{ "Contributors": "MIMIC", "Source": "MIMIC-IV", "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", "Categories": [ "Summarization" ], "Definition": [ "Summarize the CT imaging diagnostics' detailed findings for the Pelvis into a concise conclusion." ], "Reasoning": [], "Input_language": [ "English" ], "Output_language": [ "English" ], "Instruction_language": [ "English" ], "Domains": [ "Medicine", "Clinical Reports", "CT", "Pelvis" ], "Positive Examples": [], "Negative Examples": [], "Instances": [ { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 1.3 cm cyst or biliary hamartoma in the right hepatic lobe, as well\nas additional scattered hypodensities, too small to characterize, likely also\nrepresenting cysts or biliary hamartomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy. There are multiple\nhypodensities in the left kidney which are similar to prior, including a 4.9\ncm intermediate density lesion in the upper pole (2:39). A previously seen\ncluster of cysts along the anterior aspect of the interpolar region have\ndecreased in size, now measuring up to 1.1 cm, previously 3.1 cm (2:70). \nThere is mild hydroureteronephrosis extending along the entire course of the\nleft ureter. There is a punctate calculus in the lower pole of the left\nkidney, similar to prior. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is collapsed around a Foley catheter. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPosterior fixation hardware at L4-5 is similar in appearance. There are\nsevere degenerative changes of the right hip joint, with substantial joint\nspace narrowing and subchondral cystic change.\n\nSOFT TISSUES: Mild subcutaneous edema is seen in the pelvis and to a lesser\nextent along the abdomen.", "output": "1. Mild left hydroureteronephrosis including the entire length the ureter,\nwithout obstructing process demonstrated. Mild left perinephric stranding,\ncorrelate with urinalysis to assess for infection.\n2. Interval decrease in size of previously seen cluster of hypodensities in\nthe interpolar region of the left kidney. Additional hypodensities in\nintermediate density lesions are unchanged. These can be further evaluated\nwith nonurgent renal MRI if clinically indicated.\n3. Prostatomegaly.\n4. Status post right nephrectomy\n5. Severe degenerative changes of the right hip with substantial joint space\nnarrowing." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.3 cm right hepatic lobe cyst or biliary hamartoma is redemonstrated. \nAdditional subcentimeter hypodense lesions within the liver are too small to\ncharacterize but likely represent cysts or biliary hamartomas. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post right nephrectomy. Multiple intermediate density left\nrenal lesions are redemonstrated, measuring up to 4.9 cm. There is an\nexophytic lesion arising from the anterior aspect of the left midpole (2:76 ,\n601:53) that measures approximately 1.6 x 3 cm, and demonstrates\nhypoenhancement relative to the renal cortex and is unchanged in size when\ncomparing to baseline noncontrast study of ___. This corresponds to\npreviously visualized simple cyst on CTU of ___.\nA nonobstructive punctate left lower pole renal calculus is redemonstrated. \nStreak artifact from lumbar spinal fixation hardware, degrades evaluation of\nthe mid ureter, within this limitation there is no evidence of gross focal\nlesion. There is no evidence of hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding. The appendix is normal.\n\nPELVIS: A Foley balloon terminates in the bladder, which contains locules of\nair. The bladder wall is substantially thickened. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is substantially enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL4-L5 pedicle screws are redemonstrated. Severe right hip degenerative\nchanges are noted, with superior joint space narrowing, subchondral cysts and\nsclerosis, and acetabular spurring.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process.\n2. Nonobstructive left nephrolithiasis. No substantial hydroureteronephrosis.\n3. Substantial bladder wall thickening in the setting of prostatomegaly,\nconsistent with obstructive uropathy.\n4. Redemonstrated intermediate density left renal lesions. Including a 1.6 x\n3 cm exophytic left midpole lesion, that demonstrates mild enhancement, which\nrepresents a collapsed hemorrhagic/proteinaceous cyst. These can be further\nevaluated with renal MRI as clinically indicated.\n5. Additional findings are detailed above." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are 2 hypodense lesions within the dome of the liver measuring up to 13\nmm, unchanged compared to prior, and likely representing a hepatic cysts or\nbiliary hamartomas. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is post right nephrectomy without suspicious soft tissue\nlesions or nodularity noted within the resection bed. Multiple indeterminate\ncysts are again re-demonstrated of the left kidney measuring up to 4.7 cm. \nNone are new or growing when compared to the most recent CT of ___,\nhowever when compared to earlier studies from ___, some are decreased in\nsize. Punctate nonobstructing 3 mm left lower pole renal calculus is seen.\n\nThere is diffuse thickening of the urinary bladder likely representing chronic\nbladder outlet obstruction.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Colonic diverticulosis\nwithout diverticulitis is noted. Otherwise, the colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.8 cm with protrusion\nof the median lobe into the base of the bladder. Seminal vesicles are\nsymmetric and normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present. There is no abdominal\naortic aneurysm.\n\nBONES: Patient is post L4-L5 transpedicle screw fixation. No periprosthetic\ncomplications. There is no evidence of worrisome osseous lesions or acute\nfracture. Severe degenerative changes are seen involving the right hip with\nsubchondral cysts and sclerosis as well as joint space narrowing.\n\nSOFT TISSUES: Small fat containing umbilical hernia is noted. Otherwise, the\nabdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal pathology.\n2. Prostatomegaly and diffuse thickening of the urinary bladder favors chronic\nbladder outlet obstruction. However, given abdominal pain, recommend\ncorrelation with UA.\n3. Post right nephrectomy.\n4. Multiple indeterminate left renal cysts measuring up to 4.7 cm are stable\ncompared to most recent prior, with interval decrease in size of some cysts\nwhen compared to earlier ___ studies. If further characterization of the\ncysts are desired, this can be performed with renal ultrasound.\n5. Diverticulosis without evidence of diverticulitis.\n\nRECOMMENDATION(S): Nonemergent renal ultrasound." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed, with soft tissue stranding in the\nprevesical space, possibly adhesions in the setting of prior hernia repair. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia. Postoperative\nchanges following bilateral inguinal hernia repair are noted. No recurrent\nhernia.", "output": "1. Status post bilateral inguinal hernia repair without evidence of hernia\nrecurrence.\n2. Mild soft tissue stranding in the prevesical fat, could reflect prior\nhernia repair, difficult to exclude surgical adhesions. Correlate clinically." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\n___ for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. No change in the hypodensity adjacent\nto the falciform ligament, consistent with focal perfusional change. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Again seen is focal thickening near the gastric cardia,\nslightly worsened compared to the prior study from ___ (series 5:58).\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Apparent thickening of the sigmoid colon is probably due to under\ndistension given the lack of significant pericolonic fat stranding. However\ncorrelation with clinical symptoms of colitis is recommended.\n\nPELVIS: The urinary bladder is under distended but unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are surgically absent. No\nresidual adnexal mass is visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy. The 4 mm left gastric lymph node is\nunchanged compared to the immediate prior study from ___.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\nlucent area in the left iliac bone adjacent to the sacroiliac joint is\nconsistent with degenerative change and stable compared to prior exams.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Status post interval bilateral salpingo-oophorectomy without evidence of\nresidual mass.\n2. Redemonstration of thickening at the gastric cardia, correlate with\nprevious EGD findings.\n3. No new suspicious mass or lymphadenopathy.\n4. Apparent thickening of the sigmoid colon is probably due to underdistension\ngiven the lack of significant pericolonic fat stranding. However correlation\nwith clinical symptoms of colitis is recommended.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\n___ for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion. There is re-demonstration of an area of\nhypodensity near the falciform ligament likely due to perfusional change. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is no perinephric\nabnormality. There is no hydronephrosis or hydroureter. The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: There is again seen thickening of the wall of the stomach\nnear the gastric cardia, slightly increased when compared to prior (series 5\nimage 53). Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement. There is mild thickening of the rectosigmoid colon but it is\nincompletely distended. The appendix is not visualized.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Bilateral ovaries and uterus are surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present. There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Patient is status post bilateral salpingo-oophorectomy, no evidence of\nmetastatic disease.\n2. There has been slight interval increase in thickening of the region of\nknown adenocarcinoma in the gastric wall near the cardia when compared to\nprior CT.\n3. Mild thickening of the incompletely distended rectosigmoid colon similar to\nprior CT, may represent colitis in the appropriate clinical setting." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a hypoattenuating lesion in hepatic segment IV B,\nmeasuring approximately 1.5 x 1.7 x 2.4 cm (AP by TV by CC), similar in size\nto ___. A solitary vessel appears to run through this lesion with no\ndistortion of the vessel. This finding together with the characteristic\nlocation adjacent to the falciform ligament favors perfusional/focal fatty\nchange. The liver otherwise demonstrates homogenous attenuation\nthroughout.There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Again seen is focal thickening and enhancement of the\ngastric cardia (series 6, image 53), slightly decreased since ___. Please\nnote that gastric tumors may be better characterized with PET-CT. Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThe colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: There is a right adnexal mass measuring approximately 3.8\nx 4.2 x 5.4 cm (AP by TV by CC) similar in size to ___. The\nvisualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no lymphadenopathy. The left gastric lymph node is\nsimilar in size compared to prior imaging. There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No lumbar spine metastasis visualized. No radiological finding explaining\nthe patient's back pain.\n2. There is gastric thickening at the cardia which could represent the region\nof gastric adenocarcinoma seen on EGD on ___.\n3. Subcentimeter left gastric lymph node is indeterminate. Please note the\ngastric mass as well as lymph nodes could be better assessed with PET-CT\n4. Right adnexal mass appears similar in size to ___. Adnexal\nmetastasis cannot be excluded.\n5. Hypoattenuating liver lesion is favored to represent perfusional/focal\nfatty change as described above.\n6. Please refer to dedicated CT chest for further characterization." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen (2:33).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAn 8 mm left upper pole hypodensity is too small to characterize by CT, but\nstatistically likely a cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is sigmoid\ndiverticulosis with a 9.4 cm segment of sigmoid colonic wall thickening,\nadjacent fat stranding, and mucosal hyperemia, compatible with acute\nmicroperforated diverticulitis. The degree of colonic wall thickening is\nsevere (601b:24). No drainable fluid collection. The appendix is not\ndirectly visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall bone islands in the bilateral acetabula.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Findings compatible with acute, microperforated sigmoid diverticulitis,\nwithout drainable fluid collection. Significant associated bowel wall edema.\n\nRECOMMENDATION(S): Consider direct visualization with colonoscopy, given the\nseverity of the colonic wall thickening.\n\nNOTIFICATION: The above findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ at 11:15 pm on ___, 5 min after\ndiscovery." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a subcentimeter hypodensity in the left upper pole which is too small\nto characterize, but likely represents a simple cyst. Small peripelvic cysts\nare noted in the left kidney. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is again noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic foci in the bilateral acetabula likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute intra-abdominal or intrapelvic process to explain the patient's\npain.\n2. Redemonstration of colonic diverticulosis without definite evidence of\nacute diverticulitis." }, { "input": "ABDOMEN: There is a small, possibly loculated right pleural effusion along the\nmedial pleural aspect. There is bilateral compressive atelectasis, right\ngreater than left. In the anterior right lower patchy opacities may be due to\naspiration or atelectasis. The heart is enlarged. Mitral valve replacement is\npresent. The liver is shrunken and nodular compatible with known history of\ncirrhosis. No focal lesions are identified. The main portal vein is patent. \nThe pancreas is unremarkable. Patient has had a splenectomy. The adrenal\nglands are unremarkable. The kidneys enhance and excrete contrast\nsymmetrically without any focal lesions or hydronephrosis. There is a large\namount of intra-abdominal ascites. Simple in nature.\n\nAgain seen are multiple dilated loops of small bowel involving the majority of\nthe bowel with some distal loops which are collapsed. This is similar in\nappearance to ___. ___ although some loops appear slightly decreased\nin caliber. No definite transition point is identified. A air and retained\ncontrast is present within the colon. These findings are most consistent with\nan ileus. There is no free air within the abdomen. The aorta is of normal\ncaliber without evidence of aneurysm. There is mild atherosclerotic extending\ninto the iliac arteries.\n\nPELVIS: The bladder is distended unremarkable. The rectum and sigmoid colon\nare unremarkable. The endometrial cavity is distended. This may reflect\nendometrial thickening or possibly fluid within the endometrial canal. There\nis a Ill large amount of pelvic ascites. There is no free air lymphadenopathy\nP\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. There are\nmild degenerative changes within the spine. There is generalized soft tissue\nedema compatible with anasarca.. A small fluid containing ventral hernia in\nthe upper abdomen superior to the umbilicus is noted (602b:39).", "output": "1. No evidence of intra-abdominal infection.\n2. Cirrhosis with massive ascites and anasarca.\n3. Dilated loops of small bowel with air and oral contrast within the colon\nmost compatible with ileus and similar to the prior exam from ___\nwith possible slight improvement in extent of bowel dilation.\n4. Distended endometrial cavity. Recommend correlation with presence of\nvaginal bleeding and pelvic ultrasound for evaluation of endometrial\nthickening.\n5. Small right pleural effusion, possibly loculated with bilateral compressive\natelectasis, right greater than left. Opacities in the anterior right lower\nlobe may represent aspiration or atelectasis.\n6. Small fluid containing ventral hernia.\n\nNOTIFICATION: These findings were discussed with Dr. ___ by Dr. ___\n___ telephone at 16:45 on ___." }, { "input": "LOWER CHEST: Small bilateral pleural effusions and left-sided pleural\nthickening are decreased in extent compared with the immediate prior study of\n___. Multiple round masses scattered throughout both lungs are\nessentially unchanged from the prior study, compatible with known metastatic\ndisease. Please see separately submitted report of Chest CT for full\ndescription of the lungs.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal and hepatic veins are patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI: The stomach is decompressed without obvious intraluminal mass or wall\nthickening. The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction. The appendix is not definitively\nvisualized, but there is no fat stranding or free fluid in the right lower\nquadrant to suggest acute appendicitis. There is a moderate colonic fecal\nload.\n\nRETROPERITONEUM: The aorta is normal in caliber, with no atherosclerotic\ncalcifications. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nOSSEOUS STRUCTURES: A single lytic lesion in the right iliac bone measures\n1.4 by 1.0 cm, unchanged from the prior study of ___. No new lytic\nlesions are identified.", "output": "1. Unchanged lytic lesion in the right iliac bone. No new osseous metastases. \nNo evidence of new metastatic disease within the abdomen or pelvis.\n2. Moderate colonic fecal load.\n3. Please see separately submitted report of CT chest for full description of\nthe intrathoracic findings." }, { "input": "VASCULAR:\n\n Pre EVAR Angiogram of the Abdominal Aorta\n\nABDOMINAL AORTA DIAMETERS\nSuprarenal: 2.1 x 2.2 cm\nAt lowest renal artery right: 1.8 x 1.9 cm\n5 mm below lowest renal artery: 1.9 x 1.9 cm\n10 mm below lowest renal artery: 1.9 x 1.8 cm\n15 mm below lowest renal artery: 1.9 x 1.8 cm\n\nANEURYSM Infrarenal, fusiform with eccentric clot\nDiameter (Cross-sectional): 4.4 x 4.3 cm\nLength: 7.7 cm\n\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: normal 1.6 x 1.7 cm; Left: normal 1.5 x 1.8 cm.\nExternal Iliacs: Right: normal 0.9 cm; Left: normal 1.0 cm.\nInternal Iliacs: Right: normal 0.8 cm; Left: normal 0.7 cm.\nFemoral: Right: normal 0.7 cm; Left: normal 0.5 cm.\n\nTortuosity Iliacs: Right: mild; Left: mild.\nFemoral Calcifications: Right: none; Left: none.\n\nThere is a focal dissection of the right common iliac artery (axial series 3,\nimage 111). There is narrowing involving the origin of the right internal\niliac artery (axial series 3, image 117). Moderate narrowing with plaque\nright internal iliac. Focal dissection distal abdominal aorta.\n\nLOWER CHEST: The lung bases are clear. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Focal fatty deposition adjacent to the\nfalciform ligament. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 1.0 cm right adrenal nodule measuring less than 10 ___ on the\nprecontrast images in keeping with a benign adenoma. The left adrenal gland\nis unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Uncomplicated sigmoid diverticulosis. Appendix\ncontains air, has normal caliber without evidence of fat stranding. There is\nno evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Mild to moderate prostatomegaly.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing paraumbilical hernia.", "output": "1. Infrarenal abdominal aortic aneurysm as described above.\n2. 1.0 cm adrenal nodule with attenuation in keeping with benign adenoma.\n3. Mild to moderate prostatomegaly." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. Cardiomegaly\nsecondary to enlargement of the right atrium. There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates mildly heterogeneous attenuation\nthroughout. 2.6 x 1.1 cm irregularly enhancing lesion at the tip of the\nliver. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder decompressed. Small amount of perihepatic\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout 5 mm hypodensity in\nthe tail of the pancreas could represent a side branch IPMN. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Thickening of the\nsigmoid in relation to the pelvic mass without obstruction (03:57). Remainder\nof the colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Small amount\nof fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Irregular endometrial hypodense mass has not\nsignificantly changed since prior. Bilateral adnexa heterogeneously enhancing\nhypodense masses again noted. The overall ___ are 8.4 x 8 cm,\npreviously 9 x 8.4 cm, not significantly changed allowing for differences in\nmeasurement technique. This masses abut the rectosigmoid colon with loss of\nfat plane.\n\nLYMPH NODES/OMENTUM/RETROPERITONEUM: 1.3 cm portacaval lymph node, series 2,\nimage 20, grossly stable. Additional prominent upper abdominal lymph nodes\nappear stable. Multiple mesenteric, retroperitoneal, bilateral iliac lymph\nnodes up to 1 cm in diameter are suspicious for involvement. There is\nnodularity and thickening of the omentum with adjacent collapsed loops of\nsmall bowel concerning for omental caking.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Redemonstrated endometrial and adnexal heterogeneous hypodense masses with\nan overall measurement of 8.4 x 8 cm concerning for malignancy. Probable\ninvolvement of the rectosigmoid junction, without evidence of obstruction.\n2. Ascites, presumably malignant from likely ovarian, less likely uterine\norigin, has worsened since ___. Redemonstration of omental caking\nconsistent with carcinomatosis, and portacaval, mesenteric, retroperitoneal\nand bilateral iliac involved adenopathy.\n3. Focal 2.6 cm lesion in the tip of the liver is concerning for metastasis." }, { "input": "PELVIS: The partially visualized small and large bowel are unremarkable. The\nappendix is normal. The urinary bladder and distal ureters are unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: Moderate degenerative changes are visualized about the bilateral hips\nand lower lumbar spine without evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No fracture identified." }, { "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: There is diffuse decreased attenuation of the hepatic\nparenchyma compatible with steatosis. 2.2 x 2.0 cm cyst in segment ___ of the\nliver (09:46) is unchanged in size dating back to ___.\nThe gallbladder is distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous enhancement with no main duct dilation.\nSPLEEN: No splenomegaly or focal splenic lesions.\nADRENALS: No adrenal nodules.\nURINARY: No hydronephrosis on either side. A partly exophytic cyst arising\nfrom the superior pole of the left kidney and measuring 5.8 x 6.1 x 6.1 cm\nwith thin rim calcification is unchanged compared to the prior exam from ___. This cyst demonstrates a 1.6 cm lobulated component which also\ndemonstrates rim calcification within it as before.\nSmaller bilateral simple renal cortical cysts are unchanged compared to the\nprior exam. No solid enhancing renal masses. No hydronephrosis.\nGASTROINTESTINAL: There is no bowel obstruction. A moderate amount of stool\nburden is seen throughout the colon.\nLYMPH NODES: The patient has a history of bladder cancer. Again identified\nare bilateral external iliac, up to greater, common iliac, aortocaval lymph\nnodes measuring up to 8 mm in short axis. The aortocaval node (9:69) is\nslightly smaller in size compared to the exam dated ___. However\nthe right external iliac lymph node (9:108) measures 10 mm in short axis\ncompared to a prior measurement of 6 mm.\nVASCULAR: Abdominal aorta is normal in caliber. There is a moderate amount of\ncalcified atherosclerotic plaque throughout the abdominal aorta and its\nbranches without aneurysmal dilation.\n\nPELVIS:\nThe bladder is minimally distended and demonstrates wall thickening in the\nregion of the bladder dome (13:41) that has progressed compared to the prior\nCT dated ___. Coarse calcification is noted within a nonenlarged\nprostate.\n\nBONES AND SOFT TISSUES:\nMultilevel degenerative changes of the lumbar spine with no osteolytic or\nblastic bone lesions noted. .", "output": "1. Minimal interval increase in size of a right external iliac lymph node with\ndecrease in size of aortocaval lymph node as described in detail above. \nNumerous subcentimeter lymph nodes along bilateral external iliac, common\niliac, aortocaval region are unchanged in size.\n2. Bladder wall thickening in the region of the dome with stranding of\nsurrounding perivesicular fat has progressed compared to the prior CT from ___, in this patient with known bladder cancer.\n3. Hepatic steatosis.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "8 mm hypodensity in segment 7 of the liver demonstrates nodular enhancement\nwith filling on 3 minute delayed phase imaging and is in keeping with a\nhemangioma. 6mm hypodensity in segment ___ (series 5, image 62) is too small\nto accurately characterize. The portal vein is patent. There is no intra or\nextrahepatic biliary dilatation. The gallbladder is unremarkable. The spleen\nis normal size.\n\nThere is no pancreatic ductal dilatation or mass. The adrenal glands are\nunremarkable. There is no hydronephrosis involving either kidney.\n\nT-shaped intrauterine device is noted. There is inward convexity of the\ncontour of the left uterine cavity thought to be on the basis of a 2.1 cm\nsubmucosal fibroid. The bladder is unremarkable. There is no free\nintraperitoneal fluid. No small or large bowel dilatation is present. There\nis no abdominal or pelvic lymphadenopathy.\n\nPostsurgical changes are noted along the left chest wall/abdominal wall from\nbreast surgery with myocutaneous flap reconstruction.\n\nThe bones are unremarkable. Minor linear atelectasis is seen involving the\nleft lower lobe. The lung bases are otherwise clear.", "output": "1. No definite evidence of metastatic disease within the abdomen or pelvis.\n2. Postsurgical changes along the left chest/abdominal wall related to the\nbreast surgery with reconstruction." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere subcentimeter hypoattenuating lesions in the kidneys bilaterally, too\nsmall to characterize. There is no hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is moderate\nfecal loading; the colon and rectum are otherwise within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. An IUD is seen within the endometrial cavity.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: At the T12 vertebral body, there is a 0.9 cm sclerotic focus. At the\nL1 vertebral body extending into the right pedicle, there is a 4.2 x 3.6 cm\nlytic lesion with soft tissue extension into the anterior and right lateral\nspinal canal and subsequent moderate spinal canal narrowing. At the L3\nvertebral body, there is a sclerotic lesion. The right iliac, there is a 0.8\ncm lytic lesion.\n\nSOFT TISSUES: Postsurgical changes are noted along the left chest and\nabdominal wall. An umbilical hernia containing fat is noted.", "output": "1. 4.2 cm L1 vertebral body lytic lesion with soft tissue extension into the\nanterior and right lateral spinal canal. Moderate spinal canal narrowing.\n2. Additional sclerotic and lytic lesions are noted along the vertebra and\npelvis, concerning for bone metastasis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodense lesion is seen in the lower pole of the left\nkidney and is too small to further characterize (series 2, image 78). The\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of suspicious focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis\nwithout evidence of wall thickening or fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Intrauterine device seen within the endometrial cavity. \nThe visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: The known sclerotic lesions in T7 and T8 are again seen but are\nslightly less conspicuous compared to prior exam. The previously noted\nexophytic lytic lesion seen extending from the L1 vertebral body into the\nspinal canal is no longer visualized; however, within the vertebral body there\nis redemonstration of sclerotic and lytic changes. The previously noted right\niliac lesion is not seen on today's exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of progression of disease. There has been interval improvement\nin bone metastasis.\n2. The known T7 and T8 vertebral body sclerotic lesions persist but are\nslightly less conspicuous compared to prior.\n3. The previously noted exophytic lesion extending from the L1 vertebral body\ninto the spinal canal is no longer seen. However, within the L1 vertebral\nbody, there is persistent sclerotic and lytic changes.\n4. The previously noted right iliac lesion is not seen." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is redemonstration of multiple subcentimeter hypodense lesions in the\nbilateral kidneys, unchanged from prior study and too small to characterize. \nThere is no evidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is minimal\ncolonic diverticulosis without evidence of diverticulitis. Otherwise, the\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. An\nintrauterine device is again visualized within the endometrial cavity.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is redemonstration of sclerotic and lytic changes to the L1\nvertebral body, unchanged from prior study. The known sclerotic lesions in T7\nand T8 are again seen and unchanged. There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: There is redemonstration of postsurgical changes to the anterior\nabdominal wall, unchanged. There is a small left spigelian hernia with a neck\nmeasuring approximately 10 mm (602:59), containing a loop of small bowel\nwithout evidence of bowel dilation, wall thickening, or adjacent stranding.", "output": "1. No evidence of disease progression. Unchanged osseous metastatic lesions,\nas described above.\n2. Small left spigelian hernia containing a loop of small bowel without\nevidence of incarceration or obstruction.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "LOWER CHEST: Please see report of CT chest from same day.\n\nABDOMEN:\n\nHEPATOBILIARY: An 8 mm hyperenhancing lesion in segment 7 of the liver has\nremained stable in size and appearances since ___. The appearances are\nconsistent with a hemangioma. No focal liver lesions suspicious for\nmetastases. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are subcentimeter renal lesions bilaterally consistent with\nsimple cysts. The kidneys are of normal and symmetric size with normal\nnephrogram. There is no evidence of solid renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa appear normal. There is an ICD\nin-situ.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Multiple lytic and sclerotic lesions are re-demonstrated in the lumbar\nspine and pelvis.\nThe mixed lytic sclerotic lesion involving the L1 vertebral body appears more\nsclerotic compared to prior. Sclerotic lesions of the posterior aspect of the\nL2 and L3 vertebral bodies are stable. A predominant lytic lesion with\nsurrounding area of sclerosis in the S1 vertebrae has increased in size from\n8 mm to 14 mm.\nSubcentimeter sclerotic foci within the right and left iliac bones are\nunchanged (series 6, image 93).\nA lucent lesion in the left sacral ala appears more sclerotic (series 6, image\n97).\nA mixed lytic sclerotic lesion in the right anterior acetabulum is more\nsclerotic (series 6 image 117).\nA lucent lesion in the right acetabulum is marginally larger in size (series\n6, image 111).\nNo evidence of vertebral collapse, spinal stenosis or pathological fracture .\n\nSOFT TISSUES: Evidence of prior ventral abdominal wall hernia repair.", "output": "1. Redemonstration of multiple bone metastases in the lumbar spine and pelvis.\n2. There has been mixed interval change in these lesion as demonstrated by\ninterval increase in size of 2 predominantly lytic lesions (in S1 and right\nacetabulum) concerning for enlarging metastatic lesions. The other mixed\nlytic sclerotic lesions have become more sclerotic (suggesting treatment\nresponse). Other smaller sclerotic lesions are unchanged.\n3. No visceral metastases in the abdomen or pelvis.\n4. Stable segment 7 hepatic hemangioma\n5. For chest findings reference is made to CT chest report of the same day" }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is simple appearing hypoattenuating cystic lesions within the\nkidneys bilaterally which are similar in size dimension to ___. There is\nnow hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a retroverted uterus. The visualized\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There are multiple hyperenhancing, enlarged, round left inguinal\nlymph nodes measuring up to 1.7 cm in diameter. There is a round enhancing\nright inguinal lymph node that is 6 mm in diameter (series 2, image 108).\nThere are multiple enlarged left external iliac lymph nodes measuring up to\n1.4 cm in diameter (series 2, image 104).\nThere is a left common iliac lymph node measuring 0.9 cm in diameter (series\n2, image 78).\nThere is a 0.6 cm periaortic lymph node at the bifurcation which is also\nsuspicious.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is a stable Tarlov/perineural cyst within the sacrum. There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There are multiple enlarged, left iliac and inguinal lymph nodes which are\nsuspicious and consistent with biopsy proven lymphoproliferative disorder. \nThe left inguinal lymph nodes may be amenable to biopsy/excision if indicated.\n2. No splenomegaly.\n3. Reference is made to CT chest report of the same day for chest findings." }, { "input": "LOWER CHEST: Postsurgical changes noted at the right lung base. Mild\ndependent bibasilar atelectasis. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears shrunken and nodular, compatible with\ncirrhosis. There is no evidence of concerning focal lesions within the\nlimitations of an unenhanced scan. A tiny punctate calcification is noted\nwithin the right hepatic lobe, likely compatible with calcified granuloma\n(02:18). There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas appears mildly atrophic, without evidence of focal\nlesions within the limitations of an unenhanced scan. There is no pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. Numerous hypodense\nlesions within the bilateral kidneys are compatible with simple cysts, with\nthe largest in the right interpolar region measuring 4.2 cm (02:29). Multiple\nadditional subcentimeter hypodensities are too small to characterize, though\nlikely compatible with simple cysts. There is no evidence of concerning focal\nrenal lesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is a punctate nonobstructive stone within the right\nupper pole (02:26).\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is not visualized, however no secondary signs of\ninflammation in the right lower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is mild aneurysmal dilatation of the lower thoracic aorta,\nmeasuring up to 4.3 cm (02:11). Extensive atherosclerotic disease is noted. \nThere is an IVC filter in place.\n\nBONES: There is no evidence of worrisome osseous lesions. Severe degenerative\nchange of the lumbar spine, including mild to moderate multilevel compression\ndeformities most notably involving L2, L3, and L4. There is grade 1\nanterolisthesis of L5 on S1. Moderate to severe degenerative change involving\nthe bilateral femoral heads, left greater than right, with moderate sclerosis\nof the left femoral head and mild sclerosis of the right femoral head,\nsuggestive of osteonecrosis.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. No acute intraperitoneal or retroperitoneal bleed.\n2. Severe degenerative change involving the bilateral hip joints, with\nmoderate sclerosis and flattening of the left femoral head and mild sclerosis\nacross the right femoral head, most compatible with osteonecrosis.\n3. Severe degenerative change of the lumbar spine, most notably including\nmultilevel compression deformities worst at L2 through L4, and mild\nanterolisthesis of L5 on S1.\n4. Cirrhotic liver morphology without evidence of concerning focal lesions\nwithin the limitations of an unenhanced scan.\n5. Cholelithiasis without evidence of acute cholecystitis.\n6. Punctate nonobstructive stone within the right upper renal pole.\n7. Mild aneurysmal dilatation of the lower thoracic aorta measures up to 4.3\ncm." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon is\npredominantly fluid-filled throughout with diffuse mild mural wall thickening\nand hyperemia. No drainable fluid collection is seen. No pneumoperitoneum or\nascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The infrarenal abdominal aorta is mildly ectatic measuring up to 2.7\nx 2.5 cm (02:41), stable compared to ___. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Compression deformity of the T12 vertebral body appears similar to\nprior exam performed ___. No aggressive osseous lesions are\nidentified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Diffusely fluid-filled colon with mild mural wall thickening and\nenhancement compatible with provided history of diarrhea. Findings may\nreflect a mild pancolitis.\n2. Stable ectatic infrarenal abdominal aorta.\n3. Unchanged T12 compression deformity." }, { "input": "Soft tissues: There is a small intramuscular hematoma measuring 2.4 x 2.3 cm\nwithin the left iliacus muscle. There is no associated fracture. The osseous\nstructures are osteopenic. Skin thickening of the posterior proximal left\nthigh is noted, possibly correlating with skin findings of ecchymosis.\n\nThe visualized lower abdomen demonstrates a large gallstone within the\ndependent portion of the gallbladder from of the right extrarenal pelvis, and\nmoderate severe vascular calcifications of the inferior abdominal aorta and\niliac vessels. There is no free fluid in the lower abdomen or pelvis. The\nbladder is well distended. There is no pelvic lymphadenopathy. Visualized\nbowel is not obstructed with significant colonic fecal load. A calcified\nlymph node is noted in the right lower quadrant, of uncertain etiology.\n\nBones: There is grade 2 anterolisthesis of L4 on L5, with pars defects\nbilaterally. Significant facet arthropathy is noted at L4-L5 and L5-S1. \nModerate degenerative changes of the left hip were noted.There is a right hip\ntotal hemi arthroplasty, with no evidence of perihardware fracture.", "output": "1. Small hematoma within the left iliacus muscle. No fracture.\n2. Grade 2 anterolisthesis of L4 on L5 with bilateral pars defects.\n3. Cholelithiasis" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. The partially visualized left\nand right cardiac atria are dilated.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is minimal\ncolonic diverticulosis. The appendix is normal.\n\nPELVIS: The urinary bladder is under distended but grossly unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are bilateral L5 pars defects associated with mild grade 1 L5-S1\nanterolisthesis.\n\nSOFT TISSUES: There is prominent fat within the left inguinal canal, likely\nrepresenting a 4.7 x 3.4 x 3.0 cm spermatic cord lipoma.", "output": "No evidence of malignancy in the abdomen or pelvis. Minimal sigmoid\ndiverticulosis and left spermatic cord lipoma noted." }, { "input": "LOWER CHEST: There are severe calcifications at the coronaries and aortic\nvalve. Visualized lung fields are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There are multiple hyperdense lesions\ncompatible with choledocholithiasis within the common bile duct. The stones\nwithin the common bile duct measure up to 11 mm in greatest diameter. The CBD\nmeasures 10 mm. There is diffuse intrahepatic biliary dilatation with subtle\nwall enhancement. The gallbladder is surgically absent with surgical clips in\nthe fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands are normal in shape and size.\n\nURINARY: There are multiple subcentimeter hypodensities throughout the\nbilateral kidneys too small to fully characterize on CT though statistically\ncysts. The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus with multiple calcified fibroids. The\nbilateral adnexal are unremarkable.\n\nLYMPH NODES: Enlarged 1.1 cm aortocaval lymph node is identified. There are\nmultiple additional retroperitoneal lymph nodes that do not meet CT criteria\nfor lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Visualized osseous structures are diffusely demineralized. Several\nvertebral body hemangiomas are identified, specifically at L 2, L3 and T8. \nThere is levoscoliosis of the lumbar spine. No acute fracture. There is\nsevere degenerative changes at the left hip. There is moderate degenerative\nchanges at the right hip.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted. There is also fat\ncontaining spigelian hernia on the left (2:61).", "output": "Choledocholithiasis with diffuse intrahepatic dilatation. Intrahepatic wall\nenhancement raises possibility for ascending cholangitis.\nSlightly enlarged aortocaval lymph node." }, { "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Few tiny\nsubcentimeter hypodensities in the bilateral kidneys are too small to\ncharacterize, though likely compatible with simple renal cysts. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The appendix is\nnormal. Numerous diverticula are seen scattered throughout the colon, with a\nshort segment of descending colon in the left lower quadrant demonstrating\nbowel wall thickening with surrounding fat stranding, compatible with acute\ndiverticulitis. No focal fluid collection or free intraperitoneal air is\nidentified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis. Prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Acute uncomplicated diverticulitis involving a short segment of the distal\ndescending colon in the left lower abdominal quadrant. No focal fluid\ncollection or free intraperitoneal air identified.\n\nExtensive diverticulosis throughout the colon." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis. Tiny bilateral subcentimeter hypodense lesions\nare again seen which are too small to characterize but may represent renal\ncysts. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Numerous\ndiverticula are again seen throughout the colon with a short segment of\ndescending colon noted to have mild surrounding mesenteric fat stranding. \nWall thickening is difficult to access due to collapse of the bowel at this\nlevel. There is no organizing fluid collection, free air, or abscess\nidentified. The appendix is mildly dilated up to 7 mm with no adjacent\nmesenteric fat stranding, not substantially changed compared to prior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias.", "output": "Extensive colonic diverticulosis with mesenteric fat stranding involving a\nshort segment of the descending colon without definite bowel wall thickening\nis concerning for mild acute diverticulitis or colitis. No evidence of\nperforation or abscess." }, { "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY:\nThe liver demonstrates homogenous attenuation throughout. There is no\nevidence of steatosis: 126 ___ on contrast scan (normal >100HU)There is no\nevidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\nPANCREAS:\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\nSPLEEN:\nThe spleen shows normal size and attenuation throughout, without evidence of\nfocal lesions.\nADRENALS:\nThe right and left adrenal glands are normal in size and shape.\nURINARY:\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of stones, focal renal lesions or hydronephrosis.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\nGASTROINTESTINAL:\nStatus post cystectomy of the antral mass with postoperative changes and mesh\nplacement in the anterior abdominal wall. There is no leak. No\nlymphadenopathy seen around the stomach.\nPost colectomy and ileostomy in the right lower quadrant\nRETROPERITONEUM & MESENTERY with no interval change since the in ___\noutside study\nThere is no evidence of retroperitoneal, mesenteric and omental lymph node\nenlargement. No solid or cystic mass.\nVASCULAR:\nThere is no abdominal aortic aneurysm. There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe left renal vein is dilated to the level where it passes behind the SMA and\nanterior to the aorta. In addition there is a large varix extending from the\nrenal vein to of the left common iliac vein just behind the aorta. These\nfindings indicate nutcracker syndrome due to compression of the renal vein\nbetween the SMA and aorta\nABDOMINAL WALL AND SOFT TISSUES:\nIleostomy in the right lower quadrant is seen with air parastomal hernia\ncontaining small bowel\n.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement. No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nProstate is normal status post colectomy and rectal resection\n\nSKELETAL:\nThere is no evidence of worrisome lesions.", "output": "1. Status post recent resection of a gastric tumor.\n2. Not likely left renal vein we large renal-iliac vein collateral/varix.\n3. No renal tumour\n4. Post colectomy with a ileostomy in the right lower quadrant and parastomal\nhernia containing small bowel, nonobstructing" }, { "input": "LOWER CHEST: Please see separate report for intrathoracic findings from\nsame-day CT chest.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates an unremarkable noncontrast appearance\nwithout obvious focal lesions. There is no intrahepatic biliary ductal\ndilation. Lack of IV contrast precludes evaluation of the portal vein. A 4\nmm gallstone layers dependently within the gallbladder lumen (series 2, image\n42). The gallbladder is otherwise unremarkable.\n\nPANCREAS: The pancreas demonstrates homogeneous attenuation. There is no\nperipancreatic stranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: The kidneys demonstrate a normal noncontrast appearance. There is no\nevidence of renal, ureteral, or bladder calculi. There is no hydronephrosis.\n\nGASTROINTESTINAL: Postoperative changes are noted along the anterior midline\nabdominal wall near the gastric antrum from prior resection, unchanged. The\nduodenum is unremarkable. Non-dilated small bowel loops are normal in course\nand caliber without evidence of obstruction. Again seen in the right lower\nabdominal quadrant is a parastomal hernia containing a few loops of\nunremarkable appearing small bowel (series 2, image 54), also unchanged in\nappearance. The patient is status post colectomy.\n\nRETROPERITONEUM: Moderate to severe atherosclerotic calcification is most\nprominent in the infrarenal abdominal aorta. The abdominal aorta is normal in\ncaliber without evidence of aneurysm or dilation. There is no retroperitoneal\nfluid collection. There is no mesenteric or retroperitoneal lymphadenopathy\nby CT size criteria. There is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs, including the bladder and terminal ureters, are\nunremarkable. There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy. There is no free pelvic fluid.\n\nMUSCULOSKELETAL: Postsurgical changes along the midline abdominal wall are\nsimilar to prior exams, with evidence of midline incision as well as surgical\nmesh placement. An abnormal appearance to the lumbosacral spine at L5-S1 is\nunchanged from prior exams, chronic and degenerative in nature, with evidence\nof vacuum disc phenomenon of the L5-S1 intervertebral disc. No concerning\nfocal lytic or sclerotic osseous lesions are seen.", "output": "1. No retroperitoneal hematoma.\n2. No evidence of acute intra-abdominal or intrapelvic process.\n3. Status post colectomy. Unremarkable small bowel. Unchanged small\nparastomal hernia at the right lower quadrant end ileostomy.\n4. Cholelithiasis.\n5. Unchanged postsurgical appearance of the anterior abdominal wall adjacent\nto the site of prior antral gastric resection.\n6. Moderate to severe atherosclerotic abnormal aortic calcification. No\naneurysm or dilation.\n7. Please see separate report for intrathoracic findings from same-day CT\nchest." }, { "input": "VASCULAR:\n\nThe abdominal aorta and its branches are patent with normal caliber. There\nis mild calcium burden in the abdominal aorta and great abdominal arteries. \nNote is made of replaced left hepatic artery arising from the left gastric\nartery.\n\nLOWER CHEST: Please refer to the separate report of cardiac CT performed on\nthe same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains a gallstone in the\ngallbladder fundus without evidence of cholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post total colectomy with end\nileostomy in the right lower quadrant. No bowel obstruction. There is a\nparastomal hernia containing nonobstructed small bowel loops and free-fluid. \nThe appendix is surgically absent. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder wall appears thickened most likely due to\ndecompression. There is a 0.4 cm nonobstructing stone within the urinary\nbladder (series 4, image 225) as on prior study. The distal ureters are\nunremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes of the lumbar spine are unchanged.\n\nSOFT TISSUES: Post hernia repair mesh are noted in the anterior abdominal\nwall. Small fat containing umbilical hernia on the left.", "output": "1. No acute process within the abdomen or pelvis.\n2. For detailed evaluation of the chest and vascular diameters, please see\nseparate report performed separately with the cardiac CT.\n3. Cholelithiasis without cholecystitis. Unchanged 0.4 cm nonobstructing\nstone in the urinary bladder." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is marked calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe visualized portions of the liver, spleen, kidneys, pancreas and bowel are\nunchanged from the CT scan of the abdomen and pelvis performed 4 hours prior. \nAgain noted is a right lower quadrant ileostomy with an adjacent parastomal\nhernia containing nonobstructed small bowel loops.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and prostate are unremarkable. There is a left\nfat containing hernia as well as a small bowel containing right inguinal\nhernia.\n\nBONES: Anterolisthesis of L5 over S1 is unchanged. Echo oasis at L4-L5. No\nacute osseous abnormality.\n\nSOFT TISSUES: Re-demonstrated is expansion of the right adductor musculature\ncompatible with the previously described hematoma. The size of the hematoma\nhas not changed. Postcontrast there is no evidence of active extravasation. \nNo retroperitoneal hematoma. Unchanged fat stranding along the medial right\nupper thigh and low pelvis.", "output": "1. Right adductor musculature hematoma, unchanged in size since 4 hours prior,\nwith no evidence of active hemorrhage. The remainder of the examination is\nunchanged when compared to the immediate prior CT." }, { "input": "LOWER CHEST: Minimal compressive atelectasis of the left lower lobe. \nPartially imaged cardiomegaly with similar leftward deviation of the heart\napex. Pacer lead is visualized within the right ventricle. No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no suspicious\nrenal lesions within the limitations of an unenhanced scan. There is no\nhydronephrosis. There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is collapsed. No bowel obstruction is seen. \nPatient is status post right lower quadrant ileostomy. The right lower\nquadrant osteoma site is normal appearance without evidence of bowel\nobstruction. Status post total colectomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted.\n\nBONES: Redemonstrated chronic anterolisthesis of L5 over S1, similar in\nappearance.\n\nSOFT TISSUES: Midline anterior abdominal wall ventral hernia repair is\nredemonstrated. The abdominal and pelvic wall is within normal limits.", "output": "1. Cholelithiasis without evidence of acute cholecystitis.\n2. Status post colectomy and right lower quadrant ileostomy. No bowel\nobstruction. No acute findings within the abdomen and pelvis.\n3. No renal, ureteral, or bladder calculus. No hydronephrosis bilaterally.\n4. Partially imaged cardiomegaly." }, { "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild diffuse low-attenuation of the liver parenchyma,\nconsistent with liver steatosis. No morphologic features of cirrhosis. No\nfocal parenchymal lesions. Portal and hepatic veins patent. Unremarkable\ngallbladder. No intrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreas is normal in bulk and attenuation. No focal parenchymal\nlesions identified. No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (9 cm). There are no focal splenic\nlesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Normal kidneys. No concerning renal parenchymal lesions. No\nhydronephrosis.\n\nGASTROINTESTINAL: Normal stomach and small bowel. Moderate volume stool\nburden. Large-bowel otherwise unremarkable. The appendix in the right lower\nquadrant normal.\n\nPERITONEUM: No intra-abdominal free air or free fluid.\n\nPELVIS: Unremarkable urinary bladder.\n\nREPRODUCTIVE ORGANS: The prostate gland is enlarged. There is median lobe\nhypertrophy, with protrusion into the bladder lumen. Seminal vesicles are\nnormal.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber. Origins of the celiac axis,\nSMA, renal arteries, and ___ are patent. Portal vein, portal confluence, SMV,\nand splenic vein patent.\n\nBONES: No acute or focal destructive osseous lesions. Mild degenerative\nremodeling lumbar spine. In TS of fat surround the bony pelvis.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.", "output": "1. No CT evidence of malignancy within the abdomen or pelvis.\n2. Mild diffuse low attenuation of the liver, consistent with liver steatosis.\nNo gross morphologic features of cirrhosis.\n3. Note that findings pertaining to the chest will be reported separately." }, { "input": "CHEST:\nThe visualized bases of lungs are clear.\n\nABDOMEN:\nThe liver is normal without evidence of focal lesions or intrahepatic biliary\nductal dilatation. The patient is status post cholecystectomy. The spleen is\nhomogeneous, and normal in size. The adrenal glands bilaterally are normal.\nThe kidneys bilaterally are normal without evidence of focal solid or cystic\nlesions concerning for malignancy. The pancreas is normal without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nThe stomach, duodenum, and small bowel are normal without evidence of wall\nthickening or obstruction. The colon appears to demonstrate moderate fecal\nloading, with evidence of a redundant colon.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\nDegenerative changes are seen throughout the spine. No focal lytic or\nsclerotic lesions concerning for malignancy are seen.", "output": "Moderate fecal loading with the redundant colon. Moderately distended cecum\nwhich lies in the midline. No other abnormalities identified." }, { "input": "LOWER CHEST: There is minimal bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The common bile duct measures 1 cm in\ndiameter, and tapers smoothly to the ampulla. A small focus of subcapsular\nair is noted as well as air along the anterior abdominal wall, likely related\nto recent intervention. The patient is post cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix not definitively visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Trace\nintrapelvic free fluid is within physiologic limits.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Post cholecystectomy with expected postoperative changes. Mild intra and\nextrahepatic biliary ductal dilatation, without radiopaque stone. No fluid\ncollections." }, { "input": "LOWER CHEST: Emphysema is noted at the imaged lung bases with mild scarring\nand nodularity. A left lower lobe nodule is seen on series 2 image 7\nmeasuring 4 mm. Also noted in the right lower lobe on series 2, image 13 is a\n6 mm nodule. No pleural or pericardial effusion seen. Pacemaker wires are\nnoted.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The liver is unremarkable.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nSPLEEN: Unremarkable.\nADRENALS: Unremarkable.\nURINARY: There are multiple bilateral simple renal cysts. Subcentimeter\nhypodensities in bilateral kidneys are too small to be characterized. There\nis no hydronephrosis.\nGASTROINTESTINAL: Stomach and duodenum are unremarkable. Small bowel is\nunremarkable without signs of ileus or obstruction.\nColonic diverticulosis is noted without diverticulitis. While E appendix is\nnot seen, there are no secondary signs of appendicitis.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS: Uterus is unremarkable. No adnexal mass is seen. Distal ureters\nopacify normally. The urinary bladder appears well distended and normal.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. There is\ngrade 1 anterolisthesis of L4 over 5 with associated degenerative disc disease\nat this level and no pars defects.", "output": "1. No evidence of colitis. Diverticulosis noted without diverticulitis.\n2. Lung base emphysema with subtle nodules measuring 4 and 6 mm for which\nfollowup CT is recommended in ___ months." }, { "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes. \nCoronary artery calcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere are multiple sub-centimeter hypodensities too small to characterize in\nboth kidneys. There is no perinephric abnormality. There is no hydronephrosis\nor hydroureter. The bladder is partially decompressed but demonstrates\ncircumferential wall thickening.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. There is a moderate stool burden in the rectum and\nsigmoid colon. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged, measuring 6.4 cm in largest axial\ndiameter.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no aortic aneurysm. There is a moderate atherosclerotic\nburden in the abdominal aorta. There is a mild atherosclerotic plaque burden\nin the iliac arteries. The celiac trunk, SMA and ___ are patent. Vascular\ncalcifications are noted in the right greater than left renal arteries. The\nSMV measures 1.6 cm at its proximal aspect.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous soft tissue densities overlying the abdominal wall\nlikely reflect sequelae of injections. There is a small fat containing\nsupra-umbilical hernia. There is also a small fat containing umbilical hernia.\nThe abdominal and pelvic wall is otherwise within normal limits.", "output": "1. Moderate atherosclerotic burden in the abdominal aorta with a mild\natherosclerotic burden in the iliac arteries. The SMV measures 1.6 cm at its\nproximal aspect.\n2. Circumferential bladder wall thickening is likely related to chronic outlet\nobstruction in the setting of enlarged prostate.\n3. Coronary artery calcifications are partially visualized." }, { "input": "LOWER CHEST: Bibasilar atelectasis. Cardiomegaly. Coronary calcifications. \nNo pericardial or pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in segment 6 is too small to characterize. There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: There is fatty infiltration of the pancreatic head and uncinate\nprocess. No focal lesions. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple cysts in the lower pole and interpolar region of the right kidney\nmeasures 2.3 and 2.7 cm respectively. There is no evidence of solid renal\nlesions or hydronephrosis. There is small amount of fluid in the right\nperinephric space.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic\ndisease is noted. Incidentally noted a retroaortic left renal vein.\n\nBONES: Patient is status post right total arthroplasty. No areas of lucency\nconcerning for loosening or infection. No periprosthetic fractures. L1\ncompression fracture. Degenerative changes of the lumbar spine.\n\nSOFT TISSUES: In the right iliacus muscle extending to the ileus psoas is a\nfairly homogeneous hyperdense collection spanning the muscle bulk measuring\n7.4 x 4.8 x 8.5 cm (AP, transverse, cc). The collection extents to the level\nof the prosthesis. Apparent hypodense focus in the distal iliopsoas, in close\nto the insertion at the lesser trochanter is likely streak artifact from the\nright hip arthroplasty.", "output": "1. 7 x 5 x 9 cm hematoma centered in the right iliacus muscle.\n2. Total right hip arthroplasty. No evidence of fracture.\n3. Age indeterminate L1 compression deformity." }, { "input": "LOWER CHEST: Probable small filling defect in a left lower lobe lateral basal\nsegment pulmonary artery, compatible with provided history of bilateral\npulmonary emboli. The partially imaged lung bases are otherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is contains stones, without\nevidence of gallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Small accessory spleen.\n\nADRENALS: Small, nodular right adrenal gland measuring 1 Hounsfield unit,\ncompatible with an adrenal adenoma. The left adrenal gland is normal in size\nand shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypoattenuating renal lesions are too small to completely characterize, but\nstatistically likely reflect simple cysts.No hydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout. Colon and rectum are\nwithin normal limits. there is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There are few locules of gas in the urinary bladder, correlate with\nrecent instrumentation. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. Incidental\nduplicated inferior vena cava with the left inferior vena cava draining into\nthe left renal vein. There is a suprarenal inferior vena cava filter.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A large oblique musculature intramuscular hematoma is increased\nin size in the craniocaudal direction since 4 days prior, measuring\napproximately 26 x 17 x 12 cm, previously 18 x 19 x 11 cm. No evidence of\nactive extravasation or pseudoaneurysm formation. There is significant\nadjacent fat stranding, increased since the prior examination. There is a\nsmall, fat containing umbilical hernia.", "output": "1. A large left oblique musculature intramuscular hematoma has increased in\nsize since 4 days prior in the craniocaudal direction, measuring approximately\n26 x 17 x 12 cm, previously 18 x 19 x 11 cm. No evidence of active\nextravasation or pseudoaneurysm formation.\n2. Probable small left lower lobe lateral basal segment pulmonary artery,\ncompatible with provided history of bilateral pulmonary emboli.\n3. Cholelithiasis.\n4. Small, 2.0 x 0.6 cm right adrenal adenoma.\n5. Few locules of gas in the urinary bladder. Recommend correlation with\nrecent instrumentation." }, { "input": "CHEST: Dependent atelectasis is in the postero-basilar segments of the lower\nlobes. There are no lung nodules or consolidation suspicious for malignancy\nor infection. There is no pericardial pleural effusion.\n\nABDOMEN: Unchanged the 1.2 cm hypodense lesion in segment 4, otherwise the\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent.\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions. The adrenals glands\nare unremarkable bilaterally.\n\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of stones or hydronephrosis. Smaller than 4 mm bilateral kidney\nhypodensities are unchanged since ___ and too small to be\ncharacterized.\n\nThere is no evidence of pathologically enlarged retroperitoneal and mesenteric\nlymph nodes.\n\nThe abdominal aorta demonstrates mild atherosclerosis.\n\nPELVIS: The urinary bladder is empty after Foley catheter placement. Distal\nureters are unremarkable. Stable dual fluid collection adjacent to the sigmoid\ncolon is now more displaced anteriorly of tear urinary bladder and ablation,\nand with the nasion of 4.4 x 5.8 cm (series 2: Image 73). Smaller than 1 cm\nsatellite lymph nodes of the left iliac chain are likely reactive. There is no\nevidence of inguinal lymphadenopathy. Small amount of free fluid is anterior\nto the pelvic abscess previously described (2:77).\n\nBONES AND SOFT TISSUES: There are no bone lesions suspicious for malignancy\nor infection.", "output": "1. 4.4 X 5.8 cm left pelvic abscess is more displaced anteriorly since CT\nperformed same day after urinary bladder depletion with Foley catheter\n2. Small amount of free abdominal fluid is anterior to the pelvic abscess\n3. Unchanged 1.2 cm hypodense lesion in segment 4\n4. Smaller than 4 mm bilaterally kidney hypodense lesion are too small to be\ncharacterize but stable since in ___" }, { "input": "There is deformity of the posterior iliac bones bilaterally, these appear to\nbe post surgical or post traumatic changes, possibly related to prior bone\ngraft donor sites (03:37). This appearance is unchanged compared to multiple\nprior studies dating back to ___. There has been prior posterior\nfusion at L4-L5 with grade 1 anterolisthesis of L4 on L5, this is unchanged in\nappearance when compared to the prior studies.\n\nThere is no convincing evidence of a sacral insufficiency fracture. On 1\nimage only, there is a linear lucency through the right iliac bone close to\nthe sacroiliac joint (03:30). This was not definitely seen on the earlier\nstudies however there was a cortical irregularity in this area and this is\nunlikely to represent acute fracture. If the patient has pain in this area,\nthis could reflect an undisplaced fracture. MRI may be better able to\nclarify.\n\nThere are moderate degenerative changes in the bilateral hip joints, more\nprominent on the left than the right. Degenerative changes also noted in the\nsymphysis pubis and bilateral sacroiliac joints. A small sclerotic focus in\nthe right parasymphyseal region is likely a bone island.\n\nAssessment of the pelvic parenchymal structures is limited. There is\nextensive atherosclerotic calcification. Extensive colonic diverticulosis\nwithout evidence of diverticulitis. There is a fat containing ventral hernia\n(04:13). No pelvic lymphadenopathy seen. Calcifications noted in the right\nadnexal region.", "output": "1. Subtle linear lucency the posterior right iliac bone is likely a nutrient\nforamen however given the provided history, undisplaced insufficiency fracture\ncannot be excluded. MRI may be helpful to clarify.\n2. New deformity and irregularity of the bilateral posterior iliac bones\nconsistent with bone graft donor site.\n3. Degenerative changes in the bilateral hip joints and sacroiliac joints.\n4. Small fat containing ventral hernia.\n5. Calcifications in the right adnexal region, likely in the right ovary but\nincompletely evaluated on this study.\n6. Diverticulosis without evidence of diverticulitis." }, { "input": "VASCULAR:\n\nNo active contrast extravasation is identified to suggest active\ngastrointestinal bleeding. There is no abdominal aortic aneurysm. There is\nminimal calcium burden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. Trace bilateral\npleural effusions. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nSeveral hepatic hypodensities measure up to 9 mm and are nonenhancing,\nconsistent with simple cysts or biliary hamartomas. There is no evidence of\nconcerning focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. Mild gallbladder wall thickening the fundus suggest\nadenomyomatosis. The gallbladder is otherwise within normal limits, without\nstones or gallbladder wall edema. Pericholecystic fluid is likely secondary\nto underlying ascites.\n\nPANCREAS: Normal attenuation throughout the pancreas, however there is the\nsuggestion of mild diffuse enlargement and edema of the pancreas, most\npronounced at the pancreatic head. No main ductal dilatation. Peripancreatic\nfluid is seen diffusely about the pancreas without evidence of organization.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally. Several subcentimeter cortical\nhypodensities too small to characterize by CT likely represent simple cysts. \nThere is no evidence of stones, concerning focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There are prominent gastric rugae throughout, however there\nis relatively increased wall edema seen at the distal stomach near the antrum\nand pylorus (series 5, image 67). The level of the duodenal bulb, there is a\nradiopaque density (series 5, image 62), likely reflective of known clip. \nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. There is mild circumferential mural thickening of the right\ncolon, otherwise the colon and rectum are within normal limits. There is no\nevidence of mesenteric lymphadenopathy. The appendix is normal. No evidence\nof active extravasation within the colon or rectum.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is moderate volume,\nsimple abdominopelvic ascites. A left lower quadrant approach approach\nperitoneal dialysis catheter terminates in the right lower quadrant.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable. There are bilateral vasectomy clips.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of active contrast extravasation within the gastrointestinal\ntract.\n2. Marked circumferential mural edema involving the gastric antrum and pylorus\nwhich may be due to third spacing, but can also be seen with gastritis.\n3. Mildly enlarged and somewhat edematous appearance of the pancreas with\nperipancreatic fluid findings suggestive of mild acute interstitial edematous\npancreatitis. No evidence for pancreatic necrosis. Correlation with serum\nlipase levels suggested.\n4. Mild mural thickening of the right colon may be secondary to third spacing.\n5. Moderate volume low-density abdominopelvic ascites. Left lower quadrant\napproach peritoneal dialysis catheter terminates in the right lower quadrant\nand appears intact. Trace bilateral pleural effusions.\n6. Atrophic kidneys bilaterally consistent with known medical renal disease." }, { "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation. There is focal fat\ndeposition at the falciform ligament. An additional tiny hypoattenuating\nfocus is identified in the left lobe of the liver and is unchanged from the\nstudy performed ___. Portal and hepatic veins are patent. The\ngallbladder is decompressed. There is no intrahepatic or extrahepatic bile\nduct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation. No focal\nparenchymal lesions identified. No main duct dilatation.\n\nSPLEEN: The spleen measures at the upper limits of normal at 13 cm in\ndiameter. There are no focal splenic lesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: There is a hyperdense 13 mm lesion at the upper pole of the right\nkidney (103 Hounsfield units) on the portal venous phase. On the 3 minutes\ndelay, it appears to washout to 70 ___ units. On the study performed\nin ___, a small hypodense cystic lesion was seen in this location,\nmeasuring approximately 8 mm in diameter. There are bilateral non-obstructing\nrenal calculi. A calculus at the interpolar region of the right kidney\nmeasures approximately 3 mm in diameter (series 8, image 28). A calculus at\nthe upper pole of the left kidney measures 4 cm in diameter (series 8, image\n30). No hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: Normal stomach and small bowel. No mural thickening or\nluminal distention. Normal rectum and large bowel. Appendix in the right\nlower quadrant normal.\n\nPERITONEUM: No free air or free fluid.\n\nPELVIS: Normal appearance of the urinary bladder\n\nREPRODUCTIVE ORGANS: Unremarkable prostate gland and seminal vesicles.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber. Major branch vessels are\npatent. Incidental note is made of a retroaortic left renal vein, a normal\nvariant.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Abdominal and pelvic wall are unremarkable.", "output": "1. Findings pertaining to known metastatic disease to the chest will be\nreported separately.\n2. No evidence of metastatic disease to the abdomen or pelvis.\n3. Indeterminate hyperdense 13 mm lesion at the upper pole of the right\nkidney, which appears to washout on the 3 minutes delay. A smaller simple\ncystic lesion was noted in this location on the study performed in ___. This warrants further investigation with an MRI (with and without\ncontrast.\n4. Bilateral non-obstructing renal calculi.\n\nRECOMMENDATION(S): Renal mass MRI with and without contrast." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a stable subcentimeter hypoattenuating focus in the left lobe. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size (12 cm) and attenuation throughout,\nwithout evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral nonobstructive subcentimeter renal calculi that appear\nunchanged compared to most recent study. A previously seen hyperdense lesion\nin the upper pole of the right kidney was better evaluated on the previous\nstudy perhaps secondary to phase of contrast administration. There is no\nevidence of hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Right renal lesion was better evaluated on the previous study and at that\ntime, an MRI was recommended for further evaluation.\n3. Bilateral nonobstructing renal calculi." }, { "input": "LOWER CHEST: For chest findings reference is made to CT chest report of the\nsame day\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Subcentimeter biliary hamartoma\n(series 2, image 47) is again noted. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is normal in morphology. A\nsmall linear hyperdensity measuring 4 mm likely represents a gallbladder polyp\nappear similar compared to prior MRI done ___, this could be better\nassessed with dedicated ultrasound.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Previously seen lesion at the posterior upper pole of the right\nkidney has largely undergone involution. Bilateral punctate, milli metric\nnonobstructing renal calculi noted bilateral. There is no evidence of solid\nrenal lesions or hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted. Incidental note is made of a retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic bony lesions appear similar compared to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. The abnormality seen on recent MR spine correlates to a lesion/collection\nin the left pleural space and reference is made to CT chest for a description\nof this finding.\n2. There is no evidence of metastatic disease in the abdomen or pelvis.\n3. A small linear hyperdensity noted in the gallbladder could represent a\ngallbladder polyp, this could be better assessed with dedicated ultrasound.\n4. Bilateral punctate, milli metric nonobstructing renal ___\nplaques appear similar compared to prior imaging. No hydronephrosis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones and\nsludge without wall thickening or surrounding inflammation.\n\nPANCREAS: There is new mild peripancreatic stranding adjacent to the\npancreatic head and uncinate process (02:26, 601:34, 602:44). Otherwise, the\npancreas demonstrates fatty atrophy but normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen is persistently enlarged measuring approximately 14 cm. \nThere is interval enlargement of a 5.4 cm peripherally hyperenhancing,\ncentrally hypoenhancing, splenic lesion, previously measuring 4.9 cm in\n___. Addition, there is a similar appearing lesion more anteriorly\nwhich appears new measuring approximately 3.4 cm (02:19). Otherwise, there\nare stable scattered calcified granulomas.\n\nADRENALS: The right adrenal gland is normal in size and shape. The left\nadrenal gland again demonstrates a unchanged 1.6 x 2.1 cm nodule, stable\ncompared to ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a stable exophytic 2.0 cm lesion arising from the upper pole of the\nleft kidney with bulk fat likely representing angiomyolipoma (02:28). \nAdditionally, there is a stable sized 2.0 cm right cortical simple cyst\n(02:39). There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia otherwise, the stomach is\nunremarkable. A misty mesentery appearance is stable compared to ___. Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Patient status post right colectomy without evidence\nof complications. Diverticulosis of the colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an partially calcified fibroid uterus. No\nadnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: A right femoral vein stent is visualized. A partially visualized\nright femoral artery graft demonstrates relative abrupt decreased\nopacification (2:75, 77). There is no abdominal aortic aneurysm. Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nStable multilevel degenerative changes of the visualized thoracolumbar spine\nare noted.\n\nSOFT TISSUES: There is a right lower abdominal scar and mild soft tissue\nstranding in the right groin, likely postprocedural/postsurgical. There is a\ntiny fat containing umbilical hernia. The remaining abdominal and pelvic wall\nis within normal limits.", "output": "1. Findings compatible with early acute interstitial pancreatitis. \nCorrelation with clinical findings and serum lipase levels is recommended.\n2. Partially imaged right femoral artery graft demonstrates relative decreased\nopacification, which may represent occlusion. Correlation with prior surgical\nhistory and vascular surgery consultation is recommended.\n3. Enlarging and new splenic lesions may represent hemangiomas. However,\ngiven history of reported colon cancer, MRI abdomen with intravenous contrast\nis recommended.\n4. 2.0 cm indeterminate left adrenal nodule, stable compared ___. \nThis can be reassessed on follow-up imaging.\n\nRECOMMENDATION(S): Vascular surgery consultation.\n\nMRI abdomen with and without contrast, on a non emergent basis\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:50 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "LOWER CHEST: Again demonstrated, are fibrotic lung changes at the bases in\nkeeping with history of interstitial lung disease. Otherwise, visualized lung\nfields are within normal limits. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere bilateral cortical hypodensities some of which are too small to\ncharacterize but likely represent cysts statistically. Otherwise, there is no\nevidence of focal renal lesions or hydronephrosis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small fluid-filled hiatal hernia. Otherwise, the\nstomach is fluid-filled and slightly distended. There is a fluid-filled\ndistal esophagus. There is a small-bowel obstruction with a transition point\nin the right mid abdomen quadrant where there is a short segment of thickened\nsmall bowel with a targetoid appearance (2:44, 601:24). There is\nfecalization of small bowel loop immediately proximal to the abnormal\nappearing short-segment of small bowel, which is after near a transition in\ncaliber, the site of suspected obstruction (02:38). Small quantities of fluid\ndo pass the point of suspected obstruction, however. More distal small bowel\nis decompressed. There is segment of mid sigmoid with equivocal wall\nthickening and hyperenhancement, although assessment is difficult due to under\ndistension (2:64). The terminal ileum appears normal. Colonic diverticulosis\nwithout evidence of acute diverticulitis. The colon and rectum are overall\ndecompressed.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\ntrace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged. The seminal vesicles\nare grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a moderate sized fat containing umbilical hernia. \nOtherwise, the abdominal and pelvic wall is within normal limits.", "output": "1. Small-bowel obstruction with transition point in the right mid abdomen,\nwhere there is a short segment of hyperemic/thickened small bowel. The short\nsegment has a targetoid appearance with intramural edema or inflammation. \nPossibilities include that this is due to congestion associated with small\nbowel obstruction, including the possibility of early ischemic change, versus\nintrinsic small-bowel abnormality such as a short-segment of inflammatory\nbowel disease. The latter possibility seems less likely, however. This\nappearance is not suspicious for a tumor but it may be appropriate,\nparticularly to exclude a background inflammatory process, to consider\nfollow-up imaging within a few months.\n2. Hyperemic sigmoid colon may represent a skip lesion in the setting of\ninflammatory bowel disease. However, this apparent hyperenhancement may be\ndue to under distension and is an equivocal abnormality.\n3. No evidence of free intraperitoneal air.\n4. Colonic diverticulosis without evidence of acute diverticulitis.\n5. Small to moderate sized fat containing umbilical hernia without significant\nsecondary inflammatory changes.\n6. Small hiatal hernia.\n\nRECOMMENDATION(S): Follow-up cross-sectional imaging, CT or MR, may be\nappropriate within 3 months in order to assess for any possibility of an\nunderlying small-bowel process to explain obstruction. However, obstruction\ndue to adhesion is favored as the most likely etiology.\n\nNOTIFICATION: Findings and recommendations discussed with Dr. ___ at\napproximately 12:45 by telephone." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A few subcentimeter scattered hypodensities are seen in the\nliver, incompletely characterized but unchanged since prior exams dating back\nto ___. Otherwise, the liver demonstrates homogenous attenuation throughout.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2 mm nonobstructive renal stone is noted in the left lower renal pole. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild scattered\ncolonic diverticulosis is noted without evidence of acute diverticulitis. \nOtherwise, the colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is distended. There is no distal hydroureter. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is again an L4 vertebral body hemangioma. No acute fractures are\nseen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute process seen in the abdomen or pelvis.\n2. Mild scattered colonic diverticulosis without evidence of acute\ndiverticulitis.\n3. 2 mm nonobstructive left lower renal pole stone." }, { "input": "LOWER CHEST: Multiple bilateral pulmonary nodules are again noted and are\nunchanged in size and distribution in this patient with known sarcoidosis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan. There is\nno hydronephrosis. 2 mm new nonobstructive stone in the upper pole of the\nleft kidney is noted (series 3, image 76). There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. 2 mm nonobstructive kidney stone in the upper pole of the left kidney. No\nhydronephrosis.\n2. Multiple micronodules in both lower lobe of the lung are unchanged in size\nand distribution from prior CT of ___." }, { "input": "VASCULAR:\n\nThere is a saccular 3.4 x 3.1 cm (in the axial plane) pseudoaneurysm abutting\nand likely arising from the SMA. There components of arterial contrast\nopacification within the pseudoaneurysm which is otherwise thrombosed. \nThough no active extravasation is visualized, the wall of the pseudoaneurysm\nis hazy with adjacent fatty stranding raising concern for impending rupture.\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Linear atelectasis/scarring is visualized at the right lung base.\nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.2 cm right hepatic lobe hypodensity likely compatible with\nhepatic cyst versus biliary hamartoma. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is contains sludge versus\nvicarious excretion of contrast as well as stones, without evidence of\ngallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic though symmetric in size with normal\nnephrogram. Multiple bilateral renal hypodensities are visualized measuring\nup to 3.5 cm with an exophytic left upper pole lesion compatible with simple\nrenal cysts. Additionally there is an intermediate density nonenhancing\nexophytic right upper pole lesion that measures 3 cm and is compatible with\nhemorrhagic or proteinaceous cyst. There is no evidence of stones, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Diverticulosis visualized without evidence of\nbowel wall thickening or adjacent fatty stranding. Appendix is not seen. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Contour abnormality of the right ventral aspect of the bladder near\nthe base is again seen though without frank herniation into the now fat\ncontaining right inguinal hernia. The distal ureters are unremarkable. There\nis no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with fiducials visualized\nbilaterally.\n\nBONES: Degenerative changes are seen in the lumbar spine without evidence of\nworrisome osseous lesions.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted. Fat containing\numbilical hernia is also noted.", "output": "1. A partially thrombosed pseudoaneurysm measuring up to 3.4 cm which appears\nto arise from the SMA. Subtle adjacent fat stranding raising possibility of\nimpending rupture, though no active extravasation is visualized. This\nappearance has not changed since yesterday's exam.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Diverticulosis without diverticulitis.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:45 pm." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nPatient is status post resection and repair of a SMA aneurysm with surgical\nstaples in the resection bed (03:56). Soft tissue stranding at the site of\nprior SMA pseudoaneurysm extends to the first SMA branch point and is likely\npostsurgical (3:51, 58, 59). No evidence of residual pseudoaneurysm.\n\nOtherwise the celiac axis, ___, renal, and iliac arteries and their major\nbranches are patent with no signs of occlusive or aneurysmal disease.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.8 x 1.5 cm hypodense lesion in segment V is unchanged compared to ___ (03:39). There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is contains stones, without evidence of\ngallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere no hydronephrosis. A hyperdense right interpolar lesion measures 2.7 x\n2.4 cm, which is grossly similar compared to prior exam and does not\ndemonstrate postcontrast enhancement. This likely represents a hemorrhagic\ncyst (02:28). An exophytic 3.7 x 3.6 cm left interpolar renal cyst is\nunchanged compared to prior. Multiple other renal hypodensities are too small\nto fully characterize but appear in similar size and configuration compared to\nprior exam and likely represent simple renal cysts. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Diverticulosis in the sigmoid colon is noted. \nAppendix contains air, has normal caliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducial markers are again demonstrated in the prostate.\n\nBONES: Mild degenerative changes of thoracolumbar spine. There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias, right greater than\nleft.", "output": "Previously demonstrated SMA pseudoaneurysm is no longer visualized. Soft\ntissue density surrounding the SMA and extending into the first SMA branch\npoint is likely secondary to postoperative changes and is associated with two\nsurgical clips. No evidence of residual pseudoaneurysm." }, { "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion. 0.7 cm hypodensity in segment 2, is too\nsmall to characterize, likely represents a simple cyst. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions. There\nis no pancreatic ductal dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is no perinephric\nabnormality. There is no hydronephrosis or hydroureter. 3.1 cm simple cyst\nin the left inter pole is unchanged in size. Additional hypodensities are too\nsmall to characterize. The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. Marked\nappendiceal distention with surrounding stranding in keeping with\nappendicitis. Along the mid aspect of the appendix the wall appears thin and\nthere is an associated air-fluid level suggesting a prior rupture and\ncontained perforation/abscess formation. Surrounding stranding as well as\nreactive lymph nodes are noted.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A incompletely distended penile implant reservoir is\nnoted in the pelvis. No evidence of complications is noted. The prostate is\nenlarged measuring 6 cm.\n\nLYMPH NODES: Prominent inguinal, retroperitoneal and pelvic sidewall lymph\nnodes are noted, overall unchanged compared to prior study.\n\nVASCULAR: Moderate atherosclerotic disease is present. There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Marked appendiceal distention with surrounding stranding in keeping with\nappendicitis. Along the mid aspect of the appendix the wall appears thin and\nthere is an associated air-fluid level suggesting a prior rupture and\ncontained perforation/abscess formation.\n2. Prominent inguinal, retroperitoneal and pelvic sidewalls lymph nodes are\noverall unchanged compared to prior, however a possible lymphoproliferative\ndisorder should be excluded if not done previously.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 130 pm, 5 minutes after discovery\nof the findings." }, { "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: There are multiple scattered hepatic hypodensities measuring up\nto 9 mm in size, likely cysts.\nThe gallbladder is partially distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation no focal pancreatic lesions.\nSPLEEN: No splenomegaly or focal splenic lesions.\nADRENALS: No adrenal nodules.\nURINARY: No hydronephrosis or solid enhancing renal masses noted\nGASTROINTESTINAL: There is no bowel obstruction. None no bowel wall\nthickening noted.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears normal. The prostate has a\nhomogeneously hypodense appearance, and is not enlarged. No free fluid in the\npelvis..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.\nMild body wall edema noted.", "output": "1. No abdominal/pelvic lymphadenopathy or splenomegaly noted.\n2. Scattered hepatic hypodensities measuring up to 9 mm in maximum dimension,\nlikely cysts." }, { "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes. No\npleural pericardial effusion. Coronary artery calcifications are partially\nvisualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion. Mild intrahepatic ductal dilatation. \nThe gallbladder is surgically absent.\n\nPANCREAS: Status post pancreaticoduodenectomy. The remainder of the pancreas\ndemonstrates normal enhancement without evidence of focal lesion or pancreatic\nductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Accessory spleen is seen at the distal tip of the\nspleen (series 2, image 30).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is no perinephric\nabnormality. There is no hydronephrosis or hydroureter. The urinary bladder\nis underdistended, limiting its evaluation.\n\nGASTROINTESTINAL: Post surgical changes related to interval\npancreaticoduodenectomyare seen. Enteric contrast is seen within the stomach\nand small bowel without evidence of contrast extravasation to suggest a leak\nor perforation. Tiny foci of intraperitoneal air is likely related to recent\nsurgery (series 2, image 30). Visualized small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement. Diverticulosis of the sigmoid colon\nis noted, without evidence of wall thickening or fat stranding. The ascending\nand transverse colon is under distended. There is an oblong fluid and air\ncontaining collection along the anterior wall of the peritoneum measuring\napproximately 14.1 x 2.3 x 8.7 cm (SI by AP by TRV; series 602, image 56,\nseries 601, image 17).\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Again demonstrated is a focal calcification in the\nuterine myometrial wall. A hypoattenuating cystic structure near the cervical\nos measures 1.1 x 1.0 cm, possibly a nabothian cyst, and unchanged compared to\nthe prior examination (series 602, image 53).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present. There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine. No aggressive\nosseous lesions are identified.\n\nSOFT TISSUES: There is a large skin and subcutaneous defect along the right\nupper anterior abdominal wall extending to but not insert passing the\nperitoneum. Findings are compatible with recent debridement. Heterogeneous\nmaterial within the defect may reflect packing material. Scattered foci of\nair and fluid along the midline anterior abdominal wall may be related to\nrecent debridement versus phlegmonous change. Surgical staples are seen\noverlying the upper abdominal wall. There is moderate body wall anasarca. No\ndefinite organized collection is seen in the subcutaneous soft tissues.", "output": "1. Status post radical pancreaticoduodenectomy with an oblong fluid and air\ncontaining collection abutting the anterior peritoneum measuring approximately\n14.1 x 2.3 x 8.7 cm (SI by AP by TRV).\n2. Large skin and subcutaneous defect along the right upper anterior abdominal\nwall compatible with recent debridement and packing. Scattered areas of air\nand fluid along the midline anterior abdominal wall may be related to recent\ndebridement versus phlegmonous change. No identifiable drainable fluid\ncollection in the subcutaneous soft tissues of the abdominal wall.\n3. Mild intrahepatic ductal dilatation.\n4. Tiny foci of intraperitoneal air is likely related to recent surgery." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Note is made of bibasilar\natelectasis as well as minimal left pleural thickening posteriorly. A venous\ncatheter tip terminates at the cavoatrial junction.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\ndilatation, similar from prior. The gallbladder is surgically absent. There is\nan unchanged tubular focus just medial to the inferior right hepatic lobe,\nnonspecific (2:48).\n\nPANCREAS: The patient is status post pancreaticoduodenectomy. The residual\npancreas is normal in bulk with a normal enhancement pattern and no evidence\nof focal lesion or main ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes related to pancreaticoduodenectomy are\nnoted. Evaluation of the postoperative anatomy is limited in the absence of\noral contrast media. There is no evidence of bowel obstruction. Oral contrast\nmedia is seen within the rectum as well as in multiple colonic diverticula,\nlikely representing residual oral contrast from the prior exam.\n\nThere is re-demonstration of a fluid collection along the anterior abdominal\nwall. A pigtail drainage catheter is noted within the superior component of\nthis collection which is substantially smaller on the current exam and\ndifficult to discretely measure. The more inferior component of this\ncollection measures approximately 6.9 x 1.6 x 1.7 cm, previously 9.1 x 1.4 x\n6.9 cm (TV by AP by CC) (2:38, 602:45). Anterior to the greater curvature of\nthe stomach abutting the peritoneum there is re-demonstration of a 1.5 x 1.5 x\n1.4 cm rim enhancing collection slightly changed in morphology from prior but\nprobably slightly larger (2:39). There is unchanged nonspecific soft tissue\nnodularity within the anterior superior mesenteric fat could reflect\npostsurgical change or omental disease (2:42).\n\nPELVIS: The urinary is distended but unremarkable in appearance. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Unchanged 1 cm cystic focus adjacent to the cervical os,\npossibly a nabothian cyst (2:77). A focus of calcification in the uterine\nmyometrium is unchanged.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is extensive body wall anasarca with a slightly\nconglomerate appearance in the right anterior wall pannus without evidence of\nrim enhancement (2:62). Presumed post debridement changes are noted along the\nanterior abdominal wall with a slightly heterogeneous appearance which may\nreflect packing material.", "output": "1. Status post pancreaticoduodenectomy, suboptimally evaluated in the absence\nof oral contrast media. Unchanged mild intrahepatic biliary ductal\ndilatation.\n2. Interval decrease in size of an anterior abdominal wall fluid collection\nstatus post pigtail catheter placement as described above.\n3. A 1.5 cm rim enhancing collection anterior to the greater curvature of the\nstomach is slightly changed in morphology from prior and slightly larger,\nlikely below size threshold for drainage.\n4. No definite new focal fluid collections, however evaluation is limited\nwithout oral contrast.\n5. Nodular soft tissue deposits within the anterior superior mesenteric fat\nmay reflect postsurgical change or omental disease.\n6. Nonspecific tubular structure just medial to the inferior right hepatic\nlobe is unchanged from prior and may reflect sequelae of cholecystectomy. \nAttention on follow-up is recommended.\n7. Diffuse body wall stranding and anasarca with evidence of an anterior\nabdominal wall wound defect status post packing." }, { "input": "NOTE: History of malignant biliary obstruction status post pylorus preserving\npancreaticoduodenal ectomy.\n\n\nLOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nThere is nodular soft tissue within the mesentery in the midline (series 5,\nimage 22) a, slightly smaller in size compared to ___, together\nmeasuring 2.2 x 0.6 cm in size. Persistent 4 mm soft tissue nodule along the\ninferior margin of the liver (series 5, image 31) also noted.\n\nHEPATOBILIARY: The liver enhances homogeneously with no focal liver lesions.\nThe gallbladder is surgically absent.\nPANCREAS: The patient is post pylorus preserving pancreaticoduodenectomy. The\nremnant pancreas enhances homogeneously with mild prominence of the main\npancreatic duct.\nSPLEEN: No splenomegaly or focal splenic lesions..\nADRENALS: There is a right adrenal nodule measuring 1.3 x 0.8 cm in size\n(series 5, image 12) that was not seen on the MRI from ___, and\nis more conspicuous compared to ___ concerning for a metastatic\nlesion in the given clinical scenario.\nThere is new uniform thickening of the left adrenal gland (series 5, image\n14), close attention on follow-up recommended.\n\nURINARY: No hydronephrosis or solid enhancing renal masses noted.\nGASTROINTESTINAL: There is no bowel obstruction.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears unremarkable. The uterus and\nadnexae are unremarkable..\n\nBONES AND SOFT TISSUES:\nMild degenerative changes of the thoracolumbar spine noted. No worrisome\nosseous lesions identified.\n\nThere is interval resolution of the previously noted fluid collection located\nbetween the stomach, left lobe of the liver and the anterior abdominal wall.\n\nPostsurgical changes of the upper anterior abdominal wall noted.\nSubcutaneous hypodense nodules in the right anterior pelvic wall measuring up\nto 1.6 cm in size may be related to injections (5:64).", "output": "1. Interval resolution of previously visualized fluid collection located\nbetween the liver, stomach and the anterior abdominal wall. There has been\ninterval removal of the percutaneous drain noted on the prior scan. No new\nintra-abdominal fluid collections seen.\n2. Decrease in size of nodular soft tissue thickening within the upper\nabdominal midline mesentery. Continued attention on follow-up.\n3. New/more conspicuous right adrenal nodule measuring 1.3 cm in size, and\nthickening of the left adrenal gland-close attention on follow-up recommended." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent. No\nfluid collections at the gallbladder fossa. No ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Fluid filled\ncolon, appears otherwise normal. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Normal appendix.\n2. Fluid-filled colon with otherwise normal wall appearance. Correlate with\ndiarrhea.\n3. Status post cholecystectomy with no fluid collections at the gallbladder\nfossa." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. In\nthe subhepatic space abutting the inferior border of the right hepatic lobe\nand adjacent duodenum is a heterogenously enhancing mass measuring 5.8 x 4.7\ncm, (series 2, image 57) and previously measured 10.5 x 8.7 cm on most recent\nprior. The solid homogeneous enhancing mass, anterior to the large subhepatic\nheterogenously enhancing lesion, (seen on prior imaging; series 2, image 37)\nis no longer demonstrated on current study. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreatic parenchyma demonstrates mild fatty replaced. There\nis no evidence of focal lesion or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen remains posteriorly displaced by the mass extending from\nthe stomach. The spleen demonstrates normal size and attenuation throughout,\nwithout evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are bilateral non there is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Extending from the greater curvature of the stomach is a\nheterogenously enhancing, complex cystic and solid mass with a centrally\nnecrotic component measuring 9.8 x 6.8 x 10.3 cm and previously measured up to\n18.1 cm. There is a small hiatus hernia. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal. There has been interval resolution\npreviously demonstrated hyperdense ascitic fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Moderate prostatomegaly. The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild multilevel degenerative changes of the lower thoracic and\nlumbar spine including intervertebral disc space narrowing osteophytosis and\nvacuum phenomena.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.", "output": "1. There has been significant interval decrease in size of of the GIST tumor\nextending from the greater curvature of the stomach and the metastatic mass in\nthe subhepatic space.\n2. Interval resolution of previously demonstrated solid homogeneous enhancing\nmass, anterior to the subhepatic lesion.\n3. Interval resolution of small volume hyperdense ascites.\n4. Cholelithiasis and diverticulosis are incidental findings." }, { "input": "Lungs: Please see the report of the CT chest performed on the same day for\nmore details.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious liver\nlesion.\n\nIn the subhepatic space abutting the inferior border of the right hepatic lobe\nand adjacent to the duodenum, there is redemonstration of the hypodense mass\nmeasuring 5.2 cm x 4.0 cm x 2.6 cm, previously 5.8 cm x 4.7 cm x 3.6 cm,\nmildly decreased in size.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder contains a stone as before.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Mild fatty replacement as before. There is no pancreatic duct\ndilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nGastrointestinal: Colonic diverticula are seen. Stable duodenal diverticulum.\n\nThere is no evidence of bowel dilatation or obstruction.\n\nThere is redemonstration of the mass extending from the greater curvature of\nthe stomach, abutting the spleen. It measures 6.6 cm x 10.1 cm x 4.6 cm,\npreviously 6.8 cm x 10.3 cm x 5.6 cm, mildly decreased in size.\n\nVascular: There are mild atherosclerotic calcifications of the abdominal\naorta.\n\nThe portal vein and hepatic veins are patent.\n\nLymph nodes: There are no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion. Moderate\ndegenerative disc disease is seen in the lumbar spine. Fat-containing\numbilical hernia again seen.", "output": "1. Mild decrease in size of the mass extending from the greater curvature of\nstomach and the subhepatic mass.\n\n2. Uncomplicated cholelithiasis.\n\n3. Please see the report of the CT chest performed on the same day for more\ndetails." }, { "input": "LOWER CHEST:\nPlease refer to same day chest CT report for subdiaphragmatic findings.\n\nABDOMEN AND PELVIS:\n\nHepatobiliary: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.\n\nPancreas: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSpleen: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nAdrenals: The right and left adrenal glands are normal in size and shape.\n\nUrinary: The kidneys are normal and symmetric in size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGastrointestinal: Unchanged appearance of a hypodense mass adjacent to the\nduodenum in proximity to the gall bladder and right hepatic lobe (05:56)\nmeasuring 5.2 x 4.0 cm. Also relatively unchanged is a hypodense mass along\nthe greater curvature of the stomach and close proximity to the spleen (05:43)\nmeasuring 10.8 x 6.3 cm. The stomach is unremarkable. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPelvis: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nReproductive Organs: The seminal vesicles are unremarkable. The prostate is\nmildly enlarged.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVascular: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBones: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSoft Tissues: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable masses along the greater curvature of the stomach and duodenum, in\nkeeping with the known primary malignancy. No other lesions concerning for\nnew metastatic disease.\n2. Uncomplicated cholelithiasis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nGIST LESIONS: Well-defined low-density soft tissue just inferior to the porta\nhepatis, contacting the gastric pylorus, medial margins of hepatic segments 5\nand 6, and the colonic flexure is stable in size and appearance, measuring up\nto 4.7 x 4.1 cm.\nSimilarly, the well-defined irregular soft tissue mass abutting the greater\ncurvature of the gastric fundus 10.1 by 6.6 cm in maximum ___, similar\nto previous examination. This lesion blends with the gastric surface, and\nabuts the anterior spleen.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is cholelithiasis without evidence of\ngallbladder wall thickening or adjacent fluid.\n\nPANCREAS: The pancreas shows fatty replacement, otherwise is normal in\nattenuation without evidence of focal lesion. There is no MPD dilatation.\n\nSPLEEN: Closely associated with the left upper quadrant mass, otherwise shows\nnormal parenchymal attenuation without evidence of a focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is no perinephric\nabnormality. There is no hydronephrosis or hydroureter. The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Left upper quadrant mass is inseparable from the gastric\nfundal wall, most likely serosal in origin. The porta hepatis mass similarly\nis closely associated with the gastric pylorus serosa. There is no gastric\nmucosal thickening. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement. The colon and rectum are within normal limits.\nThe appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present. There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are present, most severe between L2\nand S1.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia is noted.", "output": "1. Stable size and appearance of low-density masses in the left upper quadrant\nand porta hepatis, closely associated with gastric serosa. No lymphadenopathy\nor evidence of other metastatic disease.\n2. Uncomplicated cholelithiasis." }, { "input": "LOWER CHEST: There is bibasilar linear atelectasis. There is a 3 mm right\nlower lobe ground-glass nodule (series 2, image 7). There is no evidence of\npleural or pericardial effusion.\n\n\n\nABDOMEN:\n\nThere is small volume free fluid in the abdomen and pelvis.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nWithin the subhepatic space, abutting the inferior aspect of the right lobe of\nthe liver, is a 10.5 x 8.7 x 7.1 cm heterogeneous cystic and solid mass\n(series 2, image 35), with loss of intervening being fat plane between the\nliver and the mass, without evidence of hepatic invasion. The mass abuts the\npylorus and duodenum, also with loss of intervening fat planes as seen on\nseries 601, image 27. There is central necrosis within this mass.\nAnother solid homogeneously enhancing mass measuring 7.6 x 3.2 x 4.0 cm\n(602:36/02:37) is located anterior to this necrotic mass in the right\nhemiabdomen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is displaced posteriorly by the large mass. The spleen\nshows normal size and attenuation throughout, without evidence of focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a large exophytic heterogeneously enhancing cystic\nand solid mass measuring up to 18.1 cm possibly arising from the greater\ncurvature of the stomach (series 601, image 40). There are areas of central\nnecrosis. The lesion displaces the spleen posteriorly with no discrete\ninvasion of the spleen.\n\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nThe hepatic flexure passes near the smaller subhepatic mass, with intact\nintervening fat plane. There is focal colonic wall thickening and mesenteric\nstranding (series 2, image 42), likely reactive.\nThere is diverticulosis. No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is\nmoderate intermediate density ascites.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: No enlarged lymph nodes by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia noted.", "output": "1. Two large heterogeneously enhancing, mixed solid and cystic intraperitoneal\nmasses noted. The larger mass measuring up to 18.1 cm is likely arising from\nthe greater curvature of the stomach, extending exophytically into the left\nupper quadrant of the abdomen, displacing the spleen posteriorly. \nDifferential includes a cystic GIST. The second, smaller similar appearing\nmass measuring up to 10.5 cm in maximum dimension may represent a peritoneal\nmetastasis.\n2. A more solid homogeneously hyperdense/enhancing mass, discrete from the\nsmaller subhepatic mass is located anterior to the smaller subhepatic mass and\ngiven the ___ of ___ represent a hematoma.\n3. Small volume hyperdense ascites, concerning for hemoperitoneum. \nCholelithiasis and diverticulosis are additional incidental findings.\n4. Recommend tissue biopsy, either percutaneously or via endoscopy.\n\nRECOMMENDATION(S): Please see impression 4." }, { "input": "VASCULAR:\n\nThe patient is status post EVAR. The abdominal aorta is ectatic, measuring up\nto 3.3 cm at the esophageal hiatus. And aorto bi-iliac stent is in situ. \nType 2 endoleak appreciated in the distal aorta, likely from a supplying\nlumbar artery. The native aneurysm sac has not changed in size and measures\n5.3 x 4.8 cm.\n\nFocal short segment narrowing of the celiac caliber at the diaphragmatic crus.\nThere is an accessory left hepatic artery arising from the left gastric\nartery. The common hepatic artery is replaced, arising from the SMA. The\nsingle right and single left renal arteries are patent. There is slight\nsuprarenal extension of the aorto bi-iliac stent. There is contrast\nopacification of the right stent did common iliac artery, external iliac\nartery, CFA, SFA, and profunda femoris.\n\nThere is contrast opacification of the internal iliac artery, though there is\nmild attenuation of the obturator branch. On the left side, there is contrast\nopacification of the external iliac artery, with evidence of mural calcific\nand noncalcific plaque. The CFA, SFA, and profunda femoris are patent. The\ninternal iliac artery is patent.\n\nLOWER CHEST: Lung bases are clear. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are a few tiny hypodensities within the liver, incompletely\ncharacterize, but statistically representing cysts. Small area of focal fat\nis seen adjacent the falciform ligament. . The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Small cysts within the left kidney is noted. There is evidence of\nparenchymal scarring and cortical thinning in bilateral kidneys. No evidence\nof hydronephrosis. The bladder is unremarkable. Large fluid collection is\nseen in the right scrotal sac which is incompletely imaged, which may\nrepresent a hydrocele.\n\nGASTROINTESTINAL: There has been prior APR. A right lower quadrant ileostomy\nis in situ. There is no evidence of mesenteric or retroperitoneal\nlymphadenopathy.\n\nBONES: Degenerative changes within the thoracolumbar spine. No worrisome\nosseous findings.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Aorto bi-iliac stent with type 2 endoleak likely from supine lumbar artery.\nNo interval change in the size of the native aneurysm sac." }, { "input": "VASCULAR:\n\nAgain seen are postsurgical changes status post endovascular repair of an\ninfrarenal abdominal aortic aneurysm. Aneurysm graft extends from the just\nsuperior to the renal arteries, into the bilateral common iliac arteries, as\non the prior examination. Type 2 endoleak at the inferior aspect of the graft\nis similar in appearance to the prior examination, and appears to arise from a\nlumbar artery.\n\nThe aneurysm sac measures 5.0 cm AP x 5.6 cm transverse, increased in size\nfrom prior examination, where it measured 4.6 cm AP x 5.1 cm transverse, using\nsimilar measurements.\n\nAccessory left hepatic artery again noted arising from the left gastric. \nCommon hepatic artery is again noted to arise from the SMA.\n\nThe celiac and superior mesenteric arteries are patent.\n\nThe renal arteries remain patent. The inferior mesenteric artery is\nnon-opacified, and excluded by the graft.\n\nThe internal iliac arteries are well opacified and remain patent.\n\nThe external iliac arteries are patent.\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nArterially enhancing lesions in segment 3 and segment 7 are unchanged, and\nlikely represent hemangiomas. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo stones. 1 cm cyst noted projecting from the upper pole of the left kidney.\nAdditional subcentimeter renal lesions are too small to completely\ncharacterize and statistically most likely to represent simple cysts. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Right lower quadrant ileostomy noted. The colon\nand rectum are surgically absent. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged. Right hydrocele noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Re-demonstration of a type 2 endoleak status post endovascular repair of an\ninfrarenal abdominal aortic aneurysm. Aneurysm sac size has increased in size\nfrom the prior examination, now measuring 5.0 x 5.6 cm, previously 4.6 x 5.1\ncm." }, { "input": "VASCULAR: Postsurgical changes status post endovascular repair of infrarenal\nabdominal aortic aneurysm with graft extending from the level of the renal\narteries through the common iliac arteries. Seen on prior, there is a type 2\nendoleak with contrast seen within the excluded aneurysm sac likely from\npatent lumbar branches. Currently, aneurysm measures 5.1 x 6.0, previously\n5.0 x 5.9 cm. There is no evidence of rupture. Otherwise, no change from\nprior. Atherosclerotic burden is unchanged.\n\nLOWER CHEST: Emphysema at the lung bases noted with areas of atelectasis in\nthe left lower lobe and lingula. The heart is mildly enlarged as on prior.\n\nABDOMEN:\n\nHEPATOBILIARY: Arterially enhancing lesions again seen within segment 3,\nseries 3, image 40 measuring 10 mm and segment 7, series 3, image 18 measuring\n3 mm are unchanged and likely represent hemangiomas. No new or worrisome\nliver lesion. Main portal vein is patent. The gallbladder is unremarkable.\n\nPANCREAS: The pancreas appears normal without focal concerning lesion, ductal\ndilation or signs of inflammation.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: Adrenals are unremarkable.\n\nURINARY: The kidneys enhance symmetrically. No hydronephrosis. A hypodensity\narising from the left renal upper pole is likely a cyst though too small to\ncharacterize. A lobular contour of the kidneys is unchanged with slight\natrophy of the left kidney again noted. No signs of pyelonephritis.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal. Small bowel loops\ndemonstrate no signs of ileus or obstruction. An ileostomy is again noted in\nthe right mid abdomen appearing uncomplicated. The colon and rectum are\nsurgically absent. No free air or free fluid is seen. No mesenteric\nadenopathy or fluid collection.\n\nRETROPERITONEUM: No retroperitoneal hematoma or adenopathy.\n\nPELVIS: The urinary bladder is moderately distended appearing normal. The\nprostate is not enlarged. Fluid in the right hemiscrotum is partially\nvisualized. No pelvic sidewall or inguinal adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Re-demonstration of a type 2 endoleak status post endovascular repair of an\ninfrarenal AAA. Minimal interval increase in sac size, previously 5.0 x 5.9\ncm, currently 5.1 x 6.0 cm." }, { "input": "Study is limited by motion degradation.\n\nVASCULAR:\n\nSince the prior CTA of the abdomen/pelvis from ___, has been interval\nembolization of a left lumbar artery coursing from the region of the left\nL5-S1 neural foramen to the left internal iliac artery.\n\nAgain seen is an aorto bi-iliac stent graft. There is an aneurysm of the\ninfrarenal aorta measuring 5.5 x 5.9 cm (series 6:73), unchanged in size and\npreviously 5.4 x 5.9 cm on CTA abdomen pelvis ___. Again noted are\nfoci of enhancement within the excluded aneurysm sac, compatible with a\npersistent type 2 endoleak. There is no stranding surrounding the aneurysm\nsac.\n\nModerate atherosclerotic burden is again noted. The celiac artery and SMA are\nwidely patent. The bilateral renal arteries arise from the superior aspect of\nthe stent graft and are widely patent. The ___ is not visualized.\n\nIncidental note is made of a circumaortic left renal vein.\n\nLOWER CHEST: There is mild dependent subsegmental atelectasis in the bilateral\nlung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a segment III hypodensity measuring 8 mm (series 6:37) which is\nunchanged from prior and too small to characterize but statistically likely\nrepresents a simple cyst or biliary hamartoma. 7 mm hyperattenuating focus in\nsegment III (series 6:35) and punctate hyperattenuating focus at the hepatic\ndome (series 6:15) are unchanged and likely represent capillary hemangiomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is diffuse cortical thinning of the left kidney, slightly more\nprominent compared to the right side. A 1.3 cm hypoattenuating focus in the\nupper pole of the left kidney (series 6:32) likely represents a simple cyst. \nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The colon and rectum are surgically absent. Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThe right lower quadrant ileostomy is unremarkable. There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate does not appear enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. There is\na right-sided hydrocele.", "output": "Interval embolization of a left lumbar artery coursing from the region of the\nleft L5-S1 neural foramen to the left internal iliac artery. Aorto bi-iliac\nstent graft with the infrarenal abdominal aortic aneurysm sac measuring 5.5 x\n5.9 cm, unchanged compared to prior CTA of the abdomen/pelvis from ___, with a persistent type 2 endoleak." }, { "input": "VASCULAR:\n\nAorto bi-iliac stent graft traversing a large infrarenal abdominal aortic\naneurysm is again seen. This measures up to 5.5 x 6.1 cm, not significantly\nchanged compared to prior exam. Foci of enhancement within the aneurysm sac\nin a similar distribution compared to prior exam is again compatible with type\n2 endoleak supplied by at least two vessels, one of which is a lumbar artery. \nThe celiac axis and SMA are patent. The bilateral common, external, and\ninternal iliac arteries are patent. Bilateral renal arteries are patent.\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 5.5 x 6.1 cm\nDiameter (Center-line): 6.3 cm\nVolume:\n\n1. Aneurysm: 176 ml\n2. Renal to Aortic bifurcation: 218 ml\n3. Renal to Iliac bifurcation: 240 ml\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.3 cm.\nLength distal graft to iliac bifurcation: Right: 1.7 cm; Left: 3.0 cm\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodense lesion in segment 3 is stable from prior and too small\nto characterize, but likely represents a simple cyst or biliary hamartoma. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality. \nIndeterminate hypodense lesion measuring 0.3 cm arises from the interpolar\nregion of the right kidney, but stable since at least ___. 1.3 cm cyst\narising from the upper pole of the left kidney is poorly assessed on this exam\ndue to motion artifact.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Status post total colectomy. There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis. Prostate and seminal vesicles are unremarkable. Right-sided hydrocele\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Right upper quadrant ileostomy is noted.", "output": "Status post EVAR of infrarenal abdominal aortic aneurysm measuring 5.5 x 6.1\ncm, not significantly changed compared to prior exam with persistent type 2\nendoleaks." }, { "input": "POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.2 x 5.7 cm, previously 6.1 x 5.5 cm.\nDiameter (Center-line): 6.4 cm, previously 6.3 cm.\nVolume:\n\n1. AAA diameter (largest centerline axis):\n2. AAA diameter (largest axial view):\n3. AAA volume: 185 cc, previously 176 cc.\n4. Lowest renal artery to aortic bifurcation volume: 222 cc, previously 218\ncc.\n5. Lowest renal artery to the iliac bifurcation volume: 269 cc, previously\n240 cc.\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.5 cm; compared to 1.3 cm.\nLength distal graft to iliac bifurcation: Right: 1.9 cm, compared to 1.7 cm;\nLeft: 0.6 cm, compared to 0.3 cm.\n\nAorto bi-iliac stent graft within an infrarenal abdominal aortic aneurysm is\ngrossly similar when compared to prior exam on ___. The largest\naxial dimension measures 6.3 x 5.6 cm, previously 6.1 x 5.3 cm on ___ (3:81). There is persistent foci of enhancement within the aneurysmal\nsac, similar in appearance compared to prior exam, likely due to a type 2\nendoleak, most likely supplied by lumbar arteries (3:80).\nOtherwise, the major abdominal vasculature remain patent, specifically the\nceliac axis, SMA, and bilateral renal arteries.\n\n LOWER CHEST: Atelectasis of the bilateral lung bases are mild. There is no\npericardial or pleural effusion. The descending thoracic aorta is mildly\ndilated measuring 3.5 cm.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable, aside from a subcentimeter hypodensity in segment III (03:30),\nlikely a simple cyst or biliary hamartoma, and subcentimeter hypodensities in\nbilateral kidneys, that are too small to characterize by CT (03:33).\n\nGASTROINTESTINAL: Patient is status post total colectomy and end ileostomy. \nThere is no intestinal obstruction or ascites.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid. There is persistent right hydrocele.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.", "output": "Status post TEVAR of infrarenal abdominal aortic aneurysm with persistent type\n2 endoleak measuring 6.2 x 5.7 cm, previously 6.1 x 5.5 cm in ___. The volume has increased minimally from 176 cc to 185 cc." }, { "input": "VASCULAR:\n\n POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.7 x 5.7 cm (previously 6.3 x 5.6 cm)\nDiameter (Center-line): 6.6 x 6.1 cm (previously 6.2 x 5.7 cm)\nVolume:\n\n1. Aneurysm: 201 ml (previously 185 mL)\n2. Renal to Aortic bifurcation: 215 ml (previously 222 mL)\n3. Renal to Iliac bifurcation: 272 ml (previously 269 mL)\nENDOLEAK: Type IIB (aneurysm sac is filling via multiple branch vessels\nsimilar to prior).\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.6 cm; compared to 1.5 cm.\nLength distal graft to iliac bifurcation: Right: 1.5 cm, compared to 1.9 cm;\nLeft: 0.3 cm, compared to 0.6 cm.\n\nThe aorto bi-iliac stent graft is in stable position. Type IIB endoleak is\nagain demonstrated. There is slight increase in sac size since the previous\nCTA. The descending thoracic aorta is diffusely dilated at up to 3.4 cm,\npreviously 3.3 cm. The celiac and SMA are widely patent. There is a replaced\ncommon hepatic artery from the SMA. The bilateral renal arteries also appear\nwidely patent and there is symmetric enhancement of the kidneys. Circumaortic\nleft renal vein is noted. There is no new iliac/common femoral stenosis below\nthe graft.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nstable 9 mm arterially enhancing focus in segment 4B is consistent with a\nflash hemangioma and a stable 6 mm hypodensity in 4B is consistent with a cyst\nor biliary hamartoma. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid masses, or hydronephrosis. A few small\ncortical hypodensities are incompletely characterized due to size but likely\ncysts.\n\nGASTROINTESTINAL: The patient is status post colectomy and end ileostomy\nformation.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. A\npartially visualized chronic large right hydrocele is noted.", "output": "Ongoing Type IIB endoleak with slight increase in aneurysm sac size. Aneurysm\nvolume is calculated at 201 mL, previously 185 mL." }, { "input": "VASCULAR:\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.7 x 6.0 cm, previously 6.7 x 5.7 cm\nDiameter (Center-line): 6.6 cm, previously 6.6 cm\nVolume:\n\n-Aneurysm: 214 ml, 201 and 185 ml on the previous 2 studies\n-Renal to Aortic bifurcation: 239 ml, 215 and 222 mL on the previous 2 studies\n-Renal to Iliac bifurcation: 294 ml, 272 and 2 cc 9 on the previous 2 studies\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.6 cm; compared to 1.6 cm.\n Length distal graft to iliac bifurcation: Right: 3.6 cm, compared to 1.5 cm;\nLeft: 2.0 cm, compared to 0.3 cm.\n\nThe patient is status post right iliac limb extension into the external iliac\nartery and coil embolization of the right internal iliac artery. The aorta\nbi-iliac stent graft is in a stable position. Type II B endoleak is again\ndemonstrated with numerous hyperenhancing foci along the periphery of the\naneurysmal sac (for example 03:57, 61, 64). There has been slight interval\nincrease in the aneurysmal sac size since the previous CTA. The celiac, SMA,\nand bilateral renal arteries are widely patent. There is a replaced common\nhepatic artery from the SMA. There is a circumaortic left renal vein.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nKnown arterially enhancing 9 mm focus within segment IV B, previously\ncharacterized as a flash hemangioma, is not seen. A stable 6 mm hypodensity\nin segment IVb (03:34) likely represents a cyst or biliary hamartoma. No new\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.2 cm exophytic simple cyst arising from the upper pole of the left kidney\nis stable. Few other cortical hypodensities are too small to characterize but\nlikely represent cysts. There is no evidence of stones or hydronephrosis.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post colectomy and end ileostomy\nformation. No evidence of obstruction.\n\nLYMPH NODES: There is no evidence of mesenteric or retroperitoneal\nlymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged. The seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A partially visualized chronic large right hydrocele is again\nseen. The abdominal and pelvic wall is within normal limits.", "output": "-Continued aneurysmal sac enlargement with evidence of ongoing, apparent\nmultifocal type II endoleak. Aneurysm volume is calculated at 214 mL,\npreviously 201 mL.\n-Status post right iliac artery limb extension into the right external iliac\nartery and coil embolization of the right internal iliac artery." }, { "input": "POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 7.1 x 6.3 cm, previously 7.0 x 5.6 cm in ___, and 6.7 x 6.0 cm in ___\nDiameter (Center-line): 7.1 cm, previously 6.6 cm in ___\nVolume:\n\n1. Aneurysm: 222 ml, previously 214 mL\n2. Renal to Aortic bifurcation: 262 ml, previously 239 mL\n3. Renal to Iliac bifurcation: 307 ml, previously 294 mL\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.2 cm; compared to 1.6 cm.\nLength distal graft to iliac bifurcation: Right: 4.2 cm, compared to 3.6 cm;\nLeft: 4.0 cm, compared to 2.0 cm.\n\nAgain seen is the aorto bi-iliac stent graft, with measurements as above. The\npatient is status post right iliac limb extension into the external iliac\nartery and coil embolization of the right internal iliac artery. Multiple\nhyperdense foci along the peripheral aneurysm sac are compatible with known\ntype IIB endoleak, possibly from lumbar arteries (for example, 2:81). Focal\nhyperdensity anterior to the superior aspect of the right iliac limb graft, at\nthe level of overlapping segments (for example, 2:85) may possibly reflect a\nsmall type III endoleak.\n\nThe celiac, SMA, and bilateral renal arteries are patent. Again seen is a\nreplaced common hepatic artery from the SMA, along with a circumaortic left\nrenal vein. Mild-to-moderate atherosclerotic disease.\n\nLOWER CHEST: Mild, bibasilar atelectasis. No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodense focus within segment IV B (02:33) appears unchanged,\nlikely a cyst or biliary hamartoma. An ill-defined hypodensity, at the\nperiphery of segment IVB (02:41), likely reflects focal fat. No other lesions\nare identified. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys mildly atrophic, but are of symmetric size with normal\nnephrogram. A simple appearing cyst within the upper pole of the left kidney\nmeasures 1.2 cm, unchanged. Other, subcentimeter renal hypodensities are too\nsmall to characterize. There is no evidence of stones or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. The patient is status post\ncolectomy and end ileostomy, with the ostomy site located within the right\nhemiabdomen. No evidence of bowel obstruction.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A right hydrocele is partially imaged. The prostate is\nmildly enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Aside from the right hemiabdomen ostomy, the abdominal and\npelvic soft tissues are normal.", "output": "1. Interval increase in size of the infrarenal abdominal aortic aneurysm sac,\nwith total aneurysm volume measuring 222 mm, previously 214 mm in the\ndedicated study from ___. No substantial change in configuration\nor position of the aorto bi-iliac stent graft with right iliac limb extension.\n2. Redemonstrated findings compatible with type II endoleak, with a focal\nhyperdensity anterior to the superior aspect of the right iliac limb graft, at\nthe level of overlapping segments, possibly reflecting a small type III\nendoleak." }, { "input": "LOWER CHEST: There is subsegmental basilar atelectasis. 4 mm solid nodule\nwithin the right middle lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable. Mild biliary dilatation is likely\ndue to post cholecystectomy.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Splenomegaly measuring 13.7 cm in craniocaudal ___. No focal\nlesions.\n\nADRENALS: Unremarkable.\n\nURINARY: Simple cyst within the upper pole the right kidney. Otherwise,\nunremarkable.\n\nGASTROINTESTINAL: There is no intestinal obstruction. The appendix is within\nnormal limits. No free air..\n\nPELVIS:Patient is again noted to be post hysterectomy. The right ovary is\nmildly enlarged, however there are multiple cysts measuring up to 3 cm and two\ncorpora lutea. On the same date ultrasound, there was no peripheral\ndisplacement of the follicles. Moderate amount of intermediate density fluid\nwithin the pelvis, likely reflects a ruptured cyst or hemorrhagic cyst.\n\nLYMPH NODES: No lymphadenopathy.\n\nVASCULAR: . Moderate narrowing at the origin of the celiac artery, likely due\nto compression from the median arcuate ligament.\n\nBONES: Unremarkable.\n\nSOFT TISSUES: Unremarkable.", "output": "1. Corpora lutea within the right adnexa with high-density fluid in the pelvis\nlikely secondary to a ruptured hemorrhagic corpus luteum.\n2. No acute appendicitis.\n3. The spleen is at the upper limit of normal for size which is of uncertain\netiology or clinical significance.\n4. 4 mm solid nodule within the right middle lobe, for which no specific\nfollow up is recommended in a low risk patient.\n\nRECOMMENDATION(S): Consider CT chest within 12 months." }, { "input": "Evaluation is somewhat limited given the lack of images of the abdomen and\nenteric contrast\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There are\nlikely fluid filled loops of small bowel in the pelvis. In addition, there\nare two apparently noncommunicating, incompletely rim enhancing collections in\nthe pelvis measuring 3.5 x 3.0 and 3.2 x 2.4 cm (2: 23, 601:21, 30). Further\nevaluation after the administration of enteric contrast is advised\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. The ovaries are not\ndefinitely identified.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "Suggestion of incompletely rim enhancing fluid in the deep pelvis may\nrepresent developing collections, though the lack of enteric contrast limits\nevaluation and it is difficult to separate these areas from adjacent loops of\nsmall bowel. If further evaluation is required, CT of the abdomen and pelvis\nwith enteric contrast (delayed scanning) is recommended for optimal\nassessment." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis. A 2.5 x 2.7 x\n2.6 cm simple cyst is seen in the upper pole of the left kidney. No\nnephrolithiasis noted in either kidney. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Uterus and adnexa are unremarkable. There is trace fluid\nin the cul-de-sac, within physiological range.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of nephrolithiasis or hydronephrosis.\n2. No acute findings in the abdomen or pelvis to explain patient's symptoms." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in segment 2 is too small to characterize, but\nlikely represents a simple cyst or biliary hamartoma. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is mild thickening of the left adrenal gland without discrete\nnodularity. Right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is a 1.1\ncm simple cyst in the lower pole of the left kidney. Additional subcentimeter\nhypodensities bilaterally are too small to characterize, but also likely\nrepresent simple cysts.\n\nGASTROINTESTINAL: Small hiatal hernia. Stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the transverse, descending, and sigmoid colons\nare noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCoxa valga deformity of bilateral hips is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "No evidence of metastatic disease in the abdomen or pelvis." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter left hepatic hypodensity (04:47) is too small to characterize,\nbut appears unchanged. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA simple cyst within the lower pole of the left kidney measures 1.2 cm. \nOther, bilateral renal hypodensities are too small to characterize. There is\nno hydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis, without evidence of acute diverticulitis.\n\nPELVIS: The bladder is unremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits. Small bilateral hydroceles are partially imaged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Please refer to the separate report of the chest CT performed on the same\nday for thoracic characterization." }, { "input": "LOWER CHEST: Please refer to dedicated CT chest report from the same day for\ndetails of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal glands is normal in size and shape. The left\nadrenal gland is mildly thickened without discrete nodules, unchanged since\n___.\n\nURINARY: The kidneys are of normal and symmetric size and nephrogram. \nMultiple subcentimeter hypodensities scattered throughout the kidneys are too\nsmall to characterize, but likely represent renal cysts. 11 mm exophytic\nhypodense lesion of the left lower pole averaging 29 ___ units likely\nrepresents a hemorrhagic or proteinaceous cyst which is unchanged since\n___. No evidence of solid renal lesions or hydronephrosis. No\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Appendix is normal.\n\nPELVIS: The urinary bladder is decompressed. Distal ureters are unremarkable.\nNo free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Mild atherosclerotic disease is\nnoted.\n\nBONES: There is a new 14 mm lucent within the L2 vertebral body with an\nexpansile soft tissue component (10:29, 5:68). Compared to the CT of ___ there are new lucent lesions within the T3 and T4 vertebral bodies\nwhich display FDG avidity on the PET-CT of ___.\nNo evidence of acute fracture. Sclerosis at the T11 inferior endplate is\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. There is a new 14 mm L2 vertebral body lucent lesion with an expansile soft\ntissue component. Additional lucent lesions of T3 and T4 displaying FDG\navidity on the PET-CT of ___, are concerning for metastatic\ndisease.\n2. Please refer to the dedicated CT chest report from the same day for details\nof intrathoracic findings." }, { "input": "CHEST: There is bibasilar dependent atelectasis and minimal septal\nthickening. There is no pleural effusion. A small to moderate hiatal hernia\nis present.\n\nABDOMEN:\n\nGENERAL: There is a large upper abdominal midline fat and fluid containing\nventral hernia. There is a small volume of ascites, predominantly in the\nperihepatic and mesenteric distribution. There is no intra- or\nretroperitoneal fluid collection. There is no peritoneal thickening.\nHEPATOBILIARY: The liver enhances homogeneously. There are no concerning\nfocal hepatic lesions. The intrahepatic and extrahepatic bile ducts are\nmildly prominent, likely secondary to cholecystectomy. The gallbladder is\nsurgically absent. There are dropped surgical clips inferior to the gastric\nantrum.\nPANCREAS: The pancreas appears normal. There are no concerning focal\npancreatic lesions. No peripancreatic fluid collection is present. There are\nno signs of inflammation.\nSPLEEN: The spleen enhances normally. There is no concerning focal\nabnormality. There is no splenomegaly. There are several coarse\ncalcifications consistent with exposure to granulomatous disease.\nADRENALS: There are no adrenal nodules.\nKIDNEYS: Renal corticomedullary enhancement is normal bilaterally. There is\ndelayed renal excretion of contrast. There are no concerning solid lesions. \nThere are no stones. There is no hydronephrosis or hydroureter. There is a\n3.7 cm simple right renal cyst\nGASTROINTESTINAL: There is marked edema of the gastric antral wall. There is\nno evidence of bowel obstruction. The small and large bowel enhance normally.\nThere is diffuse, minimal wall thickening in the small and large bowel. There\nis no mass. There is no intraperitoneal fluid collection. The appendix is\nnormal in caliber, without mass or evidence of inflammation.\nLYMPH NODES: There is no lymphadenopathy identified in the abdomen or pelvis.\nVASCULAR: The abdominal aorta and its main branches are patent, with moderate\ncalcified plaques. There is no aneurysm or dissection. The IVC is minimally\nflattened but there are no overt signs of shock. The main portal vein and its\nfirst order intrahepatic branches are patent.\n\nPELVIS: There is no pelvic or inguinal lymphadenopathy. There is no free\nfluid in the pelvis.\nGENITOURINARY: The urinary bladder and distal ureters are unremarkable. There\nis a Foley catheter balloon within the collapsed bladder. The reproductive\norgans are within normal limits.\n\nBONES AND SOFT TISSUES: There is no acute fracture. There are no destructive\nosseous lesions concerning for malignancy or infection. There are no soft\ntissue masses.", "output": "Edema of the gastric antrum most consistent with gastritis. Possible mild\nsmall bowel edema, which can be seen in gastroenteritis. No free air to\nsuggest perforation. No evidence of bowel obstruction or ischemia.\n\nNOTIFICATION: Preliminary findings were communicated to Dr. ___ by Dr.\n___, in person on ___ at 5:00 ___, at the time of interpretation. Wet\nread updated to reflect that perforated ulcer is unlikely. Update\ncommunicated to Dr. ___ at 17:46." }, { "input": "LOWER CHEST: There is atelectasis at the bilateral lung bases. Otherwise\nvisualized lung bases are clearer.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are tiny hypodensities throughout the liver that are too small to\ncharacterize however likely to be cysts (for example 5; 61). There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\ndecompressed without gallstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape. There is a\nheterogeneous 3 x 2 cm lesion in the left adrenal gland (5; 66).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Prominent lymph nodes are not pathologically enlarged by imaging\ncriteria.\n\nBONES: No evidence of worrisome bony lesions. Posterior spinal fusion\nhardware is noted. Compression deformity of L2 and L3 is likely chronic.\n\nSOFT TISSUES: Heterogeneously enhancing right iliacus muscle lesion measuring\n4.6 x 4.3 x 4.7 cm (5; 101 and 8; 31). Additional left gluteus minimus/medius\nlesion with dominant part measuring 4.7 x 2.6 x 4.9 cm and additional\nposterior 2.6 cm extension (5; 105 and 106).", "output": "1. 3 cm left adrenal gland mass, for which in the setting of primary lung\ncancer is concerning for metastasis.\n2. 5 cm right iliacus and 5 cm left gluteal muscle lesions suspicious for soft\ntissue metastasis." }, { "input": "LOWER CHEST: Trace bilateral pleural effusions with subjacent atelectasis is\npresent. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hepatic lesions, some of which are new or\nlarger compared to prior. For example 2 lesions at the dome each measure 1 cm\n(08:14). A segment VII lesion measures 1.7 cm, previously 0.6 cm. There also\nmultiple new segment VI lesions, the largest measuring 2 cm (08:40).\n\nNo biliary dilation. The gallbladder is distended with no gallstones. \nPericholecystic ascites is likely related to small volume generalized ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A left adrenal mass is larger, measuring 3.8 x 2.7 cm, previously\n2.9 x 1.9 cm. There is a new right adrenal nodule measuring 2.2 x 1.1 cm.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. Bilateral perinephric\nstranding is nonspecific.\n\nGASTROINTESTINAL: Enhancing, near circumferential mass in the second portion\nof the duodenum is in keeping with the known ampullary metastasis (8:63). \nThere are multiple additional sites of curvilinear enhancing masses involving\nthe jejunal wall, many of which are nearly circumferential (for example 10:35,\n8:100). In the left upper quadrant, there is a defect in the posterolateral\njejunal wall at the site of a mass (8:66, 11:105). Additionally, there is\nsmall volume pneumoperitoneum and ascites. There is also air in a branch of\nthe superior mesenteric vein (8:82).\n\nSmall hiatal hernia. The lesions in the gastric fundus seen on endoscopy are\nnot well appreciated on CT. The colon is unremarkable.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is trace free fluid in\nthe pelvis.\n\nVASCULAR:\nThere is severe calcified and noncalcified atherosclerotic plaque, including\nareas of plaque ulceration in the infrarenal aorta. The infrarenal aorta is\nectatic but not frankly aneurysmal. Near occlusion is noted at the origin of\nthe right common iliac artery.\n\nThere is severe stenosis at the origin of the celiac artery. The superior\nmesenteric artery is patent. The inferior mesenteric artery is diminutive,\nbut patent.\n\nThe SMA and main portal vein are patent.\n\nREPRODUCTIVE ORGANS: The prostate gland is mildly enlarged.\n\nBONES: L4-5 laminectomy and posterior fusion is re-demonstrated. Sclerotic\nendplate changes of L2 and L3 are similar to prior, probably degenerative.\n\nSOFT TISSUES: Re-demonstrated enhancing masses in the right iliacus and left\ngluteus musculature, which of each significantly increased in size. The right\niliacus mass now measures 8.0 x 6.8 cm, previously 4.3 x 4.6 cm. The left\ngluteus mass measures 8.0 x 4.6 cm, previously 4.7 x 2.6 cm.\n\nSmall bilateral fat containing inguinal hernias.", "output": "1. Focal perforation of the jejunum at the site of an enhancing jejunal lesion\n(likely metastasis) with small volume pneumoperitoneum and portal venous gas.\n2. Overall worsening metastatic disease, with small bowel metastases,\nincreasing size of liver lesions, bilateral adrenal masses, and soft tissue\nmasses in the right iliacus and left gluteus musculature.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:45 Pm, 5 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. Pneumobilia is noted likely postprocedural. \nThere is a common bile stent in place.\n\nPANCREAS: Again noted is an infiltrative locally advanced pancreatic tumor\noriginating from the uncinate process. The tumor is ill-defined,\napproximately measures 4.1 cm in AP dimension (series 7, image 98). There is\nmild dilatation of the pancreatic duct. There is marked infiltration of\nadjacent soft tissues and mesentery. The tumor extends to the root of\nmesentery and invades the third portion of duodenum as well as few small bowel\nloops with no evidence of obstruction. The tumor encases the SMA and narrows\nthe SMV. Overall the findings are stable from recent MRI dated ___.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hyperattenuating\nSize (maximal axial dimension in cm): Ill-defined infiltrative\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nabsent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\n\n___ involvement: present\nSolid soft-tissue contact: >180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first ___ branch: present\n\nCeliac Axis involvement: absent\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: present\nSolid soft-tissue contact: <=180\u00b0\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: none\nVariant vessel contact: absent\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\n___ involvement: present\nDegree of solid soft-tissue contact: >180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent\nExtension to first draining vein: absent\nThrombus within vein: absent; type of thrombus: none\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: present invading the mesentery, no definite\nnodule.\nAscites: present\nSuspicious lymph nodes: porta hepatis\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a duodenal stent in place which is patent. Some\ndebris is noted in the duodenal stent. The tumor involves several loops of\njejunum, however there is no evidence of obstruction. The remaining of the\nsmall bowel is normal. The colon is normal in caliber.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. A\nporta hepatis lymph node is seen measuring 1 cm (series 7, image 84).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is a small volume\nascites (series 7, image 163).\n\nREPRODUCTIVE ORGANS: There is a heterogeneously enhancing lobulated subserosal\nfibroid measuring 9.7 x 7.8 cm\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. 1\ncm anterolisthesis of L5 on S1 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Locally advanced infiltrative pancreatic tumor arising from the uncinate\nprocess extending to the root of mesentery, duodenum and several loops of\njejunum as well as encasing the SMA and narrowing the SMV as described. \nOverall the tumor is stable from prior MRI of ___.\n2. Recently placed duodenal stent is patent." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.\n\nA metallic CBD stent is again noted, with pneumobilia seen, compatible with\nstent patency. The gallbladder is within normal limits.\n\nPANCREAS: Known mass in the pancreas uncinate process is not well delineated\non the current study, making measurement difficult. Soft tissue haziness and\nstranding encasing the superior mesenteric artery and vein (4:54-58) and\ncontacting the caudal aspect of the third portion of duodenum (4:64) (spanning\napproximately 3.8 cm) appear similar. Redemonstration of mild narrowing of\nthe SMV near the portal venous confluence, however the vessel remains patent. \nProminence of the main pancreatic duct up to 4 mm is unchanged.\n\nSPLEEN: The spleen is mildly enlarged 14.1 cm, previously 13.6 cm. No focal\nlesions seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable. A stent in the third\nportion of the duodenum is again noted and appears patent. Small and large\nbowel loops are normal in caliber. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Redemonstration of an enlarged uterus containing multiple\nfibroids measuring up to 5.8 cm. No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBilateral L5 pars defects associated with grade 2 anterolisthesis of L5 on S1\nis unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Known mass in the pancreas uncinate process is not well delineated on the\ncurrent study. Soft tissue haziness and stranding encasing the superior\nmesenteric vessels and contacting the caudal aspect of the third portion of\nthe duodenum appear similar.\n2. Patent CBD and duodenal stents in situ.\n3. No evidence of new lymphadenopathy or new distant metastatic disease in the\nabdomen or pelvis.\n4. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings." }, { "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is redemonstration of a metallic CBD\nstent, with pneumobilia seen, compatible with stent patency. The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: There is redemonstration of a mass in the pancreas uncinate process,\nwhich is ill-defined and difficult to measure on today's exam; however, within\nthese limitations, the mass measures 1.4 x 1.9 cm (series 5, image 95)\n(previously measured up to 3.5 cm on CT dated ___. Soft tissue\nhaziness and fat stranding is seen encasing the superior mesenteric artery and\npartially encasing the superior mesenteric vein. Additionally, the fat\nstranding is seen contacting the third portion of the duodenum but is\nunchanged in appearance. There is redemonstration of mild narrowing of the\nsuperior mesenteric vein near the portal venous confluence; however, the vein\nremains patent. The main pancreatic duct measures up to 3 mm (series 5, image\n80).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Fibroid uterus measuring up to 5.9 cm. There is no evidence of pelvic\nor inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: No evidence of worrisome osseous lesions or acute fractures. \nRedemonstration of bilateral L5 pars defects and stable L5 on S1\nanterolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nVASCULAR: There is no abdominal aortic aneurysm. No significant\natherosclerotic disease is noted.", "output": "1. The known mass at the pancreatic uncinate process is again seen but appear\nsmaller compared to prior CT dated ___.\n2. Redemonstration of soft tissue haziness and stranding encasing the\nsuperior mesenteric vessels and contacting the caudal aspect of the third\nportion of the duodenum.\n3. No evidence of new lymphadenopathy or new distant metastatic disease in\nthe abdomen or pelvis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Tip of a central venous\nterminates in the SVC/right atrial junction.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Re-demonstrated is mild central\nintrahepatic biliary ductal dilatation as well as left lobe predominant\npneumobilia. There is air within the gallbladder lumen, likely secondary to a\npatent biliary stent. The gallbladder is otherwise within normal limits.\n\nPANCREAS: The known mass in the pancreatic uncinate process is not well\nvisualized on the current study. There has been interval increase in\nperipancreatic soft tissue density which encases the SMA and partially encases\nthe SMV (601:17, 2:29, 33, 35). There is also increased attenuation of the\nSMV by the mass (02:33). Soft tissue density extends around the third portion\nof the duodenum which contains a duodenal stent (02:38, 601: 23, 24). \nIncreased soft tissue within the lumen of the duodenal stent is also noted,\nalthough it is difficult to determine how much of this is due to tumor\nextension versus ingested contents. However, this result in near complete\nocclusion of the duodenal lumen.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach and proximal duodenum are distended with air and\nfluid secondary to a nearly completely occluded duodenal stent (602:44). \nDuodenal stent remains in similar position. There is increased soft tissue\ndensity encasing the third portion of the duodenum. Distal loops of small\nbowel are largely collapsed. The colon and rectum are within normal limits.\nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are multiple uterine masses consistent with\nfibroids. There has been interval increase in size in a 7.6 cm hypodense\ncystic structure arising from the left adnexa (2:69). There is also a new,\n2.7 cm hypoattenuating cystic structure arising from the right adnexa (2:63). \nThere are multiple prominent vessels in the pelvis bilaterally as well as\ndilated gonadal veins.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L5 on S1 is unchanged with bilateral L5 pars\ndefects.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Gastric outlet obstruction secondary to a nearly occluded duodenal stent.\n2. Interval increase in peripancreatic soft tissue density which encases the\nSMA and SMV causing severe attenuation of the SMV, as well as involving the\nthird portion of the duodenum concerning for worsening pancreatic malignancy.\n3. Interval increase in size in a hypoattenuating left adnexal cystic lesion\nas well as a new cystic lesion in the right adnexa. Findings are concerning\nfor ovarian metastases. This can be further evaluated with a nonurgent pelvic\nultrasound if clinically indicated.\n4. Prominent vessels in the pelvis as well as a dilated gonadal veins\nbilaterally can be seen with chronic pelvic congestion syndrome, but clinical\ncorrelation is needed.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:53pm, 10 minutes\nafter discovery of the findings." }, { "input": "VASCULAR:\nThe abdominal aorta is non-aneurysmal. Minimal atherosclerotic burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the dedicated CT chest report for intrathoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions. There is a similar, moderate degree of pneumobilia\npredominantly within the left lobe of the liver with unchanged mild central\nbiliary ductal dilatation. The gallbladder is within normal limits, without\nstones or gallbladder wall thickening. Again demonstrated is a stent spanning\nthe common bile duct and terminates within the duodenum.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is similar\nmild pancreatic duct dilatation measuring up to 4 mm. Again there is a poorly\ndefined soft tissue density in the region of the uncinate process of the\npancreas with unchanged encasement of the SMA and SMV. There is unchanged\nnarrowing of the SMV at the confluence with the portal vein (4: 95-97). \nUnchanged partial encasement of the third part of the duodenum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size. No evidence of stones,\nsolid renal lesions, or hydronephrosis. No urothelial lesions in the kidneys\nor ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is unchanged positioning\nof 2 telescoping duodenal stents spanning the ___ to ___ part of the duodenum.\nThere is similar diffuse small bowel wall edema more prominent proximally and\nwithout associated fat stranding which can be seen in chronic portal venous\ncongestion. Compared to the CT dated ___, there is an area of mild\njejunal dilatation within the left lower quadrant measuring up to 4.2 cm. \nThere are several foci of intraluminal air, but no evidence pneumatosis or\ndefinite transition points.\n\nThe colon and rectum are within normal limits. The appendix is normal.\n\nRETROPERITONEUM: New subtle foci of peritoneal hyperdensity within the left\npericolic gutter and a 1 cm nodule in descending colon mesentery are \nconcerning for peritoneal studding (4:114; 4:110). No evidence of\nretroperitoneal lymphadenopathy.\n\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. No evidence\nof pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus with punctate calcifications. \nPreviously mentioned bilateral ovarian cysts are surgically absent in keeping\nwith history of bilateral salpingo oophorectomy.\n\nBONES: Unchanged mild multilevel degenerative changes with similar grade 1\nanterolisthesis of L5 over S1. Unchanged foci of heterotopic ossification\nalong the posterior aspect of the proximal right femur. No evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia, otherwise the abdominal\nand pelvic wall is within normal limits.", "output": "1. New foci of peritoneal hyperdensity within the left lateral mid abdomen\nconcerning for peritoneal studding (4: 110; 4: 114).\n2. No significant change in poorly defined uncinate process pancreatic mass\nwith similar encasement of the SMA, SMV and partial encasement of the third\npart of the duodenum.\n3. Similar diffuse small bowel edema which is likely related to chronic venous\ncongestion from known SMV narrowing.\n4. Stable positioning of the common bile duct and duodenal stents.\n5. Please refer to the dedicated CT chest report for intrathoracic findings." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is no substantial calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Left sided pneumobilia is similar to the\nprior study. A CBD stent is demonstrated within the extrahepatic biliary\ntree, stable in position compared to the prior study and terminating at the\nlevel of the duodenum. The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: There is redemonstration of a hypoenhancing ill defined mass arising\nfrom the uncinate process corresponding to known infiltrative locally advanced\npancreatic neoplasm. Stable low density soft tissue surrounding the\nmesenteric root measures approximately 4.1 cm in the AP diameter (series 2,\nimage 116), with close involvement of the third portion of the duodenum, few\nsmall bowel loops as well as the SMA and SMV. The SMA is circumferentially\nencased. The SMV is narrowed and attenuated at the level of the uncinate\nprocess (series 2, image 118), with patent tributaries. The pancreatic duct\nis mildly dilated measuring 4 mm, unchanged from prior study. The soft tissue\ndensity extends to the mid to distal SMA, unchanged from the prior study from\n___, measuring approximately 1.4 x 1.0 cm (series 2, image 137).\n\nSlow flow and venous mixing is demonstrated within the portal vein at the\nconfluence of the SMV and splenic vein without discrete intraluminal thrombus.\n\nSPLEEN: No discrete splenic lesions are demonstrated. The spleen is mildly\nenlarged, measuring 13.3 cm, unchanged from the prior study.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There's redemonstration of 2\ntelescoping duodenal stents spanning the ___ to ___ part of the duodenum. \nThere's diffuse small bowel edema along the proximal small bowel similar in\nextent compared to multiple prior studies. The pancreatic lesion\ninterdigitates along the central left proximal small bowel mesentery in\nsimilar extent compared to the prior study (series 2, image 129). No evidence\nof bowel obstruction. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening or fat stranding. The appendix is normal.\n\nRETROPERITONEUM: There is redemonstration of diffuse peritoneal haziness and\nnodularity with slightly more prominent discrete nodules, including a 0.6 cm\nsoft tissue nodule in the right lower quadrant (series 2, image 133), and\nanterior mesenteric nodule (series 2, image 115). Soft tissue density within\nthe left perirenal fat in close proximity to the descending colon measures 1.7\nx 1.5 cm, previously 1.7 x 1.6 cm (series 2, image 117) more inferiorly along\nthe mesentery of the descending colon there is additional soft tissue density\nmeasuring approximately 1.1 cm, which is unchanged. Previously demonstrated\nleft pericolic stranding is not as well visualized compared to the prior\nstudy. Some interloop fluid along the perirectal mesentery is not\nsubstantially changed compared to the prior study.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: Redemonstration of a fibroid uterus with punctate\ncalcifications. Patient is status post bilateral salpingo-oophorectomy.\n\nBONES: Degenerative changes are seen in the lumbar spine. Grade 2\nanterolisthesis of L5 over S1 is unchanged, with bilateral pars defects noted.\nNo suspicious osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Stable ill-defined uncinate process infiltrative pancreatic lesion with\nunchanged encasement of the SMA, SMV and third portion of the duodenum, with\nextension into the mesentery of loops of proximal small bowel.\n2. CBD and duodenal stents are grossly unchanged in position.\n3. Similar to slightly increased diffuse stranding and nodularity throughout\nthe peritoneum.\n4. Unchanged proximal small bowel edema without obstruction likely related to\nchronic venous congestion. No bowel obstruction.\n5. Please refer to separately dictated same day CT chest for full description\nof thoracic findings." }, { "input": "VASCULAR:\nThere is no abdominal aortic aneurysm. There is no significant calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. Predominantly left-sided pneumobilia is\nsimilar to prior studies. Similar position of a CBD stent, which is seen\nterminating at the level of the duodenum. The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: There is overall similar appearance of a hypoenhancing, ill-defined\nmass arising from the pancreatic uncinate process corresponding to the known\ninfiltrative pancreatic neoplasm. Low-density soft tissue surrounding the\nmesenteric root measures approximately 4.1 cm in the greatest axial dimension\n(4:96), with close involvement of the third portion of the duodenum and few\nloops of small bowel, similar to prior study. There is similar involvement of\nthe SMA and SMV, with complete circumferential encasement of the SMA. The\nsoft tissue density extends to the mid to distal SMA, unchanged from multiple\nprior studies, measuring approximately 1.5 x 1.0 cm (4:111). The SMV appears\nnarrowed and attenuated at the level of the uncinate process with patent\ntributaries (4:97). The main pancreatic duct is mildly dilated measuring 4\nmm, unchanged from prior study.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 14.5 cm. The spleen\nshows normal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is similar appearance\nand position of two telescoping duodenal stents spanning the ___ and ___\nportion of the duodenum. Diffuse small bowel edema involving the proximal\nsmall bowel appears similar in extent to multiple prior studies. The\npancreatic lesion interdigitates along the central left proximal small-bowel\nmesentery in similar extent compared to the previous studies (4:99). No\nevidence of bowel obstruction. Mild sigmoid diverticulosis is noted, without\nevidence of diverticulitis. The colon and rectum are otherwise within normal\nlimits. The appendix is normal.\n\nRETROPERITONEUM: There is overall similar appearance of diffuse peritoneal\nhaziness and nodularity with few prominent discrete nodules. For instance,\nthere is a 6 mm soft tissue nodule in the right lower quadrant (4:109), and a\n5 mm soft tissue nodule in the anterior mesentery (4:101), both unchanged from\nprior study. There is stable soft tissue density within the left perirenal\nfat in close proximity to the descending colon measuring approximately 1.7 x\n1.5 cm (4:100), unchanged from prior study. Additional soft tissue density\nmeasuring approximately 1.1 cm is seen along the mesentery of the descending\ncolon (4:110). A small amount of interloop fluid along the perirectal\nmesentery is not substantially changed compared to prior studies.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: There is an enlarged fibroid uterus containing multiple\ncalcifications. No adnexal abnormality identified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative change of the lumbar spine. Stable\nappearance of grade 2 anterolisthesis of L5 over S1 with associated bilateral\npars defects, unchanged from prior study.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia. The abdominal and pelvic\nwall is otherwise within normal limits.", "output": "1. Stable appearance of the ill-defined infiltrative pancreatic lesion within\nthe uncinate process, with similar encasement of the SMA, SMV, and third\nportion of the duodenum, as well as extension into the mesentery as described\nabove, overall unchanged compared to prior study from ___.\n2. Overall similar appearance of diffuse peritoneal stranding and nodularity\nas described above, also unchanged from prior study.\n3. Unchanged proximal small bowel edema, likely related to chronic venous\ncongestion. No evidence of bowel obstruction.\n4. Unchanged position and appearance of the CBD stent and duodenal stents.\n5. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day." }, { "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits. There is no focal hepatic lesion. \nThere is mild intrahepatic bile duct dilation with pneumobilia reflecting the\npresence of a CBD stent. No radiopaque ductal stones are seen. The\ngallbladder is collapsed, and appears normal.\n\nThe pancreas is mildly atrophic. The main pancreatic duct is mildly\nprominent, measuring up to 4 mm, unchanged from prior. Again seen is an\ninfiltrative uncinate process mass, measuring up to 4.1 cm, unchanged since\nthe prior CT examination, with continued encasement of the SMA and upper SMV\n(series 4, image 106). The portal SMV confluence and splenic vein remain\npatent.\n\nThe spleen size is within normal limits. There are no focal splenic lesions.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber. There is a duodenal stent in situ (series 4, image\n110), without upstream dilation.\n\nThe bladder is moderately distended, and appears normal. A fibroid uterus is\nagain demonstrated (series 8, image 65). No concerning adnexal lesions are\ndetected.\n\nA 6 mm anterior omental nodule is unchanged (series 4, image 99). A 2.0 x 2.0\ncm left pararenal soft tissue is unchanged (series 4 image 111). An inferior\nleft pararenal soft tissue is also unchanged, measuring 1.0 cm (series 4,\nimage 120). A 6 mm right pericolic node is unchanged (series 4 image 119).\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches remain patent and normal in caliber. The intrahepatic portal and\nhepatic veins are patent.\n\nThere are no osseous lesions concerning for malignancy or infection. There is\ngrade 1 anterolisthesis of L5 over S1 (series 8 image 64).", "output": "1. Unchanged infiltrative pancreatic uncinate process mass, measuring up to\n4.1 cm, with continued encasement of the SMA and upper SMV.\n2. Unchanged 6 mm anterior mesenteric and right pericolic nodes. Unchanged\n2.2 cm and 1.0 cm left pararenal metastases.\n3. Duodenal and CBD stents in situ, without obstruction.\n4. No new abdominopelvic metastasis or lymphadenopathy.\n5. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings." }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Punctate pleural based left lower lobe pulmonary nodule is\nunchanged compared to prior exam (series 2, image 6). There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is persistent mild intrahepatic biliary\ndilatation and pneumobilia, predominantly in the left lobe of the liver,\nlikely due to the CBD stent placement. The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: Similar to prior exam, there is a 4.1 cm uncinate process mass\n(series 5, image 55), which is unchanged compared to prior exam. As before,\nthis mass encases the SMA, SMV, and duodenum (series 5, image 59. There is\npersistent prominence of the pancreatic duct measuring up to 4 mm (series 5,\nimage 44).\n\nSPLEEN: The spleen is enlarged measuring up to 15 cm (series 601, image 72). \nNo focal lesions identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters.\n\nGASTROINTESTINAL: The stomach is unremarkable. Patient is status post\nduodenal stent placement, which is similar in appearance and positioning\ncompared to prior exam. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. No active colonic contrast extravasation identified. There is\nredemonstration of a 6 mm anterior mesenteric lymph node (series 5, image 65)\nand a prominent 7 mm right pericolic lymph node (series 5, image 72),\nunchanged compared to prior.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere is redemonstration of two similar-appearing left perinephric soft tissue\nlesions measuring 2.5 x 1.5 cm (series 5, image 61) and 1.9 x 0.8 cm more\ninferiorly (series 5, image 72).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and heterogeneous, and contains\nmultiple known fibroids, as seen on prior studies, further characterized on\nultrasound dated ___.\n\nBONES: Grade 1 spondylolisthesis of L5 over S1 is again seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No active contrast extravasation seen in the abdomen or pelvis.\n2. Redemonstration of a 4.1 cm ill-defined uncinate process mass with\nencasement of the SMA, SMV, and duodenum.\n3. The duodenal stent and CBD stent are unchanged in position.\n4. Similar-appearing mesenteric lymph nodes and left perinephric soft tissue\nmetastases. No n" }, { "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe superior mesenteric vein is markedly narrowed by the focally enlarged\npancreas and surrounding soft tissue abnormality.\n\n\nLOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There remains mild bilobar intrahepatic\nbiliary dilatation and pneumobilia in the left lobe of the liver. There is a\nbiliary stent in-situ. The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: There is redemonstration of an infiltrative locally advanced tumor\nat the uncinate process of the pancreas.. The margins are difficult to\ndelineate however it appears grossly similar in size when compared with the\nprevious study. The mass extends into the root of the mesentery. The mass\nencases the SMA and SMV. The SMV is severely narrowed and attenuated by the\nmass. The pancreatic duct is dilated measuring up to 0.5 cm in the body of\nthe pancreas.\n\nSPLEEN: The spleen measures 14.3 cm in long axis, previously 15 cm. Normal\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a stent within the\nsecond and third parts of the duodenum. There is in growth of soft tissue\nthrough the stent but there is no evidence of bowel obstruction (2:121). A\ncluster of small bowel in the proximal jejunum appears tethered together and\nto the infiltrative mass extending from the pancreas. The colon and rectum are\nwithin normal limits.\n\nRETROPERITONEUM: There is redemonstration of 2 soft tissue masses abutting the\nleft anterior pararenal fascia. The larger of these masses (2:84) abuts the\nadjacent descending colon. It demonstrates interval increase in size now\nmeasuring 2.6 x 2.4 cm compared with 2.1 x 1.5 cm of the previous study. \nSlightly caudal to this, the second nodule measures 1.5 x 0.7 cm and is stable\nin size when compared with the previous study.\n\nPeritoneum: Peritoneal nodularity along the anterior pelvis is more\nconspicuous than on prior study (2:190\n\nLYMPH NODES : No significantly enlarged retroperitoneal or mesenteric nodes. \nA 1 cm nodule anterior to the left gonadal artery may represent a lymph node\nor peritoneal deposit it is stable in size when compared with the previous\nstudy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nBONES: There is grade 1 anterolisthesis of L5 on S1. No evidence of bone\nmetastases.\n\nSOFT TISSUES: There is nodular enhancement of the lower confluence of the\nrectus abdominus muscle measuring up to 1.7 cm in AP dimension (2:187),\nincreased compared to prior where it measured 1.4 cm.", "output": "1. Redemons" }, { "input": "The chest is reported separately.\n\nNo suspicious focal liver lesions are identified. Caudate appears slightly\nenlarged in rounded appearance. Left lateral segments are also relatively\nprominent in size. There is no biliary dilatation. The gallbladder appears\nnormal. The pancreas is unremarkable. The spleen is mild to early enlarged\nmeasuring up to 16.9 cm in length. A few small infarcts are noted along the\nsuperior margin of the spleen which are age indeterminate. Adrenals appear\nnormal. There is no evidence for stones, solid masses or hydro nephrosis\ninvolving either kidney.\n\nStomach and small bowel appear normal. The large bowel is also unremarkable. \nAppendix is also identified and appears within normal limits.\n\nTrace air in the bladder suggests recent instrumentation. Prostate is mildly\nenlarged with central hypertrophy. Seminal vesicles appear normal. Small\nquantity of ascites in the pelvic cul de sac in addition to anasarca. No\nenlarged lymph nodes are found. Major vascular structures appear widely\npatent.\n\nThere are no suspicious bone lesions. Vertebral body heights and interspaces\nare preserved in height.", "output": "Enlarged spleen with infarcts. Possible early morphological changes of\nchronic liver disease. Small quantity of ascites and anasarca." }, { "input": "LOWER CHEST:\nThere are bilateral small pleural effusions. Extensive bilateral lower lobe,\nand right middle lobe consolidations compatible with the known septic\npulmonary emboli noted. There is a trace pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no free intraperitoneal air identified. Trace perihepatic\nfree fluid noted. Small volume free fluid is also seen in the pelvis.\nHEPATOBILIARY: The hepatic parenchyma demonstrates diffuse decreased\nattenuation compatible with steatosis.\nThe gallbladder is under distended and not clearly visualized..\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation..\nSPLEEN: The spleen is enlarged, measuring 16.4 cm in the craniocaudal axis. \nThere are multiple wedge-shaped hypodensities within the spleen compatible\nwith embolic infarcts. No abscess or perisplenic fluid collection noted.\nADRENALS: No adrenal nodules.\nURINARY: Both kidneys demonstrate low-grade enhancement, which is symmetric\nand homogeneous without hydronephrosis or evidence of pyelonephritis.\nGASTROINTESTINAL: No bowel obstruction. No bowel wall thickening or\npneumatosis noted to suggest bowel wall ischemia.\n\nLYMPH NODES: There are no enlarged abdominal or pelvic lymph nodes..\nVASCULAR: The abdominal aorta is normal in caliber. No filling defects noted\nwithin the abdominal aortic branches particularly the SMA or the ___.\n\nPELVIS:\nThe bladder is minimally distended and unremarkable there is small volume free\nfluid in the pelvis. No prostatomegaly.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions. No evidence of discitis or\nosteomyelitis involving the visualized lower thoracic or lumbar spine.\nExtensive diffuse subcutaneous edema compatible with anasarca noted.", "output": "1. There is no evidence of bowel wall ischemia or edema. No pneumatosis, free\nintraperitoneal air or portal venous gas identified.\n2. Splenomegaly with multiple splenic infarcts, that are embolic in the given\nclinical context.\n3. Diffuse hepatic steatosis, bilateral small pleural effusions and bilateral\nlower lobe pulmonary consolidations compatible with septic emboli, small\nvolume ascites, diffuse anasarca are additional incidental findings.\n\nNOTIFICATION: The findings were discussed with ___, MD, by ___\n___, M.D. on the telephone on ___ at 10:30AM , 2 minutes\nafter discovery of the findings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is relative ___ of the liver centrally which\nis likely related to fluid overload. There is one too small to characterize\nhypodensity in the right lobe segment VII (image 2; 54). No other focal\nlesions seen. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. Extrarenal\npelvis on the right is noted. There is a 3 cm exophytic renal cyst in the\nupper pole of the right kidney as previously. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are mildly\ndilated with no or thickening and decreased amount of intraluminal fluid as\nileostomy in the left lower lobe indicated by numerous air-fluid levels. \nIleostomy in the left lower quadrant noted.\n\nABDOMINAL CAVITY: A moderate amount of fluid is seen in the abdominal cavity\nwith relatively uneven distribution. The large collection seen in the left\nlower quadrant. Small amount of fluid is in the right paracolic gutter and\n___ pouch. The small collection in the right lower quadrant,\nanteriorly. Thickened peritoneum is noted in the left lower quadrant\ncollection (image 2; 82).\n\nPELVIS: The urinary bladder is distended and contains small amount of air,\nlikely post instrumentation.. There is moderate amount of fluid in the cul de\nsub, behind the uterus, with thickened peritoneal lining (image 2; 105). No\nfree air or abnormal air collection are seen.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStatus post right hip replacement.\n.\nSOFT TISSUES: Anasarca edema is noted..", "output": "1. Mild small bowel ileus.\n2. A symmetric in distribution ascites in the abdomen with some peritoneal\nthickening in the left lower quadrant and cul-de-sac may indicate superimposed\ninfection.\n\nRECOMMENDATION(S): Consider tapping left lower quadrant and cul-de-sac\ncollection" }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\n1.4 cm hypodensity in segment VIII is likely a hepatic cyst or biliary\nhamartoma. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a small accessory spleen (02:27).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMinimal grade 1 L5 on S1 anterolisthesis is noted with mild degenerative\nchanges at L5-S1.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.", "output": "1. No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain. Normal appendix.\n\n2. Small hiatal hernia." }, { "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes. No\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates fairly homogeneous attenuation\nthroughout. Slight heterogeneous enhancement of the right lobe is likely\nrelated to delayed image acquisition. There is no suspicious focal lesion. \nThere is mild-to-moderate circumferential periportal edema, which can be seen\nin the setting of rapid fluid resuscitation. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a 1.1 cm accessory splenule in the\nsplenic hilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions. There is a 0.6 cm simple cyst in\nthe medial upper polar cortex (2:54). There is no perinephric abnormality. \nThere is no hydronephrosis or hydroureter. The urinary bladder is\nunremarkable.\n\nGASTROINTESTINAL: The stomach contains multiple high-density tablets but is\notherwise unremarkable. Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement. There are no abnormally dilated loops of small\nbowel. Diverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal in caliber.\n\nPELVIS: Trace pelvic free fluid is within physiologic range.\n\nREPRODUCTIVE ORGANS: An intrauterine device is noted within the uterus. There\nis a small amount of fluid within the endometrial cavity. There is no adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted. There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Periportal edema, which can be seen in the setting of aggressive fluid\nadministration. Otherwise, no definite acute intra-abdominal process. \nSpecifically, there is no evidence of a small-bowel obstruction.\n2. Sigmoid diverticulosis without evidence of diverticulitis.\n3. Intrauterine device is visualized within the uterus. Trace pelvic free\nfluid is within physiologic range." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 5.6 mm nonobstructing stone in the interpolar region of the upper\npole of the right kidney. A punctate nonobstructing calculus is demonstrated\nin the upper pole of the left kidney. Adjacent vascular calcifications are\nnoted. A 4.2 cm x 3.3 cm x 6 cm simple cyst is demonstrated in the lower pole\nof the left kidney which is slightly larger than prior exam but simple in\nappearance. Multiple other low-density probable simple cysts are demonstrated\nin the bilateral kidneys. There is no evidence of focal renal lesions or\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Moderately severe degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. No acute abdominopelvic abnormality. Specifically, no colitis or\nappendicitis.\n2. Nonobstructing stones in the bilateral kidneys, the largest of which is\nlocated in the upper pole of the left kidney and measures approximately 6 mm.\n3. Colonic diverticulosis without diverticulitis." }, { "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion. Coronary artery and mitral\nannulus calcifications are seen. Aortic valve calcifications are partially\nimaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of focal lesions within the limitations of an unenhanced\nscan. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. There is no\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Demonstrated 5 mm calculus in the upper pole of the right kidney. \nMultiple additional bilateral nonobstructing renal calculi. 4.5 x 3.6 cm cyst\narises from the posterolateral left kidney. Additional cysts measuring 1.3 cm\nis seen arising from the lateral interpolar region of the left kidney. \nScarring at the lateral right kidney is noted. There is no hydronephrosis.\n\nGASTROINTESTINAL: Stomach is relatively collapsed. No bowel obstruction or\nbowel wall thickening is seen. There is colonic diverticulosis without acute\ndiverticulitis. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic\ndisease is noted.\n\nBONES: Severe multilevel degenerative changes are seen L2 through S1,\nincluding disc space narrowing, vacuum phenomenon, and anterior and posterior\nosteophytes. Moderate to severe narrowing of the central canal is seen L2/L3\nthrough S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.", "output": "1. Bilateral nonobstructing nephrolithiasis. No frank hydronephrosis.\n2. Normal caliber appendix.\n3. Extensive atherosclerotic calcifications.\n4. Severe multilevel degenerative changes L2 through S1, including moderate to\nsevere central canal narrowing at L2/L3 through S1." }, { "input": "VASCULAR:\n\nNo evidence of active arterial extravasation. No evidence of peristomal\nhematoma or venous bleeding. There are a conglomerate of vessels seen around\nthe stoma which appear to be varices draining into the SMV (303; 45).\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions within limitations of the arterial phase\nimaging. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is is not visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is enlarged measuring 14.2 cm, with subcentimeter hypodense\nlesions, too small to characterize, but likely represent cysts or hemangioma,\nsimilar to prior CT from ___.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nAgain, the right kidney appears slightly rotated around its axis. There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Patient is status post gastric lap band, which appears to be\nin appropriate position. Patient is status multiple partial small bowel\nresections with ileostomy. The remaining small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout. Patient is status post\nproctocolectomy. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere levoscoliosis of the lumbar spine with apex at L3-L4 is identified with\nsevere multilevel degenerative changes, most notable at L3-L4.\n\nSOFT TISSUES: Within the lower right anterior abdominal wall is a region\ncontaining locules of air, which may represent a prior catheter insertion site\nor a prior surgical site and is similar to most recent prior CT ___ 30). \nThere is extensive soft tissue edema noted throughout the abdominal wall. \nMultiple soft tissue calcifications within the soft tissues may represent\ninjection granulomas. 3.5 x 6.3 cm soft tissue mass along the left hip is\ncompatible with known fibroma (303; 94).", "output": "1. No evidence of active extravasation. No evidence of peristomal hematoma. \nThere are varices around the stoma draining into the SMV.\n2. Splenomegaly similar to prior." }, { "input": "There is extensive artifact related to positioning of the arm and technique\nwhich limits evaluation of the upper abdomen\n\nLOWER CHEST: There is interval development of a trace pneumothorax in the\nmedial anterior right lung. There is interval development of compressive\natelectasis. Mild dependent atelectasis. Moderate atherosclerotic\ncalcifications of the coronary arteries.\n\nHEPATOBILIARY: Patient is status post tips with stent in appropriate position.\nDue to artifacts as described above, further evaluation of the liver is\nmarkedly limited.\n\nPANCREAS: Mild atrophy of the pancreas.\n\nSPLEEN: Splenomegaly the spleen measuring 17 cm. Re-demonstrated\nsubcentimeter hypodensities in the inferior aspect of the spleen are similar\nto ___.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis or nephrolithiasis. Right renal cysts are similar\ndating back to ___ measuring up to 1 cm.\n\nGASTROINTESTINAL: Small hiatal hernia is re-demonstrated with hyperdensity\nwithin it pre and postcontrast, likely representing embolization clips. Lap\nband appears in similar position when compared to prior studies. Patient\nstatus post multiple small bowel resections with the right lower quadrant\nileostomy. Large ventral hernia containing undilated loops of small bowel. \nPatient is status post partial colectomy. Rectal stump noted.\n\nPELVIS: Foley within bladder with expected air. Hysterectomy. The adnexa are\nunremarkable for age.\n\nPERITONEUM/RETROPERITONEUM: Small volume low-density ascites in the right\ngreater left upper quadrant and scattered within the lower quadrant.\n\nLYMPH NODES: No abdominopelvic adenopathy.\n\nVASCULAR: There is no evidence of contrast extravasation. Patient is status\npost TIPS which appears in appropriate position. Normal caliber aorta with\nmoderate atherosclerotic calcifications. The aorta is mildly tortuous. The\nceliac axis, splenic artery, hepatic artery and SMA are patent. The ___ is\nagain noted to be occluded. Limited evaluation of the portal vein due to\ntiming of the contrast, however the main portal vein and portal splenic\nconfluence are patent. Coils are seen along the superior rectal vasculature.\n\nBONES: Degenerative changes of the spine. Rotatory scoliosis. No suspicious\nosseous lesions.\n\nSOFT TISSUES: A right chest port is again seen. Severe anasarca. Calcified\ngranulomas in the anterior abdomen and buttock. The hyperdense soft tissue\nmasses in the lateral aspect of the left hip along the left piriformis and\ngreater left trochanteric region are compatible with the known fibromas,\ndating back to ___. Large ventral abdominal wall defect again noted.\n\nThe foci of gas seen in the anterior abdominal wall on series 2, image 70 are\nagain noted and unchanged from last year and may be related to air within a\ncrevice related to the large pannus. No drainable fluid collections are seen.", "output": "1. Interval development of small right pneumothorax, partially seen. Small to\nmoderate right and small left pleural effusions.\n2. No site of extravasation demonstrated.Status post TIPS in appropriate\npositioning.\n3. Sequela of portal hypertension including splenomegaly and small volume\nascites.\n4. Esophageal dilatation most likely secondary to the laparoscopic gastric\nband, as on prior. Additional findings as above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:05 am, 2 minutes after\ndiscovery of the findings." } ] }