Instruction: Generate impression based on medical findings.

Input: 66 year old female with history of orthotopic heart transplant in 6/2015 for non ischemic cardiomyopathy, hypertension, anxiety and GERD now presenting with chest pain, a small pericardial effusion, neck stiffness, and possible meningitis. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated consistent with transplant morphology.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 181 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumSmall pericardial effusion. There is evidence for pericardial inflammation by T2stir images and delayed enhancement in the pericardium. No myocardial extension of inflammation was noted.Extracardiac FindingsPost heart transplant surgery findings. Small bilateral pleural effusions. Parenchymal lung process, most prominent in LLL. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal biventricular size and systolic function.2. Small pericardial effusion with evidence for pericardial inflammation.3. Abnormal lung MRI findings.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: 61-year-old female with follicular lymphoma MRI brain:Again seen is a right transfrontal ventriculostomy/Ommaya catheter terminating in the right frontal horn laterally. There is a 15x24 mm focus of CSF intensity collection surrounding the catheter with extensive surrounding vasogenic edema, appearing similar in extent to recent CT study. This results in effacement of the adjacent cortical sulci and mild mass effect on the right frontal horn and mild midline shift to the left similar to prior study. The ventricular system caliber is not significantly changed from prior study, with transverse diameter of the left frontal horn of the lateral ventricle measuring 12 mm in caliber, unchanged, and the transverse diameter of the anterior third ventricle measuring approximately 10 mm, also unchanged. No evidence of infarct. No intracranial hemorrhage is identified. There is nonsuppression of CSF involving the bilateral frontoparietal sulci on the FLAIR sequence. No intracranial mass or mass effect. 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.Left maxillary mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The images are degraded by motion artifact. No intraconal or extraconal space mass is identified. The globes and extraocular muscles are intact. Evidence of left lens replacement.Cervical spine:Marked suboptimal evaluation of the cervical spine due to motion artifact. Within these limitations there is no obvious mass effect or compression of the spinal cord. No cord signal abnormality. Minimal degenerative changes are seen without significant spinal canal stenosis.

Output: 1. Please note examination is limited due to absence of intravenous contrast and limited sequences obtained of the brain, orbits, and cervical spine. Patient could not tolerate further imaging and examination was terminated prematurely. 2. No obvious intracranial mass or diffusion abnormality to suggest lymphoma. There is nonsuppression of CSF on the FLAIR sequence involving the bilateral frontoparietal sulci which may be artifactual, but can be seen with leptomeningeal disease; postcontrast sequences would be helpful for differentiation. Again seen is 15x24 mm CSF collection surrounding the Ommaya catheter with extensive surrounding vasogenic edema and associated mass effect, similar to recent CT from 5/30/15. 3. No obvious orbital mass or cervical cord signal abnormality on the limited sequences.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with back pain and lumbar stenosis. Preoperative planning for decompression. A grade 1 anterolisthesis of L5 relative to S1 is new compared to the 2006 examination. Sagittal alignment is otherwise unremarkable.A T2 hyperintense and T1 heterogeneous lesion within the anterior aspect of the L3 vertebral body is unchanged and likely represents an atypical hemangioma. No other suspicious marrow space lesions are seen. No evidence of marrow edema is detected.Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are observed.L1-2: Mild facet arthropathy, progressed. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy and ligamentum flavum thickening, progressed. Minimal bulging disc, progressed. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy and ligamentum flavum thickening, progressed. Mild predominantly laterally bulging disc without change. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged. L4-5: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Minimally bulging disc, slightly progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina, worse from prior. Mild bilateral foraminal narrowing is unchanged. L5-S1: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Disc uncovering and disc bulging, with mild loss of disc height, progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina equina nerve roots which is progressed. Mild to moderate bilateral foraminal narrowing is also progressed.

Output: 1.Progressive degenerative disease is seen most notably at L4-5 and L5-S1. In combination with a congenitally slender spinal canal, disc and posterior element degeneration results in a significant spinal canal stenosis at these levels.2.Relatively mild degenerative findings are slightly progressed at other levels, most particularly involving the facet joints.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with left hip pain, only temporary relief from injection x2. ACETABULAR LABRUM: The acetabular labrum cannot be well-visualized likely secondary to underlying degenerative changes as described below.ARTICULAR CARTILAGE AND BONE: There is marked bone marrow edema within the left acetabulum and femoral head with associated partial collapse of the femoral head. On the sagittal sequences there is a 'double line' sign within the femoral head which is convincing evidence of underlying avascular necrosis. There are secondary osteoarthritic changes related to the aforementioned avascular necrosis and femoral head collapse with associated joint space narrowing.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with avascular necrosis of the left femoral head with associated partial collapse and secondary osteoarthritic changes as described above.


Instruction: Generate impression based on medical findings.

Input: 46 years, Female, dull right-sided headaches for the past several months There are two right-sided ventriculostomy catheters, one of which terminates near the foramen of Monro on the left and the other which courses through the lateral ventricles and terminates near the left thalamus. The bilateral lateral ventricles are dilated as is the third ventricle. There is mild nonspecific FLAIR hyperintensity surrounding the ventricles. Note no prior studies are available for comparison.No intracranial mass or mass effect. There is susceptibility artifact related to the ventricular shunts which limits evaluation of the parenchyma. There is however no obvious evidence of ischemia or intraparenchymal hemorrhage. There is gliosis along the course of the ventriculostomy catheters. There is an extra axial collection along the posterior left cerebral convexity deep to craniotomy at this level. No significant associated mass effect. There is severe diffuse thinning involving the corpus callosum. No findings to suggest intracranial mass, midline shift, or herniation.Paranasal sinuses and mastoid air cells are clear. Orbits are grossly unremarkable. Extracranial soft tissues are grossly unremarkable.

Output: 1. There is dilatation involving the bilateral lateral ventricles and third ventricles with two right-sided ventriculostomy catheters as described above. Would suggest obtaining prior studies for comparison. No evidence of infarct, hemorrhage, or intracranial mass. 2. Diffuse thinning of the corpus callosum which may be secondary to chronic hydrocephalus.


Instruction: Generate impression based on medical findings.

Input: 30-year-old female. Evaluate for biliary obstruction, acute pancreatitis, elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense signal of the hepatic parenchyma (series 5 image 15) could represent a cyst versus hemangioma and further evaluation is limited due to the lack of intravenous contrast. Cholelithiasis without evidence for acute cholecystitis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse thickening/edema of the pancreatic parenchyma with severe peripancreatic fluid collections. No definite evidence for parenchymal necrosis. No significant pancreatic ductal dilatation. There is some restricted diffusion compatible with acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive fluid signal in the retroperitoneal and intraperitoneal compartments.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Edematous pancreatic parenchyma with extensive fluid in the retroperitoneal and intraperitoneal compartments. Findings compatible with acute pancreatitis.2.Cholelithiasis without evidence for acute cholecystitis. Normal bile ducts.


Instruction: Generate impression based on medical findings.

Input: Reason: breast cancer with history of brain metastases s/p SRS. Please evaluate with interval MRI History: breast cancer with history of brain metastases s/p SRS. Please evaluate with interval MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. A 3mm nodule is present in the left middle frontal gyrus which previously measured 2 mm.A punctate focus of susceptibility effect associated with contrast enhancement present along the right precentral gyrus medially which is also present on the prior exam and has not changed substantially.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.Since the prior exam there is no change in a right medial precentral gyrus lesion, however, a left middle frontal gyrus lesion appears to be slightly larger. These most likely represent metastatic foci.


Instruction: Generate impression based on medical findings.

Input: This is a 5-year-old male with a history of Dandy-Walker malformation with P. with a VP shunt who presents with behavioral changes. Please evaluate ventricles and for shunt malformation. Changes consistent with Dandy-Walker malformation with large posterior fossa cyst which is continuous with the fourth ventricle. The VP shunt catheter is located in the posterior fossa within the fourth ventricle. When compared to the prior MRI in 2007 there are no changes in the size of the posterior fossa cyst. There is no significant ventricular prominence. There is an interval slight decrease in the frontal horns of the lateral ventricles.There is no evidence of intracranial hemorrhage, mass or edema.

Output: 1. Dandy-Walker malformation with VP shunt catheter located in the posterior fossa cyst.2. There are no changes in the size of the posterior fossa cyst. 3. No significant ventricular prominence.


Instruction: Generate impression based on medical findings.

Input: 35-year-old male with a history of Crohn's disease status post ileocecectomy. Presents with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Large dependent gallstone without evidence of acute cholecystitis. No intra-or extrahepatic biliary ductal dilation. Subcentimeter hepatic cyst, unchanged.SPLEEN: Small splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with the stated history of ileocecectomy. There is wall thickening and enhancement of a long segment of the neoterminal ileum, measuring approximately 4.0 cm in length, consistent with acute on chronic fibro-stenotic disease. There is prestenotic dilatation of the distal ileum proximal to this area of active disease. There is mesenteric hyperemia in the surrounding area. Again seen is a complex fistulous network in the right lower quadrant, involving multiple loops of distal ileum, appearing similar to the prior study. No fluid collection is identified to suggest abscess formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Acute fibro-stenotic disease involving the neo-terminal ileum with measurements provided above. Again seen is a complex fistulous network in the right lower quadrant involving multiple loops of distal ileum. No evidence of abscess formation.


Instruction: Generate impression based on medical findings.

Input: Any recurrence of enhancing brain lesions? Focal seizures (abated). There is no evidence of intracranial hemorrhage or acute infarct. There is no residual or recurrent abnormal intracranial enhancement. There are a few residual scattered 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. No residual or recurrent abnormal leptomeningeal enhancement. 2. A few residual scattered cerebral white matter lesions are non-specific.


Instruction: Generate impression based on medical findings.

Input: Vertigo, history of stem cell transplantation. There are multifocal restricted diffusion lesions involving bilateral periventricular white matter, thickening of interventricular septum, inferior aspect of caudate nucleus head, pineal gland and mainly bilateral cerebellar white matter as well as right superior, bilateral middle and right inferior cerebellar peduncles. On Gad enhancement, those lesions show nodular and patchy enhancement on periventricular lesions, and mainly patchy enhancement on cerebellar lesions. Gradient echo images show susceptibility artifacts for right cerebellar lesion indicating possible central hemorrhagic conversion.Considering the patient's history of stem cell transplantation, these lesions could represent post transplant lymphoproliferative disease, infiltrative tumours such as CNS lymphoma, lympho-infiltrative vasculitis with possible associated with acute ischemic infarctions and hemorrhagic transformation especially right cerebellar lesion. However, the possibilities of infectious origin cannot be excluded.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Internal Auditory Canal MRIAgain bilateral cerebellar white matter lesions and bilateral middle cerebellar peduncle lesions were seen.However, the inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted.

Output: Multifocal supra and infratentorial nodular and patchy enhancing lesions as described above. Diagnostic possibilities include PTLD, CNS lymphoma, lympho- infiltrative vasculitis with acute ischemic infarctions and hemorrhagic conversion on the right cerebellar lesion as described above.Discussed with Dr. Kline at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: see below History: Rt hand pain eval for etiology Multiple sequences are severely limited secondary to patient motion artifact. Evaluation of the intrinsic ligaments and triangular fibrocartilage complex of the wrist is limited due to lack of intra-articular contrast as well as extensive patient motion artifact.TENDONS: The flexor and extensor tendons appear intact BONES: There is subchondral cyst formation within the lunate and capitate. Note is made of negative ulnar variance. There is increased signal abnormality and fluid sensitive sequences within the lunate bone.ADDITIONAL

Output: 1. Limited examination secondary to extensive patient motion artifact. Negative ulnar variance with increased signal abnormality within the lunate which may reflect early Kienböck's disease/avascular necrosis.2. Nonspecific edema within the pronator quadratus muscle belly. Although there is no corresponding edema within the flexor digitorum profundus and flexor pollicis longus muscle bellies, the possibility of anterior interosseous nerve syndrome could be considered in the correct clinical setting.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with right-sided weakness. Evaluate for bleed, ischemia. Ill-defined area of low attenuation in the pons is new since prior study. The more well-defined focus of low attenuation in the right middle cerebellar peduncle was also not seen on prior study. Further evaluation with MRI is recommended if clinically warranted.Chronic infarct in the posterior limb of the left internal capsule involving the corona radiata is again seen. Nonspecific calcification in the pons has been seen since prior study from November 2009.There is no evidence of intracranial hemorrhage. 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: 1. Ill-defined low attenuation in the pons is new since prior study. More well-defined focus of low attenuation in the right middle cerebellar peduncle was also not seen on prior study. Recommend evaluation with MRI if clinically needed.2. Old infarct in posterior limb of left internal capsule. No acute hemorrhage.


Instruction: Generate impression based on medical findings.

Input: History of testicular cancer. Right testicular seminoma. ABDOMEN:LIVER, BILIARY TRACT: Punctate too small to characterize hyperintensities, likely cysts. No suspicious lesion, biliary ductal abnormality or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing bilateral cysts and too small to characterize hyperintensities. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy. Very small sub-5mm short-axis left periaortic lymph nodes are nonspecific, stable and of doubtful significance.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Small inguinal lymph nodes are unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of bronchus and lung, unspecified site. Evaluate for response to WBRT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple ring-enhancing lesions within the brain parenchyma including right and left temporal lobes, right external capsule, left frontal lobe and right cerebellar hemisphere. The largest lesion is centered in the left temporal lobe which has increased in size from 22 x 27 mm axial dimensions to 42 x 39 mm axial dimensions. The one in the right external capsule has increased from 10 x 8 mm to 14 x 10 mm axial dimensions. One adjacent to the right temporal horn of the right lateral ventricle previously measured 15 x 10 mm and now measures 14 x 9 mm axial dimensions. A left superior frontal gyrus lesion previously measured 7 x 10 mm axial dimensions and now measures the same. A left precentral gyrus lesion has a decreased in size. Previously measured 10 x 8 mm axial dimensions and now measures 4 x 3 mm axial dimensions a right cerebellar lesion has also decreased in size. It previously measured 10 x 11 mm and now measures 7 x 5 mm axial dimensions. A left cutaneous lesion has increased in size from 11 x 8 mm to 12 x 9 mm. There is associated midline shift present which was also present on the prior exam. The internal cerebral veins are shifted approximately 7 mm to the right of midline on the current exam and were shifted by approximately this same on the prior exam. There is associated uncal herniation which was also present on the prior exam.The extent of T2 signal change compatible with vasogenic edema as well as periventricular white matter signal change has mildly progressed compared to the prior exam. Brainstem signal changes remain stableOn susceptibility weighted imaging there are are some punctate foci of signal loss in the left insular cortex and left frontal lobe which were not present on the prior exam.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.Since the prior exam some the patient's lesions have decreased in size while others have increased in size as detailed above.2.There is mass effect with subfalcine and mild uncal herniation. This remains stable.3.Extensive white matter signal changes in the brain parenchyma has increased when compared to the prior exam. In part some this may be related to vasogenic edema and in part some this may be related to posttreatment change. 4.There is a microhemorrhage is present on the current exam which are now present on the prior located in the left hemisphere surrounding the left temporal lobe lesion. It is possible that these are treatment related.


Instruction: Generate impression based on medical findings.

Input: history of leukemia s/p BMT. History of chronic steroid use. History: Lucency and sclerosis at the medial talar dome which may represent osteochondritis dissecans Right ankle: There are vertically oriented linear T1 dark signals through the body/neck of the talus (series 7 image 13) and anterior process of the talus (series 7 image 17), likely representing nondisplaced fractures. There is diffuse bone marrow edema of the talus and subchondral fluid in the talar dome. There is heterogeneous bone marrow edema in the epiphysis and metaphysis of the distal tibia, likely representing bone infarction. There is small joint effusion and ankle soft tissue edema.Left ankle: Crescentic low T1 signal in the talar dome, probably representing osteochondritis dissecans (series 9 image 14). There is diffuse underlying bone marrow edema of the talus. There is heterogeneous bone marrow edema in the epiphysis and metaphysis of the distal tibia, likely representing bone infarction. There is small joint effusion.

Output: 1. Nondisplaced fractures through the right talus.2. Osteochondritis dissecans of the left talar dome. 3. Likely bone infarctions of bilateral distal tibia.


Instruction: Generate impression based on medical findings.

Input: 10-year-old male with sickle cell disease, ACS now with history of seizures and mental status change. There is no evidence of intracranial hemorrhage. Diffuse area of low density seen within the posterior aspect of the right temporal lobe and correlates with subacute ischemic changes and edema seen on brain MRI performed same day.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: Blurring of the gray-white junction and low density seen in the posterior aspect of the right temporal lobe consistent with focal edema due to subacute ischemic process as correlated on an MRI performed same day.


Instruction: Generate impression based on medical findings.

Input: Clinical question:? Intracranial hemorrhage. Signs and symptoms: Status post blunt head trauma and loss of consciousness. CT of brain without infusion:Diffuse periventricular and subcortical foci of decreased attenuation in bilateral cerebral hemispheres are not specific however more likely diagnosis of small vessel disease and multiple sclerosis should be considered. Please correlate with history. There are no old studies available. There is no associated mass effect with the above findings. The cortical sulci and ventricular system remain within normal. There are no old studies for comparison and please correlate with clinical findings and history and if clinically desired follow-up with an MRI is recommended. No evidence of any post traumatic finding is detected.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are unremarkable. No abnormality of the scalp is detected.CT of the maxillofacial region:Paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The ostiomeatal units of maxillary sinuses are patent bilaterally. Images through the nasal cavity demonstrate minimal nasal septum deviation to the left and a very small approximately 3 mm bony septal spur projecting to the left.Images through the orbits demonstrate no evidence of adenopathy.The minimal soft tissue thickening of the right cheek is present.

Output: 1.No evidence of post traumatic finding on CT of brain.2.Findings highly suspect that of advanced small vessel disease or demyelinating disease as described. Follow-up with an MRI is recommended.3.With the exception of minimal soft tissue thickening/edema of the right cheek the CT of maxillofacial region remains within normal.


Instruction: Generate impression based on medical findings.

Input: History of breast cancer and transaminitis with liver lesion seen on ultrasound. Additional history per Epic: left breast reduction/mastopexy for symmetry 8/2/16. ABDOMEN:LUNG BASES: Partially visualized postsurgical changes to the right breast more fully characterized on recent dedicated breast imaging. There is a T2 hyperintense structure within the posterior left breast which measures 2.1 x 3.9 cm and demonstrates a rim of intrinsic T1 hyperintensity as well as possible mild surrounding enhancement. These findings are compatible with postsurgical changes related to breast reduction/mastopexy.LIVER, BILIARY TRACT: The liver parenchyma demonstrates normal signal intensity and enhancement without focal lesions. Specifically, no lesion is identified corresponding with the hyperechoic focus seen on recent ultrasound. The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: On the large field-of-view coronal T2 images, there are two T2 hyperintense cystic structures in the left adnexa the largest of which measures up to 3 cm and demonstrates complex features.

Output: 1.Normal appearance of the liver without focal lesions.2.Complex cystic structures in the left adnexa measuring up to 3 cm. Though these may be related to a benign etiology, pelvic ultrasound is recommended for further characterization to exclude the possibility of neoplasm.3.Small fluid collection within the left breast likely related to recent mastopexy/reduction.


Instruction: Generate impression based on medical findings.

Input: 55 year-old woman with sickle cell disease, mild pulmonary hypertension with exercise associated hypoxia, diastolic dysfunction and renal disease. Resting echocardiogram suggested mildly reduced LVEF and wall motion abnormalities. Stress MRI ordered to rule out ischemia and to assess for iron overload MEDICATIONS: ASA and Furosemide 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 moderate-severely dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 119 ml/m2 (normal range: 65+/-11), the LVEDV is 200 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 93 ml (normal range 31+/-10), the LV mass index is 86 g/m2, and the LV mass is 144 g. There tardokinesis of the basal inferior and inferolateral walls. T2* (myocardium) = 43ms. T2* (liver) = 4.6 ms.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is is mildly dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 183 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 69 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is evidence of iron overload in the liver. Interstitial changes noted in both lungs. There is axillary adenopathy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate-severely dilated LV with low normal systolic function (LVEF 53%). There tardokinesis of the basal inferior and inferolateral walls. 4. T2* (myocardium) = 43ms. T2* (liver) = 4.6 ms. This is consistent with iron overload of the liver but no evidence of myocardial iron overload.5. Mildly dilated RV with normal systolic function (RVEF 62%).6. Moderately dilated left atrium. Mildly dilated right atrium.


Instruction: Generate impression based on medical findings.

Input: 41 years Male (DOB:8/29/1975)Reason: RLE radiculopathy History: samePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE 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 well formed disc at S1-S2 and associated pseudoarticulation along the sacral alla. In general the lumbar spinal canal is small on a congenital basis. The nerve roots within the thecal sac at the L4 vertebral level and at the L3 vertebral level appear to be peripherally distributed. This pattern was present on the previous exam and is unchanged.At L5-S1 there is loss of disc space height, disc desiccation and a broad-based central disc protrusion without significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation and a broad-based left paramedian disc extrusion. Since the prior exam patient is undergone left-sided facet and laminar surgery at this level there is contrast enhancing soft tissue present along the left hemicord canal and surgical site. There is effacement of the fat at the lateral recesses bilaterally at this level but worse on the left. The right. There is some crowding of nerve roots within the thecal sac present.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: 1.Status post L4-5 left posterior element and hemicanal surgery. Contrast enhancement within the left hemicord canal may be related to postsurgical change. Early scar formation cannot be excluded.2.There is a moderate degree of spinal stenosis present at L4-5 related predominantly to a broad-based left paramedian disc extrusion.3.The spinal canal is small congenital basis.


Instruction: Generate impression based on medical findings.

Input: 82 year old male with multiple myeloma and weakness. Evaluate for spinal lesions or cord compression. No evidence of spinal cord compression. There are subtle apparent punctate foci of increased STIR signal in the cervical spinal cord, for instance posterior to the C3-4 vertebral body, which are presumably artifactual and are not well assessed.Multiple small T1 hypointense lesions are seen at multiple vertebral levels including T6, T8 and T9, which are nonspecific and may be related to patient's history of multiple myeloma. There are no large lesions.The oblique T7 vertebral body fracture is again seen without significant loss of height or evidence of edema associated with the fracture to suggest that the fracture is recent. There is normal height of the remaining vertebral bodies in the spine. There is is loss of the cervical lordosis and increased kyphosis of the thoracic spine. There is grade 1 anterolisthesis of L4 on L5 and minimal retrolisthesis of L5 on S1. Multilevel degenerative changes are also seen most prominent in the cervical and lower lumbar spine, which contributes to suspected mild spinal canal stenosis at the L2-3 and L3-4 levels.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Scattered small T1 hypointense ossific lesions in the thoracic spine, which may relate to patient's history of multiple myeloma. There are no large lesions.3.Oblique linear fracture involving the T7 vertebral body without edema to suggest acuity or significant loss of height.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Spina bifida with hydrocephalus, unspecified region. Dizziness and giddiness Syncope and collapse Presence of cerebrospinal fluid drainage deviceClinical question: h/o vp shunt, Chiari malformation with falls and dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniectomy. The cerebellar tonsils are low lying and pointed. The tips of the tonsils extend to the C1 vertebral level.There is biphasic flow at the level of the foramen magnum on the CSF flow study.A ventriculostomy tube courses through the right frontal lobe into the left lateral ventricle and has its tip in the left basal ganglia. The lateral ventricles are not dilated.There is redemonstration of a T2 hyperintense focus which is low signal on FLAIR and T1-weighted imaging following CSF space on all pulse sequences located in the left thalamus which is stable compared to prior exams.The sella is enlarged and a partially empty. There is a nonenhancing focus present along the left half of the sella against the left cavernous sinus which is unchanged since the prior exam this appearance has been unchanged since the prior exam of 3/21/14 and has been present since exams dating back to 2009 when it was thinner.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The lateral ventricles are stable in size compared to prior exams. The patient is status post suboccipital craniotomy and has Chiari I malformation. There is no change in appearance compared to the prior exam. The patient's ventriculostomy shunt catheter is in stable position.2.There is a nonenhancing lesion in the pituitary fossa, eccentric towards the left side significance is uncertain. It has been stable since the prior exam but was thinner in 2009. The possibility this represents some atelectatic pituitary adenoma cannot be excluded. Please correlate with clinical symptoms. Continued follow-up would be appropriate.


Instruction: Generate impression based on medical findings.

Input: The evaluation for leptomeningeal metastatic disease is nondiagnostic given the lack of intravenous contrast.Cervical spine:Artifact limits evaluation of the lower cervical spine axial T2 sequence. There is straightening of the normal cervical lordosis. The vertebral body heights are grossly preserved. The bone marrow demonstrates heterogeneous marrow signal. There is no evidence of acute fracture. Mild degenerative spondylosis affects the cervical spine. A Schmorl's node is noted along the inferior endplate of C4. Disc osteophyte complexes are noted at C3-4 through C6-7 without significant spinal canal stenosis or neural foraminal narrowing. The cervical cord is normal in caliber and signal. The thyroid is incompletely assessed only on the sagittal images and appears heterogeneous as well as slightly prominent.Thoracic spine:There is signal dropout limiting evaluation of the STIR sequence cranially. The axial T2 images of the lower thoracic spine are nondiagnostic. Alignment of the thoracic spine is within normal limits. Vertebral body height is grossly preserved. The bone marrow signal is mildly heterogeneous. No evidence of acute fracture. Mild degenerative spondylosis affects the thoracic spine. Schmorl's nodes are present at the T8 and T9 superior endplates and T10 inferior endplate. No significant spinal canal stenosis or neural foraminal narrowing. The spinal cord is normal in caliber and signal.Lumbar spine:The axial T1, T2, and sagittal STIR sequences were not performed. Alignment of the lumbar spine is anatomic. The vertebral body heights are preserved. The bone marrow signal is within normal limits. Minimal disc protrusions affect the lower lumbar spine. There is no significant spinal canal stenosis or neural foraminal narrowing at any level. The visualized distal cord and conus medullaris are normal in caliber and signal. The cord terminates at L2-3.

Output: 1. Nondiagnostic evaluation for leptomeningeal metastatic disease given the lack of intravenous contrast.2. No evidence of abnormal cord signal or spinal canal stenosis.3. Incompletely assessed, but mildly prominent and possibly heterogeneous thyroid gland. Please correlate with physical exam.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with severe endometriosis s/p TAH, LSO. Now with severe pelvic pain, constipation History: abdominal pain, constipation PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Small right ovarian follicle.There is spiculated enhancing tissue in the pelvis, the region of the rectosigmoid, measuring approximately 4.5 x 2.6 cm (903/67), likely representing endometriosis. This tissue surrounds the rectosigmoid, extending along left lateral pelvic sidewall, and causes obstruction of the left distal ureter (7/30).BLADDER: Dilated left ureter.LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: There is bowel wall thickening involving the rectum and distal sigmoidBONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1.Soft tissue within the pelvis, surrounding the rectosigmoid, is suspicious for endometriosis.2.Bowel wall thickening of the adjacent rectosigmoid may suggest an associated colitis.


Instruction: Generate impression based on medical findings.

Input: Posterior triceps pain, lateral pain Please note exam is limited with absence of patient placed marker identifying the site of patient pain.LIGAMENTS: No significant abnormality noted. Specifically ligaments are intactTENDONS: No significant abnormality noted. All tendons are observed, specifically attention was placed on the triceps which is unremarkable and without evidence of intrasubstance abnormality or definite distinct tear. Please note however only the distalmost portion and insertion is observed, if patient symptoms are beyond 3 cm from the olecranon insertion, this anatomy may be outside the field of view and evaluation.ARTICULAR SURFACES AND BONE: Small elbow effusion without overt osseous abnormality or evidence to suggest erosions. Marrow signal unremarkable SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Small effusion and no discrete additional focal abnormality with limitations described above. Please correlate


Instruction: Generate impression based on medical findings.

Input: History of 3 mm pancreatic body cyst on outside CT. History of prostatectomy in 2008 for prostate cancer. Evaluate for abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Few nonenhancing T2 hyperintense hepatic lesions are identified, compatible with cysts, the largest within segment 5 measures 2.7 x 1.7 cm. No enhancing hepatic lesion is identified. The liver is smooth in contour and normal in morphology. The portal and hepatic veins are patent. No biliary ductal dilatation is identified.SPLEEN: No significant abnormality noted.PANCREAS: There is a 9 mm cystic lesion arising from the pancreatic head (series 5, image 77) contiguous with a side branch of the main pancreatic duct, probable sidebranch IPMN. No pancreatic ductal dilatation is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large lesion containing multiple cysts arising from the left lower pole measuring 14.2 x 12.4 cm (series 3, image 30), favor multilocular cystic nephroma given lack of enhancing or nodular components. Multiple right subcentimeter T2 hyperintense lesions are present, too small to characterize, but probable cysts. No hydronephrosis is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter cystic lesion within the pancreatic head, probable IPMN.2.Large left renal cystic lesion, favor multilocular cystic nephroma, but unable to exclude cystic renal cell carcinoma.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old, with right sided weakness. MRI head:No restricted diffusion is seen. Mild patchy periventricular white matter T2 hyperintensity is noted, a nonspecific finding. No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricular system is normal in size and morphology.MRA head:No significant vascular stenosis or occlusion is identified. No aneurysm or vascular malformation is suspected within the limitations of technique.MRA neck:The origins of the great vessels are patent. No significant stenosis is detected in the carotid vessels by NASCET criteria. Likewise, the vertebral vessels are free of significant stenosis. The right vertebral artery is slightly larger than the left.MRI cervical spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is detected. No enhancing lesions are seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Minimal facet and uncovertebral hypertrophy. No spinal canal stenosis. Moderate left foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Minimal disc osteophyte formation slightly asymmetric to the left foraminal region. Mild facet hypertrophy. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C6-7: Disc osteophyte formation with a right paracentral disc extrusion. Effacement of the right ventral thecal sac without significant generalized canal stenosis. Mild facet hypertrophy. No significant foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality is seen. At most, there are findings which may relate to mild chronic microvascular disease.2.No significant vascular lesions are detected in the head or neck.3.Disc osteophyte formation with a right paracentral disc extrusion is seen at C6-7. This results in effacement of the right ventral thecal sac but there is no significant canal stenosis.4.Moderate left-sided foraminal narrowing is seen at C3-4 and C5-6. No other significant spinal canal or foraminal stenosis is detected.


Instruction: Generate impression based on medical findings.

Input: 64-year-old woman with history of HCC status post TACE/RFA in April 2015. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in segment 5 (1011/172) appears similar to the prior examinations without evidence of arterial enhancing lesion. The liver is cirrhotic in morphology.No intra or extrahepatic biliary ductal dilatation. The patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral breast prostheses noted. Mild degenerative changes in the lumbar spine noted.OTHER: No significant abnormality noted.

Output: Segment five ablation zone without evidence of local recurrent or new disease.


Instruction: Generate impression based on medical findings.

Input: The evaluation of the study for infection is limited due to the study performed without contrast.The vertebral bodies demonstrate stable mild anterior wedging of L1. Along the anterior superior endplate of L4 there is a small area of low T1 signal with high T2 signal, with no definite corresponding lesion on the previous CT although there is minimal marginal sclerosis noted. This may represent early degenerative changes or an atypical hemangioma. The neural foramina are normal and there is no spinal stenosis at any level of the lumbar spine. There is no evidence of nerve root thickening. There is no epidural fluid collection. No marrow signal abnormality is identified concerning for infection. There is no diffusion restricted "claw sign" to suggest discitis/osteomyelitis. The discs appear normal with no evidence of degenerative changes.The conus ends at the level of L1-L2. Incidentally a thin linear T1 weighted hyperintensity is seen along the dorsal aspect of the distal thecal sac at the level of S1 that represent an incidental fatty filum.There is a small round lesion of CSF signal along the left S2 foramen that measures 6 mm in diameter, and represents a Tarlov cyst.The common bile duct is prominent for age with a diameter of 8 mm. Atrophic kidneys are seen. There is a transplanted kidney that is seen in the right hemipelvis.

Output: 1. No evidence of spinal infection within limitations of noncontrast technique.2. Incidental fatty filum, most likely a normal variant but can be associated with tethered cord. Recommend clinical correlation. 3. Mild stable anterior wedging of L1.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval GBM. Pt is on a trial of HSPPC96 vaccine.Signs and Symptoms: GBM. There is redemonstration of a left temporal lobe mass is T2 signal abnormality measures 68 x 43 mm in axial dimensions and appears to have extended a little more posteriorly on the current exam relative to the prior exam. A cystic component along its inferior anterior aspect appears smaller on the current exam. The cystic component currently measures 17 x 18 mm axial dimensions and previously measured 25 x 28 mm axial dimensions. On sagittal imaging the enhancing component currently measures 59 x 40 mm and previous and measured 36 x 52 mm. Cerebral blood volume map demonstrates elevated cerebral blood volume in the central portion of the mass. Serpiginous flow-voids are identified within the central portion of the tumor on susceptibility weighted imaging.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.Since prior exam the patient's left temporal lobe mass has enlarged and appears to have infiltrated further back posteriorly. It is associated with increased cerebral blood volume suggesting increased microvascular within the tumor.


Instruction: Generate impression based on medical findings.

Input: Pain anterior to ankle just distal to the tibia. Rule out AVN TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically the marrow signal is normal throughout, no specific findings to suggest a vascular necrosis within the ankle, specifically the talus and talar dome. Alignment preserved. No degenerative changes identified ADDITIONAL

Output: Normal exam


Instruction: Generate impression based on medical findings.

Input: Reason: CHF, CAD, new conduction abnormailities, ?viable myocardium History: DOE Left VentricleThe left ventricle is normal in size. There is global mild hypokinesis. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 72g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest myocardial infarct.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17). No evidence of right heart strain.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. The anterior leaflet is thickened. There is mitral regurgitation, estimated to be mild. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation directed posteriorly, reported to be severe on recent echocardiogram. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Within the right inferior lobar pulmonary artery and several lower lobe segmental branches, non occlusive foci of low signal are highly suspicious for pulmonary emboli (401/16 and (501/32). Potential small segmental and subsegmental pulmonary artery filling defects cannot be entirely excluded.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsModerate right and small left pleural effusions. A peripheral triangular high signal focus is suspicious for pulmonary infarct (2201/1). There is apparent bronchial wall thickening in the right lower lobe with right upper and lower lobe parenchymal areas of high signal. This may be sequelae of aspirated blood.

Output: 1. No left ventricular myocardial enhancement to suggest an infarct. LVEF = 50% due to global mild hypokinesis.2. Low signal foci within the right inferior lobar and segmental pulmonary arteries highly suspicious for pulmonary emboli. This can be confirmed with CTA PE thorax if clinically appropriate.3. There is apparent bronchial wall thickening in the right lower lobe with parenchymal areas of high signal. This may be sequelae of aspirated blood.


Instruction: Generate impression based on medical findings.

Input: 52 year old female with history of hypertension, coronary artery disease s/p multiple PCI, dyslipidemia and sarcoidosis presenting for cardiac evaluation. MEDICATIONS: aspirin, amlodipine, clopidogrel, rosuvastatin, hydrochlorothiazide, isosorbide mononitrate, losartan and metoprolol First Pass PerfusionDuring hyperemia, the patient has a perfusion defect involving the basal inferior wall, the mid anteroseptal, anterior, anterolateral, inferior, and inferoseptal walls, and the entire LV apex. The perfusion defect is in the usual territory of the LAD and RCA.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 and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 69 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 108 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. There is communication between the left and right atria, likely consistent with patent foramen ovale. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is thickened and calcified with evidence of flow acceleration. Correlation with echo suggested to further quantify/ determine severity of aortic valve sclerosis/ stenosis.Mitral ValveThe mitral valve opens widely and there is at least mild, eccentric, mitral regurgitation. The anterior leaflet of the mitral valve was thickened and possibly calcified.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a large lymph node (22mm) in the left axilla. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Large perfusion defect/ "ischemia" noted in LAD and RCA territory.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. Thickening/ calcification noted on aortic and mitral valves. 6. Small patent foramen ovale is note.7. Large left axillary lymph node noted.When compared to the prior study from 2/2009, there is no longer late gadolinium enhancement present.Findings conveyed to Dr. DeCara.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: Altered mental status. Evaluate for a cerebral abscess. Status post evacuation 11/22/2016. Additional EMR indicates patient is undergoing a seizure workup. The exam is limited along the right convexity and adjacent scalp secondary to artifact from a ventriculoperitoneal shunt device. The right sided predominantly T1 hyperintense subdural collection is slightly smaller in size, measuring 16 mm in maximal thickness. The midline shift has improved from 5 mm down to 2 mm. Susceptibility and diffusion weighted images are limited in the presence of a right sided ventriculoperitoneal shunt device positioned under the scalp but there appear to be blood products within the collection. There is evidence of a right parietal burr hole and a intraparenchymal tract measuring up to 20 mm with T1 hyperintense fluid and restricted diffusion in the right parietal brain parenchyma, as well as mild surrounding enhancement. There is susceptibility abnormality in this region as well, indicating the presence blood products. There is extensive surrounding T2 hyperintensity. There is avid diffuse enhancement and thickening of the pachymeninges which also extends to the contralateral frontal region. There is a 2 mm thick subdural collection along the posterior left temporal lobe convexity. The right frontal approach ventriculostomy catheter is unchanged in position with the tip in the frontal horn of the right lateral ventricle. The right lateral ventricle has slightly less effacement compared to the prior exam. There is diffuse T2 hyperintensity in the right hippocampus. There is no evidence of territorial infarction. The major cerebral flow voids are intact. There is a left maxillary sinus mucous retention cyst.

Output: 1.Decrease in size of the subacute right cerebral convexity subdural fluid collection with improvement in the midline shift and slight improvement in the right lateral ventricular effacement. 2.Avid diffuse pachymeningeal enhancement in the right cerebral hemisphere with extension to the contralateral frontal region is nonspecific and be reactive or related to superimposed. 3.A surgical defect in the right parietal lobe with surrounding edema may represent a subacute hemorrhagic lesion perhaps with superimposed infection and associated cerebritis.4.A small left temporal convexity subdural collection may represent addition hemorrhage or perhaps an empyema.5.Edema in the right hippocampus is likely related to seizure activity.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: Metastatic melanoma with headaches. Preop planning for tumor resection. Limited stealth MRI of the brain for presurgical planning again demonstrates a large parenchymal lesion within the right frontal lobe with heterogeneous internal characteristics. The lesion previously showed prominent susceptibility artifact compatible with blood product. Adjacent to the left anterior aspect of this lesion again demonstrates a small triangular region of tissue with some degree of enhancement. There is significant surrounding edema, mild subfalcine herniation, and mass effect on the right lateral ventricle.Redemonstrated is a resection cavity at the convexity of the left frontal lobe which appears unchanged. An additional lesion within the right precuneus, now measuring no more than 9 x 8 mm, previously 9 x 7 mm.

Output: 1. Limited stealth MRI of the brain for presurgical planning. No significant interval change in the lesions in the right frontal lobe and right parietal lobe. 2. Stable left frontal lobe resection cavity.


Instruction: Generate impression based on medical findings.

Input: Injury, other and unspecified, unspecified site (fracture of facial bones, rupture of diaphragm, renal injury etc). Motor vehicle collision with pedestrian, pedestrian injured MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is subtle T2 and FLAIR signal hyperintensity along the medial aspects of the cerebellar hemispheres. There is a small focus T2 and FLAIR signal hyperintensity along the lateral aspect of the left orbital gyrus.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 partially opacified. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.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.There is fluid in the posterior nasopharynx and oropharynx.There are pleural effusions and partial opacification of the right lung apex.There appears to be a tubular structure looped in the patient's hypopharynx.

Output: 1.Findings suggest subtle injuries to the left orbital gyrus and medial aspects of the cerebellar hemispheres.2.No evidence for cervical spinal cord injury.3.The patient has known skull base and facial fractures. Please refer to prior CT exams for further comments.4.The nasogastric tube is suspected to be looped in the patient's nasopharynx.5.Pleural effusions and lung opacity. Please refer to chest x-ray for further comments.


Instruction: Generate impression based on medical findings.

Input: There is extensive subcortical and periventricular white matter abnormal T2 signal along with additional foci within the pons and bilateral basal ganglia. This is consistent with chronic small vessel ischemic disease and old lacunar infarcts. Of note, there are no significant cerebellar lacunar infarcts. There are no diffusion-weighted abnormalities to suggest acute ischemia. There is no abnormal enhancement within the brain. There is trace focal ectasia of the left anterior cerebral artery just prior to its first bifurcation, which was present on prior CT. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. There is no mass effect or midline shift. There are no extra-axial fluid collections. There is a small mucous retention cyst in the left maxillary sinus.The left mid to distal parotid duct is significantly dilated, measuring up to 12 mm in greatest diameter, and beaded in appearance proximally within the glandular tissue. Within the dilated portion, there is no definite filling defect or enhancing lesion. No obstructing hyperdense stone is noted on prior CTA. The left parotid gland is slightly atrophic compared to the right with areas of minimal fatty replacement.

Output: 1. No evidence of acute ischemia or mass within the brain.2. Extensive white matter T2 signal abnormality involving the brainstem, basal ganglia, and periventricular and subcortical white matter which represents chronic lacunar infarcts and extensive chronic small vessel ischemic disease. 3. Dilated left Stensen duct without definite obstructing lesion within the dilated portions and slightly atrophic left parotid gland; correlate with history of chronic sialadenitis. Otherwise, MRI of the face with contrast may be considered for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Status post left DBS; now planning for right DBS. There are postoperative findings related to left transfrontal deep brain stimulator insertion, which terminates in the region of the left cerebral peduncle. 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.

Output: Expected postoperative findings related to left transfrontal deep brain stimulator insertion.


Instruction: Generate impression based on medical findings.

Input: Reason: structural brain lesion History: headache 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 and demonstrate mucus retention cysts in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on medical findings.

Input: Male, 21 months old, unresponsive, with loss of most brainstem reflexes, breathing over the vent. Assess degree of neurologic injury after prolonged cardiac arrest. Diffuse abnormal cortical and subcortical T2/FLAIR hyperintensity is seen within the cerebral hemispheres, the basal ganglia, cerebellum and to a lesser degree the brainstem. Note is also made of diffuse extensive cortical T1 hyperintensity particularly involving the basal ganglia and the cortex of the posterior frontal lobes, parietal lobes, occipital and temporal lobes. No clear restricted diffusion is seen.There may be trace scattered parenchymal susceptibility suggesting a small amount of hemosiderin deposition. Note is made of small bilateral parietal and occipital extra-axial collections which demonstrate T1 hyperintensity. The sulci and ventricles have widened compared to prior CT examinations.

Output: Sequelae of extensive hypoxic ischemic injury are demonstrated including diffuse abnormal T2/FLAIR signal and cortical T1 hyperintensity suggesting laminar necrosis. The cerebral hemispheres, deep gray nuclei, cerebellum and to a lesser degree the brainstem are all involved.Since prior CTs, the sulci and ventricles have widened which may represent a combination of resolving edema and loss of parenchymal volume.Note is made of small subacute likely subdural hematomas along the bilateral parietal and occipital lobes.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female with history of ependymoma in remission presenting with a waxing and weaning of mental status. Redemonstrated are stable changes from previous right suboccipital craniotomy. The fourth ventricle remains dilated similar to the prior examination. No evidence of worrisome signal abnormality or pathologic enhancement is detected the posterior fossa or elsewhere in the brain. Diffusion weighted images are normal. Cerebral morphology and signal characteristics are unremarkable. The supratentorial ventricular system is stable and normal in size. No abnormal fluid collections are detected. Expected vascular flow voids are demonstrated. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of recurrent tumor in the brain.2.No MRI evidence of acute intracranial pathology to explain the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with breakthrough seizures and bilateral spasticity due to prior intracranial hemorrhage, ischemic stroke and microhemorrhages. An 8 mm mildly diffusion restricting lesion is seen within the left corona radiata. A larger region of mild restricted diffusion, spanning approximately 2 cm, is seen in the anterior medial right occipital lobe.Extensive patchy and focal areas of T2 hyperintensity are seen within the cerebral hemispheres and the cerebellum with a distribution which is overall similar to the prior examination. Very mild local edema is seen in the anterior medial right occipital lobe. Otherwise, no significant mass effect is detected.No evidence of acute intracranial hemorrhage is seen. Numerous scattered punctate foci of susceptibility are seen throughout the brain compatible with chronic microhemorrhage appearing similar to prior. A more extensive region of hemosiderin staining along the right thalamic contour may relate to a prior hemorrhagic lesion. Ventricular size and contour are unchanged.

Output: 1.An area of late acute or subacute right PCA distribution ischemia is seen involving the anterior medial occipital lobe.2.A late acute or subacute small vessel ischemic stroke is evident in the left corona radiata.3.Evidence of extensive prior ischemia with scattered microhemorrhage is grossly unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old, with multiple sclerosis and worsening left leg weakness and ataxia. Brain:Image quality is degraded by motion artifact. Within this limitation, the following observations are made.A mixture of discrete and patchy confluent T2 hyperintense lesions are evident in the periventricular regions and, to a lesser extent, subcortical white matter of the bilateral cerebral hemispheres. Many of these lesions are oriented radially with respect ventricles. Most demonstrate T1 hypointensity relative to the surrounding white matter. Lesions are also evident within the basal ganglia, brainstem and the posterior fossa.At least 8 of the above-mentioned lesions demonstrate either complete or partial rim enhancement including lesions in the bilateral frontal lobes, the bilateral occipital lobes, and the right temporal lobe.No evidence of mass effect is seen. No parenchymal edema is detected. Ventricles and sulci are mildly prominent for age indicating a degree of parenchymal volume loss. The corpus callosum is mildly thinned.C-spine:A T2 hyperintense nonenhancing lesion is evident within the central cord at the C2-3 level extending approximately 20 mm in the craniocaudal dimension. A smaller T2 hyperintense nonenhancing lesion is evident in the dorsal cord at the C4 level.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No evidence of significant degenerative disc disease, spinal canal or neuroforaminal stenosis is seen.

Output: 1.Numerous supratentorial and infratentorial lesions compatible with multiple sclerosis. A number of these lesions demonstrate evidence of rim enhancement compatible with active demyelination.2.Two nonenhancing lesions are evident within the cervical spinal cord, also compatible with demyelination.


Instruction: Generate impression based on medical findings.

Input: 20 year-old female. Right knee injury playing ultimate Frisbee, foot planted, knee shifted, felt a pop. MENISCI: There is a vertical band of increased signal intensity along/within the peripheral fibers of the posterior horn of the medial meniscus, suggestive of a complete longitudinal tear. Although we see no discrete lateral meniscal tear, the popliteomeniscal fascicles are thickened and indistinct, which can be associated with peripheral tears of the posterior horn.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral tibial plateau as well as the lateral femoral condyle above the posterior horn of the lateral meniscus indicating bone contusions. There are also smaller foci of edema within the posterior aspect of the medial tibial plateau and along the far medial aspect of the medial femoral condyle, likely representing contusions as well.LIGAMENTS: The ACL is indistinct and of increased signal intensity particularly along its proximal fibers compatible with a full-thickness tear. The PCL is intact. Edema along the MCL suggests a sprain although the ligament itself appears intact. There is also edema along the LCL proper although the ligament itself appears intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Full thickness tear of the ACL with associated bone contusions.2. Findings suggestive of a longitudinal tear of the peripheral fibers of the posterior horn of the medial meniscus.3. Although we see no discrete lateral meniscal tear, thickening and poor definition of the popliteomeniscal fascicles can be associated with peripheral tears of the posterior horn of the lateral meniscus.4. Joint effusion and soft tissue edema, as described above.


Instruction: Generate impression based on medical findings.

Input: Anterolateral ankle pain TENDONS: There is longitudinal split tearing of the peroneus longus at and distal to the peroneal tubercle. The remaining tendinous structures appear intact.LIGAMENTS: The lateral collateral ligament complex and the distal syndesmotic complex are intact. There is loss of the normal fatty striations of the deep fibers of the deltoid which may reflect prior sprain; however the deltoid ligament complex otherwise appears intact.ARTICULAR SURFACES AND BONE: There is a nondisplaced fracture of the base of the anterior process of the calcaneus with edema in the adjacent marrow. There is low signal intensity along the fracture margin suggesting it is subacute in nature. The anterior process of the calcaneus also appears prominent and closely approaches the lateral margin of the navicular raising the question of a nonosseous coalition. There is a small subtalar effusion. There is mild osteoarthritis of the tibiotalar joint and talonavicular joints but there is no evidence of an osteochondral defect. Additional osteoarthritic changes are seen in the midfoot and tarsometatarsal joints. A tiny amount of fluid signal is seen dorsal to the head of the talus which may represent a synovial cyst or ganglion.ADDITIONAL

Output: 1. Nondisplaced fracture through the base of the anterior process of the calcaneus with possible nonosseous calcaneonavicular coalition.2. Osteoarthritis of the ankle and foot as described above without evidence of focal osteochondral defect.3. Longitudinal split tearing of the peroneus longus which is of questionable clinical significance.4. Additional findings described above.


Instruction: Generate impression based on medical findings.

Input: Planning for stereotactic brain biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this study.Stealth enhanced head CT for stereotactic brain biopsy protocol is utilized.There is poor visualization of a previously known mass in the inferior fourth ventricle. Compared to priors stealth brain MRI protocol there is no definitive operation interval change. This tumor however it is very poorly defined on this exam and precise measurement is not possible.This is study is otherwise unremarkable.

Output: stealth enhanced head CT for surgical planning. Exam very poorly visualizes patient's known tumor in the inferior fourth ventricle.


Instruction: Generate impression based on medical findings.

Input: 18-year-old female with history of fall, knee pain, swelling, and instability. Evaluate for ACL tear. MENISCI: Increased linear signal in the posterior horn of the medial meniscus extending to the inferior articular surface compatible with meniscal tear. The lateral meniscus is normal in signal and morphology.ARTICULAR CARTILAGE AND BONE: Increased T2 signal within the lateral femoral condyle, posterior tibial plateau, and the fibular head compatible with contusions with probable underlying microtrabecular fractures.Again noted is a broad-based central exostosis of the anterior metadiaphysis of the femur consistent with an osteochondroma.LIGAMENTS: The anterior cruciate ligament demonstrates abnormal increased signal as well as abnormal morphology compatible with a tear; a few fibers appear intact at the origin.The posterior cruciate ligament is intact. Grade 1 sprain of the medial collateral ligament; otherwise, the collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Findings consistent with anterior cruciate ligament tear.2.Vertical tear of the posterior horn of the medial meniscus.3.Osseous contusions with probable microtrabecular fractures as detailed.4.Large knee joint effusion.5.Grade 1 sprain of the medial collateral ligament.6.Sessile osteochondroma of the distal metadiaphysis of the anterior femur.


Instruction: Generate impression based on medical findings.

Input: 66 year old female with cognitive impairment, altered mental status, evaluate for stroke or brain injury MRI Brain: 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. There is global parenchymal volume loss, relatively greater in the bilateral frontal and parietal lobes. There is hippocampal volume loss which is not disproportionate to the remainder of the brain. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Small foci of volume loss and FLAIR hyperintensity along the left lateral ventricle margin are compatible with lacunar infarcts. Brain parenchyma is otherwise unremarkable for age. 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. MRA Brain: There is irregularity and moderate narrowing involving the bilateral cavernous internal carotid arteries likely related to atherosclerotic disease. There is diminished flow-related enhancement involving the left distal vertebral artery with reconstitution distally. The bilateral ACAs, MCAs, basilar artery, and PCAs demonstrate no significant stenosis. No aneurysms are appreciated.

Output: 1. No evidence of acute infarct, mass or mass effect. 2. Mild chronic small vessel ischemic disease. 3. Global parenchymal volume loss relatively greater in the bilateral frontal and parietal lobes.3. Intracranial atherosclerotic disease with moderate narrowing involving the cavernous internal carotid arteries and V3 segment of the left vertebral artery. These stenoses can be better visualized with CTA if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Low back pain For the purposes of numbering, the most inferior well-defined disc space is labelled L5-S1. Again seen is a severe compression fracture involving the L3 vertebral body with approximately 70% loss of height similar to prior. There is edema involving the L3 vertebral body, also similar to prior. Interval placement of cement/kyphoplasty at the L3 vertebral body is seen. No significant osseous retropulsion.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia.The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to priorDegenerative changes are specified by the intervertebral level as follows and unchanged since 2/22/2016: T12-L1: No spinal canal or neural foraminal stenosis.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge without significant change in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild spinal canal stenosis and mild bilateral foraminal stenosis, relatively worse on the right. L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.

Output: 1. Compared to 2/22/2016, there is no significant change in moderate to severe spinal canal stenosis at the L2-L3 level.2. No significant change in compression fracture with approximately 70% height loss of the L3 vertebral body with interval changes of vertebroplasty.3. Unchanged appearance of the low-lying conus which extends to the L5 level. Again seen is evidence of prior cord detetherings. 4. Degenerative changes at additional levels as detailed above.


Instruction: Generate impression based on medical findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (3/31/15, 4/6/15, 10/9/15, 11/2/15), ultrasound images of right breast (10/12/15), images from ultrasound guided biopsy and postprocedural right mammographic images (11/2/2015), breast MRI (11/10/2015), ultrasound images of right breast (11/12/2015), images from stereotactic needle biopsy of right breast and postprocedural right mammographic images (11/19/2015) performed at Presence St. Joseph Medical Center. For comparison, digital mammographic images (1/11/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/31/15, 4/6/15, 10/9/15, 11/2/15): The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution.In the right breast at lateral aspect around 9:00 position, there are pleomorphic calcifications, including fine linear type with a developing focal asymmetry. The calcifications are extending segmentally in discontiguous fashion, measuring 60 x 40 mm (AP x LR). The focal asymmetry is present at posterior aspect of these calcifications, measuring 11 mm. There is another asymmetry seen best on CC view at medial anterior aspect of the right breast measuring 7 mm.A circumscribed oval mass with multiple coarse benign-appearing calcifications is present at 12:00 position in the right breast, likely a fibroadenoma.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/12/15):Ill-defined hypoechoic mass measuring 7 x 9 mm at 9:00 position with echogenic rim is detected, corresponding to the focal asymmetry seen on the mammogram at posterior aspect of the segmentally distributed calcifications.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/2/2015):Ultrasound guided biopsy was performed for the mass at 9:00 position with an appropriate needle placement. Postprocedural mammograms demonstrate a marker clip (Hydromark) at the site of the focal asymmetry at 9:00 position in the right breast.Per outside radiology report, the result was malignant.BREAST MRI (11/10/2015):The study was performed with a protocol outlined in the outside report.There are 2 enhancing masses in the right breast, one at 9:00 position measuring 19 x 13 x 12 mm (AP x LR x CC), and the other at 3:00 position measuring 14 x 21 x 11 mm. The one at 9:00 position is proven carcinoma and the marker clip is present at the anterior aspect of this mass. Non-mass enhancement is present between the two masses, measuring 49 x 71 x 20 mm.No abnormal enhancement is seen in the left breast.No abnormal lymph nodes are present in either axilla.ULTRASOUND IMAGES OF RIGHT BREAST (11/12/2015):The study was performed as second look ultrasound to look for a correlate of MR detected mass at 3:00 position in the right breast. No sonographic correlate was detected in this study.IMAGES FROM STEREOTACTIC NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/19/2015):Stereotactic biopsy was performed for the asymmetry best seen on CC view at medial right breast, because the asymmetry is likely correlating to the MR detected mass at 3:00 position. Postprocedural mammograms demonstrate a marker clip at upper inner aspect of the right breast, near the site of the enhancing mass seen on the MRI. Distance between 2 clips is 135 mm on CC view.Per outside radiology report, the biopsy result was malignant; invasive ductal carcinoma.

Output: 1. Biopsy proven carcinoma in the right breast, 2 sites; one at 9:00 position and the other at 3:00 position. Mammograms demonstrate suspicious calcifications segmentally at lateral right breast and MRI demonstrates extensive non-mass enhancement between the two malignant masses in the right breast.2. No mammographic or MR evidence of malignancy in the left breast.3. No MR evidence of abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on medical findings.

Input: Diagnosis: CervicalgiaClinical question: neck pain, right arm and leg sensory disturbanceSigns and Symptoms: as above 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. There is a disc bulge present at this level associated with some endplate osteophytes and uncovertebral osteophytes.At C5-6 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with some endplate osteophytes and uncovertebral osteophytes. There is some mild encroachment of the exiting nerve roots within the neural foramina bilaterally at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.A number of lymph nodes identified within the soft tissues of the neck don't quite meet size criteria for adenopathy

Output: 1.There are multilevel degenerative changes present in the cervical spine without significant compromise to the spinal canal. There is mild encroachment of the exiting nerve roots at C5-6 due to degenerative changes.2.No spinal cord lesions are appreciated.


Instruction: Generate impression based on medical findings.

Input: History of CVA, dementia, schizophrenia, presenting with subacute AMS consistent with catatonia, requiring ECT. There is ring-like restricted diffusion that measures up to 10 mm in the subcortical white matter anterior to the right precentral sulcus. There is also a punctate focus of restricted diffusion in the subcortical white matter of the left precentral gyrus. There is a background of extensive cerebral white matter confluent T2 hyperintensity. There is no evidence of intracranial tumors. There is no abnormal intracranial enhancement. There appear to be scattered foci of susceptibility effect in the cerebral hemispheres, although precise delineation is limited by patient motion. There is diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions within the posterior paranasal sinuses. There is mild hyperostosis of the skull, particularly in the left temporal region. The orbits are grossly unremarkable.

Output: 1. Ring-like restricted diffusion that measures up to 10 mm in the subcortical white matter anterior to the right precentral sulcus and a punctate focus of restricted diffusion in the subcortical white matter of the left precentral gyrus likely represent recent infarcts superimposed upon a background of extensive chronic small vessel ischemic disease. Dedicated head and neck vascular imaging may be useful for further evaluation, if clinically warranted.2. Diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes is suggestive of Alzheimer's disease. 3. Apparent scattered foci of susceptibility effect in the cerebral hemispheres may represent chronic microhemorrhages, perhaps related to amyloid angiopathy, for example, although precise delineation is limited by patient motion. Discussed with Dr. Davey at 9:15 AM on 3/26/15.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with right shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: Note is made of a full-thickness tear of the supraspinatus tendon measuring approximately 11 mm in the AP dimension with minimal retraction. There is also partial thickness insertional tearing of the anterior fibers of the infraspinatus and posterior fibers of the supraspinatus tendon at their insertion on the greater tuberosity. The supraspinatus and infraspinatus muscles appear intact. There is mild fatty atrophy of the infraspinatus at the level of the myotendinous junction. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Minimal degenerative changes affect the glenohumeral joint. The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of long head of the biceps appears intact. Circumferential fluid within the tendon sheath of the long head of the biceps may represent fluid extension from the glenohumeral joint versus a tenosynovitis. ADDITIONAL

Output: Full-thickness tearing of the rotator cuff with minimal retraction as described above. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Benign multicystic peritoneal mesothelioma status post multiple surgeries. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size signal intensity and enhancement without a focal lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No free fluid or loculated fluid collection in the upper abdomen. No evidence of bowel obstruction or inflammation.BONES, SOFT TISSUES: Midline abdominal wall surgical changes without complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Thick-walled peripherally enhancing right adnexal region cystic lesion measuring 5.3 x 4.8 cm. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small volume of septated cystic lesion with thin septation in the deep pelvis measuring up to 4.2 x 3.1 cm axially and 6.1 x 2.4 cm in the sagittal plane associated with thin septations. There is also mild smooth peritoneal surface thickening anteriorly in the left hemi-pelvis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Complex right adnexal region cystic lesion and septated cystic lesion with septations in the deep pelvis, findings suspicious for disease, given the patient's history of multicystic peritoneal mesothelioma and a similar appearance on prior studies.


Instruction: Generate impression based on medical findings.

Input: Left knee pain and swelling MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage along the patella. A defect noted along the median eminence seen on the prior exam is less prominent currently. However there is a new near full-thickness cleft along the medial facet. Additional near full-thickness cleft is seen inferiorly along the median eminence which was likely present on the prior exam. There is a near full-thickness defect of the femoral trochlear cartilage centrally and inferiorly measuring approximately 8 mm. This appears more prominent on the current exam.There is mild heterogeneity of the lateral tibial plateau suggesting mild cartilage degeneration, which is similar to the prior exam.There is mild heterogeneity of the articular cartilage of the medial femoral condyle above the free edge of the posterior horn of the meniscus suggesting mild degeneration. This appears less prominent on the current exam. There is also increased signal intensity more anteriorly within the articular cartilage of the medial femoral condyle suggesting delamination. There is a small cyst within the medial tibial plateau posteriorly which was present on the prior exam. The surrounding bone marrow edema in this area has resolved. The remaining bone marrow signal is otherwise normal.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Articular cartilage abnormalities and additional findings described above.