Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Weakness, radicular pain. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. The conus medullaris terminates at the L1-2 level. At T12-L1 through L4-5, there is no significant compromise to spinal canal or neural foramina. There is mild chronic marrow reactive change at the inferior endplate of L5. At L5-S1, there is a broad-based left latera recess disk extrusion which effaces the fat of the left lateral recess and posteriorly displaces the descending left S1 nerve root. The extrusion crosses midline, mildly effacing the fat of the right lateral recess as well. There is mild bilateral neural foraminal narrowing at this level, but the exiting L5 nerve roots are surrounded by fat.

Output: Disc extrusion at L5-S1 leading to encroaching the nerve roots at the left lateral recess and to a lesser degree the right lateral recess and posterior displacement of the descending left sided S1 nerve roots.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with decreased vision. Evaluate for etiology of retinal edema. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild progression of the periventricular and subcortical T2/FLAIR hyperintensities which is nonspecific but likely related to small vessel ischemic disease. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI orbits: Motion limited exam.There is abnormal bilateral signal and thickening along the posterior aspect of the globes with T2 hyperintensity and mild T1 heterogeneity but no abnormal susceptibility to indicate hemorrhage. The bilateral nature and configuration is suggestive of bilateral retinal attachment. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1.Findings suspicious for bilateral retinal detachment. Please correlate with an ophthalmoscopic exam.2.No evidence of intracranial hemorrhage, mass, or acute infarct. 3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. This has progressed mildly since the prior exam from 12/2008


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with right hip pain for 6 months, no improvement with conservative treatment, evaluate for labral tear ACETABULAR LABRUM: There is a tear of the anterosuperior acetabular labrum without labral detachment. There is a focal area of degeneration in the posterior labrum as well.ARTICULAR CARTILAGE AND BONE: There are no focal chondral abnormalities. There is an abnormal offset of the femoral head-neck junction, with an alpha angle measuring approximately 55 degrees.SOFT TISSUES: The visualized soft tissues are within normal limits.ADDITIONAL

Output: Anterosuperior labral tear and CAM type deformity of the right hip as described above.


Instruction: Generate impression based on medical findings.

Input: Left sided PTA. Neck CT:There is soft tissue thickening and enlargement of the left palatine tonsil, with soft tissue thickening and edema extending to the rest of the oropharynx and hypopharynx resulting in effacement of the left piriform sinus. The edematous soft tissue abnormality extends into the left submandibular and sublingual space. Cervical lymphadenopathy is seen in the neck bilaterally, greater on the left.No discrete fluid collection is seen to suggest abscess.There is mild diffuse sclerosis of the cervical spine bony structures, but no focal lesion is seen.There is a cystic lesion in the right middle cranial fossa, and may represent an arachnoid cyst. It is incompletely visualized, and can be further evaluated with MRI brain.

Output: 1. Extensive soft tissue abnormality involving the left palatine tonsils, oro- and hypopharynx, with edematous soft tissue thickening extending into the left submandibular and sublingual space. Findings suggest most likely infectious / inflammatory process. Please also correlate clinically.2. Cerivcal adenopathy greater on the left, probably reactive.3. Mild diffuse sclerosis of cervical spine may be seen in patients with metabolic and endocrine disease. Please correlate with clinical parameters.4. Right middle cranial fossa arachnoid cyst. Further imaging can be obtained with MRI brain.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess for rectus abdominus tear at pelvic insertion, sports hernia History: Pain at lower abdomen/groin. There is mild intermediate signal intensity within the prepubic aponeurotic complex, to the left of midline, which may reflect degeneration, but we see no tear of the rectus abdominis or the adductor tendons. The adductor musculature of the hip appears normal. Mild osteoarthritis affects both hips and the sacroiliac joints. Severe degenerative disc disease affects the lower lumbar spine. There is focal atrophy of the right gluteus maximus muscle, posteriorly, with vascularity perhaps representing a venous malformation. There are foci of low signal intensity within the overlying soft tissues which may represent an injection granuloma.

Output: 1. No findings to suggest a tear of the rectus abdominis or other specific findings of a sports hernia. 2. Severe degenerative disc disease of the lumbar spine and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: ORBITS: There is mild right sided proptosis. The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is abnormal T2 hyperintensity involving the medial and lateral left temporal cortex and to a much more subtle extent the subcortical white matter when windowed narrowly. There may be mild gyral thickening. There is also less prominent minimal T2 hyperintensity questionably involving the left paramedian frontal cortex. There is no abnormal intracranial enhancement.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The cerebellar tonsils lie 5 mm below the foramen magnum but maintain a rounded configuration. There is mild asymmetry of the skull with the sella slightly deviated to the right and a slightly small right hemi-cranium. The skull, paranasal sinuses, and scalp soft tissues are otherwise unremarkable.

Output: 1.Signal abnormality involving the left frontal and more prominently the left temporal cortex as well as more subtly the left temporal subcortical white matter. The appearance is non-specific but differential diagnosis includes encephalitis, infectious or paraneoplastic in etiology, with neoplasm felt to be less likely. 2.Mild right proptosis that may be secondary to mild skull asymmetry. 3.Minimally low lying cerebellar tonsils. This finding was called by Dr. Michael Rozenfeld to Dr. Hassan Shah on 1/20/2015 at 12:50 PM.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of vertebral column [C41.2], Reason for Study: ^Reason: hx L3 chordoma with hx of resection. Eval for recurrence or abnormality History: surveillance imaging For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. External fixation with pedicular screws and rods from L1 to L5 with L3 colpectomy and instrument inserted at the level of L3.There are significant metallic artifacts from L1 to L5 instrumentations.There are diffuse enhancement on the L3 colpectomy area with mesial aspects of adjacent bilateral psoas muscles which most likely represent postop scar tissue. There is no definitive mass formation or abnormal enhancing soft tissues is seen.There is relatively well delineated lenticular shaped lesion on the L3 level posterior to spinal canal with some peripheral enhancement. The lesion shows high signal intensity on T2 and low signal intensity on T1 indicating fluid content. There is no evidence of mass effects against spinal canal.There is thin walled tubular lesion on the right side of the thoracoabdominal aorta. The lesion is about 22.8mm (AP) x 26.8mm (RL) x 55.3mm (CC). Comparing to prior scan especially Abdominal CT scan obtained on Jan 28 2015, the lesion is most likely representing evolving paraaortic retroperitoneal hematoma. Visualized spinal cord appears to be normal in signal intensity and conus medullaris terminates at L1 level. There is no other abnormal enhancement or lesion.Previously seen right renal cyst is again shown, no change since prior scan.

Output: 1. Post L3 colpectomy with external fixation from L1 to L5.2. No evidence of abnormal enhancement on this scan.3. Diffuse enhancement of L3 colpectomy area including mesial aspect of bilateral psoas muscles indicating post-surgical scar tissues. No definitive evidence of enhancing mass on operation site.4. Evolving retroperitoneal para aortic hematoma.5. Fluid collection which located posterior aspect of the spinal canal without showing any evidence of mass effects toward spinal canal with mild peripheral enhancement. Likely represent post surgical fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male; 61 years old. Reason: cholelithiasis; choledocholithiasis; common bile duct dilation History: RUQ abdominal pain; fevers; elevated total bilirubin, ggt, elevated AST/ALT ABDOMEN:LUNG BASES: Trace right pleural effusion. Stable right lower lobe peripheral air space opacity suspicious for infarct with central increased T2 hyperintensity, suggesting necrosis (partially visualized); underlying infection cannot be excluded.LIVER, BILIARY TRACT: Unchanged diffuse hepatic metastatic disease.Cholelithiasis. No significant gallbladder wall thickening or enhancement. Mild pericholecystic free fluid is likely related to generalized ascites with mild perihepatic ascites seen. Normal caliber of the biliary tree. No choledochalithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Unchanged pancreatic body mass, most compatible with pancreatic adenocarcinoma. Stable focal stenosis of the splenic vein posterior to the mass to compression by the mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable gastrohepatic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominal ascites.

Output: 1.No significant interval change in multiple findings since CT exam performed yesterday, including right lower lobe infarct, diffuse hepatic metastatic disease, pancreatic mass, and abdominal lymphadenopathy.2.Normal caliber of the biliary tree without evidence of choledocholithiasis or obstruction.3.Cholelithiasis without specific evidence of acute cholecystitis.


Instruction: Generate impression based on medical findings.

Input: memory change Motion artifacts prevent precise evaluation.No evidence of acute ischemic or hemorrhagic lesion on this scan.On FLAIR images, there are patchy high signal intensity lesions especially periventricular white matter and bilateral trigone areas. These lesions are most likely non specific, possibly small vessel ischemic lesions.Left frontal lobe superior frontal gyrus shows focal subcortical high signal intensity lesion which does not show diffusion restriction indicating chronic ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Patchy periventricular and bilateral trigone areas' high signal intensity lesions on FLAIR images indicating possible non specific small vessel disease.Otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Right thumb pain LIGAMENTS: No significant abnormality noted. Specifically, the ulnar and radial collateral ligaments of the thumb appear intact.TENDONS: No significant abnormality noted. BONES: There is a cortical defect of the dorsal aspect of the base of the proximal phalanx of the thumb likely reflecting a subacute or chronic avulsion fracture. There is no significant surrounding marrow edema to suggest this is acute in nature. There is a slight volar tilt of the proximal phalanx in relation to the metacarpal but otherwise alignment of the thumb is relatively anatomic.ADDITIONAL

Output: Avulsion fracture at the base of the proximal phalanx of the thumb. Given the lack of surrounding marrow edema, this is most likely subacute or chronic in nature. There is no evidence of collateral ligament tear and aside from mild volar tilt of the proximal phalanx, the thumb is otherwise in anatomic alignment.


Instruction: Generate impression based on medical findings.

Input: 8-year-old male status post DNET tumor resection. Redemonstrated are changes from recent right pterional craniotomy consistent with resection of the right anterior temporal lobe lesion. Fluid with air and minimal blood products are present intracranially without hematoma. There is residual T2 hyperintense parenchyma along the posteromedial aspect of the resection cavity. Linear T2 hyperintensity with some susceptibility is present along the previous location of 2 depth electrodes. Overlying smooth dural enhancement is felt to be postprocedural. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. Again noted is minimal fluid signal within the bilateral mastoid air cells.

Output: 1.There is residual T2 hyperintense parenchyma along the posteromedial aspect of the left temporal lobe resection cavity. 2.Linear T2 hyperintensity with some susceptibility is present along the previous location of 2 depth electrodes. 3.Overlying smooth dural enhancement is felt to be postprocedural.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male presents with headaches for approximately 2 weeks. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Minimal foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical white matter, which are nonspecific. Chronic lacunar infarct in the left anterior basal ganglia and corona radiata with associated susceptibility suggestive of prior hemorrhage. There is a partially empty sella.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Incidental note is made of a right parietal developmental venous anomaly.The orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. No pathologic intracranial enhancement. 2. Chronic lacunar infarct in the left anterior basal ganglia and corona radiata with associated susceptibility suggestive of prior hemorrhage. 3. Partially empty sella which may be a normal variant, however, may reflect idiopathic intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on medical findings.

Input: Right vestibular schwannoma. History of SRS complete 9/2016. There is an enhancing right cerebellopontine angle cistern tumor with extension into the internal auditory canal that measures up to 22 mm, which is not significantly changed. The tumor contains small areas of cystic change and susceptibility effect likely replated to prior hemorrhage. There is mild mass effect upon the right middle cerebellar peduncle, but the brain parenchyma otherwise appears unremarkable. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the right vestibular schwannoma.


Instruction: Generate impression based on medical findings.

Input: 58 years Male (DOB:9/2/1957)Reason: brain lesion History: brain lesionPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG There is redemonstration of a T2 heterogeneous mass within the right half of the suprasellar cistern measuring 20 x 17 mm axial dimensions which abuts and partially surrounds the right internal carotid artery supraclinoid segment and extends into the interpeduncular cistern and prepontine cistern where it abuts the basilar artery and the right posterior cerebral artery. This mass is higher signal on FLAIR MRI in the low signal on T1 and somewhat heterogeneous on T1 imaging. There is no significant susceptibility effect associated with it. It displays heterogeneous enhancement following gadolinium administration. This mass is also identified on the CT scan from 7/14/2014 and is not appear to have changed substantially in dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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: There is a mass centered in the right half of the suprasellar cistern which extends into the interpeduncular cistern and prepontine cistern which partially surrounds the right internal carotid artery and abuts the basilar artery and the right posterior cerebral artery as well as the right superior cerebellar artery and the right cranial nerve III. This does not appear to have enlarged substantially since 2014. It is uncertain what this represents.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with prostate cancer. History of single Gleason 8 prostate cancer that was ablated with cryosurgery PELVIS:PROSTATE:Prostate Size: 3.2 x 2.5 x 3.0 cm.Peripheral Zone: Redemonstrated is a contour abnormality of the left peripheral zone is presumed to reflect changes of prior cryoablation. There are no new suspicious T2 hyperintense foci.Central Gland: Mild grade benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: Nonenhancing T1 hyperintense focus in the left acetabulum is unchanged since the prior exam, incompletely evaluated. Unchanged right pelvic sidewall lymph node measuring 5 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Redemonstrated are posttreatment changes in the left mid peripheral zone without interval development of any suspicious focus.2.Nonspecific 5 mm right pelvic wall lymph node.


Instruction: Generate impression based on medical findings.

Input: Bilateral breast cancer with vision changes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an enlarged right basal ganglia perivascular space that measures up to 12 mm. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: History of prostate cancer. 10/8/2015 biopsy demonstrated 3+4 left lateral apex adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 3.3 x 4.9 x 4.7 cmPeripheral Zone: Scattered foci of T1 weighted hyperintensity compatible with postbiopsy blood product. No discrete suspicious lesion.Note is made of a prostatic utricle cyst with adjacent linear T2-hypointensity, favoring scarring.Central Gland: Mild BPH. Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic 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: No discrete suspicious lesion identified.


Instruction: Generate impression based on medical findings.

Input: History of left parotid surgery for resection of an oncocytoma. History of papillary thyroid cancer, colon cancer, and left submandibular gland pleomorphic adenoma, as well. There is a slightly irregularly-marginated, enhancing, nodular lesion in the deep lobe of the left parotid gland, just posteromedial to the retromandibular vein, which measures up to 9 mm. There is a nonspecific prominent right retropharyngeal lymph node that measures 5 mm in short axis. There is no evidence of other mass lesions of lymphadenopathy elsewhere in the neck. The right parotid gland and bilateral submandibular glands are unremarkable. There has been total thyroidectomy. The pharyngeal and laryngeal structures are unremarkable. The orbits and imaged portions of the intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6, which abuts the spinal cord.

Output: A subcentimeter nodular lesion in the deep lobe of the left parotid gland may represent recurrent oncocytoma.


Instruction: Generate impression based on medical findings.

Input: Achilles pain for 4 years. Evaluate for Achilles' tendon degenerative tear. TENDONS: Left ankle: The tendons of the ankle are intact, including the Achilles tendon. No evidence of tearing. Right ankle: The tendons of the ankle are intact, including the Achilles tendon. No evidence of tearing. LIGAMENTS: Left ankle: The ligaments of the ankle are intact.Right ankle: The tendons of the ankle are intact.ARTICULAR SURFACES AND BONE: Left ankle: There is a 6 x 6 mm low T1 and high T2 lesion within the posterosuperior aspect of the left calcaneus which may represent either a subchondral cyst or enchondroma; this is likely of no clinical significance. Bone marrow signal is otherwise within normal limits. A type II accessory navicular bone is noted.Right ankle: Bone marrow signal is within normal limits. A type II accessory navicular bone is noted.ADDITIONAL

Output: Intact Achilles tendons bilaterally.


Instruction: Generate impression based on medical findings.

Input: Evaluate for rotator cuff tear ROTATOR CUFF: No evidence is seen of a rotator cuff tear. There is some intermediate signal within the supraspinatus tendon that likely represents tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. Additional findings: There are vessels seen in the spinoglenoid notch but no evidence is seen of the sequela of suprascapular nerve entrapment

Output: Supraspinatus tendinopathy. No evidence of rotator cuff tear


Instruction: Generate impression based on medical findings.

Input: Reason: Lat Meniscus Tear History: left knee pain / Lat Jt Line MENISCI: There is blunting of the posterior horn of the lateral meniscus likely representing a combination of degeneration, prior tearing, and postsurgical change from prior partial meniscectomy. No fluid-filled tear is evident. There is blunting of the posterior horn of the medial meniscus which also may represent prior tearing and postsurgical change from prior partial meniscectomy, appearing similar to the prior study. No fluid-filled or unstable tear is evident.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus which has progressed slightly when compared to the prior study. There is underlying subchondral signal abnormality and cyst formation likely degenerative in etiology. There is focal decreased signal abnormality affecting the articular cartilage along the posterior aspect of the lateral femoral condyle which may represent a full-thickness articular cartilage fissure. There is relative sparing of the patellofemoral articulation cartilage. There are small osteophytes affecting the lateral tibiofemoral compartment.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact, although the distal fibers of the patellar tendon are obscured by metal susceptibility artifact related to the patient's ACL graft reconstruction.ADDITIONAL

Output: 1. Focal full-thickness articular cartilage degeneration along the lateral femoral condyle which has progressed slightly when compared to the prior study.2. Blunting of the posterior horn of the medial and lateral meniscus likely representing a combination of prior tearing, degeneration, and postsurgical changes from prior partial meniscectomy. No fluid-filled or unstable tear is evident.3. Mild osteoarthritis of the knee affecting the lateral tibiofemoral compartment.4. Postsurgical changes of ACL graft reconstruction. The graft appears intact.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Status post cervical fusion. Signs and symptoms: Same Nonenhanced CT of cervical spine:Routine non-infused axial 3-mm CT images of the entire cervical spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates very advanced degenerative disk disease at C3 -- C4 through C6 and C7 levels.Antral listhesis of C3 in respect to C4 is again identified with no appreciable change since prior MRI exam.There is evidence of posterior fusion with placement of bilateral trans-facet fixating screws at C3 level. There is also wide bilateral laminectomy at this level.Evidence of bilateral trans-facet screws placement at C4. No evidence of laminectomy. Fixating metallic rods bilaterally at C3 there C4 levels are also present.There is no evidence of any fracture of the instruments. The appropriateness of the position of the screws should be decided by referring clinical physician.Expected postoperative changes of air in the surgical site. No evidence of intracanalicular air.

Output: 1.Expected postoperative changes of posterior fusion of C3 and C4 and wide bilateral laminectomy of C3.2.Stable anterolistheses of C3 in respect to C4 and extensive degenerative changes of cervical spine.


Instruction: Generate impression based on medical findings.

Input: No definite new intracranial metastasis is identified. Redemonstrated are numerous small to punctate intra-axial high intrinsic T1 signal lesions with enhancement consistent with known metastases. 1.Stable to slightly smaller left medial frontal enhancing lesion on series 1201 image 126 which measured 4 mm previously, now measuring 3 mm.2.Larger left frontal lobe lesion on series 1201 image 116 measuring 5 mm3.Stable punctate focus of enhancement in the left middle cerebellar peduncle on series 1201 image 554.Stable 6 millimeter lesion in the right temporal lobe on series 1201 image 645.Stable to slightly smaller left temporal lobe lesion measuring 7 mm, previously 8 mm on series 1201 image 756.Stable right temporal lobe lesion on series 12 on image 77 measuring 5 mm7.Slightly smaller left posterior insula lesion measuring 4.5 mm compared to 6 mm previously on series 1201 image 100There is a stable focus of somewhat gyriform susceptibility effect involving the left precentral gyrus and the left middle frontal gyrus. No significant edema or mass-effect with any of these lesions. No evidence of acute infarct. No hydrocephalus. There is left maxillary sinus mucosal thickening.

Output: 1. Mixed response to interval therapy with mostly stable lesions. There is one lesion in the left frontal lobe which appears slightly larger than the prior examination, as described above. No definite new metastatic lesion is identified.2. No significant edema or mass effect with any of the lesions.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: 81 years, Female, assess recently seen left internal capsule lesion.. There is a small focus of restricted diffusion involving the left anterior limb of the internal capsule near the genu. There is also a focus of more mildly restricted diffusion with isointense ADC signal involving the right posterior frontal semiovale suspected to represent a subacute infarct. There are additional scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. There is a encephalomalacia in the left occipital lobe consistent with chronic infarct. Additional smaller cortical infarcts are also noted involving the left frontal and right parietal lobes.There is a small, 8 x 5 mm extra-axial enhancing lesion, sagittal postgadolinium series 1101 image 90, along the anterior aspect of the planum sphenoidale, likely representing a meningioma. No intracranial hemorrhage. No intracranial mass-effect. The ventricles are within normal limits in size and configuration for age. There is mild scattered paranasal sinus mucosal thickening with small fluid levels, relatively greater in the left maxillary sinus.Degenerative changes in the partially imaged cervical spine are better assessed on recent CT.

Output: 1. Small acute infarct involving the anterior limb of the left internal capsule near the genu. A punctate focus of likely subacute ischemia is also seen in the right posterior frontal centrum semiovale. 2. Additional chronic cortical infarcts are also seen in the left occipital lobe, left frontal lobe and right parietal lobe. There is also a background of mild to moderate chronic small vessel ischemic disease.3. Subcentimeter enhancing lesion along the anterior planum sphenoidale likely represents a meningioma.


Instruction: Generate impression based on medical findings.

Input: 20-year-old male with history of ulcerative colitis and perianal fistulas status post seton placement for ischiorectal abscesses with incision and drainage. Evaluate. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of proctocolectomy with ileal pouch-anal anastomosis, which appears intact. The inflammatory changes noted at the pouch previously have improved.BONES, SOFT TISSUES: There are 2 complex transsphincteric fistulas with setons in both fistulas. The right sided fistula tracks from 9:00 position, extends transphincterically, and branches into a tract extending anteriorly and posteriorly. The posterior tract extends inferiorly and exits at the right gluteal cleft. The anterior tract extends into the ischiorectal fossa and terminates at that location. There is evidence of a drain in the right ischiorectal fossa.The left-sided fistula tracks from approximately 2:00 position, extends transsphincterically, and branches into a tract extending anteriorly and posteriorly. The posterior tract extends inferiorly and exits at the left gluteal cleft. The anterior tract extends into the ischiorectal fossa without measurable fluid collection.There is additionally increased T2 signal with evidence of enhancement within the perineal region bilaterally consistent with granulation tissue.No pelvic abscess is identified.OTHER: No significant abnormality noted.

Output: 1.Complex bilateral transsphincteric fistulas as described above with evidence of extensive perineal granulation tissue.2.Postoperative changes of proctocolectomy with intact ileal pouch-anal anastomosis.


Instruction: Generate impression based on medical findings.

Input: 29 years Male (DOB:2/8/1987)Reason: MRI lumbar spine History: back pain PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY 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. There is a transitional vertebra present which for the purpose of this exam will be labeled as L5. As a result there is partial sacralization of the L5 vertebra on the left side.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation as well as a broad-based right paramedian disc protrusion which impresses on the ventral to the thecal sac and mildly encroaches on the nerve roots at the lateral recess bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and some endplate reactive change at this level predominantly on the right side where there is a Schmorl's node along the superior endplate of L4.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and Schmorl's nodes at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lumbar spine with a mild degree of spinal stenosis at L4-5 where there is some encroachment of nerve roots at lateral recess is bilaterally worse on the right than the left side.


Instruction: Generate impression based on medical findings.

Input: 8 years Male (DOB:12/27/2007)Reason: evaluate for tethered cord History: urinary incontinence, small bladder capacityPROVIDER/ATTENDING NAME: ASHLEY A AXDAHL MOHAN S. GUNDETI 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. The prone position the conus medullaris is anteriorly. There is no evidence for fatty filum. The conus medullaris ends at approximately L1.At L5-S1 there is no significant compromise to spinal canal or neural foramina.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: No compromise to lumbar spinal canal or neural foramina. No evidence for tethered cord


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.0 x 3.1 x 3.4 cm.Peripheral Zone: Volume loss of the right base consistent with prior ablation therapy. No new foci of low T2 hypointensity. Mild heterogeneous signal in the left mid gland is similar to prior study.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in findings consistent with prior ablation therapy. No evidence of residual or new tumor in the area of ablation.


Instruction: Generate impression based on medical findings.

Input: There is straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is loss of disc space at L5-S1, slightly progressed from the prior study. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L2-L3: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L3-L4: No significant disc bulge, herniation, spinal canal or foraminal stenosis. L4-L5: Mild disc bulge. No significant herniation, spinal canal or foraminal stenosis. L5-S1: Slight interval progression of large central/left paracentral disc extrusion with increased left posterior extension and indenting the left thecal sac, resulting in an eccentric mild spinal canal stenosis with impingement of the descending left greater than right S1 and S2 nerve roots. The 11 mm extent of caudal migration is approximately the same. No significant foraminal stenosis.

Output: Slight interval progression of large central/left paracentral disc extrusion at L5-S1, contributing to eccentric mild spinal canal stenosis with impingement of the left greater than right descending S1 and S2 nerve roots. No significant foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: 31 years Female (DOB:9/6/1985)Reason: history of optic chiasm glioma History: history of glioma very subtle right inferior homonymous with no change when compared to fields from 2001. Optometrist noted pallor in the left optic disc.PROVIDER/ATTENDING NAME: JEFFREY W. NICHOLS JEFFREY W. NICHOLS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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: There is no evidence for recurrence of the chiasmatic or optic nerve glioma.


Instruction: Generate impression based on medical findings.

Input: Male 50 years old Reason: Newly diagnosed Follicular Lymphoma in which staging CT scan showed an abnormal left renal mass that needed further evaluation History: Follicular Lymphoma CT scan showed an abnormal left renal mass that needed further evaluation ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Spleen is top normal in size.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney enhances homogeneously. There are few scattered T2 hyperintense foci in the right kidney that do not enhance and are compatible with cysts. In the left kidney, there is a T1 hyperintense lesion that is T2 hypointense involving the posterior midpole of the left kidney measures 1.4 x 1.2 cm on image 95/ series 24. The lesion does not show definite internal enhancement on postcontrast imaging (image 94/series 101) and is probably a hemorrhagic cyst. The lesion seen on CT along the medial aspect of the kidney is T2 hyperintense measuring 1.7 x 1.4 cm on image 32 of series 23. This lesion also does not show any appreciable enhancement and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes measurements provided below.BOWEL, MESENTERY: Mesenteric lymph nodes with haziness of the mesentery persists.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/8/2016 13:30:00)LEFT RENAL MASS: 1.7 x 1.4 cm (Image 32, Series 23); 2.2 x 1.5 cm on prior (6/23/2016) (Image 93, Series 3).LEFT PARA-AORTIC ADENOPATHY: 2.1 x 1.0 cm (Image 86, Series 25); 2.2 x 1.2 cm on prior (6/23/2016) (Image 94, Series 3).AORTOCAVAL ADENOPATHY: 2.0 x 1.0 cm (Image 90, Series 25); 1.7 x 1.1 cm on prior (6/23/2016) (Image 92, Series 3).LEFT RENAL LESION 2: 1.4 x 1.2 cm (Image 95, Series 24).

Output: 1.Lesion seen on CT compatible with a cyst.2.Second left renal lesion along the posterior aspect of the kidney likely represents a hemorrhagic cyst (within the limitation of its small size and proximity to the renal parenchyma)


Instruction: Generate impression based on medical findings.

Input: Thoracic MRI:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Minimal disc bulges are noted at the T7-8, T9-T10 and T10-11 levels. There is some STIR signal abnormality most noted at the inferior endplate of T9 and superior endplate of T10 indicating endplate degeneration. There is also some STIR signal abnormality along the anterior inferior endplate of T8 and superior anterior endplate of T9. There is ligamentum flavum thickening at the T9-10 and T11-T12 but no neuroforaminal or central canal stenosis.Lumbar MRI:The vertebral column alignment is within normal limits. The vertebral body heights are preserved but the L5-S1 disc space is decreased and there are endplate degenerative changes at the L5-S1 level. There is also multilevel disc desiccation involving the lower lumbar spine. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is a mild disc bulge and mild facet arthropathy which causes mild bilateral neural foraminal stenosis. No central canal stenosis.L3-L4: There is a mild left greater than right disc bulge and mild facet arthropathy which causes moderate left neural foraminal and mild central canal stenosis. No right neuroforaminal stenosis.L4-5: There is a mild disc bulge and mild facet arthropathy which causes mild bilateral neuroforaminal stenosis along with left lateral recess effacement. There is mild to moderate central canal stenosis.L5-S1: There is a mild disc bulge and significant facet arthropathy which causes moderate transverse dimension stenosis of the spinal canal. There is also moderate to severe right and moderate left neural foraminal stenosis

Output: 1.Within the thoracic spine there are mild degenerative changes, including at the T9-T10 level. At this level there is mild endplate degeneration but no central spinal canal stenosis or evidence of a compression fracture. 2.Within the lumbar spine there are multilevel degenerative changes especially involving the lower lumbar spine. This is most prominent at the L5-S1 level where there is moderate spinal canal stenosis and moderate to severe neural foraminal stenosis.


Instruction: Generate impression based on medical findings.

Input: Note is made of a minimally displaced fracture of the ulnar styloid. No intra-articular contrast is identified within the distal radial ulnar joint or midcarpal joint. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 14 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the left wrist for subsequent MRI arthrogram examination. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on medical findings.

Input: MRI brain: There is no restricted diffusion to suggest acute infarct. Redemonstrated is right greater than left encephalomalacia in the ACA-MCA watershed territory and encephalomalacia in the inferior left cerebellar hemisphere, consistent with chronic infarcts. There right cerebral hemispheric volume loss with mild ex vacuo dilatation of the right lateral ventricle. There is decreased caliber of the vessels in the right cerebral hemisphere. There are punctate and curvilinear foci of susceptibility artifact in the left cerebellar hemisphere, consistent with hemosiderin deposition from chronic hemorrhagic infarct. There is also a small focus of susceptibility artifact in the left temporal lobe, consistent with hemosiderin deposition. There is a small retention cyst in the right maxillary sinus. There is diffuse thickening of the skull, which is likely related to sickle cell disease.MRA brain: There is marked narrowing of the intracranial right internal carotid artery and right middle cerebral artery. The right M1 and right A1 segments are not visualized. The right ACA distal to the right A1/A2 junction is normal in caliber. The left ICA and M1 segments are normal in caliber. The left anterior cerebral artery is also diminished in caliber. There are multiple prominent lenticulostriate, right greater than left, as well as transcallosal and pericallosal collateral vessels. There is asymmetrically diminished caliber of the right MCA cortical branches. The right distal ACA, PCOM and PCA and left MCA and PCA and their distal branches are mildly dilated in caliber. The basilar artery and imaged portions of the vertebral arteries appear unremarkable. There is no evidence of cerebral aneurysms.

Output: 1. Findings compatible with Moya Moya disease in the setting of sickle cell anemia, more severely affecting the right sided cerebral vasculature. No significant change since 1/29/2014.2. No evidence of acute infarct. Chronic infarcts in the ACA-MCA watershed territories, right greater than left, and left PICA territory.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with fall after biking. Outside hospital CT showed right temporal petechial hemorrhage There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few scattered punctate foci of susceptibility are present throughout the right cerebral hemisphere including only one in the right anterior temporal pole and these are considered nonspecific. 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 and skull are unremarkable. Small right choroid plexus cyst. Edema and induration of the right supraorbital soft tissues is likely secondary to trauma. There is a focal T1 and T2 hypointesnse oval lesion in the premaxillary subcutaneous tissues of the right cheek immediately inferior to the right zygomatic arch with soft tissue swelling, which may represent an hematoma. Complete opacification of the right maxillary sinus.

Output: 1.No acute intracranial abnormality. Scattered nonspecific foci of susceptibility which may represent mineralization or trace hemosiderin deposition. No specific pattern to suggest traumatic axonal injury.2.Edema in the right supraorbital subcutaneous tissues and right premaxillary soft tissues, with subcutaneous oval area of abnormal signal in the right cheek which may represent a hematoma.3.Complete opacification of the right maxillary sinus.


Instruction: Generate impression based on medical findings.

Input: 48-year-old female with bleeding and discharge. History of cervical cancer with persistent disease on cervix despite chemoradiation therapy. Evaluate for parametrium and bladder/rectal proximity of tumor for surgical planning. PELVIS:UTERUS, ADNEXA: Enhancing soft tissue mass of the cervix measuring 6.1 x 3.5 cm (series 8 image 327). This lesion again extends into the mesorectal fascia posteriorly and parametrium bilaterally. Prior measurement was 4.6 x 2.3 cm. Upper vaginal thickening is again seen.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid in the dependent pelvis.

Output: Increased size of the known cervical soft tissue mass with extension into the mesorectal fascia and parametrium bilaterally.


Instruction: Generate impression based on medical findings.

Input: Unspecified visual disturbance [H53.9], Reason for Study: ^Reason: s/p OLT in October, admitted with thrombocytopenia. Now with vision changes. MRI w/ recommended by neuro consult service History: as above No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered high signal intensity nodular lesions on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease, slightly more prominent on today's scan but grossly no significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No abnormal contrast enhancing lesion.Nonspecific small vessel ischemic disease, no change since prior scan.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old with pain of the right ankle and foot, evaluate Right ankle:Mild soft tissue swelling along the medial aspect of the ankle. Mild spurring along the medial malleolus that may reflect old trauma, but no acute fracture evident. Small ossicle dorsal to the neck of the talus may also reflect old trauma, however, no acute fracture evident.Right foot:Severe osteoarthritis affects the first metatarsophalangeal joint with mild to moderate osteoarthritis affecting the interphalangeal joints. Mild osteoarthritis affects the midfoot. Note is made of an accessory navicular bone situated approximately 5 mm from the navicular tuberosity. If there is clinical concern for posterior tibial tendon dysfunction MRI can be obtained. Vascular calcifications also noted.

Output: Osteoarthritis of the right foot and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Vertigo, headache, and small cell lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount secretions in the left sphenoid sinus.

Output: No evidence of intracranial metastasis or acute cerebral infarction.


Instruction: Generate impression based on medical findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: seizure like activity History: as above There are symmetrically increased signal intensity on bilateral mesial hippocampus on FLAIR and T2 images. However, estimated volume of bilateral hippocampus appear to be within normal limits.These findings may suggest possible bilateral hippocampal sclerosisNo evidence of acute ischemic or hemorrhagic lesion.There are multiple scattered high signal intensity on FLAIR/T2 weighted image on bilateral periventricular white matter right frontal operculum right subluxation of the cortex white matter indicating nonspecific chronic ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Increased signal intensity of bilateral hippocampus on FLAIR/T2 images without volume loss, may suggest possible bilateral hippocampal sclerosis.2. No evidence of acute ischemic or hemorrhagic lesion.3. Nonspecific chronic ischemic lesions as described above


Instruction: Generate impression based on medical findings.

Input: Chiari malformation, developmental delay with speech, evaluate for syrinx or tethered cord: Chiari malformation spine survey for abnormalcies. The cerebellar tonsils extend up to approximately 15 mm inferior to the foramen magnum and demonstrate a peg-shaped configuration with impeded CSF flow in this area. There is mild retroflexion of the dens. The vertebral column alignment is otherwise within normal limits. The spinal cord displays normal signal and morphology, without evidence of syringohydromyelia. The conus medullaris is located at the L1-2 level. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Findings compatible with Chiari I malformation, but no evidence of syringohydromyelia or low-lying conus medullaris.


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with acute stroke. There is no evidence of intracranial hemorrhage, mass or edema. Minimal lucency within the subcortical white matter of the right frontal region is nonspecific. If there is clinical concern for acute stroke an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Minimal lucency within the right frontal region, nonspecific. If there is clinical concern for acute stroke an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Back pain. Evaluate for potential kyphoplasty. There is compression fracture of T10, with no significant retropulsion. The fracture involves primarily the anterior column. Posterior wall of the vertebral body and pedicles appear intact. Mild degenerative changes are seen in the rest of the thoracic spine. No additional fracture is seen. Please also refer to recent MRI of thoracic spine for additional findings suggesting multiple myeloma lesions.There is a left upper lobe mass, with central calcification, probably representing a calcified granuloma and measures 14 mm. Small pleural effusion is seen bilaterally.There is a large hiatal hernia. There is thickening of esophageal wall, of uncertain significance. This is prominent soft tissue density seen at the right lateral aspect of the esophagus, at T5 -- T6 level, of uncertain significance; this may represent a vascular structure, but an underlying mass cannot be excluded.

Output: 1. T10 compression fracture, with intact posterior wall of the vertebral body and pedicles.2. Please refer to recent MRI of thoracic spine for additional multiple myeloma lesions.3. Large hiatal hernia.4. Thickening of esophageal wall and prominent soft tissue density at the right lateral aspect of the esophagus, at T5 -- T6 level, of uncertain significance. Suggest correlation with contrast enhanced CT.5. Left upper lobe calcified granuloma.


Instruction: Generate impression based on medical findings.

Input: 61 year old woman with history of HTN, DM, HL, TIA, CAD with previous LAD stents (2005 and 2015), with ongoing atypical chest pain and shortness of breath, now referred for vasodilator cardiac MRI perfusion study.MEDICATIONS: aspirin, ticagrelor, fish oil, metformin, glyburide, crestor, HCTz-triamterene First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 164 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 46 g/m2, and the LV mass is 102 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 174 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 86 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial 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 significant 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 51%).5. Mild mitral regurgitation.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: Headaches, paresthesias, reevaluate white matter lesions. Brain: There are least 6 T2/flair hyperintense lesions involving the supratentorial white matter as well as the left thalamus. Many of these lesions demonstrate a morphology and distribution highly suggestive of demyelinating disease. Compared to outside MRI dated 1/13/2015, there is interval development of a new lesion measuring approximately 1 cm in size involving the left posterior callosal body with enhancement. Otherwise no other new lesions or abnormal parenchymal or meningeal enhancement is appreciated. Brain parenchymal volume is preserved. T1 hypointensity associated with some of the lesions is noted including the left periatrial white matter and adjacent to the left temporal horn. There is restricted diffusion associated with the enhancing left posterior callosal body lesion. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Examination is slightly limited due to patient motion. No abnormal signal however is seen within the cervical cord to suggest demyelinating disease. There is trace prominence of the central canal at the C6-C7 level, which is of doubtful clinical significance. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis at any level in the cervical spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multiple T2/flair hyperintense lesions in the supratentorial white matter with distribution and morphology highly suggestive of demyelinating disease. Compared to 1/13/2015, there is interval development of a new lesion with enhancement involving the left posterior callosal body which is suggestive of active demyelination. Consider further correlation with CSF analysis.2. No T2 hyperintense lesions or abnormal enhancement within the cervical cord is identified. There is trace prominence of the central canal at the C6-C7 level, which is of doubtful clinical significance.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with history of right breast cancer status post right lumpectomy and sentinel node biopsy for IDC in 2011. Family history of breast cancer in maternal aunt, maternal great aunt, and paternal aunt. No new breast complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted in the right breast and minimal enhancement in the left breast. Postsurgical/treatment changes are appreciated in the right breast and right axilla from lumpectomy and sentinel node biopsy.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical/treatment changes in the right breast with no MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on medical findings.

Input: Rule out CVA. Patient with two days of left-sided weakness. Several areas of encephalomalacia, the largest in the right occipital lobe that likely represent areas of prior infarct. Multiple areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. An MRI is recommended if there is clinical concern for acute stroke.There is no evidence of intracranial hemorrhage, mass or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Areas of encephalomalacia and evidence of small vessel ischemic disease of indeterminate age. An MRI is recommended for further evaluation if there is concern for an acute stroke.


Instruction: Generate impression based on medical findings.

Input: Grade II glioma status post treatment. There are postoperative findings related to right frontal craniotomy. There is unchanged confluent T2 hyperintensity in along the margins of the right frontal lobe resection cavity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. In particular, there is no elevated perfusion or enhancement within the treatment bed. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Stable post-treatment findings in the right frontal lobe region, without evidence of tumor progression.


Instruction: Generate impression based on medical findings.

Input: History of brain metastasis from lung cancer in the right frontal lobe, status post radiation. There is no significant interval change in size of the lesion in the right centrum semiovale with susceptibility effect and mild peripheral enhancement, which measures up to 9 mm. Likewise, there is no change in the surrounding confluent high T2 signal. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There are unchanged prominent disc-osteophyte complexes in the imaged cervical spine with associated mild to moderate spinal canal stenosis.

Output: No significant interval change of the treated metastasis in the right centrum semiovale.


Instruction: Generate impression based on medical findings.

Input: Reason: 38yo woman with known grade 1 endometrial cancer s/p levonorgestrel IUD to decide between surgery and additional medical therapy. PELVIS:UTERUS, ADNEXA: The uterus is anteverted related and retroflexed in position and measures 9 x 5 x 7 cm (CC by AP by TR). The endometrial stripe appears homogeneous and measures up to 8 mm in thickness. The posterior junctional zone is mildly thickened measuring up to 14 mm.An intrauterine device is noted.There is a polypoid lesion arising from the posterior uterine body endometrium with reference measurements below. There is no associated gross invasion of the myometrium.The ovaries are normal in size and morphology and contain small cysts or follicles. The right ovary measures 2.4 x 2.8 x 2.3 cm. The left ovary measures 3.1 x 2.0 x 2.4 cm. No abnormal adnexal masses are identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Symmetric, mildly heterogeneous bone marrow signal intensity may reflect red marrow.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 10:00:00)ENDOMETRIAL LESION: 1.1 x 0.8 cm (Image 15, Series 8).

Output: 1.Small endometrial polypoid lesion which may reflect polyp or endometrial hyperplasia/carcinoma without of gross myometrial invasion. No pelvic lymphadenopathy.2.Mild thickening of the posterior junctional zone which is nonspecific but can be seen with adenomyosis.


Instruction: Generate impression based on medical findings.

Input: 13-year-old female with right knee pain for 5 months. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: There is a small focus of bone marrow edema affecting the medial intercondylar tubercle of the tibia. Otherwise, bone marrow signal intensity is normal. The articular cartilage is intact. No fracture.LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Contusion of the medial intercondylar tubercle of the tibia.


Instruction: Generate impression based on medical findings.

Input: Reason: history of renal transplant concern for infection, previous MRI with findings concerning for left clavicle osteomyelitis, please include this in views to evaluate for osteomyelitis. LUNGS AND PLEURA: Moderate to large bilateral pleural effusions, not significantly changed with adjacent compressive atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal lymphadenopathy identified.CHEST WALL AND SOFT TISSUES: There is redemonstration of edema/fluid signal as well as increased enhancement within the fascial planes of the left upper chest wall surrounding the proximal and middle third of the left clavicle which is compatible with an inflammatory process such as cellulitis. There is also abnormal bone marrow signal, frank cortical disruption, and increased enhancement involving the proximal and to a lesser extent middle third of the left clavicle which is compatible with osteomyelitis which has progressed. This abnormal marrow signal extends to the sternoclavicular articulation with significant inflammatory change about the joint and cortical disruption of the sternum. No bony sequestrum or definite vascular involvement is visualized. T3 hemangioma.There is redemonstration of a nonspecific T2 hyperintense nodule in the subcutaneous soft tissues of the left upper back.UPPER ABDOMEN: PEG tube in place.

Output: 1.Findings compatible with increasing cellulitis and osteomyelitis of the proximal clavicle and adjacent sternum. There is involvement of the sternoclavicular articulation, concerning for septic arthritis.2.Large bilateral pleural effusions, grossly unchanged.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: Myelopathy There are postsurgical changes of anterior cervical discectomy and fusion from C4 to C5. Vertebral body heights are grossly maintained with minimal anterior superior endplate deformities at C7 and T1 with associated fatty endplate changes. No suspicious osseous lesions are seen. No findings to suggest a recent compression fracture.There is T2 hyperintensity in the bilateral cervical cord at the upper C5 level with volume loss consistent with myomalacia, which may be related to prior compression. There is minimal retrolisthesis of C3 on C4. Alignment of the cervical spine is otherwise grossly maintained.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Left greater than right facet arthropathy.C3-4: There is a disc osteophyte complex including uncovertebral hypertrophy as well as ligamentum flavum thickening contributing to mild to moderate spinal canal stenosis. There is also moderate left and mild right neural foraminal stenosis.C4-5: Myelomalacia and postoperative changes as described above. No significant spinal canal stenosis. Mild right neural foraminal stenosis. Left neural foramen is patent.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy. There is mild mild narrowing of the spinal canal. Mild to moderate bilateral neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes related to anterior cervical fusion at C4-C5.2. Bilateral cord signal abnormality and volume loss consistent with myomalacia at the upper C5 level, which may be related to prior stenosis and can be compare with prior studies if available.3. Mild to moderate spinal canal stenosis at the C3-C4 level above the fusion. Otherwise no significant spinal canal stenosis is seen in the cervical spine. Neural foraminal stenoses as detailed above.


Instruction: Generate impression based on medical findings.

Input: Female, 3 months old, twin pregnancy born at 36 weeks, with nystagmus. Assess for optic glioma, brainstem or cerebellar abnormality. The morphology and signal characteristics of the cerebrum, brainstem and cerebellum are within normal limits. No areas of significant parenchymal signal abnormality, edema or mass effect are seen. No pathologic parenchymal or extra-axial enhancement is noted. The ventricles are normal in size morphology. No abnormal fluid collections are detected.The pattern of white matter myelination is appropriate for the corrected gestational age. The region of the pituitary gland and sella are unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. Likewise the corpus callosum is fully formed and intact.On dedicated orbital imaging, the globes are round and symmetric, the extraocular muscles show normal caliber, and the optic nerves are free of pathologic thickening, signal abnormality or enhancement. On the coronal STIR sequence, mild symmetric increased signal is seen along the superior orbital soft tissues which is of uncertain but doubtful significance.

Output: Unremarkable examination with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Reason: peroneal tendonitis tenosynovitis History: pain and swelling and popping TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Normal bone marrow signal.ADDITIONAL

Output: No significant abnormality noted.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male please evaluate for edema and acute bleed. There is no evidence of intracranial hemorrhage, mass or edema. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on medical findings.

Input: Severe right thigh pain. Evaluate for soft tissue injury. There is severe diffuse muscular atrophy. There are no discrete masses, fluid collections, or additional soft tissue abnormalities. There is minimal stranding of the subcutaneous fat, which is symmetrical bilaterally.The osseous structures are unremarkable, with normal marrow signal.Severe degenerative changes of the hip, with moderate degenerative changes of the knee, similar to previous exams. No gross abnormalities in the visualized portions of the lower pelvis.

Output: Diffuse muscular atrophy, without acute abnormalities. Severe degenerative changes of the hip.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Fibromyalgia CervicalgiaClinical question: cause for neck pain, pt with fibromyalgia and spine issuesSigns and Symptoms: neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. A T1 hyperintense focus along the superior aspect of the C7 vertebral body most likely represents a vertebral body hemangioma. It suppresses on the T2 STIR images.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. There is a disc bulge present at this level which is associated with mild disc desiccation. There is mild ligamentum flavum hypertrophy present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level which is associated with mild disc desiccation. There is mild ligamentum flavum hypertrophy present 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: 1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or neural foramina.


Instruction: Generate impression based on medical findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, there is no MRI evident acoustic neuroma as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Malignant neoplasm of unspecified main bronchus [C34.00], Reason for Study: ^Reason: metastatic lesions History: back pain Cervical spineThere bone marrow replacing enhancing lesions involving C7 left side facet joints and lamina as well as T1 vertebral body indicating metastatic lesions.There is diffuse bulging of disc at the level of C45 and C56 without showing significant spinal canal stenosis.Spinal cord signal intensity is normal.Thoracic MRIThere are multifocal bone marrow replacing lesions involving T7, T8, T12 and L1 vertebral bodies. In particular, the T7 and T8 vertebral bodies demonstrate various degree of compression fractures; about 50% for T7 and 30% for T8.The T8 vertebral compression fracture is associated with minimal retropulsion, however, there is no evidence of spinal canal stenosis, nor abnormal spinal cord signal intensity. There are multiple non vertebral abnormal enhancing lesions indicating metastatic lesion involving right mid to lower pleural spaces and lung parenchyme as well as right side paravertebral muscle at the level of L1.The cord signal is normal. The conus medullaris terminates at the level of T12-L1.

Output: 1. Multifocal metastatic lesions involving C7, T1, T7, T8, T12 and L1 vertebral levels.2. Vertebral compression fractures on T7 and T8.3. No spinal cord signal abnormality.4. Multifocal metastatic lesions involving left pleural space, left lung parenchyme and right paraspinal muscle (L1 level).


Instruction: Generate impression based on medical findings.

Input: Rt facial numbness x 4-5 days The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 10mmx18mm axial dimension gyriform focus of diffusion restriction along the left occipital lobe which partially involves primary visual cortex and partially higher level cortex.There is a subtle punctate focus of DWI signal hyperintensity in the lateral aspect of the left thalamus which is not identified on ADC maps.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a small subacute infarction along the left occipital lobe as described above.2.There is a punctate lesion in the left thalamus along its lateral aspect. It is possible that this also represents a punctate subacute cerebral infarct.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: Enhancing lesion. Expressive language problem. There is no evidence of intracranial hemorrhage or acute infarct. There is increased leptomeningeal enhancement with punctate areas of restricted diffusion and possible minimal cortical involvement, as well as sulcal T2 hyperintensity and susceptibility effect in the left frontal lobe, including the precentral sulcus, and to a lesser extent the left temporal lobe. There are increased foci of cerebral white matter T2 hyperintensity, particularly in the left frontal and temporal lobes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. Interval increased leptomeningeal enhancement with possible minimal cortical involvement and sulcal T2 hyperintensity in the left frontal lobe, and to a lesser extent the left temporal lobe. Differential considerations neoplastic, vascular, or perhaps granulomatous conditions.2. Interval increased foci of cerebral white matter T2 hyperintensity is nonspecific, but may represent a vasculitis or demyelinating process, for example.Discussed with Dr. Brorson at 4PM on 1/14/15.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of fifth PIP joint subluxation status post ORIF. Assess volar plate. There is post traumatic deformity of the fifth middle phalanx as seen on recent radiographs. The majority of the middle phalanx is subluxed/dislocated volarly with respect to the proximal phalanx. A bandlike structure extending from the head of the proximal phalanx to the volar aspect of the base of the middle phalanx likely represents the volar plate and appears grossly intact. Mild deformity of and edema within the middle phalanx are compatible with healing fracture. Edema is also noted within the head, neck, and diaphysis of the proximal phalanx and may also be post-traumatic in etiology. A small bony fragment situated posterior to the base of the middle phalanx and distal to the head of the proximal phalanx is consistent with an ununited fracture fragment as seen on recent radiographs. The central slip of the extensor tendon appears to extend to this bony fragment. The lateral slips of the extensor tendon extend to the base of the fifth distal phalanx as expected. The flexor tendon apparatus appears intact, with a small amount of fluid in the flexor tendon sheath volar to the 5th metacarpal. The A2 pulley appears intact on transverse images; however, we cannot comment on the integrity of the C1 and A3 pulleys. Evaluation of the collateral ligaments is limited secondary to post-traumatic deformity of the joint and adjacent edema.

Output: Fracture and subluxation/dislocation of the fifth PIP joint as described above, with what appears to be an intact volar plate.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of Crohn's, evaluate disease status 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: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening in the rectosigmoid without enhancement, possibly reflecting prior inflammation. The transverse colon, descending colon and rectosigmoid are also relatively ahaustral with suggestion of fibrofatty proliferation, also likely the sequela of prior inflammation. No hyper enhancement or diffusion restriction. No abscesses or fistulas. The terminal ileum is normal-appearing.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 3.4 mm cyst in the left adnexa.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of active Crohn's disease.2.Findings suggestive of chronic inflammation involving the rectosigmoid, descending colon and transverse colon.


Instruction: Generate impression based on medical findings.

Input: Thoracic Spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Lumbar Spine: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There are chronic compression deformities of L3, L4 and L5 with interval normalization of previously T2/STIR signal related to edema. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the T12/L1 level. There is mild disc bulge at L2-L3 with associated minimal narrowing of the spinal canal and right neural foramen. At L3-L4 there is mild disc bulge and mild facet arthropathy with associated mild narrowing of the spinal canal and mild bilateral foraminal narrowing.At L4-L5 there is a mild disc bulge and facet arthropathy with associated mild narrowing of the spinal canal, mild right neural foraminal narrowing and mild to moderate left neural foraminal narrowing.At L5-S1 there is mild disc bulge with small central protrusion and bilateral facet hypertrophy with mild bilateral neural foraminal narrowing. There is no significant narrowing of the spinal canal.

Output: 1. Chronic mild compression deformities of L3 to L5 vertebral bodies without interval worsening of height loss and interval resolution of previously seen associated marrow edema. No new compression fractures. 2. Mild multilevel lumbar spondylosis similar to prior without high grade narrowing of the spinal canal or neural foramina at any level.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: Ms. Schuenemann is a 56-year-old female with BRCA1 gene. Family history of ovarian cancer in sister and breast cancer in maternal great aunt and maternal second cousin. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.A few benign cysts are seen in the right breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on medical findings.

Input: 9-year-old male with bilateral knee pain on chronic steroids, evaluate for AVN MENISCI AND LIGAMENTS: The menisci are intact. The ACL, PCL, MCL, and lateral collateral complex are intact.BONE AND MARROW: Diffuse demineralization of the bone is present consistent with osteoporosis, likely secondary to chronic steroids. In the proximal tibial diaphysis is a focal area of more severe osteoporosis with few trabecular present. This focal osteoporosis occupies a majority of the proximal tibial diaphysis. No evidence of avascular necrosis. No osteochondral defect is present. A focal area of increased intensity in the posterior proximal diaphysis of the tibia likely represents fluid within the bone marrow.SYNOVIUM: No significant joint effusion is present. The articular cartilage is intact.MUSCULATURE: Musculature moderately atrophic.ADDITIONAL

Output: Diffuse demineralization with a focal area of more severe osteoporosis in the proximal tibial diaphysis without evidence of avascular necrosis or osteochondral defect.


Instruction: Generate impression based on medical findings.

Input: 8-year-old boy with history of Chiari malformation and syrinx status post decompression, 3 month follow-up. BRAIN

Output: 1.Compared to the immediate postoperative study, there has been decrease in the size of CSF space along the posterior neo-foramen magnum. There is associated significant decrease in CSF flow along the neo-foramen magnum and prepontine cistern, which now appears asynchronous as well. Please correlate clinically, as there may be development of adhesions.2.Compared to the preoperative study, the size of syrinx has decreased with residual cervicothoracic syrinx as described above.


Instruction: Generate impression based on medical findings.

Input: History of olfactory groove meningioma resection on 2/25/15: surveillance. There are postoperative findings related to recent bifrontal craniotomy with areas of confluent T2 hyperintensity and scattered foci of susceptibility along the margins of the resection cavity. There is an enhancing mass in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to approximately 20 mm. There is also unchanged enhancement tumor along the left planum sphenoidale that measures up to 10 mm in thickness, adjacent to the left optic nerve. The ventricles are unchanged in size and configuration. There is no evidence of acute territorial infarction.

Output: Postoperative findings related to olfactory groove meningioma resection with no significant interval change in size of the residual tumor in the posterior aspect of the resection cavity and along the left planum sphenoidale.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with history of laryngeal cancer and low back pain. Examination is motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is moderate loss of disc height at L5-S1. Alignment is within normal limits. Bone marrow is heterogenous and nonspecific without destructive suspicious lesions. There is signal abnormality along the inferior endplate of L5 on a degenerative basis. The conus medullaris is normal in position terminating at the level of L1. The paraspinous soft tissues are within normal limits.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L2-L3: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge. Moderate facet hypertrophy with inflammatory changes surrounding the right facet joint. No significant spinal canal or neuroforaminal stenosis.L4-L5: Right paracentral disc protrusion with effacement of the right lateral recess contacting the descending right L5 nerve root. Moderate facet hypertrophy. No significant central spinal canal or neuroforaminal stenosis.L5-S1: There is moderate loss of disc height with central and left foraminal disc protrusions resulting in mild right and moderate left neuroforaminal stenosis. Moderate facet hypertrophy. No significant central spinal canal stenosis.

Output: 1. Multilevel degenerative disease as above worst at L4-5 and L5-S1. There is up to moderate left L5-S1 neuroforaminal narrowing which may be impinging on the left L5 nerve root. Additional levels as above.2. Heterogenous bone marrow which is nonspecific. No suspicious focal lesions are seen to suggest metastatic disease. 3. Facet arthropathy at L3-4, L4-5, and L5-S1 with mild inflammatory changes surrounding the right greater than left L3-4 facet joints, which may be on a degenerative basis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with new diagnosis of prostate cancer; Gleason 4+4 = 8 right mid prostate; Gleason 4+5 = 9 left base PELVIS:PROSTATE:Prostate Size: 3.1 x 3.2 x 3.8 cmPeripheral Zone: There is an elongated T2 hypointense lesion with restricted diffusion in the left peripheral zone extending from the apex to the base, largest dimensions in the mid gland measuring 16 x 9 mm. T2 hypointensity extends across midline into the right mid gland peripheral zone. This lesion demonstrates early enhancement and rapid washout. T2 hypointense lesion in the right mid gland peripheral zone with associated restricted diffusion measuring 6 x 3 mm. Additional smaller lesions are noted. Central Gland: Moderate degree of benign prostatic hypertrophy. There is extension of the left peripheral zone tumor into the mid transition zone exerting mass effect on the urethra with corresponding deformity noted. Seminal Vesicles: Extension of the left peripheral zone lesion to the medial aspect of the seminal vesicles (series 503, image 70). Extracapsular Extension: There is extracapsular extension by the left peripheral zone lesion.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.Large hypointense lesion in the left peripheral zone with portions extending from apex to base and crossing midline to the right at level of mid gland peripheral zone consistent with known diagnosis of prostate carcinoma. Additional suspicious lesions are also noted.


Instruction: Generate impression based on medical findings.

Input: Male; 70 years old. Reason: pancreas cancer with a subcentimeter liver lesion please assess and further characterize if this is a hemangioma versus metastasis History: As above ABDOMEN:LIVER, BILIARY TRACT: No focal, suspicious hepatic lesion is seen to correlate with the subcentimeter hypoattenuating focus in the left hepatic lobe seen on preceding CT, and the abnormality on CT may be related to intrahepatic biliary ductal dilation.Faint, focal T2 hyperintensity is seen in the location of the hepatic hilum hypoattenuating focus described on prior CT, which is nonspecific and may be related to focal periportal edema or biliary dilation.Distal bilateral intrahepatic biliary ductal dilation with poor visualization of the central intrahepatic biliary ducts proximal to the common duct (series 3/26), suspicious for tumor infiltration from the large pancreatic mass invading into the porta hepatis (see below).SPLEEN: No significant abnormality noted.PANCREAS: Stable ill-defined pancreatic body and tail mass with invasion into the porta hepatis, were multiple collateral vessels are seen likely due to occlusion of the superior mesenteric vein/portal confluence and partial cavernous transformation, as described on preceding CT.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right superior pole renal cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal infiltration of the pancreatic mass along the celiac trunk with attenuation seen of the proximal common hepatic and splenic arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered nonspecific T2 hyperintense vertebral body lesions, correlating with the sclerotic foci seen on prior CT. Nonspecific focus of enhancement in the right paraspinal muscles measuring 10 x 17 mm (series 1001/52).

Output: 1. Distal intrahepatic biliary ductal dilation with poor visualization of the central intrahepatic biliary ducts proximal to the common duct (series 3/26), which may be due to pancreatic tumor infiltration.2. Otherwise, no definite focal, suspicious hepatic mass.3. Pancreatic mass and additional findings as stable since prior CT.


Instruction: Generate impression based on medical findings.

Input: 22 years Female (DOB:3/2/1994)Reason: chiari malformation s/p decompression, post op follow up MRI , new symptoms after surgery, please do with csf flow study History: new neck pain after surgeryPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The patient is status post suboccipital craniectomy and removal of the posterior arch of C1 for Chiari decompression.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.The left vertebral artery ends in the left posterior inferior cerebellar artery which has a coarse echoes down to the C1-2 level.A normal biphasic flow is present at the level of foramen magnum.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Status post posterior fossa surgery and C1 surgery for Chiari decompression. There is no evidence for obstruction at the level of the foramen magnum. There is no syrinx or ventriculomegaly appreciated.2.Low-lying left posterior inferior cerebellar artery.