe bilateral neural foraminal stenosis.C7/T1: Unremarkable | 1.C4/5: Moderate left neural foraminal stenosis.2.C5/6: Mild central and severe bilateral neural foraminal stenosis.3.C6/7: Moderate to severe bilateral neural foraminal stenosis. |
Generate impression based on findings. | Left insular oligodendroglioma, WHO grade II. Status post resection on April 28, 2016. There are changes related to the recent trans sulcal microsurgical resection of the left insular/subinsular mass. Fluid/air in addition to overlying scalp soft tissue thickening and underlying dural thickening in relation to the left temporal craniotomy result in minimal, if any, mass effect on the underlying brain. There is also left frontal pneumocephalus.There is a small T1-hyperintense, T2-hypointense focus with blooming on SWI, which is compatible with focal blood products and measures up to 7 mm, involving the resection bed along the left insular cortex and adjacent frontal pars opercularis. This is associated with diffusion restriction along the resection margin. There is new extra-axial contrast enhancement in the overlying sylvian fissure, probably reactive meninges. Otherwise, the infiltrative subinsular T1-hypointense, T2-hyperintense, noncontrast enhancing lesion is unchanged in size or configuration. Also, the thin linear tract of the previous biopsy through the lesion remains unchanged.Given the superficial location of the lesion and adjacent immediate postoperative changes, it is difficult to assess perfusion characteristics but there is no gross hyperperfusion in the tumor/resection bed.The ventricles and other cerebrospinal fluid spaces are unchanged in size and configuration, including a cystic septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild maxillary mucosal thickening. | 1.Interval resection of at least the superficial portion of the infiltrative left subinsular oligodendroglioma with similar contour of the remainder of the mass.2.Minimal hemorrhage in the resection bed with associated reactive meningeal thickening and other expected postoperative findings are described above. |
Generate impression based on findings. | There is atlantooccipital assimilation primarily involving the bilateral lateral masses and the occipital condyles. There is crowding of the CSF spaces at the foramen magnum with mildly elongated appearance of the cerebellar tonsils. Measuring from the inferior aspect of the occipital bone, cerebellar tonsillar ectopia measures up to 4 mm, although measuring from the level of the posterior C1 arch which is fused to the occipital bone, cerebellar tonsils do not herniate inferior to it. CSF flow sequence demonstrates focally diminished biphasic flow at the foramen magnum ventrally and dorsally. Atlantodental interval is not well assessed with MRI with appears borderline widened measuring 2 to 3 mm. There is a syrinx in the cervical cord extending from C2 mid dens to the lower C4 level. Syrinx measures up to up to 3 x 4 mm at the mid C3 and upper C4 levels, measured in the AP and transverse dimensions. Vertebral body heights are maintained. There is loss of cervical lordosis. Multilevel degenerative changes are seen including small disc osteophyte complexes at the C3-C4, C5-C6, and C6-C7 levels. There is up to mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level. Mild to moderate left and mild right neural foraminal stenosis is present at the C6-C7 level. Spinal canal and neural foramina in the cervical spine are otherwise patent.THORACIC SPINE | 1. Atlantooccipital assimilation with mildly elongated cerebellar tonsils extending to the C1 level. There is crowding of the CSF spaces at the foramen magnum with diminished CSF flow.2. Syrinx in the cervical cord extending from the C2 mid dens to the lower C4 level. There is also trace prominence of the central canal in the thoracic cord. Aforementioned findings are compatible with Chiari I.3. No evidence of tethered cord.4. Mild multilevel degenerative changes as detailed above including mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis at the C5-C6 level.5. Borderline widening of the atlantodental interval which can be further assessed with dynamic radiographs as clinically indicated. |
Generate impression based on findings. | 64-year-old female with history of forgetfulness. There are no areas of restricted diffusion to suggest an acute infarction. There are mild scattered foci of increased T2/flair signal abnormality within the periventricular white matter, which is nonspecific. The mesial temporal lobes are unremarkable and appear symmetric. The basal cisterns are intact. There is no midline shift or mass effect. There is no evidence of intracranial hemorrhage. The orbits, paranasal sinuses, and mastoid air cells are clear. Normal vascular flow voids are present within the cerebral vasculature. | Nonspecific scattered foci of increased T2/signal abnormality within the periventricular white matter likely compatible with mild chronic ischemic small vessel disease. Otherwise, no specific findings to account for the patient's symptoms. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are images from MRI guided biopsy of the right breast (10/27/2016) performed at outside institution. For comparison, outside breast MRI (10/24/2016) are available. MRI guided biopsy was performed for focal non-mass enhancement in the right breast at posterior 10:00 position. Targeting appears appropriate. Post biopsy MR images show a hematoma at the site of the target. Per outside radiology report, a marker clip was placed at the biopsy site and post biopsy mammograms are obtained; however, those images are not submitted.Pathology result of this biopsy was fibrous breast parenchyma with mild pseudoangiomatous stromal hyperplasia. Pathology result was concordant with imaging findings. | Status post benign MRI guided biopsy of the focal non-mass enhancement in the right breast at posterior 10:00 position. Pathology result was concordant with the imaging findings.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Right shoulder pain Note that the examination is limited by motion artifact.ROTATOR CUFF: There is fluid signal intensity within the undersurface of the supraspinatus tendon near its attachment upon the greater tuberosity however there is no discrete full-thickness extension appreciated. There is interstitial tear is superimposed upon tendinosis of the supraspinatus tendon. There is perhaps mild atrophy along the myotendinous junction of the infraspinatus tendon but otherwise the infraspinatus tendon and muscle are intact. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is severe osteoarthritis of the acromioclavicular joint with slight mass effect upon the underlying supraspinatus tendon as a result of spurring. Small amount of fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. Evaluation of the labrum is limited given the lack of intra-articular contrast however within these limits, there is no evidence of gross labral detachment.BICEPS TENDON: Within the limits of the motion degraded exam, the biceps tendon appears intact.ADDITIONAL | 1. Tearing of the supraspinatus tendon just proximal to its insertion on the greater tuberosity. Although there is no discrete full-thickness defect appreciated, the presence of fluid in the subacromial subdeltoid bursa suggests the presence of a full-thickness component.2. Severe osteoarthritis of the acromioclavicular joint. |
Generate impression based on findings. | Male, 65 years old, with history of metastatic lumbar spine tumor burden with radiculopathy. Thoracic:Numerous foci of T1/T2 hypointensity are seen throughout the thoracic spine. Many of these lesions are surrounded by a rim of STIR hyperintensity. Vertebral body heights are generally well preserved with only slight anterior wedging at some levels most notably T6. Comparison with prior CT examinations is limited, though the number and size of lesions has progressed over the prior two years.At no level does there appear to be gross epidural extension. The spinal canal is not significantly narrowed at any level. The left T2-3 neural foramen is mildly compromised due to some extraosseous tumor extension. Elsewhere, the foramina are patent. The spinal cord shows normal signal intensity and morphology throughout.Multiple hepatic masses are partially visualized.Lumbar:Numerous T1/T2 hypointense lesions are seen involving every vertebral level. As above, most lesions demonstrate rim STIR hyperintensity. Significant tumor extension into the ventral and left lateral epidural space is seen at L5 which causes spinal canal stenosis and crowding of the cauda equina nerve roots. Minimal ventral epidural tumor extension is seen at L4. As above, comparison with prior CT examinations demonstrates interval increase in lesion size and number over the prior two years. It does appear that epidural tumor at L5 has progressed when compared to examinations from earlier this year.The visualized distal spinal cord and conus are unremarkable.. The nerve roots of the cauda equina are within normal limits except as discussed above.A renal cystic lesion is seen on the left.From L1-2 through L3-4, the intervertebral discs are relatively well preserved with no significant spinal canal or foraminal compromise.At L4-5, facet arthropathy, disc bulging, and epidural tumor contribute to a significant spinal canal narrowing, particularly below the disc level. The neural foramina are mildly narrowed.At L5-S1, facet arthropathy and disc bulging contribute to mild spinal canal narrowing. The left neural foramen is significantly narrowed due to tumor involvement and degenerative change. The right neural foramen is moderately narrowed due to degenerative change. | 1.Numerous sclerotic metastases are evident throughout the thoracic and lumbar spine. Lesions have increased in size and number when comparison is made to multiple prior CT examinations dating back to 2014.2.No significant epidural tumor is seen in the thoracic region. However, epidural tumor is present at the L5 level, progressed from earlier this year, which causes a significant narrowing of the spinal canal and crowding of the cauda equina. Minimal epidural extension is also seen at L4. These findings were discussed with Dr. Reed at 4:20 PM on 11/11/16. |
Generate impression based on findings. | 32-year-old male with left heel infection. Evaluate for abscess versus bone infection. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: Limited evaluation secondary to patient motion artifact. The anterior talofibular ligament is not well visualized which may reflect a chronic tear/injury. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No findings to suggest osteomyelitis.ADDITIONAL | Nonspecific subcutaneous edema most pronounced along the medial aspect of the ankle with a 3.4 cm superficial fluid collection which does not enhance on postcontrast sequences and may represent a seroma or hematoma. No evidence to suggest osteomyelitis. |
Generate impression based on findings. | History of breast cancer in mother diagnosed at the age of 49 and maternal cousin diagnosed at the age of 43. History of benign left breast biopsy. Interval placement of bilateral silicone implants which appear intact, retropectoral in right and retroglandular in left. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A few enhancing foci are unchanged in both breasts.A metallic artifact from prior benign biopsy is again seen in the left lower outer quadrant.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | Radicular pain in the L4 distribution on the right side. Evaluate for lumbar spinal stenosis or herniated disc. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spine and minimal retrolisthesis of L2 on L3 and L5 on S1. Bone marrow signal is benign with scattered foci of T1 hyperintensity likely representing foci of fat and small hemangiomas. There is loss of disc height at multiple levels, relatively worse at the L5-S1 level with adjacent endplate fatty marrow signal changes on a degenerative basis. The conus medullaris is normal in position.Small disc bulges in the lower thoracic spine are partially imaged. Multilevel degenerative changes are seen in the lumbar spine, as described below:L1-L2: Mild disc bulge and prominence of the dorsal epidural fat without significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge with prominence of the epidural fat, ligamentum flavum thickening, and bilateral facet arthropathy result in mild spinal canal stenosis. There is also mild left and minimal right bilateral neural foraminal narrowing.L3-L4: Minimal disc bulge eccentric to the right with ligamentum flavum thickening and minimal facet arthrosis. No significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L4-L5: There is soft tissue dorsal to the L4 vertebral body most likely representing extruded disc material, likely originating at L4-5 with superior migration to the upper/mid L4 level. There is complete effacement of the right lateral recess from the upper L4 to the L4-L5 level. There is also moderate central canal stenosis with mass effect on the cauda equina nerve roots in the right aspect of the thecal sac. There is also moderate right neural foraminal stenosis related to eccentric disc herniation on the right. Minimal left neural foraminal narrowing. Bilateral facet arthropathy. L5-S1: Disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is partial effacement of the bilateral lateral recesses. No significant central canal stenosis. There is moderate bilateral neural foraminal stenosis.Bilateral renal cysts are noted. Paraspinous soft tissues are unremarkable. | Multilevel degenerative changes in the lumbar spine as detailed above including a large disc extrusion at the right L4-L5 level with superior migration to the upper/mid L4 level. There is likely associated impingement of the right L4 nerve root in the lateral recess and neural foramen. There may also be impingement of the right L5 nerve root and additional lower cauda equina nerve roots related to moderate central canal stenosis at the L4/L4-L5 level related to the disc extrusion. |
Generate impression based on findings. | Weight loss and dysphagia status post gastric bypass in 2014, rule out obstruction versus malrotation ABDOMEN: LUNG 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: Postsurgical changes status post gastric bypass without evidence of obstruction or malrotation.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | Postsurgical changes status post gastric bypass without evidence of obstruction or malrotation. |
Generate impression based on findings. | Female 62 years old Reason: r/o obstruction History: conjugated hyperbilirubinemia ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are 2 cystic-appearing lesions involving the left hepatic lobe. The more lateral lesion has layering hemorrhage or debris within it and measures 3.9 x 3.1 cm. No definite solid hepatic lesions.There are few scattered other smaller lesions are too small to characterize.Hepatic and portal veins are patent. Gallbladder is distended with sludge and some debris. There is no intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small focal nonenhancing areas in the kidneys bilaterally which are wedge-shaped. Differential considerations include focal pyelonephritis vs. infarctions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered mesenteric ascites.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Probable uterine fibroids.There is bibasal atelectasis and pleural effusions, right greater than left.INDEX LESION MEASUREMENTS (Current exam date/time: 2/12/2016 21:00:00)LEFT HEPATIC LOBE LESION: 3.9 x 3.1 cm (Image 85, Series 13). | 1.No evidence of biliary ductal dilatation.2.Mild gallbladder distention with sludge.3.Lesion in the left hepatic lobe with layering debris or hemorrhage. Differential considerations include complex cyst, biliary cystadenoma, biliary hamartoma.4.Focal areas of nonenhancement in the kidneys differential considerations include focal pyelonephritis or infarctions. No hydronephrosis. |
Generate impression based on findings. | Ms. Slay is a 77 year old female with recently diagnosed IDC/DCIS of the left breast. She presents today for MRI evaluation for staging purposes. Of note, there is motion artifact seen in this exam which limits the proper evaluation of the subtraction images. Therefore, all saved images are from the non-subtracted dynamic sequence.There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left superior breast, there is a focal area of heterogeneous nonmass enhancement identified measuring approximately 3.9 x 2.6 x 2.9 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen at the superior aspect of this, compatible with biopsy-proven malignancy. This area of enhancement corresponds in distribution and span to the mammographically detected calcifications, which span approximately 4 cm. In the left inferior breast, there is a linear distribution of clumped nonmass enhancement identified measuring approximately 7.5 cm in AP dimension. This abnormal enhancement extends up and into the left nipple. Upon comparison with recent diagnostic workup, there does appear to be a mammographic correlate with linearly distributed calcifications. In addition, there is a rim-enhancing mass identified in the left lateral breast which measures approximately 0.8 x 1.0 cm. This corresponds to the mammographically and sonographically identified intramammary lymph node and has a suspicious enhancement pattern.RIGHT BREAST: There is no abnormal enhancement seen in the right breast. AXILLA: Biopsy marker clip is identified in one of the left axillary lymph nodes, with benign pathology. No abnormal lymph nodes are identified in either axillary or internal mammary region. | (1) Biopsy-proven malignancy in the left superior breast, measuring up to 4 cm in total span. MR detected enhancement corresponds in distribution and span span to the mammographically detected calcifications.(2) 7.5 cm span of clumped nonmass enhancement in the left inferior breast, which likely corresponds to the mammographically detected linearly distributed calcifications. A stereotactic biopsy targeting one of these calcifications can be performed if clinically warranted.(3) Suspicious rim-enhancement of the intramammary lymph node of the left lateral breast with sonographic correlate. An ultrasound-guided biopsy of this intramammary lymph node is recommended for further evaluation.(4) No MRI evidence for malignancy in the right breast.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Right Bell's Palsy. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is a small left ethmoid sinus retention cyst. | No evidence of right facial nerve inflammation, tumor, or acute brainstem or cerebral infarction. |
Generate impression based on findings. | 40 years Female (DOB:3/4/1976)Reason: r/o posterior circulation cva, thin cuts through auditory canal History: ataxia, dizzinessPROVIDER/ATTENDING NAME: EMILY S MURRAY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No abnormal lesions identified at the internal auditory canal or theThere is diffuse calvarial thickening present.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is no evidence for cerebral infarction or intracranial mass.2.Diffuse calvarial thickening is a nonspecific finding.3.There is no evidence for internal auditory canal mass. |
Generate impression based on findings. | 72 year old with severe tricuspid regurgitation presenting for evaluation of right heart enlargement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 57 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 20 g/m2 (normal range 67+/-11), and the LV mass is 33 g (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 normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 35 years, Female, increase in headache intensity and frequency. History of Chiari decompression in 2013. Again seen are postsurgical changes of Chiari decompression including suboccipital craniectomy and resection of the C1 posterior arch. CSF spaces at the foramen magnum are grossly preserved ventrally and dorsally with biphasic flow.Remainder of the brain parenchyma is essentially unremarkable. Ventricles remain normal in size. Incidentally noted is a tiny punctate focus of susceptibility and enhancement involving the right anterior pons which is consistent with a tiny capillary telangiectasia. No evidence of ischemia or hemorrhage. No intracranial mass or mass effect. No abnormal enhancement. Minimal scattered mucosal thickening is present within the paranasal sinuses. | 1. Postoperative changes of Chiari I decompression are again seen. Biphasic CSF flow at the foramen magnum is preserved.2. Remainder of the brain appears within normal limits. |
Generate impression based on findings. | seizure. There is no acute ischemic or hemorrhagic lesion.There is,however, localized encephalomalacia on the right temporal lobe middle temporal gyrus posterior aspect which extends posteriorly following left side parallel sulcus reaching to posterior inferior aspect of the left angular gyrus.Encephalomalacia of cortex and subcortical white matter were also seen on the right lateral orbital gyrus and some of right inferior frontal gyrus (pars orbitalis). The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Multifocal encephalomalacia on the right frontal lobe and temporal lobe as described above. |