Instruction: Generate impression based on medical findings.

Input: 48-year-old female with shoulder pain and weakness. Evaluation of the shoulder is slightly limited due to inability to optimally position the patient.ROTATOR CUFF: There is increased signal intensity within the anterior fibers of the supraspinatus tendon suggestive of mild tendinosis. Additionally, there is a small focus of high signal intensity within the anterior fibers of the tendon at their insertion on the greater tuberosity. This involves the articular surface fibers and approximately 50% of the tendon thickness, but only measures 3 to 4 mm in both the longitudinal and AP dimensions. The supraspinatus muscle appears normal. There is thin linear increased signal intensity within the infraspinatus tendon, best seen on the sagittal oblique images, which may represent an interstitial tear, but we see no evidence of an surface tear. The infraspinatus muscle appears intact. There is thickening and mild increased signal intensity of the distal subscapularis tendon which may represent mild tendinosis, possibly exaggerated by redundancy of the tendon related to internal rotation of the humeral head. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Note is made of an os acromiale. Mild to moderate osteoarthritis affects the acromioclavicular joint. We see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint, but no large joint effusion. Although we see no fluid signal intensity entering the labral substance, there is intermediate signal intensity within the superior labrum extending into the anterior labrum suggestive of a tear with small adjacent focus of fluid signal intensity indicating a paralabral cyst. The inferior glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears mildly thickened at its transition from the rotator cuff interval to the intertubercular groove suggesting tendinosis.ADDITIONAL

Output: 1. Mild rotator cuff tendinosis with a small insertional tear of the anterior fibers of the supraspinatus tendon as described above.2. Osteoarthritis of the acromioclavicular joint and os acromiale.3. Findings suggestive of a superior labral tear and small paralabral cyst.4. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Question of high thyroglossal duct cyst on CT. Soft ballotable lesion behind frenulum at root of tongue, non painful. There is no significant narrowing of the trachea or discernible pyramidal lobe. There is globular enhancing tissue in the midline of the posterior root of the tongue that measures up to 15 mm. The thyroid is diffusely enlarged and contains nodules. The left lobe of the thyroid extends inferiorly to the level of the manubrium. There is no evidence of significant cervical lymphadenopathy based on size criteria. The salivary glands are unremarkable. The major cervical flow voids are grossly intact. The imaged orbits and intracranial structures are unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Findings compatible with ectopic lingual thyroid and a multinodular goiter.


Instruction: Generate impression based on medical findings.

Input: 33-year-old female with history of PNET status post Whipple (11/2015) with hepatic masses. ABDOMEN:LIVER, BILIARY TRACT: Susceptibility artifact from coils in the right hepatic lobe, cholecystectomy clips, and common bile duct stent.Unchanged, 6.2 x 6.0 cm arterially enhancing mass in hepatic segment eight with a central scar that is T2 hyperintense and demonstrates delayed enhancement compatible with focal nodular hyperplasia. A smaller, adjacent segment 8 arterially enhancing lesion is also unchanged and may represent a focal nodular hyperplasia. Redemonstrated are segment 3 and segment 6 lesions compatible with hemangiomas, unchanged. Two segment 2 lesions are again noted compatible with hemangiomas, unchanged.Moderate intrahepatic biliary ductal dilation in the left liver lobe, increased from the prior examination. Cavernous transformation of the portal vein is again noted. Paraesophageal and gastric varices. SPLEEN: Spleen size is top normal. Splenic vein thrombosis. PANCREAS: Postsurgical changes in the head of the pancreas. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense cyst. No hydronephrosis or mass lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diastasis of the abdominal musculature.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis. Bilateral adnexal cysts likely physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple hepatic lesions with the largest lesion in hepatic segment 8, unchanged and compatible with FNH. 2.Additional hepatic lesions are unchanged as detailed above. 3.Interval increase in intrahepatic ductal dilation, raises concern for stent patency; correlation with patient's clinical history and laboratory values recommended. 4.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with left upper extremity numbness tingling and weakness. Evaluate for abnormalities. History of orthostatic liver transplant status post HCC with recent Histiocytosis X. Cervical Spine:The craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. The alignment is maintained. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild uncovertebral and facet hypertrophy which causes mild bilateral neural foraminal stenosis but no central canal stenosis.C4-5: There is a small disc osteophyte complex and mild facet hypertrophy causing mild-to-moderate left neuroforaminal stenosis but no right neural foraminal or central canal stenosis.C5-6: There is a small disc osteophyte complex with a process extending along the ventral spinal canal from the C5-6 to the C6-7 level representing either posterior longitudinal ligament thickening or disc material. There is also facet hypertrophy and ligamentum flavum thickening. This results in effacement of the ventral thecal sac and mild central spinal canal stenosis. No evidence of neural foraminal stenosis.C6-7: There is a left greater than right paracentral disc protrusion. As described above there is posterior longitudinal ligament thickening or disc material appearing in continuation with the more superior level. There is also uncovertebral and facet hypertrophy as well as ligamentum flavum thickening. This causes mild left neural foraminal stenosis and flattening of the ventral spinal cord at this level. There is no right neuroforaminal stenosis.C7-T1: There is a disc osteophyte complex, facet and uncovertebral hypertrophy as well as ligamentum flavum thickening. However there is no neural foraminal or central spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Brachial Plexus:There is evidence of a surgical incision along the left upper chest wall likely from access of the subclavian vein during the transplant procedure. Again seen is a subpectoral collection which is decreased significantly in size compared to the prior CT from November 9th. Along the subclavian vein is evidence of some inflammation and probably at least one surgical clip. Mild increased T2 signal parallels the left subclavian vein and its proximal tributaries suggesting edema or inflammation. In addition, central nonenhancement of the vein and its tributaries is noted which raises the question of possible subclavian vein thrombosis. No obvious injury to the nerves of the brachial plexus is seen allowing for motion degredation. However the nerves of the plexus pass in some proximity to the subclavian operative bed and may be affected by the above described edema and inflammation.

Output: 1.Mild degenerative changes of the cervical spine most prominent at the C6-7 level where there is a left greater than right paracentral disc protrusion which causes some flattening of the left ventral aspect of the spinal cord as well as mild left neural foraminal stenosis.2.Although there is no definite injury to the left brachial plexus, the plexus passes reasonably close to the subclavian vein operative field where there is evidence of some persistent edema and inflammation which may have affected these nerves to some degree. A previously seen subpectoral seroma or hematoma has significantly decreased in size.3.Inflammation of the left subclavian vein and its tributaries is suspected with possible thrombosis. Ultrasound may be helpful to evaluate the possibility of thrombosis if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Chronic postconcussive headache after patient hit in head with hammer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered mild cerebral white matter T2 hyperintense lesions. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There appears to be a small residual right frontal scalp hematoma. The orbits, skull, and mastoid air cells are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are postoperative findings in the upper cervical spine.

Output: 1. Apparent small residual right frontal scalp hematoma, but no evidence of intracranial hemorrhage. 2. Scattered mild cerebral white matter lesions are nonspecific, but likely represent chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of cervical degenerative disease and metastatic sarcoma. Rule out cord compression. Signs and symptoms: Right upper extremity weakness. Pre and post enhanced cervical MRI:Examination demonstrates a tiny focus of T2 hyperintensity within the center of the cord at C1-C2 level without abnormal enhancement. Clinical significance of this finding is not clear.Foramen magnum is unremarkable.C2-C3 demonstrate degenerative changes with resultant severe right and moderate left neural foraminal compromise similar to prior exam.C3-C4 redemonstrate postoperative changes of an anterior fusion and placement of metallic plate and fixating screws anteriorly. Hypertrophic changes of posterior elements similar to prior exam are again noted. There is resultant circumferential mass effect on the cord with resultant flattening deformity and central spinal stenosis as well as bilateral neural foraminal compromise.. There is intrinsic cord T2/T2 STIR hyperintensity primarily on the right suggestive of myelitis. Compared to prior exams both on sagittal T2 and sagittal T2 STIR there is suggestion of slight interval decrease in the extent of this finding. This observation although could be technique related possibility of interval decreased edema of the cord since prior exam cannot be entirely excluded. Post enhanced images demonstrate patchy enhancement of the cord at this site which is best appreciated on axial series 1/1/2001 image 27 and sagittal post enhanced series 1001 image 9. This finding is consistent with myelitis.C4-C5 demonstrate stable degenerative changes of disc and the posterior elements and resultant mild central spinal stenosis and severe left and moderate right neural foraminal compromise similar to prior exam.C5-C6 demonstrate degenerative changes of disc and posterior elements resulting in mild central spinal stenosis and severe bilateral neural foraminal compromise similar to prior exam.C6-C7 redemonstrate stable degenerative changes without spinal stenosis.C7-T1 demonstrate stable mild degenerative changes without central spinal stenosis.Post enhanced images demonstrate no findings to suggest metastatic disease.

Output: 1.Tiny nonspecific central cord T2 hyperintensity stable since prior exam and without enhancement.2.Extensive degenerative changes and postoperative fusion at C3-C4 with central spinal stenosis demonstrate no change since prior study. Focus of intrinsic T2 hyperintensity on the right aspect of the cord at this level demonstrate patchy internal foci of enhancement and is believed to represent myelitis. There is apparent decreased extent of hyperintensity of the cord at this level compared to prior exam which could be technique related, however possibility of interval decreased cord edema cannot be entirely excluded. Please correlate with neurological status.3.Extensive degenerative changes of cervical spine remains stable since prior exam from April 2015.4.Examination demonstrates no evidence of malignancy/metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with malignant neoplasm of the prostate (3+3 Gleason) PELVIS:PROSTATE:Prostate Size: 4.7 x 5.3 x 2.8 cm.Peripheral Zone: Bandlike T2 hypointensities diffusely throughout the peripheral zone. A focal T2 hypointensity is noted in the left mid gland peripheral zone.Central Gland: Mild degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal T2 hypointensity is noted in the left mid gland peripheral zone. Otherwise, no discrete nodule/lesion is evident.2.Bandlike T2 hypointensities diffusely throughout the peripheral zone may reflect prostatitis.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with LLE cellulitis, elevated inflammatory markers. Rule out myositis, abscess, osteo There is thickening and enhancement of the skin as well as reticulation and enhancement of the subcutaneous fat compatible with marked cellulitis. There is poorly defined crescentic of nonenhancing tissue within the subcutaneous fat along the anterior peripheral deep fascia that may simply represent confluent edema, although it is impossible to exclude a phlegmon/developing abscess. Mild increased signal intensity within the soleus muscle as well as the flexor digitorum longus muscle may reflect very mild myositis. Bone marrow signal intensity is within normal limits. Small knee joint effusion with extension posteromedially into a tiny Baker's cyst. Mild osteoarthritis affects the knee. Relatively mild subcutaneous edema affects the right leg on the large field-of-view coronal images.

Output: 1. Cellulitis and possible mild myositis without evidence of osteomyelitis. Nonenhancing tissue within the subcutaneous fat along the anterior peripheral deep fascia probably simply represents confluent edema, although it is impossible to exclude a phlegmon/developing abscess.


Instruction: Generate impression based on medical findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: MRA brain appears within normal limits. Please note examination is limited to MR angiogram of the head and conventional brain MRI sequences were not obtained. Prior brain MRI however from 10/10/2013 was within normal limits.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Paresthesia of skinClinical question: MSSigns and Symptoms: memory, patchy signal abnormalities in the cervical spine The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical white matter lesions which are hyperintense on T2 imaging and hypointense on T1 imaging present. Some of these are perpendicularly oriented to the lateral ventricles. Some extend to the colossal cingulate junction. Also appears to be a T2 hyperintense lesion in the posterior and peripheral aspect of the upper cervical spinal cord located midline and eccentric to the left at the C1 vertebral level which is incompletely assessed on this study.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are periventricular and subcortical white matter lesions present as well as a lesion suspected to be present in the upper spinal cord which are suspicious for demyelinating disorder which is compatible with the patient's known diagnosis of multiple sclerosis.


Instruction: Generate impression based on medical findings.

Input: Results indicate right unilateral vestibular weakness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female, with peripheral vascular disease status post left above-the-knee amputation with open wound and left leg edema. Evaluate for fluid collection, tracking air.IMAGE ACQUISITIONS: Non-IV contrast enhanced CT of the pelvis and both thighs. Lack of IV contrast decreases the ability to detect small abscesses.Patient is status post left above-the-knee amputation. Irregularity of the soft tissues of the distal end of the remaining left thigh is compatible with the stated history of open wound, and there several small pockets of gas density seen within the soft tissues surrounding and adjacent to the amputated distal left femur. There are no specific features of osteomyelitis on this study, although MRI would provide a more sensitive assessment for osteomyelitis. No abscess is identified within the left thigh. Air does not extend into the proximal thigh.There is moderate bilateral stranding of the subcutaneous fat of the thighs compatible with edema, which extends into the subcutaneous fat of the pelvis and lower abdomen. An intramedullary rod is present in the right femur and results in metallic artifact that slightly limits the exam of the surrounding anatomic structures. There are atherosclerotic calcifications seen within the pelvis and both thighs as well as a femoral artery stent on the right.

Output: Status post left above-the-knee amputation with stump wound and small foci of air immediately adjacent to the distal left femur. No abscess evident.


Instruction: Generate impression based on medical findings.

Input: There are multiple foci of susceptibility abnormality throughout both infratentorial and supratentorial brain, including at the cervicomedullary junction, with imaging features consistent with innumerable cavernous malformations. The largest of these is centered in the right thalamus measuring 16 mm AP x 15 mm transverse x 12 mm craniocaudal (as measured on T2 images). This larger lesion demonstrates heterogeneous internal signal characteristics, with a hypointense rim. There is no associated mass effect or perilesional edema. There are no associated developmental venous anomalies.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There are multiple cerebral cavernous malformations throughout the supratentorial and infratentorial brain, including at the cervicomedullary junction.2.The largest of these is centered in the right thalamus measuring 16 mm AP x 15 mm transverse x 12 mm craniocaudal (as measured on T2 images). This larger lesion demonstrates heterogeneous internal signal characteristics, with a hypointense rim. There is no associated mass effect or perilesional edema.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old, with breast cancer and worsening nausea, evaluate for brain metastases. A 6 mm enhancing nodule is evident along the superior surface of the left cerebellum with minimal associated parenchymal edema. No definite additional lesions are seen. No significant generalized mass effect is detected. A few scattered small foci of white matter T2 hyperintensity are nonspecific. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are within normal limits. Bone marrow signal characteristics are unremarkable.

Output: A single 6 mm lesion is evident along the superior surface of the left cerebellum compatible with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 33 years, Female, brain lesion. Examination is limited to sequences for operative planning and intraoperative navigation. Again seen is an enhancing mass involving the right aspect of the midbrain and thalamus. The mass measures approximately 2.5 x 2.2 x 2.3 cm in the AP, transverse, and craniocaudal dimensions. Placement of right transfrontal laser fiber is seen for ablation which extends into the deep aspect of the lesion at the level of the midbrain. Central areas of nonenhancement are noted compatible with postsurgical change. No new mass effect. Leftward displacement of the third ventricle is again noted. Ventricles remain unchanged in size. Minimal T1 hyperintensity and enhancement is evident at the laser fiber insertion site. No significant hemorrhage or extra-axial collections are evident.

Output: Examination for operative planning and intraoperative guidance. Expected postsurgical changes of laser ablation of right midbrain/thalamus mass are seen.


Instruction: Generate impression based on medical findings.

Input: 63 years, Female, new HIV diagnosis, stage IV rectal CA. Evaluate for tumor or infection. Sepsis, altered mental status. Global parenchymal volume loss is noted which is advanced for patient's age. Diffusion-weighted sequences are motion degraded limiting evaluation for acute infarct; however, no obvious acute infarct is evident. Tiny chronic lacunar infarct in the right thalamus is noted. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Trace mucosal thickening is present in the paranasal sinuses, which are otherwise clear. There is mild nonspecific opacification of the bilateral mastoid air cells. Diffuse low T1 marrow signal is noted which is nonspecific and can be seen in conditions such as chronic anemias. No destructive osseous lesions are evident. Extracranial soft tissues are unremarkable.

Output: Limited sequences obtained as patient could not tolerate the full study. No intracranial mass, mass effect, or evidence of edema. No findings to suggest intracranial abscess or empyema. Please note lack of contrast limits evaluation for small metastatic lesions as well as infection, and lumbar puncture should be considered if there is significant suspicion for meningitis.


Instruction: Generate impression based on medical findings.

Input: Gait instability. Remote history of right caudate infarct (in 2009). There is focal encephalomalacia involving the right frontal coronal radiata as well as the lateral aspect of the right caudate head and the anterior part of the right external capsule, which is unchanged since previous CT scan. Lacunar infarct involving the posterior aspect of the left caudate head is not definitively seen on prior CT. There are also scattered foci of T2-hyperintensity in the cerebral white-matter which are nonspecific but most compatible with chronic small vessel ischemia. There is tiny focus of susceptibility effect in the central superior aspect of the pons without associated edema, which likely represents chronic microhemorrhage. There is no acute infarct or acute intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is no abnormal intracranial contrast enhancement.The lateral and third ventricles are moderately dilated, which has mildly increased compared to the previous CT scan. There is also focal dilatation involving some of the sulci.There is minimal ethmoid mucosal thickening. The orbits are grossly unremarkable. There is no destructive skull lesion. Sella turcica is partially empty which is usually normal variant in this age group.

Output: 1.There is no acute infarct or intracranial mass. 2.Mild to moderate chronic small vessel ischemic disease with small chronic infarcts as described above. 3.Suggestion of mild disproportionate enlargement of the ventricles compared to the degree of volume loss. Finding may represent communicating hydrocephalus/NPH in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Metastatic breast cancer needs evaluation prior to starting trial. There are two enhancing lesions in the right cerebellar hemisphere that measure up to 7 mm and an enhancing lesions in the anterior left frontal lobe that measures up to 8 mm. There is negligible associated surrounding edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: Subcentimeter supratentorial and infratentorial lesions likely represent metastases.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with pain at the 1-3 metatarsals. Evaluate for stress fracture, bursitis or sesamoiditis. The bone marrow signal intensity is within normal limits without evidence of stress fracture. The sesamoid bones appear normal. There is a subcentimeter collection of near-fluid-signal intensity between the first and second metatarsal heads, which may represent a very mild bursitis, but this is equivocal and we otherwise see no abnormal fluid collections. The remaining visualized soft tissue structures appear normal.

Output: Tiny focus of fluid signal intensity between the first and second metatarsal heads could conceivably represent a very mild bursitis, but we otherwise see no findings to account for the patient's pain.


Instruction: Generate impression based on medical findings.

Input: 16 day old female with fever and prior subdural hemorrhage, evaluate for infectious complications Several sequences are motion greater. Given this caveat:Previously demonstrated high T1 signal intensity in the subdural spaces overlying the posterior left cerebellar and cerebral convexities has nearly resolved. There is new high T1 signal intensity material within the ventricles (right greater than left) with layering in the occipital horns consistent with interval formation of intraventricular hemorrhage. There is corresponding hypointensity with susceptibility technique. There is no evidence of acute infarct. The brain parenchyma appears unremarkable, with a normal degree of myelination for age. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The mastoid air cells and middle ear cavities are clear.

Output: 1.Previously demonstrated subacute subdural hemorrhage along the left posterior cerebellar and cerebral convexities has nearly resolved.2.New intraventricular hemorrhage as described in detail above.3.No abnormal enhancement.


Instruction: Generate impression based on medical findings.

Input: 84 years Male (DOB:6/10/1932)Reason: Degenerative disk disease lumbar spine History: Lower back painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a disc bulge and disc desiccation at this level associated bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally but more on the right than the left. There is narrowing of the neural foramina with partial effacement of the fat surrounding the exiting nerve roots.At L4-5 there is some loss of disc space height, disc bulge and moderate to marked bilateral facet ligamentum flavum hypertrophy. There is mild anterior subluxation of L4 on L5. There is effacement of the fat at the lateral recess bilaterally. There is narrowing the spinal canal and crowding of the nerve roots within the thecal sac at this level. Overall there is a moderate to marked degree of spinal stenosis at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 46 mm cystic lesion present off the inferior pole of the right kidney. There is a 32 mm cystic lesion along the superior aspect of the right kidney. Both of these cystic lesions are only partially imaged on this exam.

Output: 1.There are degenerative changes present in the lower lumbar spine.2.There is a moderate to severe degree of spinal stenosis present at L4-5 related to disc disease and facet disease as well as a small degree of subluxation.3.There is encroachment of the nerve roots at the lateral recess bilaterally at L5-S1 but worse on the right side compared to the left. There is mild to moderate spinal stenosis at L5-S1.4.There are large cystic lesion along the right kidney. These are not completely imaged on this exam. Please refer to abdomen CT exam from 9/2/2015 for further comments


Instruction: Generate impression based on medical findings.

Input: 27 years Male (DOB:7/2/1988)Reason: disc bulge causing S1 compression History: worsening leg painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a left paramedian broad-based disc protrusion which mildly encroaches on the nerve roots at the left lateral recess more than the right lateral recess. This has not changed substantially compared to the previous exam. There is disc desiccation present at this level and loss of disc space height.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Left paramedian broad-based disc protrusion at L5-S1 mildly encroaches on the nerve roots at the left lateral recess. To a lesser degree there some minor encroachment of the nerve roots at the right lateral recess at this level. Compared to the exam from August this does not appear to have changed substantially.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male patient with chronic hip pain. Bone marrow signal is within normal limits.Mild osteoarthritis affects the right hip. The right ligamentum teres is intact. A small amount of fluid within the right hip joint is within physiologic limits. There is increased signal intensity within the anterior and superior labrum likely representing degeneration and partial thickness tearing. There is increased signal intensity within the main tendon of the right gluteus medius at its insertion at the greater tuberosity representing insertional tendinosis and partial-thickness tearing. There is also mild tendinosis of the right gluteus minimus tendon at its insertion as well. There is mild edema in the peritrochanteric tissues. Similar abnormalities affect the left hip as seen on the large field-of-view images.Minimal insertional tendinosis of the hamstring tendons at their origins are not necessarily of any clinical significance. Moderate osteoarthritis affects the symphysis pubis. Severe degenerative disc disease affects the lower lumbar spine.There is a right-sided inguinal hernia containing small bowel. There is a fat-containing left inguinal hernia.

Output: Mild osteoarthritis of both hips with insertional tendinosis and interstitial tearing of the gluteus medius tendons bilaterally and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Female 70 years old Reason: r/o cord compression History: acute b/l LE weakness The spinal cord has normal signal characteristics and overall morphology. There is no evidence of acute cord compression. Compression fracture of the T7 vertebral body which is hypointense on both STIR and T1 sequences, suggesting it is likely chronic. There is no definite retropulsion of fragments. Kyphosis of the thoracic spine is centered at the T7 vertebral body. There are also mild posterior disc bulges in the cervical spine without significant compression on the spinal cord.

Output: 1.No cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2.Compression fracture of the T7 vertebral body is favored to be chronic in etiology.Findings discussed between on-call radiology resident and Dr. Wali at approximately 1945 on 11/13/2016.


Instruction: Generate impression based on medical findings.

Input: Suspected CC fistula History: blood in Schlemm's canal, evidence of elevated episcleral venous pressure, and pulsatile tinnitus. Brain MRI: The cavernous sinuses are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst. There is also an adenoidal retention cyst. There is a mildly prominent right retropharyngeal lymph node that measures 6 mm in short axis. There is a nasal septal defect. Brain MRA: There is an anomalous origin of the right opthalmic artery from the right middle meningeal artery. Otherwise, there is no evidence of significant steno-occlusive lesions, arteriovenous malformations, or cerebral aneurysms.Orbit MRI: There is mild prominence of the bilateral superior opthalmic veins. Intraocular hemorrhage cannot be resolved on this exam. The ocular adnexa appear to be intact bilaterally. There is no evidence of intraorbital mas or abnormal enhancement.

Output: 1. Nonspecific mild prominence of the bilateral superior opthalmic veins without discernible evidence of a large dural atriovenous fistula, although MRA has limited sensitivity for arteriovenous fistulas. 2. Intraocular hemorrhage cannot be resolved on this exam, but there is no evidence of intraorbital mass lesions. 3. Mildly prominent right retropharyngeal lymph node, which is nonspecific. Perhaps dedicated neck imaging may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 19 year-old female with history of hydrocephalus status post VP shunt placement presenting with headache and vomiting. Evaluate for worsening hydrocephalus. Ventricular shunt catheter enters the right parietal burr hole with catheter tip in the left lateral ventricle, unchanged in position. Stable morphology and increased volume of both lateral ventricles is evident. Previously evident contrast within the left lateral ventricle is no longer seen. There is no evidence of intracranial hemorrhage, abnormal extra-axial fluid collections, or edema. The remainder of the cerebral and cerebellar hemispheres are stable in appearance. The pituitary gland appears mildly prominent, which correlates with convex morphology seen on recent MRI.Postoperative changes status post right parietal burr hole and are unchanged, with the remainder of the calvarium visualized osseous structures intact. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable hydrocephalus with no additional acute findings to explain headache and vomiting.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with large left retroperitoneal mass per history discussed with Dr. Rogan additional or new catheter proof of current tumor is required prior to additional therapy. History of resection with this tumor representing either incomplete resectional possible recurrence. Written informed consent was obtained. Patient was prepped and draped in sterile fashion. Skin was anesthetized with lidocaine. A posterior approach was used to avoid bowel. Using coaxial technique two 18G core samples were obtained from the central portion of the mass just above iliac crest. Samples were placed in both in formalin and submitted for pathologic analysis.Procedure was complicated by shooting pain down the leg and groin during the biopsy which slowly subsided following the procedure. The patient was discharged to the floor in good condition with some mild persistent discomfort.

Output: Two 18-gauge core biopsies left retroperitoneal mass with CT guidance.


Instruction: Generate impression based on medical findings.

Input: Intra-articular contrast is identified within the radiocarpal joint extending through the expected location of the scapholunate ligament. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 22 seconds

Output: Successful fluoroscopic guided injection of dilute gadolinium into the midcarpal joint for subsequent MRI arthrogram examination.


Instruction: Generate impression based on medical findings.

Input: Multiple sclerosis. Ataxia. The patchy and confluent periventricular cerebral white-matter T2-hyperintensity has not significantly changed since the previous examinations. Some of the lesions are also mildly to moderately T1-hypointense. The corpus callosum is involved by some lesions and is thinned, as part of the generalized brain volume loss. There are also a few lesions involving the brainstem and cerebellum. An area of linear and branching subcortical enhancement in the anterior paramedian right left frontal lobe is unchanged.

Output: 1. Extensive white matter lesions that are compatible with multiple sclerosis remain unchanged since May 2015. Associated moderate brain volume loss remain unchanged.2. A small enhancing subcortical lesion in the left anterior frontal lobe may represent a developmental venous anomaly rather than an enhancing demyelinating lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are screening mammogram (1/6/2015), screening whole breast ultrasound (2/10/2015), images from ultrasound guided right breast biopsy and post procedural mammogram (2/27/2015), and MRI (3/5/2015) performed at Advocate Illinois Masonic Hospital. For comparison, mammogram and ultrasound dated 7/3/2013, and mammogram dated 7/16/2012 are available. MAMMOGRAM (1/6/2015): Two standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Benign appearing lymph nodes are projected over both axillae.WHOLE BREAST ULTRASOUND (2/10/2015): Multiple images from bilateral screening whole breast ultrasound are submitted. At the two o'clock position of the right breast, 5 cm from the nipple, there is an irregular, hypoechoic mass measuring 1.0 x 0.8 x 0.9 cm. This mass demonstrates apical vascularity on Doppler imaging. Elsewhere in both breasts, multiple subcentimeter anechoic, simple cysts are present.IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST BIOPSY AND POST PROCEDURAL MAMMOGRAM (2/27/2015): Images from ultrasound guided biopsy of the right breast mass at the 2:00 position, 5 cm from the nipple were submitted. Targeting appears appropriate. A clip was left at the biopsy site. Post procedural unilateral right CC and ML views demonstrate a coil-shaped clip within the central inner right breast.MRI (3/5/2015): Heterogeneous fibroglandular tissue is noted bilaterally, with moderate background parenchymal enhancement. A 0.7 x 0.7 cm enhancing mass is present within the inner, slightly upper right breast, approximate 2:00 position. Susceptibility artifact from biopsy clip is noted adjacent to this mass, compatible with the patient's known malignancy. The left breast is unremarkable. No abnormal lymph nodes are present within the axillae.

Output: Enhancing 0.7 cm mass with adjacent biopsy clip at the 2:00 position of the right breast, compatible with the patient's known malignancy.BIRADS:6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old, with chronic dizziness and vertigo. No restricted diffusion is seen. Numerous small foci of T2/FLAIR hyperintensity are seen scattered through the cerebral hemispheres and brainstem. No edema or mass effect is detected. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid are observed. The ventricles are normal in size and morphology. The right maxillary sinus and right ethmoid air cells are opacified.

Output: 1.No definite acute intracranial abnormality is seen.2.Scattered foci of signal abnormality are nonspecific but statistically most likely represent chronic microvascular ischemia.


Instruction: Generate impression based on medical findings.

Input: 19 year-old female. Abdominal pain, increasing frequency of stool. Ongoing symptoms with weight loss. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple prominent mesenteric lymph nodes, likely reactive.BOWEL, MESENTERY: Approximately a 20 cm long segment of most distal terminal ileum up to the IC valve demonstrates active inflammation with wall thickening, hyperenhancement, and hyperemia. No fistulae, abscess, or bowel obstruction.Artifact from gastrostomy tube limits evaluation of adjacent anatomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No perianal fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid, likely physiologic.

Output: Active inflammatory bowel disease involving approximately 20 cm of the most distal terminal ileum.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male patient with history of osteomyelitis status post right second toe amputation.New wound, edema. Evaluate for osteomyelitis. There is soft tissue ulceration along the ball of the foot with extensive signal abnormality in the underlying subcutaneous soft tissues. Additionally, there is diffuse edema throughout the soft tissues of the foot.As seen on the radiographs, there is dorsal dislocation of the proximal phalanx of the great toe relative to the first metatarsal. There is a small rim-enhancing fluid collection immediately plantar to the head of the first metatarsal. There is erosion of the plantar and medial aspects of the head of the first metatarsal surrounding a small intramedullary focus of near fluid signal intensity. Although there is little enhancement of the medullary bone, these findings are suggestive of chronic osteomyelitis and a small intramedullary abscess. There is proximal displacement of the sesamoid bones with surface irregularity and signal abnormality of the lateral sesamoid likely reflecting chronic osteomyelitis. Mild signal abnormality within the lateral aspect of the base of the proximal phalanx may be related to chronic osteomyelitis or reactive osteitis. Signal intensity of the distal phalanx appears normal.The patient is status post amputation of the second toe. There is a sinus tract extending from the plantar surface of the ball of foot to what remains of the head of the second metatarsal. Small rim-enhancing fluid collections surround the second metatarsal head and probably communicate with the aforementioned sinus. There is abnormal signal intensity and enhancement involving the head and diaphysis of the second metatarsal indicating osteomyelitis.As seen on radiographs, there is deformity of the head of the third metatarsal and signal abnormality compatible with chronic osteomyelitis. There is signal abnormality within the proximal phalanx of the third toe compatible with chronic osteomyelitis. Signal intensity within the middle and distal phalanges are within normal limits. There is also a small enhancing fluid collection adjacent to the head of the third metatarsal.Abnormal signal intensity and enhancement involving the head, neck, and diaphysis of the fourth metatarsal is compatible with osteomyelitis. The phalanges of the fourth toe appear normal.There is a tiny focus of edema type signal in the head of the fifth toe metatarsal which is favored to be arthritic in etiology over osteomyelitis. The phalanges of the fifth toe are within normal limits. There is also a small rim-enhancing fluid collection (4-5 mm) immediately adjacent to the lateral aspect of the base of the fifth metatarsal with surrounding inflammation. A 6-7 mm collection of fluid signal intensity dorsal to the base of the fifth metatarsal may represent a synovial cyst or ganglion.Degenerative arthritic changes affect the bones of the midfoot. There is thickening of the plantar fascia. The flexor hallucis longus tendon is also abnormally thickened likely due to a chronic full-thickness tear and becomes inseparable from the plantar fascia beneath the first metatarsal likely representing chronic scarring. There is also enhancement surrounding the flexor tendons near the first metatarsal neck suggestive of tenosynovitis. Distal to this, the tendons are not visualized and may be torn.

Output: Soft tissue ulceration with multifocal osteomyelitis and other findings as described above.These findings were discussed with M. Jacobs via telephone at 0959 hrs.


Instruction: Generate impression based on medical findings.

Input: 54 year-old female with CAD s/p PCI to LAD in 3/2015, RCA CTO s/p PCI in 12/2015 and 4/2016, LV dysfunction, hypertension, OSA with chest pain.MEDICATIONS: Aspirin, Atorvastatin, Bumex, Carvediolol, Clopidogrel, Gabapentin, Hydroxychloroquine, Isosorbide mononitrate, Prednisone, Ranolazine, Spironolactone, Valsartan First Pass PerfusionDuring hyperemia, possible mild perfusion defect noted at the mid inferior segment. No significant perfusion defects noted. Stress perfusion study improved when compared with previous performed 3/2016.Viability/ Myocardial ScarDiffuse subendocardial LGE extending from the base to mid inferior wall. This was noted in the previous study from 3/2016. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size in function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 170 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 72 g. Basal to mid inferior wall hypokinesis (mild). Pre-contrast T1 mapping = 973 msLeft AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size in function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 144 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in sized. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, possible mildmid inferior wall perfusion defect. This defect is much improved from previous stress MRI dated 3/3016.2. Diffuse area of LGE extending from the base to mid inferior wall. This was noted on the previous study and is still present. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%). Basal inferior wall hypokinesis (mild)4. Normal RV size and systolic function (RVEF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Headache with a history of ALL. Question metastases or mass. There is suggestion of a small subdural hematoma at the vertex. There is no evidence of mass effect, edema or midline shift. Lack of intravenous contrast limits the evaluation for metastases. If there is clinical concern for metastases, an MRI with contrast is recommended for better evaluation.The ventricles and sulci appear prominent for the patient's age, consistent with volume loss. This is more prominent than on the prior study.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Suggestion of a small subdural hematoma at the vertex. If there is clinical concern for metastases, an MRI with contrast is recommended for evaluation.


Instruction: Generate impression based on medical findings.

Input: 57 year old female with a family history of breast cancer in 3 sisters and paternal grandmother. History of melanoma diagnosed 13 years ago. Patient is on tamoxifen. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.There are multiple small cysts in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: Other malaise and fatigue [780.79] / Diplopia [368.2], Reason for Study: ^Reason: eval for structural lesions History: weakness No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.There is a small developmental venous anomaly on the right cerebellar hemisphere mesial aspect which drains toward vein of Gallen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Partial opacifications on bilateral mastoid air cells.

Output: Normal brain MRI.


Instruction: Generate impression based on medical findings.

Input: 56 years Male (DOB:9/2/1959)Reason: Eval new focal weakness r/o myelopathy History: New R-sided weaknessPROVIDER/ATTENDING NAME: MICAH T PROCHASKA MICAH T PROCHASKA The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is a left paramedian disk protrusion present associated with end plate osteophytes which encroaches on the nerve roots in the left lateral recess and exiting the left neural foramen at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There is a left paramedian disk protrusion present associated with end plate osteophytes which encroaches on the nerve roots in the left lateral recess at C6-7 ( left C7 nerve roots).


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain. Concern for rotator cuff tear. ROTATOR CUFF: There is mild increase signal intensity within the distal fibers of the supraspinatus tendon compatible mild tendinopathy. The supraspinatus, infraspinatus, teres minor muscles/tendons are intact. There is increased signal intensity within the subscapularis tendon compatible moderate tendinopathy. The tendon is otherwise intact without evidence of muscle atrophy. SUPRASPINATUS OUTLET: There is no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Increased T2 signal within the region of the greater tuberosity is non-specific and may be related to degenerative changes or edema; correlate for history of trauma. No fracture is evident.There is increased signal within the body and possible partial detachment of the superior labrum extending anteriorly. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Moderate subscapularis and mild supraspinatus tendinopathy. No rotator cuff tear.2. Abnormal signal within the region of the greater tuberosity may represent degenerative change or edema possibly from trauma; correlate for history of injury.3. Signal abnormality and possible detachment of the superior labrum extending anteriorly.


Instruction: Generate impression based on medical findings.

Input: 58 years Female (DOB:4/12/1958)Reason: Left arm radicular pain with history of cervical fusion in 2002 History: AbovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The patient status post anterior fusion from C3 through C6. There is also osseous bridging across the C6-7 disc space. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis at this level. There is also narrowing of the neural foramina bilaterally at this level with encroachment of exiting nerve roots. There is facet hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: The patient is status post anterior fusion from C3 through C7. There is a moderate degree of spinal stenosis present at C7-T1 associated with encroachment of exiting nerve roots within the neural foramina at C7-T1.


Instruction: Generate impression based on medical findings.

Input: A 37 year old female with morbid obesity who had recently an episode of wide complex tachycardia while felling palpitations. The echocardiography showed normal left ventricular function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 76 ml (normal range 31+/-10), the LV mass index is 33 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of underlying focal replacement fibrosis or an infiltrative, or inflammatory process. Native myocardial T1 relaxation times are mildly elevated at the basal septum and within normal range throughout the remainder of the left ventricle. Increased T1 relaxation times can be seen with the presence mild interstitial fibrosis. Left AtriumThe left atrium is normal in size. The LA volume is 93 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). No fatty infiltration, focal aneurysm or regional wall motion abnormality are noted.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 54%. 2. There is no late gadolinium enhancement to suggest the presence of underlying myocardial scar or infiltrative/ inflammatory process. There is, however, a mild increase in native myocardial T1 relaxation time in the basal septum, which is likely due to the presence of mild interstitial myocardial fibrosis. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. No fatty infiltration, focal aneurysm or regional wall motion abnormality was see. No MRI findings to support the diagnosis of arrhythmogenic right ventricular dysplasia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old, neurofibromatosis type I with extensive neck tumors. Cervical:Innumerable subcutaneous and paraspinal T2 hyperintense masses are again seen compatible with neurofibromas. There has been no significant interval change in the overall size or number of these lesions.Also stable are foraminal neurofibromas which are present bilaterally at every level. The largest of these occupies the right C5-6 foramen measuring 30 x 20 mm, previously 30 x 20 mm. This lesion, and several others to a lesser degree, do extend into the spinal canal with resultant canal narrowing and some deformation of the spinal cord, findings which are overall unchanged. No definite evidence of cord edema is seen.Again seen is evidence of laminectomy from C4 through C7. A focal kyphotic angulation of the spine is seen at C6-7, unchanged. Alignment is unremarkable. Marrow signal characteristics are within normal limits.Lumbar:Innumerable subcutaneous and paraspinal neurofibromas are redemonstrated, without significant interval change. Neurofibromas within or adjacent to all of the visualized neural foramina are also grossly unchanged. The nerve roots of cauda equina remain diffusely thickened likely secondary to the presence of numerous lesions. A dominant lesion situated within and effacing the right lateral recess at the L4-5 level measures 11 x 10 mm, previously 11 x 9 mm. This lesion results in moderately severe encroachment upon the thecal sac and some crowding of the cauda equina.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits.

Output: 1.Stable neurofibromas in the cervical region. Several of these encroach upon the spinal canal with resultant canal stenosis and cord deformation, most notably at C5-6 and C6-7.2.Stable neurofibromas in the lumbar region. A dominant lesion within the right lateral recess at L4-5 continues to cause moderate sac encroachment.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with family history of breast cancer in her mother and sister and personal history of cervical cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on medical findings.

Input: C7 lesion seen on CT and history of hepatocellular carcinoma. There is diffuse low T1 and T2 signal in the C6 and C7 adjacent to the disc space, with associated mild patchy enhancement related to underlying degenerative spondylosis. In particular, at C6-7, there is a disc-osteophyte complex that results in moderate spinal canal stenosis and bilateral neural foraminal stenosis. In addition, at C7-T1, there is 5 mm of anterolisthesis and a disc-osteophyte complex, as well as ligamentum flavum thickening that results in severe spinal canal and bilateral neural foraminal stenosis. There is also rather significant bilateral neural foraminal stenosis and mild spinal canal narrowing at C3-4. The degenerative spondylosis at other levels is otherwise less pronounced. The vertebral body heights are preserved. The spinal cord displays normal signal characteristics. There is no evidence of mass lesions within the cervical spine. The paraspinal soft tissues and imaged intracranial contents are unremarkable. There appear to be small retention cysts in the bilateral maxillary sinuses.

Output: 1. Sclerotic degenerative endplate alterations at C6-7 and an associated disc-osteophyte complex that results in moderate spinal canal stenosis and bilateral neural foraminal stenosis, but no findings specific for metastatic disease.2. At C7-T1, 5 mm of anterolisthesis and a disc-osteophyte complex, as well as ligamentum flavum thickening result in severe spinal canal and bilateral neural foraminal stenosis.3. Rather significant bilateral neural foraminal stenosis and mild spinal canal narrowing at C3-4.


Instruction: Generate impression based on medical findings.

Input: Six-week follow-up, atlantooccipital dissociation Craniocervical alignment is within normal limits. Atlantoaxial interval is normal. Alignment of the remainder of the cervical spine is also maintained. There is no disruption involving the tectorial membrane or of the posterior longitudinal ligament inferiorly. Transverse ligament is also intact. Posterior ligamentous complex and anterior longitudinal ligaments also appear intact in the cervical spine.Previous seen collection (which was likely subdural) posterior to the cervical spine and posterior to the tentorial membrane has resolved. There is heterogeneity of the fat at the craniocervical junction ventral to the tectorial membrane (epidural space) without discrete residual hematoma. There is decrease in previously seen mild edema involving the lateral mass C1-C2 articulation. Mild joint fluid in the occipital condyle-C1 articulation is again seen and is nonspecific.No abnormal cord signal. No spinal canal or neural foraminal stenosis at any level in the cervical spine.

Output: Findings are compatible with relatively mild ligamentous injury without frank ligamentous disruption at the craniocervical junction. Compared to 8/2/2015, there has been evolution of the findings with resolution of associated blood products. Please see details above.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old, with drug resistant focal epilepsy, fMRI for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps as expected along the calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant. Broca's area is well visualized on all paradigms and identified as several foci of activation within the inferior left frontal gyrus. Wernicke's area is visualized only on the sentence completion paradigm and identified as a focus of activation along the posterior aspect of the left superior temporal sulcus.

Output: Technically successful functional MRI for surgical planning. The sensorimotor and primary visual cortices are well demarcated. Language is left dominant with Broca's and Wernicke's areas identified in their customary locations.


Instruction: Generate impression based on medical findings.

Input: 5-week-old male with apparent life threatening episode and reported cyanosis. Rule out bleed or skull fracture. There is no evidence of intracranial hemorrhage, mass or midline shift. Hypodensity in the subcortical white matter along the convexities and in the frontal and parietal regions bilaterally is slightly lower T1 signal than expected for unmyelinated parenchyma and could represent gliosis from prior ischemia. An MRI is recommended for better visualization of these areas, if clinically indicated.The ventricles and basal cisterns are normal in size and configuration for the patient's age.The calvaria and skull base are radiographically normal without evidence of fracture.

Output: Subcortical white matter hypodensity in the frontal and parietal regions bilaterally shows lower T1 signal than expected for unmyelinated parenchyma. An MRI is recommended for better visualization of these areas, as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Pathological hyper-reflexia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered nonenhancing punctate foci of cerebral white matter T2 hyperintensity. There is a left cerebellar hemisphere developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small disc-osteophyte complex at C5-6, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, there is a heterogeneous nodule in the right tracheoesophageal groove that measures up to approximately 20 mm.

Output: 1. Minimal scattered punctate foci of cerebral white matter T2 hyperintensity are nonspecific. Otherwise, no characteristic findings to suggest multiple sclerosis, for example. 2. Incidental left cerebellar hemisphere developmental venous anomaly. 3. No evidence of cervical spinal cord compression or demyelinating lesions.4. A nodule in the right tracheoesophageal groove that measures up to approximately 20 mm may represent a thyroid lesion. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Redemonstrated is posterior spinal fusion at L4-S1, utilizing posterior fusion rods, bilateral pedicle screws, interbody spacer devices and bone graft material. There is unchanged mild anterolisthesis of L4 on L5. The vertebral body heights are maintained. There is moderate loss of disc height at L5-S1 with disc dessication and endplate degenerative changes. There is degenerative spondylosis of the lower lumbar spine. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is edema at the posterior subcutaneous soft tissues. T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: Bilateral facet degeneration, and thickening of the ligamentum flavum. No significant disc bulge, spinal canal or foraminal stenosis. L3-L4: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration. No significant spinal canal or foraminal stenosis.  L4-L5: Bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L5-S1: Bilateral facet degeneration and marginal osteophytes, contributing to mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.

Output: 1. Posterior spinal fusion at L4 through S1.2. Degenerative spondylosis with bilateral mild neural foramen narrowing at L5-S1. No significant spinal canal stenosis. This is stable compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old, history of hemoglobin SC disease, complicated in the past by acute chest syndrome, with colorectal cancer status post chemoradiation and partial colectomy, now with concerns for metastatic disease. Thoracic:Pathologic marrow replacement is seen involving the spinous process and right lamina of T2 without significant epidural encroachment. A larger area of marrow replacement is seen involving the left T11 pedicle and lamina with left dorsal epidural encroachment and a mild to moderate spinal canal stenosis. The cord is displaced anteriorly and to the right, but no evidence of cord invasion or pathologic cord signal is seen.Small peripherally enhancing lesions along the superior and inferior T12 endplates are nonspecific could reflect areas of pathologic marrow replacement or developing Schmorl's node deformities.A significant dextroscoliosis of the spine is evident centered at T7. Sagittal alignment is otherwise unremarkable.Vertebral body height is preserved.Except as discussed above, no significant spinal canal stenosis is seen. Small left paracentral disc protrusions are evident at T6-7 and T7-8. A right paracentral disc protrusion is evident at T10-11. No significant foraminal stenosis is detected.Incidental note is made of small bilateral pleural effusions. Multiple healed rib fractures are suspected on the left.Lumbar:Near complete marrow replacement of the L2 vertebral body is seen with central loss of height of approximately 40%. A combination of vertebral body retropulsion and epidural disease spread results in a moderate to severe spinal canal stenosis at this level with mild crowding of the cauda equina. The L1-2 and L2-3 neural foramina on the right are mildly narrowed as well.No other definite areas of disease are seen in the lumbar spine.The lumbar spine is mildly levoscoliotic. Sagittal alignment is within normal limits.With the exception of mild disc bulging and moderate to severe facet hypertrophy at L5-S1, no significant degenerative disease is seen. Except as above, no additional high-grade spinal canal stenosis or neuroforaminal narrowing is seen.

Output: 1.Multiple sites of osseous metastatic disease are seen including the right lamina of T2, the left pedicle and lamina of T11, the L2 vertebral body, and questionably the T12 vertebral body.2.Metastatic disease results in epidural encroachment and mild to moderate spinal canal narrowing at T11; as well as compression of the L2 vertebral body with epidural encroachment and moderate to severe spinal canal stenosis.


Instruction: Generate impression based on medical findings.

Input: Left ulnar radicular pain, is there nerve impingement? Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc desiccation and minimal bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge and dorsal annular fissure. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. There is a tiny left-sided perineural cyst which is a frequently seen incidental finding and of doubtful clinical significance.Paraspinous soft tissue structures appear within normal limits. There is a 6 mm right thyroid nodule.

Output: 1. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.2. Minor incidental findings as above.


Instruction: Generate impression based on medical findings.

Input: The intra-articular contrast remains within the distal radial ulnar joint. No intra-articular contrast is identified within the radiocarpal joint to suggest disruption of the triangular fibrocartilage complex. There is positive ulnar variance..Exposure time: 1 minute and 17 seconds.

Output: Right wrist arthrogram without evidence of disruption of the triangular fibrocartilage complex. Note is made of positive ulnar variance.


Instruction: Generate impression based on medical findings.

Input: Direct comparison to the previous MRIs is difficult, given technical limitations of those studies. Multiple periventricular white matter lesions appear more conspicuous and confluent than on the prior study, which may be due to technique and/or progression. For example, a posterior left frontal lobe lesion was not definitely apparent on the prior study and may represent a new lesion. Additionally, there are several punctate lesions in the bilateral cerebral hemispheres, which were not apparent previously and which may indicate new lesions. Furthermore, the T2 signal surrounding the right occipital horn of the lateral ventricle appears more pronounced than on the prior study. Many of these lesions demonstrate T1 hypointensity indicating chronicity. In particular, a right pons/midbrain lesion appears to have developed T1 hypointensity along with decreased T2 hyperintensity. The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect.

Output: Numerous supratentorial and infratentorial demyelinating lesions. Comparison with the prior exam is limited due to differences in technique, although some lesions may have slightly progressed and some now exhibit more chronic features.


Instruction: Generate impression based on medical findings.

Input: History of pancreatic adenocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is a 1.7 x 1.4 cm focus adjacent to the gallbladder fossa which demonstrates signal dropout on out of phase imaging consistent with focal fatty infiltration. Additional 1.2 and 1.4 cm foci adjacent to the right portal vein demonstrates signal dropout on out of phase imaging consistent with focal fatty infiltration. No focal suspicious hepatic lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in morphology without a discrete lesion. The splenic artery and vein are unremarkable.PANCREAS: Best appreciated on series 4 image 6 is a hypointense lesion in the pancreatic body measuring 2.1 x 1.8 cm which demonstrates heterogeneous enhancement on postcontrast imaging sequences and mild restricted diffusion. The distal pancreatic body and tail are mildly atrophic with decreased T1-weighted signal intensity.The lesion involves and nearly completely occludes the superior mesenteric vein (series 18 image 19 through 25). The lesion abuts the superior mesenteric artery (series 18 image 18). The lesion abuts the ventral aspect of the splenic vein (series 18 image 25) just proximal to the portal vein confluence.No suspicious peripancreatic or retroperitoneal lymphadenopathy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2.1 cm pancreatic body mass with distal pancreatic parenchymal atrophy consistent with patient's stated history of pancreatic adenocarcinoma. Near complete occlusion of the superior mesenteric vein. Abutment of the superior mesenteric artery without frank encasement. No suspicious peripancreatic or retroperitoneal lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 46 show man with dental x-rays showing "left maxillary cyst." Patient is status post left upper molar extraction about one year ago -- since that time swelling in left cheek. Patient appears to be status post left temporal craniectomy and mastoidectomy with a large defect in the tectum of the petrous bone. There is inferior herniation of the temporal lobe through this bony defect to the expected level of the external auditory canal and middle ear. The inner ear structures are visualized and appear grossly normal. Middle ear structures are not visible and the external auditory canal is not visible. There is soft tissue density present in the expected position of the external auditory canal. Correlate with physical examination and medical history and consider evaluation with MRI.The left maxillary sinus is completely opacified and expanded with bony remodeling extending anteriorly into the soft tissues of the left cheek, medially into the left nasal cavity, inferiorly into the left alveolar process of the maxilla and posteriorly into the pterygopalatine fossa. The left ostiomeatal unit is not visible. The bony floor of the left orbit has normal contour and the orbital contents have normal appearance. This lesion is consistent with a mucocele.There is minimal mucosal thickening in the inferior portion of the right maxillary sinus. The right ostiomeatal unit is not clearly seen to be patent on this study. The frontal sinuses, ethmoid air cells, and sphenoid sinuses are normal in appearance. The right orbit is unremarkable. Limited examination of the soft tissues of the face is normal.The right mastoid air cells and middle ear cavity has normal CT appearance. The right external auditory canal is not clearly patent on this study, however, this may be due to soft tissue compression by the InstaTrak device.

Output: 1. Expansile lesion in the left maxillary sinus causing extensive bony remodeling. The appearance of this lesion is consistent with a mucocele. 2. Postsurgical changes of left temporal craniectomy and mastoidectomy with absence of middle ear structures and EAC. Inferior herniation of temporal lobe through bony defect and soft tissue at expected position of the external auditory canal. Consider evaluation with MRI.The ordering physician was not available by pager at the time of study interpretation and no additional contact information was available.


Instruction: Generate impression based on medical findings.

Input: known left thalamic and basal ganglia ICH with mass effects. There is 47mm x 57mm sized left thalamic and basal ganglia ICH with surrounding edema and midline shift toward right side.As well, IVH and right hemispheric SAH were also seen.Comparing to prior CT scan, the approximate size of the ICH, the degree of midline shift toward right side, and the extent of the IVH do not show any significant interval change.There is no evidence of acute ischemic lesion on this scan.Brain edema was also seen on the left cerebral peduncle, midbrain and upper pons area.The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Acom artery is patent and bilateral Pcom arteries are also patent.There is no evidence of intracranial arterial aneurysm or significant luminal stenosis or occlusion.3D MRA neck non-gadolinium enhanced MRA with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in bilateral CCAs, extracranial ICAs and VAs.Aortic arch origins of major vessels cannot be precisely evaluated but appear to be within normal limits. Extracranial cranio-cervical arterial system appear to be normal without evidence of luminal irregularity or stenosis.

Output: 1. Re-demonstration of left thalamic and Basal ganglia ICH with mass effects as well as IVH and SAH.2. No evidence of acute ischemic lesion on this scan.3. No evidence of intracranial arterial aneurysm, significant luminal stenosis or occlusion.4. No evidence of extracranial cranio cervical arterial system's significant luminal stenosis or occlusion .


Instruction: Generate impression based on medical findings.

Input: 17-year-old male with left knee pain and swelling s/p ACL recon and lateral meniscal repair by Dr. Leland. MENISCI: There is a complex tear which includes a vertical component of the posterior horn of the lateral meniscus. Although this may be due to postsurgical changes, it more likely represents a re-tear of the lateral meniscus. The medial meniscus is intact with no evidence of tear.ARTICULAR CARTILAGE AND BONE: Intact with no abnormal signal noted. LIGAMENTS: There has been interval reconstruction of the ACL with the ACL graft intact and in anatomic alignment. The other ligaments are intact with no abnormal signal or tear evident.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear with a vertical component of the posterior horn of the lateral meniscus may be due to postsurgical changes however it more likely represents a tear of the lateral meniscus. Joint effusion about the knee.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of thymic carcinoma. Status post chemo/RT, please evaluate, CHEST:LUNGS AND PLEURA: Multiple small calcified micronodules are identified consistent with a previous granulomatous infection. Centrilobular emphysema is again noted. No pleural effusion can be identified.MEDIASTINUM AND HILA: There is redemonstration of an anterior mediastinal mass measuring 28 mm x 14.3 mm (image 47, series 4), previously, measuring 15 mm x 28.8 mm. Port-A-Cath with its tip in the SVC. A coronary artery and aortic calcifications. Cardiac size is normal. There is no evidence of pericardial effusion.No mediastinal or hilar lymphadenopathyCHEST WALL: Right-sided port. Degenerative changes in the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Hypodense subcentimeter lesions, most likely representing cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule is stable, measuring 14.1 mm x 18.5 mm (image 92, series 4).KIDNEYS, URETERS: Redemonstration of a small exophytic mass arising from the superior pole. The left kidney. (Image 96, series 4). Dedicated CT or MRI is recommended to evaluate this lesion. Several subcentimeter hypodense lesions in the right kidney, most represent cysts. Again noted is an accessory right renal artery.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic diseaseBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Anterior mediastinal soft tissue mass is stable and presumably represents the residual of this patient's thymic carcinoma.2. Stable right adrenal nodule and small exophytic left renal mass that is indeterminate. Dedicated CT or MRI is recommended to evaluate these lesions.3. Centrilobular emphysema with evidence of a previous granulomatous infection.4. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 23 months old, status post unrestrained motor vehicle collision, assess for diffuse axonal injury. Assess for spinal cord injury. Brain:Numerous scattered foci of restricted diffusion are seen, predominantly at the gray-white interface, within both cerebral hemispheres. Prominent diffusion restriction is demonstrated at the splenium of the corpus callosum. Restricted diffusion is also seen along the anteromedial thalami. Scattered punctate susceptibility effect are present in association with some of these lesions.No large intraparenchymal hematoma is seen. However, scattered trace FLAIR hyperintensity in the cerebral sulci probably reflects subarachnoid blood product as suspected on prior CT. A fluid level within the left occipital horn, and to a lesser extent in the right occipital horn, may also represent blood product. Trace subdural FLAIR hyperintensity is seen along the right occipital and temporal lobes compatible with minimal blood product.No evidence of significant parenchymal edema or generalized mass effect is seen. The expected flow voids are appropriately visualized. Ventricular size and morphology are within normal limits. Opacification of the paranasal sinuses and mastoid air cells is seen bilaterally.Cervical spine:The articulation of the right lateral masses of C1 and C2 is slightly widened and edematous. Mild edema is also seen within the posterior lateral paraspinal soft tissues at C1-2. The posterior atlantoaxial ligament is visualized and appears to be intact. The craniocervical junction and the remaining cervical ligamentous structures appear to be intact. No evidence of spinal malalignment is seen. The intervertebral discs are intact and the vertebral bodies show no evidence of marrow edema. The visualized spinal cord shows no obvious focal signal abnormality given the limitation of moderate motion artifact. No compromise of the spinal canal or neural foramina is seen.Airspace opacity and perhaps some pleural fluid are partially visualized on the right. The anterior tongue appears to be edematous.

Output: 1.Multiple intracranial findings are seen compatible with diffuse axonal injury. In addition, scattered trace subarachnoid and subdural blood product is redemonstrated. Mild intraventricular blood product is seen without evidence of ventricular dilatation.2.No definite evidence of spinal cord injury is seen within the limitations of motion artifact. However, there are findings to indicate ligamentous injury involving the articulation of the right lateral masses of C1 and C2. Soft tissue injury is also seen within the posterior lateral paraspinal soft tissues at C1-2. No vertebral body or disc injuries are evident.


Instruction: Generate impression based on medical findings.

Input: HIE: perinatal depression, subgaleal hemorrhage, s/p cooling. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are grossly unremarkable. There is mild subgaleal and subcutaneous fluid posteriorly, right more than left.

Output: 1. No evidence of acute infarction.2. Small scalp hematoma.


Instruction: Generate impression based on medical findings.

Input: eval for upper extremity injury; midhumerus stress fracture History: mid humerus pain with throwing LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is cortical thickening at the mid humerus with no evidence of periosteal reaction. Minimal marrow edema noted at the greater tuberosity of the humerus.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Nonspecific cortical thickening of the humerus without periosteal reaction may represent a stress reaction.


Instruction: Generate impression based on medical findings.

Input: Motion degraded examination, specifically affecting the axial pre and post T1 sequences and the axial and coronal T2 sequences. Brain parenchymal morphology is within normal limits. Several scattered small foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres which were not definitively seen on the prior examination. No edema or mass effect is detected. Diffusion-weighted images are within normal limits. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology. Curvilinear enhancing structure in the right cerebellar hemisphere likely reflects a small developmental venous anomaly.

Output: 1. No evidence of an intracranial lesion.2. Scattered nonspecific foci of FLAIR hyperintensity may be seen in the setting of migraines. However, the differential considerations are numerous including prior inflammation, chronic small vessel ischemic disease, gliosis, etc.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old. Reason: patient with known left thyroid PTC, please evaluate lateral and central lymph nodes for abnormality RIGHT LOBE MEASUREMENTS: 5.8 x 1.1 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.9 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mildly heterogeneous echotexture. A nodule at the lateral aspect of the right thyroid lobe measures approximately 0.5 x 0.4 cm, mixed cystic and solid, incompletely characterized and nonspecific.LEFT LOBE: Mildly heterogeneous echotexture. A left lower pole nodule measures 0.9 x 0.6 x 0.7 cm, solid, isoechoic with calcifications and a hypoechoic rim, and internal vascularity.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 5 lymph node measures 0.9 x 0.4 x 0.6 cm, with a fatty hilum. A left level 3 lymph node measures 0.6 x 0.3 x 1.3 cm, with suggestion of fatty hilum. An additional left level 3 lymph node measures 0.5 x 0.6 x 1.5 cm, with a fatty hilum. An additional left level 3 lymph node measures 1.1 x 0.6 x 0.9 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: 1.A subcentimeter solid left thyroid nodule correlates with a known history of capillary thyroid cancer.2.An additional subcentimeter mixed cystic and solid nodule at the lateral aspect of the right thyroid lobe is incompletely characterized and nonspecific.3.Subcentimeter cervical lymph nodes, most with fatty hila, as detailed above.


Instruction: Generate impression based on medical findings.

Input: Female 37 years old Reason: Brachytherapy planning History: Brachytherapy planning PELVIS:UTERUS, ADNEXA: Significant decrease in the size of the patient's known cervical mass which now measures 6.6 x 5.4 cm image #44, series #4 a 1. Again noted uterine and bilateral parametrial invasion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant interval increase in the size of the patient's known cervical mass.


Instruction: Generate impression based on medical findings.

Input: Facial myokymia [G51.4] / Anesthesia of skin [R20.0], Reason for Study: ^Reason: MS History: left facial numbness and tingling The examination is slightly limited by motion artifact. There is mild reversal of the cervical lordosis which may be positional. The vertebral body heights and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. The spinal cord demonstrates normal caliber and signal intensity. There is no significant central spinal or neuroforaminal stenosis. Craniocervical junction appears unremarkable. The paraspinous and retropharyngeal soft tissues appear to be within normal limits. Incidentally noted is a 1.1 cm proton density hyperintense lesion within the strap muscles of the right neck just below the hyoid.

Output: 1. No specific abnormality of the cervical spine.2. Probable right thyroglossal duct cyst.


Instruction: Generate impression based on medical findings.

Input: Diplopia [H53.2] / Multiple sclerosis [G35], Reason for Study: ^Reason: r/o new lesions History: double vision Brain MRIMultifocal various sized patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale are seen. Considering the difference of imaging technique and MR machine, the number and distribution appear to be stable and unchanged. However, on today's scan, there is focal FLAIR high signal intensity at the posterior aspect of mid pons adjacent to the anterior wall of the 4th ventricle at the level of middle which is more conspicuous than prior scan. There is about 5mm caudal herniation of cerebellar tonsil.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIMotion artifacts degraded exam quality.There is normal cervical lordosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There broad based disc protrusion central to left which abuts thecal sac at C67. However, there is no evidence of spinal canal stenosis or neural foraminal stenosis.Other intervertebral disc levels appear to be normal.

Output: 1. Multifocal various size bihemispheric periventricular white matter and centrum semiovale FLAIR/T2 high signal lesions consistent with multiple sclerosis lesions, unchanged since prior scan.2. More conspicuous FLAIR high signal posterior aspect of mid pons could be related to technical differences, however, clinical correlation is recommended.3. Broad based disc herniation central to left at the level of C67 without evidence of spinal canal stenosis.