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18656167-RR-244 | 382 | ## EXAMINATION:
CT abdomen and pelvis without contrast
## INDICATION:
Abdominal distention and constipation.
## FINDINGS:
Heart size is normal without significant pericardial fluid. There is
bilateral lower lobe bronchiectasis with areas of mucous plugging.
##
CT ABDOMEN WITHOUT CONTRAST:
Liver, gallbladder, spleen, pancreas and right
adrenal gland are unremarkable in the context of a noncontrast examination. A
2.2 cm left adrenal mass measuring -18 Hounsfield units is unchanged,
compatible with adenoma.
There are several bilateral punctate nonobstructing renal calculi. There is
no hydronephrosis. There are several bilateral hypodense and dense renal
lesions, measuring up to 3.4 cm in the left lower pole kidney. The hypodense
lesions are compatible with simple cysts. The hyperdense lesions measure up
to 1.4 cm in the left interpolar kidney measuring 97 Hounsfield units
compatible with proteinaceous or hemorrhagic cyst.
Stomach is distended but otherwise unremarkable. Small bowel loops are
diffusely dilated up to a maximum of 4.5 cm. There is a possible single
transition point in the left lower quadrant of a probable loop of jejunum
(2:60) just deep to the anterior abdominal wall on the left. There is
additional large bowel wall thickening of a roughly 10 cm segment of the
proximal transverse colon with surrounding inflammatory fat stranding. The
large bowel appears mildly distended proximally with air-fluid levels.
Abdominal aorta is normal caliber with moderate atherosclerotic
calcifications. There is no mesenteric or retroperitoneal lymphadenopathy by
CT size criteria. There is no ascites, pneumoperitoneum or ventral abdominal
hernia.
## CT PELVIS WITHOUT CONTRAST:
Bladder is decompressed around a Foley catheter.
Prostate and rectum are grossly unremarkable. There is no free pelvic fluid
or air. There is no inguinal or pelvic sidewall lymphadenopathy by CT size
criteria.
## BONES AND SOFT TISSUES:
There is no suspicious focal bone lesion.
## IMPRESSION:
1. Dilated small bowel loops with a probable transition point in the left
lower quadrant raising concern for small bowel obstruction.
2. Focal wall thickening and surrounding inflammatory change of the proximal
transverse colon compatible with colitis.
3. Bilateral lower lobe bronchiectasis with areas of mucous plugging.
4. Stable left adrenal adenoma.
5. Several bilateral nonobstructing punctate renal calculi.
## RECOMMENDATION(S):
Follow-up colonoscopy after patient's acute symptoms is
suggested, if not recently performed, to exclude an underlying lesion in the
transverse colon.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18656167", "visit_id": "N/A", "time": "2171-12-19 20:50:00"} |
16859424-DS-7 | 836 | ## HISTORY OF PRESENT ILLNESS:
y/o woman with a history of pancreatic cancer metastatic to
liver, s/p palliative resection, not currently on treatment,
history of TIA w/inpatient admission to Neurology ,
breast CA, and hypertension who is admitted to the oncology
service from the emergency department where she was sent from an
outpatient neurology appointment for evaluation of bilateral
swollen extremities.
.
She was at her outpatient neurologists appointment today for
follow up from her admission in when she was noted to
have bilateral lower extremity edema. She was sent to the ED for
evaluation
.
In the emergency department, her initial vital signs were 97.7
## HR:
74, BP:165/73 rr:20 sat:97%RA. She had negative bilateral
lower extremity ultrasound imaging. The IVC was examined and was
noted to not be collapsable, which lead to concerns for right
heart strain. A CTA of her pulmonary vasculature revealed a
right main and right lower lobe pulmomary arterial embolus. Also
noted were increases in size of multiple pulmonary nodules.
## PAST MEDICAL HISTORY:
# TIAs, most recently , when she was admitted to Stroke
service at . Found to have left cortical punctate infarcts.
Followed by Dr.
# Right frontal meningioma - had old MRI form evaluated by
Dr. from patient it "has not changed" .
# Metastatic Pancreatic Cancer, s/p Roux en Y palliatively
tumor was not resectable. Felt lousy on chemotherapy and has
declined further treatment at this point since last oncology
visit .
# Right sided breast cancer, ( ) s/p lumpectomy and
radiation, no chemotherapy.
# Superficial thrombophlebitis
# Left total hip replacement
# GERD
# Migraine headaches- lately rarely experiences them, when she's
stressed she gets scotoma with throbbing unilateral HA.
# Hypertension
## GENERAL:
well appearing, No actue distress
## HEENT:
NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
## PULMONARY:
Rhonchi at bases on inspiration.
## CARDIAC:
RRR, nl. S1S2, no M/R/G noted
## ABDOMEN:
soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
## EXTREM:
L bilateral edema, right erythema
## CT ANGIOGRAM:
Pulmonary embolus in right main pulmonary artery and right lower
lobe artery. Evident increase in size of multiple pulmonary
nodules from prior study, presumably due to metastatic
involvement of pancreatic carcinoma. Again (partially imaged) is
mass near pancreatic head.
## CXR:
left sided port-a-cath in place. Aorta seems generous
## EKG:
NSR, normal axis and intervals. no ST segment changes.
## BRIEF HOSPITAL COURSE:
Ms. is a y/o woman with metastatic pancreatic cancer,
TIAs, meningioma, admitted to the oncology service with
pulmonary embolism.
# Pulmonary Embolism: Ms. has trousseau's syndrome with
pulmnary embolus & migratory thrombophlebitis, also TIA. The
neurology team consulted and agreed that anticoagulation was
suitable for her (given her h/o meningioma and TIA), and d/c her
plavix. She was started on lovenox. Coumadin was suggested
because the patient does not have drug coverage for lovenox, but
she declined and preferred to pay for lovenox out of pocket.
she remained asymptomatic, not hypoxic, dyspneic, or tachypneic
while in-hospital.
# Bilateral Lower Extremity Edema: phlebitis on exam. treated
with keflex for concern of associated cellulitis. Patient
afebrile.
## # PANCREATIC CANCER:
patient declined therapy. Outpatient
management
# history of TIAs: lovenox
# Diabetes: glipizide
## # FEN:
regular
# COde; FULL - discussed with patient
on Admission:
Plavix 75 mg po daily
Atenolol 50 mg po daily
Spironolactone 12.5 mg po daily
Viokase (pancreatic enzymes) 16 po qid
Glipizide XL 2.5 mg po daily
## DISCHARGE MEDICATIONS:
1. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 6 days.
Disp:*24 Capsule(s)* Refills:*0*
2. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Spironolactone 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
4. Amylase-Lipase-Protease 30,000-8,000- 30,000 unit Tablet Sig:
Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
5. Glipizide 2.5 mg Tab,Sust Rel Osmotic Push 24hr Sig: One (1)
Tab,Sust Rel Osmotic Push 24hr PO DAILY (Daily).
6. Enoxaparin 60 mg/0.6 mL Syringe Sig: Fifty (50) mg
Subcutaneous Q12H (every 12 hours).
Disp:*60 syringe* Refills:*2*
## DISCHARGE DIAGNOSIS:
Pulmonary embolus
phlebitis
pancreatic cancer
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital with blood clots in your lung.
You will need to be on anticoagulation (or blood thinners) for
the remainder of your life. We have recommended coumadin as an
acceptable drug to treat this, but you have decided to take
lovenox. This drug will treat your lungs, but may put you at
risk for bleeding. If you have bleeding that does not stop, or
blook in your stool, please seek medical advice. If you have
trouble breathing or pains in your chest you should also seek
medical advice.
After consulting with the neurologists, we have decided to stop
your plavix now that you are taking a blood thinner.
In addition we are also treating you for phlebitis. You should
take keflex (an antibiotic) for a week. If you have fevers,
chills, worsening leg pain and redness, then please seek medical
attention.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16859424", "visit_id": "20564117", "time": "2130-02-07 00:00:00"} |
13350579-RR-79 | 109 | TWO VIEW CHEST, .
## INDICATION:
Chest tube on water seal.
## FINDINGS:
Right apical hydropneumothorax is present, with the visceral
pleural line at level of intersection of inferior aspect of right fourth
posterior rib and second anterior right rib. As compared to the previous
study, the amount of pleural gas has slightly decreased, and the air-fluid
level within this region is new. Additionally, there has been improved
aeration of the right middle and right lower lobes. Subcutaneous emphysema
has slightly worsened in the right chest wall. Appearance of the left lung
has not substantially changed.
## IMPRESSION:
Moderate right hydropneumothorax, with decrease in size of
pneumothorax compared to recent radiograph.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13350579", "visit_id": "23534988", "time": "2199-01-22 11:18:00"} |
13133600-DS-13 | 131 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
open treatment of proximal humerus fx
## HISTORY OF PRESENT ILLNESS:
yo with a hx of a fall, with direct impact to shoulder
## PAST MEDICAL HISTORY:
1. high blood pressure, which is controlled with diet and
exercise
2. leukemia, which has been in remission since .
## PHYSICAL EXAM:
HEENT WNL, Regular cardiac rhythm, no dyspnea. right shoulder
demonstrated bruising. active and passive motion poor.
## PERTINENT RESULTS:
xray and ct scan demonstrate a comminuted fx into head and neck
of the humerus
## BRIEF HOSPITAL COURSE:
patient was admitted for pain control. once managed, he was
discharged. there were no intra-hospital complications.
## DISCHARGE DIAGNOSIS:
right proximal humerus fx
## DISCHARGE INSTRUCTIONS:
keep right arm in sling and swathe, clean and dry
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13133600", "visit_id": "28084311", "time": "2180-04-09 00:00:00"} |
15484715-RR-14 | 316 | ## INDICATION:
year old man with alcoholic cirrhosis c/b HCC here with
worsening ascites and renal failure// Liver ultrasound with Doppler; patent
portal veins? renal ultrasound, hydronephrosis?
## LIVER:
The hepatic parenchyma appears coarsened. The contour of the liver is
nodular, consistent with cirrhosis. There is a 3 cm ill-defined focal area of
irregular, hypoechoic hepatic parenchyma which is not completely evaluated on
today's ultrasound, this likely corresponds to the known HCC. There is
moderate ascites.
## DOPPLER EVALUATION:
The main portal vein is patent, with flow in the appropriate direction.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein is are patent, with antegrade flow. The superior mesenteric vein
is not visualized due to overlying bowel gas.
## BILE DUCTS:
There is no intrahepatic biliary dilation. The CBD measures 5 mm.
## GALLBLADDER:
Cholelithiasis and sludge without gallbladder wall thickening.
## PANCREAS:
The pancreas is not well visualized, largely obscured by overlying
bowel gas.
## SPLEEN:
Normal echogenicity, measuring 10.6 cm.
## KIDNEYS:
The right kidney measures 11.5 cm. The left kidney measures 10.6 cm.
Normal cortical echogenicity and corticomedullary differentiation is seen
bilaterally. There is no evidence of masses, stones, or hydronephrosis in the
kidneys. Multiple simple renal cysts are identified on the right. A cyst
with internal echogenic debris is similar in size compared to the MRI from an
outside facility , and most likely represents hemorrhagic cyst.
## RETROPERITONEUM:
Visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
1. Patent hepatic vasculature with appropriate flow.
2. The known HCC is not well-visualized on today's exam, an ill-defined
hypoechoic region measuring approximately 3 cm within the posterior right lobe
likely corresponds to the lesion seen on outside MRI from .
3. No hydronephrosis.
4. Cholelithiasis.
5. Moderate ascites.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15484715", "visit_id": "23346013", "time": "2118-03-30 09:11:00"} |
14297516-RR-3 | 282 | ## FINDINGS:
There is a mild retrolisthesis of C3 on C4 as well as
anterolisthesis of C4 on C5.
There is a C3 spinous process fracture with mild distraction, which appears
chronic.
There is a C4 spinous fracture which appears to extend into the left lamina.
This also appears chronic.
There is a C5 anterior wedge compression fracture with retropulsion of the
fracture fragment into the spinal canal resulting in moderate to severe
central canal narrowing. This likely is chronic as the fracture margins
appear sclerotic. There appears to be remote fractures of the lamina
bilaterally. There is associated mild C5-C6 bilateral facet widening. There
is also a C5-C6 disc bulge contributing to the moderate-to-severe spinal canal
narrowing.
There are multiple levels of bilateral mild neural foraminal narrowing
throughout.
No prevertebral soft tissue swelling is seen. Deformity of the right posterior
cricoid likely represents a remote fracture.
There is a left mastoid air cell opacification inferiorly as well as maxillary
mucosal thickening, left greater than right and sphenoid sinus air fluid
level. Findings suggest the presence of ongoing inflammation.
## IMPRESSION:
1. C5 compression fracture with retropulsion of fracture fragments, likely
chronic as well as C5-C6 disc bulge contributing to moderate-to-severe spinal
canal narrowing at this level. Associated chronic bilateral laminar fractures
which result in facet widening at this level. MRI is recommended for further
evaluation for cord injury given the presence of moderate to severe central
canal narrowing.
2. C3 and C4 spinous process fractures, likely chronic.
3. Mild grade I retrolisthesis of C3 on C4 and anterolisthesis of C4 on C5.
4. Multilevel degenerative changes with associated mild neural foramen
narrowing bilaterally throughout.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14297516", "visit_id": "23356018", "time": "2153-05-24 08:57:00"} |
10645926-DS-26 | 2,398 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Bone biopsy of the left distal tibia
## HISTORY OF PRESENT ILLNESS:
year old Female transferred from 4 inpatient psychiatry,
for concern of osteomyelitis of the shin. The patient was
originally transferred to with acute liver failure status
post vicodin overdose with LFT's in the 10,000s. She was
admitted to the ICU and treated with vancomycin/zosyn, pressors,
pRBCs, FFP and NAC. She developed acute renal failure of ATN,
but this normalized without intervention. She had a brief
episode of hematochezia, and sigmoidoscopy showed an old ulcer,
but no acute bleeding. Her LFTs normalized and she was
transferred to the service. There she was treated
with meropenem for an ESBL UTI for seven days. Once medically
stable, she was transferred to inpatient psychiatry for her
suicide attempt.
Patient had a prior tylenol overdose in . At the time she
received
vasopressors through veins in feet resulting in ischemic
necrosis. She has been followed by plastic surgery for bilateral
medial ankle wounds that have been treated with VAC-dressing
therapy on the left and a right wet-to-dry dressing. She was
treated with a course of levofloxacin for infection of the left
wound in .
She notes her ankle primarily hurts with motion, and has swollen
some, although since having it ace-wrapped it is better. She
reports that she sees a doctor closer to her home for wound
care, and she was treated for an wound infection with levaquin
at the end of as well.
There is concern for osteomyelitis, and patient is scheduled to
have bone biopsy on . Patient is off antibiotics (had
briefly been on keflex and bactrim). She reports that the pain
is primarily down in the distal shin/dorsum of the foot.
## PAST MEDICAL HISTORY:
h/o Tylenol OD c/b ARF, hepatic
failure, VAP, foot necrosis pressors; Bilateral DVT
8mm clean ulcer at prepyloric antrum seen on EGD
(H.Pylori neg); Psychiatric disorder (anxiety vs bipolar);
chronic pain; h/o domestic abuse; Crohn's disease; anklyosing
spondylitis; Long term alcoholism; h/o Hep A; iron-deficiency
anemia
## PAST SURGICAL HISTORY:
Distal ileum resection , CCY ,
R
hip replacement c/b multiple infections, L hip replacement
also c/b infections, back/knee surgeries per past notes
## ALCOHOL:
Per daughter, patient has a significant history of
abuse. Patient endorses drinking when her children were young
"because of depression" and felt that it got "somewhat out of
hand."
## TOBACCO:
<1ppd x yrs, usually smokes 1 pack every days
## ILLICITS:
sig h/o crack cocaine abuse per daughter; patient
denies
## :
Denies ever abusing her prescription medications or
feeling that her use of the medications was out of her control.
## FAMILY HISTORY:
Father - colitis? (frequent stomach pain)
Mother - RA, ankylosing spondylitis
Grandmother - ankylosing spondylitis
Family psychiatric history:
Per initial eval by Dr. , : several siblings with
significant drug and alcohol abuse; patient's uncle killed her
grandmother when he was released out of jail; one brother is in
jail for sexual assault on a same sex minor. One brother managed
to escape because he left the house at an early age.
Today, on eval, denies family history of mood disorder / suicide
attempts / substance abuse (although wonders sometimes whether
sister abuses drugs).
## PHYSICAL EXAM:
PHYSICAL EXAM on admission
## HEENT:
EOMI, MMM, - OP Lesions
## ABD:
quite tender over LLQ in specific point (around ipsilateral
from mcburney's point), ND, +BS, - CVAT
## EXT:
- CCE, LLE in ace wrap with tenderness on pretibial surface
from dorsum of foot to mid shin
## DERM:
maculopapular rash over entire lower back, non-blanching
## GENERAL:
Alert and oriented x 3, in no acute distress
## HEENT:
EOMI, moist mucus membranes, no lymphadenopathy
## PULM:
Clear to auscultation bilaterally, no adventious breath
sounds
## CARDIAC:
Regular rate and rhythm no murmurs rubs or gallops
appreciated
## ABDOMEN:
Soft, nontender, nondistended, no rebound or guarding.
No palpable masses
## EXTREMITIES:
LLE with dressing on wound, C/D/I, no erythema
outside of the wound, non-tender foot, brisk capillary refill
## DERM:
pink pleomorphic papules on her abdomen, no rash on her
back.
## 3:00 PM FLUID,OTHER SITE:
TIBIA LEFT TIBIA.
ACID FAST SMEAR/CULTURE AND ADDED PER REQ ( ).
FUNGAL CULTURE ADDED .
GRAM STAIN (Final :
1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
NO MICROORGANISMS SEEN.
## ACID FAST CULTURE (PENDING):
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
POTASSIUM HYDROXIDE PREPARATION (Final :
NO FUNGAL ELEMENTS SEEN.
## FUNGAL CULTURE (PRELIMINARY):
RESULTS PENDING.
Pathology LT TIBIA BX (1 JAR)
Left tibia, biopsy:
- Fragments of bone with reactive changes.
- No osteomyelitis identified.
## CLINICAL:
Left ankle, soft tissue wound ? osteomyelitis.
## GROSS:
The specimen is received in one formalin container,
labeled with the patient's name, , the
medical record number, and additionally labeled "left tibia".
It consists of a bone fragment measuring 0.4 cm in length x 0.1
cm in diameter, entirely submitted in cassette A, following a 50
minute decalcification. Also in the same container are multiple
irregular portion of clot measuring up to 0.5 x 0.2 x less than
0.1 cm in aggregate, entirely submitted in cassette B.
Imaging
Left Ankle three view xray
## IMPRESSION:
1. Soft tissue swelling. Soft tissue calcification and/or
ossification.
2. Periosteal new bone formation. While this could represent
reactive change related to overlying soft tissue
inflammation/infection, the possibility of bony changes due to
osteomyelitis cannot be entirely excluded. MRI with contrast
could help for further assessment. However, if the patient
cannot tolerate an MRI, an initial attempt at further evaluation
could be performed with either CT or triple phase bone scan.
MRI of Left ankle
## IMPRESSION:
1. Distal tibial abnormal bone marrow signal with the adjacent
periostitis,as described above, concerning for acute on chronic
osteomyelitis.
2. Abnormal medial soft tissues at the level of the distal tibia
and the
talus with heterogeneous enhancement, which represent the
patient's known
wound with scar tissue and areas of induration with some
hyperemia. No
discrete mass or fluid collection.
3. Possible tendinosis of the anterior tibialis tendon.
4. Tendinosis of the posterior tibialis tendon.
5. Degenerative changes of the tibiotalar joint.
6. Talonavicular infarctions as above.
CT Abdomen and Pelvis
1. Inflammed / super-infected omental infarct or epiploic
appendigitis
identified on the anti-mesenteric border of the distal
descending / sigmoid colon junction. No evidence for active or
recurrent Crohn's disease.
2. Non-obstructing left renal calculi.
3. Bilateral collections identified anterior to both hip
replacements, greater on the left side, new since prior imaging.
## BRIEF HOSPITAL COURSE:
yo F with history of chronic lower extremity wounds, anxiety,
chron's disease who was transferred from the inpatient
psychiatry for work-up of possible osteomyelitis.
1. Probable Osteomyelitis
Patient had MRI findings suggestive of osteomyelitis of the
distal tibia. She was taken off of antibiotics to increase the
yield of the bone biopsy. She underwent a CT guided biopsy on
without complications. The results came back negative for
ostetomyelitis and Infectious Disease decided to proceed with
topical wound care only, no oral or IV antibiotics. She was
afebrile and hemodynamically stable throughout her admission.
2. Depression, Trichotilomania
The patient was originally transferred from inpatient psychiatry
after an overdose concerning for suicidality. She was evaluated
by psychiatry who felt that she was safe and did not require a
1:1 sitter. Her seroquel was increased per psychiatry for
increased trichotilomania.
3. Chronic pain-
On admission patient was taking narcotics for pain relief. She
was continued on morphine sulfate while inpatient which was
weaned down. She was switched to a Fentanyl patch prior to
discharge with modest control. For outpatient management of her
pain, she was interested in suboxone. She has intake appointment
for partial program on (see appointments)
4. Tinea Corpis-
Patient had rash on her abdomen and back that was under
treatment with ketoconazole topical per dermatology. This rash
markedly improved with ketoconazole at the time of discharge.
5. Epiploic appendigits-
Patient developed left lower quadrant pain during her admission
and was evaluated by surgery who were concerned for
diveritculitis. CT scan of the abdomen and pelvis showed no
diverticulitis and an epiplotic appendigitis in the location of
her pain. She was treated with pain relief and pain had
resolved at the time of discharge.
Chronic problems:
1. Crohn's
Patient's chron's was stable during her inpatient stay. She
remained on her home medications.
2. History of Gastric Ulcers
Patient ws switched to ranitidine for her ulcers because her
famotidine would interact with tizanidine.
3. History of DVT
- Off coumadin due to completion of >3months of treatment for a
provoked episode of DVT with no other risk factors for
hypercoagulability.
## TRANSITIONAL ISSUES:
-Patient requires follow-up of her psychiatric issues
-Patient is high risk for readmission for chronic pain
management
-Patient needs follow-up with plastic surgery for wound
management
-Patient needs EGD to be performed by GI for gastritis
-Patient has follow-up for her rash with dermatology
## MEDICATIONS ON ADMISSION:
Morphine Sulfate 45 mg PO/NG Q4H:PRN pain
Clonazepam 1 mg PO/NG BID
Clonidine Patch 0.1 mg/24 hr 1 PTCH TD QMON
Lorazepam 0.5 mg PO BID:PRN anxiety, insomnia
Gabapentin 600 mg PO/NG TID
Sertraline 50 mg PO/NG DAILY
Mirtazapine 30 mg PO/NG HS
Ketoconazole 2% 1 Appl TP BID
traZODONE 25 mg PO/NG HS:PRN insomnia
PredniSONE 10 mg PO/NG DAILY
Vitamin D 800 UNIT PO/NG DAILY
Calcium Carbonate 500 mg PO/NG BID
Senna 1 TAB PO/NG BID
Docusate Sodium 100 mg PO BID
Famotidine 20 mg PO/NG Q12H
Sarna Lotion 1 Appl TP QID:PRN itching
Ondansetron 4 mg IV Q8H:PRN nausea
## SIG:
One (1) Appl Topical
QID (4 times a day) as needed for itching for 1 weeks.
Disp:*1 tube* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation for 5 days.
Disp:*10 Capsule(s)* Refills:*0*
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
## SIG:
One (1) Tablet, Chewable PO BID (2 times a day) for 1
weeks.
Disp:*14 Tablet, Chewable(s)* Refills:*0*
5. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
6. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
7. ketoconazole 2 % Cream Sig: One (1) Appl Topical BID (2 times
a day) for 1 weeks.
Disp:*1 tube* Refills:*0*
8. clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
9. clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QMON (every .
Disp:*1 Patch Weekly(s)* Refills:*0*
10. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) as needed for anxiety for 5 days: Take one tablet by
mouth as needed up to one time per day for extra anxiety.
Disp:*5 Tablet(s)* Refills:*0*
11. tizanidine 2 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
12. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
13. fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours) for 6 days: Please change
patch on and then .
Disp:*2 Patch 72 hr(s)* Refills:*0*
14. clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
15. trazodone 50 mg Tablet Sig: 0.5 Tablet PO at bedtime for 1
weeks.
Disp:*7 Tablet(s)* Refills:*0*
16. mirtazapine 30 mg Tablet Sig: One (1) Tablet PO at bedtime
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
17. gabapentin 800 mg Tablet Sig: One (1) Tablet PO three times
a day for 1 weeks.
Disp:*21 Tablet(s)* Refills:*0*
18. sertraline 100 mg Tablet Sig: One (1) Tablet PO once a day
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
## SECONDARY DIAGNOSES:
Trichotelamania
Epiploic appendigitis
Anxiety
Crohn's disease
Gastritis
Tinea corporis
## DISCHARGE CONDITION:
Patient is medically stable to be transferred and appropriate
for discharge.
## DISCHARGE INSTRUCTIONS:
You were transferred from Deaconess 4 because of concern for
osteomyelitis (bone in fection) in your left lower leg where you
have a nonhealing wound. This was a concern based on the xray
and MRI you had of the area for osteomyelitis. Once on our
floor you underwent a bone biopsy by Interventional Radiology
without complications. You were stable without fevers
throughout your stay. Your bone biopsy culture came back
negative for infection. The infectious disease specialists
following you recommended topical wound care and no antibiotic
therapy at this time. Your wound will be followed by her
outpatient plastic surgeon and they will consult infectious
disease if there is any concern. There was a rash that was
noticed on your abdomen and back. Dermatology had previously
seen you and felt that this was Tinea corporis. It responded
well to topical treatment and has improved. You have an
outpatient follow-up with them.
The psychiatry team continued to follow you while you were in
the hospital and recommended an increase in one of your
medications to help with your anxiety.
For your chronic pain, we increased one of your medications and
started you on a new medicine at night to help with the pain and
sleep.
Your Chron's disease was stable during your hospital stay and
you were continued on your home medications for that.
.
The following changes were made to your medications:
1. Morphine sulfate 30mg by mouth every 6 hours as needed for
pain (new)
2. ducosete prn (new)
3. senna (new)
4. tinazidine 2mg po at bedtime (new)
5. Increase dose of zoloft to 100mg by mouth once a day
(change)
6. Increase dose of gabapentin from 600mg by mouth three times a
day to 800mg by mouth three times a day (change)
7. Stop coumadin (change)
8. Stop oxycodone (change)
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10645926", "visit_id": "20629727", "time": "2191-10-14 00:00:00"} |
19906067-RR-111 | 70 | ## HISTORY:
female with right wrist fracture. Assess for healing.
## IMPRESSION:
1. Interval healing of right distal radial fracture with partial
intra-articular extension. Near anatomic alignment. No other fracturess.
2. Degenerative changes involving the hand diffusely including the first CMC
and triscaphe joint.
3. Small 1-2 mm density within the soft tissues of the volar aspect overlying
the second distal phalanx, most likely representing a foreign body.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19906067", "visit_id": "N/A", "time": "2130-08-08 10:37:00"} |
11076668-RR-21 | 368 | MR EXAMINATION OF THE BRAIN WITHOUT AND WITH CONTRAST,
## HISTORY:
woman with metastatic breast cancer; assess interval
change.
## FINDINGS:
The study is compared with the most recent enhanced MR examination
dated , as well as the Imaging enhanced examination of
.
There are now innumerable small round nodular and larger enhancing foci,
largely superficially- located in both the supra- and infratentorial
compartments. Many of these are at the surface of the brain and likely in the
subarachnoid space; this is particularly evident in the posterior fossa. Small
lesions in the internal auditory canals, bilaterally, strongly support
subarachnoid space involvement. The largest lesion, at the posteromedial
aspect of the inferior left cerebellar hemisphere, measures 15 (AP) x 13 mm
(TRV). While the lesions themselves demonstrate focal FLAIR-hyperintensity,
there is no surrounding hyperintense region to suggest vasogenic edema. More
symmetric, confluent FLAIR-hyperintensity in bihemispheric periventricular
white matter may represent radiation-related change, the sequelae of chronic
microvascular ischemic disease, or a combination of the two. Many of the
lesions demonstrate intrinsic T1-hyperintensity, pre-contrast, without
"blooming" susceptibility artifact, which may represent subacute blood
products. Only the dominant lesion at the caudal aspect of the left
cerebellar hemisphere demonstrates a thin but relatively uniform rim of
restricted diffusion (602: 6, 800:9); there is no definite restricted
diffusion associated with any other lesion and no focus of restricted
diffusion, elsewhere, to suggest an ischemic event. The principal
intracranial vascular flow voids are preserved.
Though there is heterogeneous T1-hypointensity in the limited included upper
cervical vertebral, clival and calvarial bone marrow, which may represent red
marrow reconversion in response to treatment, no bone destructive lesion is
seen.
Incidentally noted is fluid-opacification of the mastoid air cells,
bilaterally, with minimal mucosal thickening involving the left maxillary
antrum and anterior ethmoidal air cells, not significantly changed since the
examination.
## IMPRESSION:
Dramatic interval change with marked progression of intracranial
metastatic disease involving both the supra- and infratentorial compartments.
Their distribution, including the superficial location, as well as the lack of
subjacent edema, strongly suggests that the bulk of these lesions involve the
subarachnoid space, including the spaces, centrally.
## COMMENT:
These findings were discussed with Dr. requesting
medical oncologist, at 1515 H, .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11076668", "visit_id": "N/A", "time": "2119-06-21 07:54:00"} |
15585360-RR-89 | 142 | ## THE RIGHT LOBE MEASURES:
(transverse) 2.3 x (anterior-posterior) 1.4 x
(craniocaudal) 5.0 cm.
The left lobe measures: (transverse) 2.5 x (anterior-posterior) 1.6 x
(craniocaudal) 4.9 cm.
Isthmus anterior-posterior diameter is 0.4 cm.
Thyroid parenchyma is homogenous and has normal vascularity. Within the lower
pole of the right thyroid lobe, there is a minimally hypoechoic rounded and
well-circumscribed nodule measuring 1.0 x 0.8 x 0.9 cm. Within the upper pole
of the left thyroid lobe, there is a hypoechoic rounded and well-circumscribed
nodule measuring 0.3 x 0.4 x 0.2 cm.
## IMPRESSION:
Right lower pole and left upper pole thyroid nodules measuring up to 1.0 cm,
as above, without overtly suspicious features.
## RECOMMENDATION(S):
Recommend year follow-up thyroid ultrasound to document
stability.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15585360", "visit_id": "N/A", "time": "2198-06-07 12:14:00"} |
11129224-RR-25 | 101 | ## INDICATION:
year old man with right foot ankle pain last several months
that comes and goes with history of gout // ?abnormality
## FINDINGS:
There is a an old fracture of the fibular sesamoid bone. No acute fracture or
dislocation is detected. There are mild degenerative changes of the first
MTP. The mortise is congruent on this non stress view. The tibial talar
joint space is preserved and no talar dome osteochondral lesion is identified.
No suspicious lytic or sclerotic lesion is identified. No soft tissue
calcification or radiopaque foreign body is identified.
## IMPRESSION:
Mild degenerative changes of the first MTP.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11129224", "visit_id": "N/A", "time": "2130-04-09 14:07:00"} |
17046754-RR-21 | 121 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST Q311 CT SPINE
## INDICATION:
man with c-spine ttp after assault, please eval for
fx.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 6.3 s, 24.8 cm; CTDIvol = 32.6 mGy (Body) DLP = 807.6
mGy-cm.
Total DLP (Body) = 808 mGy-cm.
## FINDINGS:
Alignment is normal. No fractures are identified. There is minimal anterior
osteophytosis at C3-C4 and C4-C5. There is no evidence of significant spinal
canal or neural foraminal stenosis. There is no prevertebral soft tissue
swelling. There is no evidence of infection or neoplasm. Incidental note is
made of an azygos fissure. The visualized lung apices are otherwise
unremarkable.
## IMPRESSION:
No evidence of fracture or traumatic malalignment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17046754", "visit_id": "26099188", "time": "2174-05-25 10:08:00"} |
14327368-RR-26 | 279 | ## CLINICAL HISTORY:
male with hypertension, and prior right central
retinal vein occlusion in , presenting from clinic
with possible left visual field cut.
## MR BRAIN:
Image quality is degraded by patient motion. The ventricles,
sulci, and cisterns are mildly prominent, without a regional distribution.
There is no mass effect, midline shift, space-occupying lesion, or extra-axial
fluid collection. There is no decreased diffusion to indicate an acute
infarct. Foci of susceptibility artifact are noted in the right parietal lobe
and possibly in the left parietal lobe, although evaluation is suboptimal
given the degree of patient motion. Scattered areas of T2 and FLAIR
hyperintensity are noted in the periventricular, subcortical, and deep white
matter. The flow voids of the major vessels are present.
## MRA HEAD:
Image quality is degraded by patient motion. The visualized
intracranial and internal carotid arteries, anterior cerebral arteries, middle
cerebral arteries, vertebral arteries, basilar artery, and posterior cerebral
arteries are grossly unremarkable, without hemodynamically significant
stenosis, dissection, or aneurysm.
## MRA NECK:
The common carotid, internal carotid, and external carotid arteries
demonstrate normal flow with normal enhancement, without evidence of a focal
stenosis or dissection. The vertebral arteries are also unremarkable.
## IMPRESSION:
1. No acute infarct.
2. Scattered foci of susceptibility artifact may represent the sequela of
prior injury or trauma, with no T1 or T2 signal abnormalities to suggest an
acute process.
3. Areas of white matter hyperintensity are a nonspecific finding, but may
represent the sequela of chronic microangiopathy given the patient's age.
4. Grossly unremarkable MRA of the head and neck, although sensitivity is
decreased given patient motion. There is no definite evidence of a
hemodynamically significant stenosis, dissection or aneurysm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14327368", "visit_id": "26252918", "time": "2141-02-07 00:06:00"} |
18870233-RR-104 | 101 | ## EXAMINATION:
CHEST (upright AP AND LAT)
## INDICATION:
with left-sided chest pain history of COPD MI// Pneumonia?
Pulmonary edema? Pleural effusions? Evidence of infarction?
## FINDINGS:
AP upright and lateral views of the chest provided. Port-A-Cath over the
right chest wall with catheter tip in the mid SVC unchanged. Mild left basal
atelectasis noted. No focal consolidation is seen concerning for pneumonia.
No large effusion, pneumothorax or signs of edema. Cardiomediastinal
silhouette appears normal. Imaged bony structures are intact. No free air
below the right hemidiaphragm peer
## IMPRESSION:
Mild left basal atelectasis. Port-A-Cath appears well positioned.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18870233", "visit_id": "23930219", "time": "2169-03-06 11:31:00"} |
19007151-RR-46 | 229 | ## CLINICAL INFORMATION:
Patient with anaplastic oligodendroglioma for followup.
## FINDINGS:
Left frontal post-operative changes and encephalomalacia are
identified with hyperintensities on T2 and FLAIR images. Subtle foci of
chronic blood products are also seen. A small area of susceptibility in the
left frontal lobe best visualized on series 6, image 19 is not visualized on
the prior study and could be due to interval hemosiderin deposition.
Following gadolinium there is no definite nodular enhancement seen at the site
of encephalomalacia. However there is a subtle area of increased signal
identified on post-gadolinium images at the left frontal convexity seen on
series 9, image 20 and series 12, image 99 which was not seen on the prior
study. It is unclear whether this is secondary to artifact or due to a small
new area of enhancement remote from the site of original tumor. The area
should be further evaluated on followup studies. There are no other areas of
abnormal enhancement seen.
## IMPRESSION:
The pre-gadolinium and T2 abnormalities are unchanged since the
previous MRI examination. There is no distinct enhancement seen in the left
frontal lobe at the site of surgical cavity. However, adjacent a subtle
hyperintensity seen on post-gadolinium images as dscribed above, new from
prior study. This can be artifactual or new area of enhancement, this area
should be further evaluated on followup examination.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19007151", "visit_id": "N/A", "time": "2183-11-16 08:48:00"} |
14324214-RR-23 | 314 | ## INDICATION:
year old man with left frontal intraparenchymal hemorrhage.
Evaluate for intracranial mass.
## FINDINGS:
Study is moderately degraded by motion.
There is an approximately 7 (AP) x 3 (TV) x 4 (SI) mm left frontal
intraparenchymal T1 isointense, T2 mostly hyperintense with some isointense
regions, GRE hypointense FLAIR hyperintense collection with few scattered foci
of enhancement on postcontrast imaging (see 07:14, 14:14, 11:14, 1201:67, 12:
81, 90, 96 ).
There is no evidence of acute infarction. The ventricles and sulci are
stable in caliber and configuration, with continued effacement of frontal horn
of the left lateral ventricle. Layering dependent bilateral occipital horn
intraventricular hemorrhage is again noted. Grossly stable approximately 5 mm
left-to-right midline shift is again noted. There is prominence of the sulci,
is suggestive of involutional changes. Periventricular and subcortical T2 and
FLAIR hyperintensities are noted, which may represent small vessel ischemic
changes. Limited imaging of cervical spine suggest degenerative changes, with
at least mild vertebral canal narrowing (see 6: 12).
## IMPRESSION:
1. Study is moderately degraded by motion.
2. Grossly stable left frontal approximately 7 x 3 x 4 cm probable
intraparenchymal hemorrhage with adjacent edema and mass effect on left
lateral ventricle. Nonspecific foci of enhancement within this collection may
be related to hemorrhage, however underlying mass is not excluded on the basis
examination. Recommend follow-up imaging to resolution.
3. Grossly stable bilateral dependent intraventricular hemorrhage.
4. Grossly stable 6 mm left-to-right midline shift.
5. Within limits of study, no definite enhancing intracranial mass identified.
## RECOMMENDATION(S):
1. Grossly stable left frontal approximately 7 x 3 x 4 cm probable
intraparenchymal hemorrhage with adjacent edema and mass effect on left
lateral ventricle. Nonspecific foci of enhancement within this collection may
be related to hemorrhage, however underlying mass is not excluded on the basis
examination. Recommend follow-up imaging to resolution.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14324214", "visit_id": "25495873", "time": "2176-03-17 15:19:00"} |
12332998-RR-52 | 177 | ## EXAMINATION:
COMPLETE GU U.S. (BLADDER AND RENAL)
## INDICATION:
year old woman with recurrent UTIs, incomplete emptying.
Evaluate for renal stones and bladder emptying.
## FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Redemonstration of a simple cyst in the upper pole the right kidney, which
measures 1.8 x 1.4 x 1.7 cm on current exam compared to 1.5 x 1.2 x 1.8 cm
previously and is unchanged in size. Otherwise, there are 2 new additional
simple cysts within the upper pole the left kidney, the larger of which
measures 2.1 x 1.4 x 1.7 cm and the smaller of which measures 0.8 x 0.6 x 0.7
cm.
## RIGHT KIDNEY:
11.0 cm
Left kidney: 11.9 cm
The bladder is moderately well distended and normal in appearance. The pre
void urinary bladder volume measures 84 cc. The postvoid residual measures
8.5 cc.
## IMPRESSION:
No hydronephrosis or significant postvoid urinary bladder residual volume.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12332998", "visit_id": "N/A", "time": "2183-01-29 09:09:00"} |
17856161-RR-42 | 143 | ## EXAMINATION:
MRA NECK WITH CONTRAST
## INDICATION:
year old man with possible right vertebral artery dissection
on CTA s/p neck trauma on . Also had episode of amaurosis fugax on the
left. Evaluate prevertebral or carotid artery disruption.
## FINDINGS:
Study is limited by motion artifact.
There is a 3 vessel aortic arch. The common carotid, cervical internal
carotid, and proximal external carotid arteries, as well as the vertebral
arteries, appear patent without flow-limiting stenosis. On the dynamic
gadolinium enhanced MRA. Mild left ICA plaque is better assessed on the
recent neck CTA. Left vertebral artery is dominant. Axial T1 weighted
fat-suppressed images demonstrate no evidence of intramural hematoma involving
the proximal nondominant, diminutive right vertebral artery, where dissection
was suspected on the prior CTA, nor involving the other cervical arteries.
## IMPRESSION:
No evidence for arterial dissection or flow-limiting stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17856161", "visit_id": "N/A", "time": "2168-11-20 12:10:00"} |
15052620-RR-28 | 680 | ## EXAMINATION:
CT Torso with contrast
## INDICATION:
with high speed eval for evidence of trauma
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 9.2 s, 72.3 cm; CTDIvol = 23.8 mGy (Body) DLP =
1,721.3 mGy-cm.
Total DLP (Body) = 1,721 mGy-cm.
## HEART AND VASCULATURE:
The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
## AXILLA, HILA, AND MEDIASTINUM:
There is prominence of multiple mediastinal
lymph nodes, specifically subcarinal node measuring up to 1.3 cm (series 2:
Image 54), likely reactive. No adenopathy by size criteria noting remaining
mediastinal specifically right paratracheal and AP window nodes all
subcentimeter in size. No axillary or hilar lymphadenopathy is present. No
mediastinal mass or hematoma.
## PLEURAL SPACES:
No pleural effusion or significant pneumothorax. Tiny foci of
nondependent air abutting the pleural surface on the left, potentially
paraseptal emphysema and a tiny pneumothorax is not entirely excluded
## LUNGS/AIRWAYS:
There are multifocal ground glass opacities in the lower lobes
and right middle lobe, which are nonspecific but may represent pulmonary
contusions. Otherwise, there is no focal consolidation or pneumothorax. The
airways are patent to the level of the segmental bronchi bilaterally.
## BASE OF NECK:
Visualized portions of the base of the neck show no abnormality.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
Multiple hypodensities are seen scattered throughout the liver, the largest
measuring up to 1.2 cm likely representing hepatic cysts or biliary
hamartomas. There is no evidence of focal lesion or laceration. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is within normal limits.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
pancreatic ductal dilatation. There is a 1 cm partially cystic lesion in the
pancreatic tail which is not fully characterized on this exam (series 2: Image
130). There is no peripancreatic stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Duodenum
diverticulum is noted. The colon and rectum are within normal limits. The
appendix is normal. There is no evidence of mesenteric injury.
There is no free fluid or free air in the abdomen.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The prostate and seminal vesicles are unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm or retroperitoneal hematoma.
Mild atherosclerotic disease is noted.
## BONES:
Acute nondisplaced fractures seen with thick angulation of the anterior
right fourth through seventh ribs in the anterior left sixth rib. No
additional fractures identified. No focal suspicious osseous abnormality.
## SOFT TISSUES:
Edema and stranding is seen in the subcutaneous tissues of the
anterior chest wall.
## IMPRESSION:
1. Multifocal ground-glass opacities are seen in the lower lobes and right
middle lobe, which are nonspecific but may represent pulmonary contusions.
2. Nondisplaced anterior right fourth through seventh and left anterior sixth
rib fractures.
3. Tiny foci of air abutting the pleural surface anteriorly on the left which
could be paraseptal emphysema versus tiny pneumothorax.
4. Mild edema is seen in the subcutaneous tissues of the anterior chest wall.
5. No other evidence of injury in the chest, abdomen or pelvis.
6. Incidental note is made of a 1 cm cystic lesion in the pancreatic tail,
incompletely characterized on this exam.
## RECOMMENDATION(S):
A dedicated nonemergent MRI is suggested for further
evaluation of the 1 cm cystic pancreatic tail lesion.
## NOTIFICATION:
The updated findings were discussed with , M.D. by
, M.D. on the telephone on at 10:00 pm, 45 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15052620", "visit_id": "29705123", "time": "2139-01-26 19:58:00"} |
16840485-RR-6 | 149 | HIGH RISK OBSTETRIC ULTRASOUND
## INDICATION:
female, pregnant, presents for full fetal survey.
Assess cervical length for prior history of LEEP.
## FINDINGS:
A single live intrauterine gestation is present in cephalic
presentation. The placenta is identified anteriorly. Transvaginal ultrasound
was performed for evaluation of the cervical length, which measures 3.1 cm.
The tip of the placenta is identified approximately 1 cm from the internal os.
The amniotic fluid appears appropriate. Dedicated views of the fetal cavum
septum pellucidum, choroid plexus, cerebellum, profile, nose, lips, heart,
outflow tracts, stomach, kidneys, bladder, three-vessel cord, cord insertion
site, lower extremities, upper extremities, and spine were unremarkable.
The following fetal biometric data was obtained:
## EFW:
263 grams. The maternal ovaries were unremarkable.
## IMPRESSION:
1. Size equals dates with appropriate interval growth.
2. Normal fetal anatomic survey.
3. Cervical length 3.1 cm.
4. Low placenta, 1 cm from the internal os.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16840485", "visit_id": "N/A", "time": "2160-01-14 14:58:00"} |
10507647-RR-36 | 205 | ## HISTORY:
female with metastatic retroperitoneal leiomyosarcoma
and headaches.
## FINDINGS:
There is a lytic lesion centered in the midline frontal bone with
epidural and subgaleal components, measuring 3 x 2.2 cm. There is no evidence
for edema or loss of gray/white matter differentiation in the underlying brain
parenchyma. There is no acute intracranial hemorrhage. A faint hypodensity in
the left parietal white matter, without mass effect, is nonspecific but likely
sequela of chronic small vessel ischemic disease. A 5 mm focus of fluid
density in the right cerebellar hemisphere suggests a chronic infarct or a
prominent fissure from asymmetric volume loss. The ventricles and sulci are
normal in size and configuration.
The visualized paranasal sinuses, mastoid air cells and middle ear cavities
are clear.
## IMPRESSION:
1. Lytic lesion centered in the midline frontal bone with epidural and
subgaleal components, most likely a metastasis. Recommend MRI to evaluate for
dural or parenchymal invasion.
2. Faint low density in the left parietal white matter is most likely sequela
of chronic small vessel ischemic disease, given the patient's age, but MRI
would help exclude parenchymal metastatic disease.
Results entered into critical results by on
at 2:40 to be conveyed to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10507647", "visit_id": "N/A", "time": "2132-08-14 13:08:00"} |
14411782-DS-13 | 774 | ## HISTORY OF PRESENT ILLNESS:
yo G7P at 26w6d with history of seizure
disorder who reports having two seizures on the day of
admission. She fell once while getting ready this morning, does
not think she hit her head, but does report a contraction after
this fall. She thought she felt leakage of fluid and thus
decided to take a shower. No bleeding, good fetal movement this
morning. After her shower, she lost consciousness and woke up
sitting against the wall, her neighbor called ambulance. She
does not recall hitting her head, but is complaining of painful
right head bump and headache. Pt also is nauseated and vomited
once here. She denies any scotomata, recent headaches or RUQ
pain. She has not felt fetal movement since. No VB, unsure if
further LOF. No abdominal pain or further contractions. She
denies any known abdominal trauma.
She reports baseline 2 seizures/week. She states that she
occasionally does not take her Keppra at night, if she falls
asleep, but has been compliant. She is followed by Dr.
. According to the epilepsy fellow, who is very
familiar with her case, there is a concern about medication
compliance and possible faking of seizures.
## PNC:
Dating - LMP c/w first tri u/s
Labs - O+/RPRNR/RI/Hbneg/HIV-
U/S - Nl ERA, Nl FFS
## PMH:
Seizure disorder
Asthma, no hospitalizations
## POBH:
SVD 6#9 no complications
SVD 7#1 no complications, had szs during this pregnancy
## PGYN:
+abnl pap, s/p ?LEEP, pt unsure, repeats wnl
denies STDs
## HEAD:
5cm hematoma to parietal area of skull, tender, no
lacerations
RRR
CTAB
soft, gravid, diffusely tender over uterus but easily
distractable, no distention, no rebound/guarding, no epigastric
or RUQ tenderness
NT/NE
## NEURO:
Initially pt was unable to answer my questions and
tightened up her arms and face, lasted 5 secs and resolved, then
fully awake, alert. Fully oriented. Speech fluent. CN I: not
tested, CN II: Pupils 4->2 b/l. Fundi clear CN III, IV, VI: EOMI
no nystagmus or diplopia, CN V: intact to LT throughout, CN VII:
full facial symmetry and strength, CN VIII: hearing intact to FR
b/l, CN IX, X: palate rises symmetrically, CN XI: shrug and
symmetric, CN XII: tongue midline and agile. Normal muscle tone
bilaterally. Sensory intact to light touch. Biceps and
patellar reflexes 2+ bilaterally.
## FHR:
baseline 145, mod var, no accels, no decels
## SSE:
neg pool, neg fern, neg nit
## SVE:
ext os 1cm, int os closed, thick, post, med consistency
## CT HEAD W/OUT CONTRAST :
There is no evidence of
intracranial hemorrhage, edema, mass, mass effect,
hydrocephalus, or infarction. A right parietal scalp hematoma is
noted without evidence of underlying fracture. The visualized
paranasal sinuses and mastoid air cells are well aerated.
## BRIEF HOSPITAL COURSE:
The patient was brought in by ambulance to the emergency
department with an episode of seizure-like activity accompanied
by head trauma and loss of consciousness. A head CT ruled out
acute intracranial pathology related to her fall, and she was
transferred to Ob Triage for further evaluation and treatment.
Consultation was obtained with the neurology service, and a
recommendation was made to increase her dose of Keppra and to
admit her for at least 24 hours of monitoring. She was noted to
have some abdominal tenderness on initial examination, and was
thus observed on L&D for 24 hours without other clinical
evidence of abruption; fetal testing and maternal laboratory
screening were reassuring and within normal limits. A course of
betamethasone was started for fetal lung maturity, and
consultation was obtained with the NICU.
She was admitted to the antepartum service and consultation was
obtained with maternal-fetal medicine. They recommended
completion of the betamethasone, continued use of her Keppra per
neurology, and workup for cardiogenic causes of her periodic
episodes of loss of consciousness. Of note, the patient has
already undergone just such a workup at an outside institution.
The patient was followed by social work while in house, who
recommended that consultation be obtained with psychiatry due to
perceived lack of insight re: the risks to her infant of a very
preterm delivery. This consultation was to be obtained at the
beginning of the week.
The patient elected to sign out against medical advice on HD#3.
Follow-up appointments were arranged with both her outpatient
neurology and her primary obstetrician.
## DISCHARGE MEDICATIONS:
1. Levetiracetam 100 mg/mL Solution Sig: Thirty (30) ml PO
Q8AM/Q10PM ().
Disp:*qs bottle* Refills:*2*
2. Levetiracetam 100 mg/mL Solution Sig: Twenty (20) ml PO Q3PM
().
Disp:*1800 ml* Refills:*2*
## DISCHARGE INSTRUCTIONS:
follow up with your doctors as .
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14411782", "visit_id": "20630263", "time": "2136-11-10 00:00:00"} |
17497590-RR-16 | 149 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
female with left-sided weakness. Evaluate for
cerebral vascular accident.
## DOSE:
This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 16.8 cm; CTDIvol = 53.2 mGy (Head) DLP =
891.9 mGy-cm.
Total DLP (Head) = 892 mGy-cm.
## FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass. Prominent ventricles and sulci are likely related to involutional
changes. Periventricular and deep white matter hypodensities are likely
sequela of chronic small vessel ischemic disease.
No fracture is seen. Mild mucosal thickening of the ethmoid air cells is
noted. The remaining paranasal sinuses, mastoid air cells and middle ear
cavities are clear. The orbits are unremarkable. Bilateral calcifications of
the internal carotid siphons are noted.
## IMPRESSION:
No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17497590", "visit_id": "25752278", "time": "2173-03-04 18:30:00"} |
10038332-RR-37 | 227 | ## EXAM:
AP view of the pelvis and AP and lateral views of the right hip.
## CLINICAL INFORMATION:
male with history of chronic nonhealing
right sacral ulcer, history of osteomyelitis in the past.
## FINDINGS:
AP view of the pelvis and AP and lateral views of the right hip
were obtained. Soft tissue calcifications projecting over the right gluteal
region, best seen on the lateral views of the right hip, also seen on prior
CT, with irregularity of the adjacent iliac wing, which appears to be chronic.
Cortical thickening of the proximal femur is again seen, partially imaged.
Lucency projecting just inferior to the right inferior pubic ramus likely
represents large soft tissue ulceration. There is subtle irregularity of the
right inferior pubic ramus, new since the CT from , however, osseous
edema was seen at this site on MRI from . 3.6 cm ovoid ossific
structure projecting over the soft tissues just inferomedial to the left
femoral neck is stable. No acute fracture or dislocation is seen. The pubic
symphysis and sacroiliac joints are not widened.
## IMPRESSION:
1. Large lucency projecting over the soft tissues inferior to the right
inferior pubic ramus, most likely representing ulceration. Irregularity of
the right inferior pubic ramus adjacent to the level of this lucency could be
due to acute osteomyelitis, although osseous edema also seen at this location
on prior MRI.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10038332", "visit_id": "23080299", "time": "2166-06-07 18:10:00"} |
12240639-RR-61 | 359 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
year old woman with right subdural hematoma. Evaluate change.
## FINDINGS:
Compared to the 2 prior head CTs, the previously noted iso- to hypodense small
subdural collection at the right parietal vertex has resolved. The prior MRI
also demonstrated a small amount of subarachnoid hemorrhage in the same
location, but it was not dense on the CTs at that time. Presently, there is no
acute intracranial hemorrhage, edema, mass effect, or loss of gray/ white
matter differentiation. The ventricles and sulci are mildly prominent due to
age-related parenchymal involutional changes. Again seen are multiple foci of
low density in the subcortical, deep, and periventricular white matter of the
cerebral hemispheres, likely sequela of chronic small vessel ischemic disease
in a patient of this age.
There is no evidence for fracture. Previously noted left frontal scalp
hematoma has resolved.
Evidence of bilateral maxillary antrostomies and partial ethmoidectomies is
again seen. Bilateral maxillary neo ostia are patent. There is fluid and
moderate mucosal thickening in the visualized portion of the right maxillary
sinus, and near complete opacification of the left maxillary sinus, with
hyperdense material in both maxillary sinuses compatible with inspissated
secretions or fungal colonization. Left maxillary sinus walls are sclerotic.
Many of the remaining right anterior and posterior ethmoid air cells are
opacified. Right frontoethmoidal recess is opacified with mucosal thickening
in the inferior right frontal sinus. Bilateral frontal sinuses are
hypoplastic. There are aerosolized secretions in the right sphenoid sinus, and
its ostium appears occluded. Left frontal sinus, the remaining left ethmoid
air cells, and the left sphenoid sinus are well aerated. Compared to , fluid in the right frontal sinus has resolved. Other paranasal sinus
findings are unchanged.
There is near-complete left mastoid cell opacification, similar to . There is trace opacification of the right mastoid air cells, also
unchanged.
## IMPRESSION:
1. Resolution of the previously noted small iso- to hypodense small subdural
collection at the right parietal vertex. No evidence of new intracranial
abnormalities.
2. Extensive chronic paranasal sinus disease is again noted, as detailed
above. Left greater than right mastoid air cell opacification is also again
seen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12240639", "visit_id": "N/A", "time": "2175-09-11 14:00:00"} |
13730100-RR-87 | 80 | ## INDICATION:
620.0; ovarian cyst nos
## FINDINGS:
The uterus is anteverted and measures 8.5 x 3.7 x 6.2 cm. The endometrium is
somewhat heterogenous with some small cystic areas, which is within normal
limits on tamoxifen. The endometrium measures 11 mm. The IUD was demonstrated
within the endometrial cavity. The IUD appears satisfactorily placed. The
ovaries are normal. There is no free fluid.
## IMPRESSION:
Normal ovaries. Satisfactory position of the IUD within the endometrial
cavity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13730100", "visit_id": "N/A", "time": "2155-01-12 15:15:00"} |
18453745-RR-13 | 152 | ## EXAMINATION:
FULL FETAL LOW RISK
## FINDINGS:
There is a single live intrauterine gestation. The fetus is in
cephalicposition. The cervical length measures3.5. The placenta is posterior.
There is no evidence of previa. There is a normal amount of amniotic fluid.
Views of the fetal head, face, heart, outflow tracts, stomach, kidneys, cord
insertion site, bladder, spine, 3 vessel cord, and extremities were normal. No
fetal morphologic abnormalities are detected. The uterus is normal. No adnexal
abnormality is seen. The previously described large left adnexal mass has
been removed.
The following biometric data was obtained:
BPD 45mm, 19 weeks 6 days.
HC 168mm, 19 weeks 3 days.
AC 137mm, 19 weeks 1 days.
FL 34mm, 20 weeks 4 days.
## AGE BY US:
19 weeks 6 days.
Age by Dates: 19 weeks 3 days.
EFW 310 g.
## IMPRESSION:
Single, live fetus measuring size equals dates. No fetal morphologic
abnormalities are detected.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18453745", "visit_id": "N/A", "time": "2180-10-05 09:37:00"} |
15616719-RR-115 | 147 | ## EXAMINATION:
DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
## INDICATION:
year old woman getting NG tube replaced // eval NG tube
## FINDINGS:
Compared the prior study, the radiopaque portion of the NG tube has advanced
and now overlies the gastric fundus.
Again seen is the tracheostomy tube and a right-sided PICC line with tip at
the cavoatrial junction.
Linear opacities again overlie the right superior mediastinum, question
outside the patient.
The cardiomediastinal silhouette is unchanged. There is bibasilar atelectasis
and mild vascular plethora. Patchy opacity left base is slightly more
pronounced in the possibility of an early infiltrate at the left base cannot
be excluded. The extreme right costophrenic angle is excluded from the film.
Allowing for this, no effusion identified.
## IMPRESSION:
Radiopaque tip of a NG tube no overlies the gastric fundus.
Slight increase in patchy opacity left base --early infiltrate cannot be
excluded.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15616719", "visit_id": "26378988", "time": "2194-08-17 00:30:00"} |
15889489-RR-47 | 215 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
with 3 episodes of falls this am with head strike// eval for
mass or ICH or stroke
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.1 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
There is no evidence of acute large territorial infarction,hemorrhage,edema,
or mass. There is diffuse cerebral atrophy and prominence of the ventricles
and sulci suggestive of involutional changes. The deep subcortical,
periventricular white matter hypodensities are nonspecific and likely
represent sequela of chronic microvascular ischemic changes. Atherosclerotic
vascular calcifications are noted of bilateral cavernous portions of internal
carotid arteries.
There is no evidence of fracture. There is mild mucosal thickening of the
ethmoid air cells. The remainder of the visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The right
orbit is unremarkable. The left lens is not imaged in this study.
## IMPRESSION:
1. No evidence acute intracranial hemorrhage or fracture.
2. No acute intracranial abnormality. Please note MRI of the brain is more
sensitive for the detection of acute infarct.
3. Atrophy, probable small vessel ischemic changes, and atherosclerotic
vascular disease as described.
4. Paranasal sinus disease , as described.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15889489", "visit_id": "23611125", "time": "2183-10-18 12:43:00"} |
14318651-RR-100 | 134 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD.
## INDICATION:
with report of punch to left eye with pain, evaluate for
acute injuries.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 8.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are slightly prominent, suggesting mild cortical volume
loss, however, this finding is nonspecific.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
## IMPRESSION:
1. No acute intracranial process or calvarial fracture.
2. Slightly prominent ventricle sulci for patient's age suggesting mild
cortical volume loss.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14318651", "visit_id": "N/A", "time": "2148-08-01 06:42:00"} |
13851330-DS-12 | 950 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
Mr. is a primarily
right-handed
male with a history of diabetes, nonalcoholic steatohepatitis,
GERD, hypertension, and hyperlipidemia; who presents with
constant vertigo since 7:30 ( ) in the setting of
intermittent episodes of vertigo for the past 2 days. It is
worse
with any movement and he has extreme difficulty walking as a
result. It is been accompanied by nausea and multiple episodes
of vomiting. He has never had similar symptoms before. There is
been no recent head trauma, nor any history of other
neurological symptoms. He denies blurry or double vision, and
is
able to read. No weakness, numbness, paresthesias, or trouble
speaking or comprehending.
On general review of systems, the pt denies recent fever or
chills. Denies cough, shortness of breath. Denies chest pain,
abdominal pain, diarrhea, constipation.
## FAMILY HISTORY:
Mother with hypertension and hyperlipidemia.
## HEENT:
NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
## NECK:
Supple. No nuchal rigidity
## PULMONARY:
Lungs CTA bilaterally without R/R/W
## CARDIAC:
RRR, nl. S1S2, no M/R/G noted
## SKIN:
no rashes or lesions noted.
## -MENTAL STATUS:
Alert, oriented x 3. Able to relate history
without difficulty using combination of and .
Language is fluent with intact comprehension. Normal prosody.
ble
to read without difficulty. Speech is not dysarthric. Able to
follow both midline and appendicular commands. There is no
evidence of apraxia or neglect.
## II:
PERRL 3 to 2mm and brisk. VFF to confrontation.
## III, IV, VI:
Right-beating nystagmus on all directions of gaze,
including in primary gaze. Amplitude greatest on rightward
gaze.
Unable to interpret head impulse testing due to continuous
nystagmus.
## V:
Facial sensation intact to light touch.
## VII:
No facial droop, facial musculature symmetric.
## VIII:
Hearing grossly intact to speech.
## XI:
strength in trapezii and SCM bilaterally.
## XII:
Tongue protrudes in midline.
## -MOTOR:
Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
Delt Bic Tri WrE FFl FE IO IP Quad Ham TA
L 5 5 5 5 5 5 5 5 5 5
R 5 5 5 5 5 5 5 5 5 5
## -SENSORY:
No deficits to light touch. No extinction to DSS.
-DTRs:
Bi Tri Pat Ach
L 1 1 1 3 2
R 1 1 1 3 2
Plantar response was withdrawal bilaterally.
## -COORDINATION:
No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF. Able to continue finger-nose-finger with
eyes closed bilaterally, without progressive offshoot.
## -GAIT:
Did not assess
Discharge exam:
vitals: 133/70 HR 70, 97%RA
## PULM:
breathing comfortably on RA
## NEURO:
alert and oriented x3. PERRL, EOMI with right beating nystagmus
on right gaze, face symmetric, language intact, no dysarthria,
follows simple and complex commands, strength throughout,
sensation to LT intact throughout
## IMPRESSION:
1. No evidence of territorial infarction, hemorrhage, or edema.
2. Mild paranasal sinus disease with fluid in the left maxillary
sinus, which can be seen with acute sinusitis; correlate
clinically.
## BRIEF HOSPITAL COURSE:
right-handed man with a history of diabetes,
hypertension, hyperlipidemia, NASH, GERD, gout, and prior
smoking who presents with vertigo and right-beating nystagmus.
Based on the history of recent URI and exam findings, etiology
is most likely peripheral in nature. MRI brain without contrast
showed no acute infarct. Given his risk factors LDL 108 (already
on statin)and A1c 8.4 patient was started on ASA 81mg daily.
Concerning his elevated A1c h follows closely with his PCP who
recently made adjustments to his regimen. He will need to follow
up with his PCP for further management. His symptoms improved
the following day. Patient was evaluated by who recommended
outpatient vestibular physical therapy. He was discharged din
stable condition with neuro outpatient follow up.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Allopurinol mg PO DAILY
2. GlipiZIDE 10 mg PO DAILY
3. Lisinopril 10 mg PO DAILY
4. MetFORMIN (Glucophage) 1000 mg PO BID
5. Naproxen 500 mg PO Q8H:PRN Pain - Mild
6. Omeprazole 20 mg PO DAILY
7. Pravastatin 40 mg PO QPM
8. Ketoconazole 2% 1 Appl TP BID
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Meclizine 25 mg PO Q6H:PRN Vertigo
RX *meclizine 25 mg 1 tablet(s) by mouth every eight (8) hours
Disp #*15 Tablet Refills:*0
3. Allopurinol mg PO DAILY
4. GlipiZIDE 10 mg PO DAILY
5. Ketoconazole 2% 1 Appl TP BID
6. Lisinopril 10 mg PO DAILY
7. MetFORMIN (Glucophage) 1000 mg PO BID
8. Naproxen 500 mg PO Q8H:PRN Pain - Mild
9. Omeprazole 20 mg PO DAILY
10. Pravastatin 40 mg PO QPM
11.Outpatient Physical Therapy
## DISCHARGE INSTRUCTIONS:
Dear were admitted to for symptoms of vertigo. were
admitted to the Neurology team for evalulation. To rule out
dangerous causes of vertigo underwent a MRI of your brain
which was normal.
Based on your history and exam we think the reason for your
vertigo is most due to a problem in your inner ear (sometimes
called "peripheral vertigo"). This is a common cause of vertigo
frequently due to a small infection or irritation in the inner
ear that improves with time.
As part of your work up we found that have an elevated A1c a
sign of elevated blood sugars. We strongly recommend follow
up with your primary care physician to continue to work towards
well controlled blood sugars.
We also started on Aspirin 81mg daily.
were seen by physical therapy who recommended outpatient
to help recover from your imbalance.
were also prescribed a medicine Meclizine to take as needed
in case of recurrent vertigo.
It was a pleasure taking care of ,
-Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13851330", "visit_id": "21339457", "time": "2181-09-30 00:00:00"} |
10720116-RR-5 | 72 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST
## INDICATION:
History: in MVC significant intrusion // ?traumatic injuries
## FINDINGS:
No evidence of acute fracture is seen. There is no dislocation. Minimal
degenerative changes are seen. No prevertebral soft tissue swelling is seen.
The thyroid gland is homogeneous. Small sub-centimeter cervical lymph nodes
are not pathologically enlarged. Partially imaged lung apices are clear.
## IMPRESSION:
No acute fracture or dislocation of the cervical spine.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10720116", "visit_id": "N/A", "time": "2128-07-19 21:28:00"} |
12494219-RR-31 | 405 | ## INDICATION:
with a past medical history notable for breast cancer with
metastases to the spine presents with tachycardia, +D-dimer. Although may be
anemia, please perform CTA chest to r/o PE. // r/o PE
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 7.6 mGy (Body) DLP = 3.8
mGy-cm.
2) Spiral Acquisition 4.0 s, 30.9 cm; CTDIvol = 13.6 mGy (Body) DLP = 419.2
mGy-cm.
Total DLP (Body) = 423 mGy-cm.
## FINDINGS:
The aorta is normal in course and caliber.
No evidence of pulmonary embolism is seen.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
Small bilateral pleural effusions are noted, right greater left. There is no
evidence of pericardial effusion.
There is mild dependent and streaky linear atelectasis bilaterally. Nodular
and partially ground glass opacities, mostly subpleural, are seen in both
lungs. This may be seen in infectious or inflammatory conditions, although
worsening metastatic disease cannot be excluded. The airways are patent to
the subsegmental level.
There is a T6 compression fracture, likely pathologic and new since . There is new loss of height of the T3 vertebral body, possibly due to
early compression fracture. The previously noted compression fracture of the
T11 vertebral body is stable. Incompletely healed fractures of the lateral
aspects of the left seventh and ninth ribs are again seen. Previously seen
sclerotic rib lesions, probably metastatic, appear progressed in the left
lateral , and , ribs. New right lateral rib fractures are seen in
the , and 10th ribs, likely pathologic. There is mild sclerosis in
the distal sternum which is new since prior exam.
Limited images of the upper abdomen are remarkable for probable left
parapelvic cysts.
## IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Nodular and ground glass opacities, mostly subpleural, are seen
bilaterally, which may be infectious or inflammatory in origin. However,
metastatic progression is not excluded. Attention at follow-up.
3. Progression of osseous metastases including of the left ribs, as above as
well as new right through 10th rib fractures, new compression fracture of
T6 vertebrae, possible early compression fracture of T3, and areas of
sclerosis in the sternum.
## RECOMMENDATION(S):
Attention is recommended on follow up exams for bilateral
nodular lung opacities.
## NOTIFICATION:
The findings were discussed by Dr. with Dr.
on the telephoneon at 12:47 , 10 minutes after modifications
to the final read.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12494219", "visit_id": "21728337", "time": "2151-04-02 06:13:00"} |
11499195-RR-27 | 384 | ## HISTORY:
woman with groove pancreatitis and pancreatic mass.
## FINDINGS:
Scattered throughout the liver are multiple T2 hyperintense lesions that
demonstrate early arterial enhancement that is discontinuous and nodular with
gradual centripetal filling. The largest is within hepatic segment
measuring 3.5 x 2.0 cm (image 28:7). A smaller hepatic segment 7 lesion
measures 1.5 cm (17:17). There are 2 smaller ones within hepatic segment 8
(image 22: 17) and another hepatic segment 7 hemangioma (33:17), measuring 8
mm. The hepatic arterial anatomy is conventional. The portal and splenic
veins are attenuated but patent. The SMV demonstrates no thrombus.
There is an ill-defined region in the region of the pancreatic groove which
measures 2.5 x 2.4 cm (24: 6 a) and is smaller than on the prior study. This
region demonstrates minimal restricted diffusion and lower T1 signal intensity
than the adjacent pancreas. It demonstrates mass effect, causing displacement
of the adjacent duodenum laterally. Multiple punctate foci of T2
hyperintensity and T1 hypointensity indicative of cystic changes seen within
this region. The previously identified liquefaction is not seen on today's
MRI. This area demonstrates minimal delayed enhancement, which differs from
the background parenchyma of the pancreas. There is normal pancreatic ductal
drainage. The main pancreatic duct is normal in caliber.
The common bile duct is prominent measuring 9 mm. The cystic duct and
gallbladder are normal in caliber. There is no cholelithiasis. The
intrahepatic biliary tree is normal.
The kidneys demonstrate normal enhancement. There are multiple simple
appearing cysts within the kidneys bilaterally, the largest is seen within the
interpolar region of the left kidney measuring 1.9 cm (image 59: 20). One
cyst within the upper pole of the left kidney shows thin internal septations
and measures 1.5 x 1 cm (24: 5).
The spleen and adrenals appear normal. There has been a prior colectomy with
ostomy.
There is no ascites or pseudocyst formation.
## IMPRESSION:
1. Overall there has been interval decrease in the inflammatory change within
the region of the pancreatic groove. There is persistent cystic and fibrotic
change within the region, compatible with groove pancreatitis. There is no
evidence of complication. Recommend continued surveillance as this continues
to resolve; suggest followup in months.
2. Stable hepatic hemangiomas and renal cysts.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11499195", "visit_id": "N/A", "time": "2178-06-24 07:21:00"} |
11532838-RR-12 | 292 | ## INDICATION:
male status post trauma. Question intracranial
hemorrhage. Patient has history of assault with glass bong with laceration to
the posterior scalp.
## FINDINGS:
There is no definite intracranial hemorrhage, mass effect, edema,
or shift of normally midline structures. The brain parenchyma demonstrates
normal gray-white matter differentiation. Ventricles and sulci are normal in
caliber for age. Suprasellar and basilar cisterns are patent.
There is a slightly depressed angulated fracture of the lateral orbital wall
(3, 8). There is concurrent mildly comminuted and depressed fracture of the
right zygomatic arch. There is minimal air within the right orbit (3, 4).
Trace layering fluid is seen in the right orbit. No obvious entrapment of
inferior rectus muscle. Further assessment could be performed on the
dedicated CT sinus. The pterygoid plates, left zygomatic arch, lamina
papyracea, and anterior clinoid processes are intact. Paranasal sinuses and
mastoid air cells are well aerated with the exception of polypoid disease and
aforementioned trace fluid in the right maxillary sinus. A small laceration
is seen in the left parietal subgaleal soft tissues with a few fragments of
foreign body (3, 43). No underlying skull fracture in this region.
There is an equivocal nondisplaced right skull base fracture traversing the
foramen magnum (2, 3). Globes and other intraconal elements appear within
normal limits.
## IMPRESSION:
1. No definite intracranial hemorrhage.
2. Displaced right zygomatic arch and lateral orbital wall fracture.
Recommend further assessment by dedicated facial bone CT.
3. Equivocal right skull base fracture traversing the foramen magnum. If
there is concern for vascular injury, a CTA should be performed.
Also note lateral maxillary sinus fracture.
## FINAL ATTENDING COMMENT:
above mentioned lucency extending into the foramen
magnum likely represents a vascular groove, no indication for a CTA is
present.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11532838", "visit_id": "N/A", "time": "2153-07-26 23:10:00"} |
14517807-RR-85 | 267 | ## INDICATION:
male with gastric cancer referred for evaluation for
disease recurrence.
## DOSE:
As per CT abdomen/pelvis.
## FINDINGS:
There is unchanged punctate hypodense nodule in the left thyroid lobe which is
unchanged. No pathologically enlarged supraclavicular, mediastinal, right
hilar or axillary lymph nodes. A borderline left hilar lymph node insuring 8
mm in short axis has not grown since the prior exam (4, 36).
The heart size is normal, and there is no pericardial effusion. The main
pulmonary artery and thoracic aorta are normal caliber.
Several solid pulmonary nodules measure as follows:
6 mm right upper lobe, stable since (5, 86)
1 mm subpleural right upper lobe, stable since (5, 88)
3 mm right upper lobe, stable since (5, 115)
4 mm right lower lobe, stable since (5, 178)
4 mm right middle lobe perifissural nodule, stable since , and likely
representing an intrapulmonary lymph node (5, 182)
3 mm left lower lobe, stable since (5, 190)
5 mm right lower lobe nodule, stable since (5, 216)
No new pulmonary nodules are identified. An area of left lower lobe scarring
is unchanged. There is no endobronchial lesion or pleural abnormality.
The patient is status post gastrectomy with numerous hypodense hepatic
lesions. For a detailed discussion of the upper abdomen, please refer to the
separate report from the CT abdomen/pelvis performed concurrently.
There are no bony lesions worrisome for infection or neoplasm. A T11 vertebral
body bone island is unchanged.
## IMPRESSION:
Several solid pulmonary nodules which are stable since prior CT exam. No new
pulmonary nodules identified. 6 month followup CT of the nodules is
recommended.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14517807", "visit_id": "N/A", "time": "2126-12-30 08:05:00"} |
10609408-RR-17 | 384 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## NO PO CONTRAST; HISTORY:
with psoriatic arthritis,
fibromyalgia, antiphospholipid syndrome who presents with elevated lactate,
elevated white blood countNO PO contrast// Infection or mass
## SINGLE PHASE CONTRAST:
MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 7.0 s, 0.5 cm; CTDIvol = 33.7 mGy (Body) DLP =
16.9 mGy-cm.
2) Spiral Acquisition 7.3 s, 57.1 cm; CTDIvol = 27.7 mGy (Body) DLP =
1,582.9 mGy-cm.
Total DLP (Body) = 1,600 mGy-cm.
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
Patulous distal esophagus. Otherwise, the stomach is
unremarkable. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement throughout. The colon and rectum are within normal limits. The
appendix is not visualized.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The uterus is not visualized. Several cysts are seen
within the right ovary, the largest measuring up 2.6 cm in diameter, likely
physiologic. No left adnexal abnormality.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Sclerotic bone island in the right parasymphyseal region is noted.
## SOFT TISSUES:
Small umbilical hernia containing fat is noted.
## IMPRESSION:
No acute intra-abdominal or intrapelvic abnormalities.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10609408", "visit_id": "N/A", "time": "2118-04-11 11:35:00"} |
12699143-RR-117 | 102 | ## EXAMINATION:
KNEE( (SINGLE VIEW) BILATERAL
## INDICATION:
year old woman with possible meniscal tear, medial R knee,
bilateral degenerative joint disease // eval R knee
## LEFT KNEE:
Single lateral view demonstrates prior ACL reconstruction x2. The
endo buttons and staples are unchanged.Joint spaces are preserved without
significant degenerative changes.There is no knee joint effusion.
## RIGHT KNEE:
Single lateral view of the right knee demonstrates normal
mineralization without signs of acute fractures or dislocations. The joint
spaces are preserved. There is no knee joint effusion.
## IMPRESSION:
1. Prior ACL reconstruction with intact hardware.
2. Unremarkable lateral radiograph of the right knee.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12699143", "visit_id": "N/A", "time": "2140-10-19 14:30:00"} |
11710342-RR-16 | 109 | CAROTID ULTRASOUND DATED
There are no prior studies for comparison.
## FINDINGS:
There is intimal thickening consistent with atherosclerotic plaque
formation bilaterally which is partially calcified. However, this does not
result in a significant stenosis on either side. The following peak systolic
flow velocities were obtained in m/sec.
## RIGHT SIDE:
CCA 0.6, proximal ICA 0.52, mid ICA 0.74 and distal ICA 0.56.
## LEFT SIDE:
CCA 0.74, proximal ICA 0.40, mid ICA 0.31 and distal ICA 0.40.
There is antegrade flow in both vertebral arteries.
## IMPRESSION:
1. No significant ICA stenosis on either side.
2. Antegrade flow in both vertebral arteries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11710342", "visit_id": "27434104", "time": "2151-01-04 15:08:00"} |
14795613-DS-21 | 1,327 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
with Alzheimer's dementia recently discharged from
inpatient ger-psych to rehab where he was initially
calm and cooperative in the rehab facility. Upon the patient's
daughter leaving, he became acutely agitated and started pulling
doors off of walls at which point he was transferred to .
History obtained from chart review as family was not at
bedside, patient unable to recount history and no records were
sent from .
In the ED, initial vitals were:
T 98.4 HR 68 BP 124/61 R 18 SpO2 100% RA
- Labs notable for:
## UA:
Small Leuks, +Nit, Few bac, 6 WBC
Cr 1.5 (baseline ~1.3)
Hgb 11.4 (baseline ~11)
- Imaging was notable for: None obtained
- Patient was given:
23:09 IM Haloperidol 2 mg
23:33 IM Haloperidol 2 mg
00:44 IV CeftriaXONE 1
Upon arrival to the floor, patient was calm and sleeping
## REVIEW OF SYSTEMS:
no fevers/chills. No chest pain or dyspnea.
No n/v/d. No abd pain or dysuria
This morning, the patient does not have complaints. Collateral
history obtained from daughter/HCP. She states year ago, he
started becoming less active in his iadls, and while he used to
take care of his wife who has had a gradual medical decline, she
began being more dominant taking care of him. Then, in he
stopped being able to take care of his personal hygiene. Since
then, he has been forgetful, and occasionally becomes agitated.
In the past, the daughter states this was in the setting of UTI.
She noticed he doesn't walk as much as he used to, but has not
particularly noticed a slow or shuffling gait. She describes he
has had delusions of where he has been but has not described
visual hallucinations.
She expresses frustration over his medical course over the last
month. He was discharged to facility, in which his
medications were uptitrated. They started to treat him for a UTI
and gave him a few days of abvx then stopped because the
cultures were negative. He then was transferred to a rehab where
the incident described in admission note occurred in the setting
of her leaving him the first night.
## PAST MEDICAL HISTORY:
Likely dementia
BPH
Diabetes.
Glaucoma
Hx TIAS
## FAMILY HISTORY:
Deferred. Reports both parents died of "old age"
## HEENT:
sclerae anicteric. b/l arcus senilis
## RESP:
No increased WOB, CTAB no rhonchi, wheezing or crackles
## NEURO:
no facial droop. PERRL. Moving all 4 extremities. Able
to follow commands. AAOx1-2 (person and knows its a hospital)
## GEN:
NAD, comfortable appearing in bed. Alert to gentle touch
## RESP:
No increased WOB, decreased at bases
## NEURO:
Moving all 4 extremities. Not cooperative to exam
## MICRO:
======
9:45 pm URINE
**FINAL REPORT
URINE CULTURE (Final :
MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
AND/OR GENITAL CONTAMINATION.
09:45PM URINE Blood-NEG Nitrite-POS Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-SM
09:45PM URINE RBC-1 WBC-6* Bacteri-FEW Yeast-NONE Epi-0
9:00 am RPR w/check for Prozone (Final :
## DISCHARGE LABS:
==============
No labs checked on day of discharge, most recent labs below:
10:20AM BLOOD WBC-4.7 RBC-4.09* Hgb-12.1* Hct-36.2*
MCV-89 MCH-29.6 MCHC-33.4 RDW-13.7 RDWSD-44.2 Plt
10:20AM BLOOD Plt
10:20AM BLOOD Glucose-199* UreaN-31* Creat-1.5* Na-144
K-4.1 Cl-105 HCO3-27 AnGap-16
10:20AM BLOOD ALT-30 AST-41* AlkPhos-102 TotBili-0.5
10:29AM BLOOD Valproa-102*
10:20AM BLOOD Valproa- discharge with history of rapid cognitive decline over last
6 months c/w dementia with recent discharge from
facility, medically optimized on increased antipsychotics and
Depakote and transferred to long term facility with dementia
unit.
## #DEMENTIA:
#AGITATION:
Patient presented after becoming acutely agitated
after his daughter left him at , after same day
transfer out unit. His presentation
was consistent with behavioral changes seen in dementia (new
facility/care-takers after month-long stay at unit,
acute timing after daughter left.) Rapid cognitive decline over
last 6 months c/w vascular dementia (CAD as risk factor, h/o
TIA) in addition to Alzheimers. He was trialed on olanzapine
with Depakote, but continued to have behavioral disturbances. He
was stabilized on a regimen of: Haldol 5mg qam, Haldol 7.5mg
qpm, Depakote 250mg po QAM, Depakote 1000mg PO QPM and trazdone
25 mg at for sleep.
## #CONSTIPATION:
He was constipated on presentation. He was
subsequently regulated with home lubipristone, miralax, and
Senna with good effect.
## #ASYMPTOMATIC PYURIA:
UA on presentation had leukocytes and few
bacteria. He was asymptomatic and had negative urine cultures,
no fever, and no leukocytosis.
## CHRONIC ISSUES:
=============
#CKD:
At baseline. Medications were renally dosed and
nephrotoxins avoided.
#HTN: during this admission, patient was continued on home
amlodipine 5mg daily
#Normocytic anemia: at baseline
#H/O DM2: AM blood sugars ranged from 104-199, with no ISS or
oral hypoglycemics on this admission.
#BPH: on this admission, patients home tamsulosin was held, and
patient was maintained on finasteride 5mg QHS
#CAD: on this admission, patient was continued on ASA daily
## TRANSITIONAL ISSUES:
===============
[] Patient is at high risk for behavioral changes/agitation with
change of environment due to underlying dementia. Patient will
benefit from minimization of tethers, orientation to new
surroundings with help of family presence/health aide, and time
to acclimate to new environment. Based on patients previous
history and on this admission, patient may benefit from close
monitoring without significant interventions while adjusting to
new facility.
[] Additionally, known trigger for patient is incontinence care,
which can be minimized/consolidated per floor staff to minimize
intervention to as needed basis to maintain hygiene.
[] Please continue to monitor patient agitation/anxiety/sedation
on stabilized on a regimen of: Haldol 5mg qam, Haldol 7.5mg qpm,
Depakote 250mg po QAM, Depakote 1000mg PO QPM and trazdone 25 mg
QHS.
[]MOLST form filled out with HCP :
DNR
DNI
No non-invasive ventilation
Transfer to the hospital
No dialysis
No artificial nutrition
Use artificial hydration
## # CODE:
DNR/DNI
# CONTACT:
Name of health care proxy:
## DAUGHTER
PHONE NUMBER:
Psychiatry followed and helped
establish this regimen.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 325 mg PO DAILY
2. Tamsulosin 0.4 mg PO QHS
3. Travatan Z (travoprost) 0.004 % ophthalmic QHS
4. amLODIPine 5 mg PO DAILY
5. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID
6. Multivitamins 1 TAB PO DAILY
7. OLANZapine 5 mg PO BID
8. Divalproex (DELayed Release) 250 mg PO BID
9. Januvia (SITagliptin) 50 mg oral DAILY
10. Lubiprostone 24 mcg PO QAM
11. Finasteride 5 mg PO QHS
## DISCHARGE MEDICATIONS:
1. Divalproex Sod. Sprinkles 250 mg PO QAM
2. Divalproex Sod. Sprinkles 1000 mg PO QPM
3. Haloperidol 5 mg PO DAILY
4. Haloperidol 7.5 mg PO QPM
5. Polyethylene Glycol 17 g PO DAILY
6. Senna 8.6 mg PO BID
7. TraZODone 25 mg PO QPM insomnia
8. amLODIPine 5 mg PO DAILY
9. Aspirin 325 mg PO DAILY
10. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID
11. Finasteride 5 mg PO QHS
12. Januvia (SITagliptin) 50 mg oral DAILY
13. Lubiprostone 24 mcg PO QAM
14. Multivitamins 1 TAB PO DAILY
15. Travatan Z (travoprost) 0.004 % ophthalmic QHS
## DISCHARGE DIAGNOSIS:
Mixed vascular and Alzheimer's dementia
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted with agitation. Your most recent episode was
likely due to your underlying dementia. You were stabilized on a
slightly different medication regimen on this admission, which
in addition to the help of a personal aide continued to have
good control of your anxiety/agitation.
Please continue your stabilized medication regimen as instructed
below.
It was a pleasure taking care of you.
Wishing you all the best,
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14795613", "visit_id": "26233926", "time": "2162-06-03 00:00:00"} |
17321198-RR-15 | 226 | ## FINDINGS:
CT OF THE ABDOMEN WITHOUT AND WITH IV CONTRAST:
The right kidney contains a sub-2-mm punctate non-obstructive stone in the
interpolar region (2:27). Otherwise, bilateral kidneys are without evidence
of stones or hydronephrosis.
The visualized lung bases are clear. The visualized heart is normal in size
without a pericardial effusion. The liver, gallbladder, spleen, stomach,
visualized loops of small and large bowel, and bilateral adrenal glands and
pancreas are within normal limits. The abdominal aorta is normal in caliber
and contour. No mesenteric or retroperitoneal lymphadenopathy. There is no
free fluid or free air in the abdomen.
CT OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
The bladder, uterus, rectum and sigmoid colon are within normal limits. The
left ovary contains a septated cystic structure measuring 5.6 cm (transverse)
x 4.5 cm (AP) x 4.5 cm (craniocaudal). No pelvic or inguinal lymphadenopathy.
Small amount of free fluid is noted in the pelvis. The right ovary appears
within normal limits.
## OSSEOUS STRUCTURES:
There are no lytic or sclerotic osseous lesions
suspicious for malignancy.
## IMPRESSION:
The left ovary contains a septated cystic structure measuring 5.6 x 4.5 x 4.5
cm. This may be representative of normal follicular activity; however, given
the correlation with site of pain further characterization with a dedicated
pelvic sonogram is recommended.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17321198", "visit_id": "N/A", "time": "2156-11-04 23:48:00"} |
16086687-RR-46 | 99 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## FINDINGS:
A small focus of chronic infarction at the right frontal vertex is new from
prior. There is no intra-axial or extra-axial hemorrhage, edema, or shift of
normally midline structures. Ventricles and sulci are prominent, suggestive of
volume loss. There are periventricular and subcortical hypodensities, which
may represent small vessel ischemic changes. The imaged paranasal sinuses are
clear. Mastoid air cells and middle ear cavities are well aerated. The bony
calvarium is intact.
## IMPRESSION:
No acute intracranial hemorrhage. Small chronic infarct at the right frontal
vertex. Small vessel disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16086687", "visit_id": "24503065", "time": "2180-09-19 09:25:00"} |
14080963-DS-18 | 1,591 | ## ALLERGIES:
Hydrochlorothiazide / Norvasc / Clarithromycin / Lisinopril
## HISTORY OF PRESENT ILLNESS:
w/ myeloma (s/p velcade x1, in remission), hypothyroidism,
GERD, gout, HTN, s/p ventral hernia repair 4wks PTA p/w 2wk
subacute hx of poor po intake, anorexia, fatigue, darker BMs,
and found to have ARF, anemia below baseline on routine
laboratories drawn in clinic the AM of admission.
.
Patient underwent ventral hernia repair 4wks PTA without
complication. 1wk post-op f/u was unremarkable per OMR record.
In 2wks PTA patient describes mild anorexia a/w some decreased
po intake. In a similar time period, also describes brown stool
(?darker than usual) without bright-red blood. No dyschezia,
tenesmus. Denies decreased UOP. No dizziness, no
light-headedness. Also describes 2wk hx of R lateral hip/lateral
thigh pain/anesthesia at the site of recent fall plain
films of the hip at the time negative). Patient's daughter
describes recent medication non-compliance (?memory difficulty,
mental slowing) as well.
.
## ROS:
As above. Specifically, denies h/a, no shortness of breath,
no chest pain/chest pressure, no arthralgia, no joint swelling,
no new rashes. Denies back pain, no dysuria, no change in urine
color, no hematuria. Does describe possibly modest increase in
edema, though no PND, orthopnea. Denies new bony pain.
.
Of note, patient w/ recent episode of ARF (Cr 0.9--> 1.6 in
, in setting of poor po intake, resolved w/ fluids).
.
## ED/CLINIC COURSE:
Evaluated in clinic with VS Afebrile, P 77, BP
102/57, RR 18, 100% RA. Labs notable for BUN/Cr of 55/2.7
(Baseline is , Hct 25 (Baseline . Patient
was instructed to present to the ED. VS were unchanged
(normotensive, afebrile, not tachycardic). A Foley was placed
with 100cc urine. She was subsequently admitted to the floor.
## PAST MEDICAL HISTORY:
HTN
HF w/ preserved EF (mild diastolic dysfunction)
Hypothyroidism
GERD
Gout
MM (s/p Velcade x1)
Depression
Visual Hallucinations (unclear etiology, ?cerebrovascular
disease)
s/p cataract surgery (R eye , L eye
s/p PE (distant; not on anti-coagulation)
## FAMILY HISTORY:
No hx strokes, no dementia hx, no seizure d/o.
## GEN:
Lying in bed, NAD
## HEENT:
sclerae not pale, no OP ulcers
## NECK:
JVP 12cm, no wheeze, no bruit
## ABD:
Soft, ventral hernia (3x5cm) palpable, non-tender. +BS. No
rebound. No HSM.
## MSK:
No mid-line bony tenderness along spinous processes
## NEURO:
CN II-XII intact to direct examation
Sensation intact to light touch UE. ?Decreased sensation to
light touch RLL
## HIP:
No worsening pain with internal/external rotation,
flexion/extension
## LFTS:
AST/ALT , Alk Phos 65, TBili 0.2
## U/A:
Negative (no protein, no RBC, no WBC)
UPEP/SPEP/IFE PENDING
##
0. RF:
Most likely etiology was pre-renal hypovelemia poor
po intake, medication non-compliance). Elevated BUN/Cre resolved
with gentle hydration (Cre 2.5-->1.1, baseline Cr 0.9-1.1).
Patient's and Lasix were held on admission. Intrinsic
sources of renal failure were felt to be unlikely, including
myeloma related vs. gout-associated urate nephropathy. Serum
uric acid was modestly elevated, though urine uric
acid:creatinine ratio did not suggest urate nephropathy. A spot
urine protein:creatinine ratio was normal, arguing against acute
or chronic nephropathy. A U/A was notable for no proteinuria
arguing against a BCJ tubulopathy or myeloma associated
cryoglobulinemia. Patient was never oliguric/anuria during
admission argues against post-infectious or other etiologies of
GN. No e/o hypotension to argue for post-ischemic ATN, no new
medications to mediate AIN, and no stigmata on exam or hx to
suggest vasculitic etiology.
.
#GIB: On admission, Hct was 25 (baseline and patient was
reportedly guiac positive. The patient was never hemodynamically
unstable. Iron studies were consistent with AOCD, bone marrow
hypoproliferation. Other sources of reversible anemia were
normal (Folate was normal, recent B12 normal). Etiology of GIB
was not fully clarified during admission. Prior colonoscopy with
severe diverticulosis ( ) and benign cecal polyp. Patient was
transfused 1U pRBC after Hct nadir of 22.9. Utility of EPO
therapy is unclear in the setting of non-myeloid malignancy and
was deferred during admission. Patient's ASA was held on
admission, and PPI was continued. The plan was for close
follow-up with her primary care physician, with consideration
for additional evaluation (EGD/Colonoscopy) pending hematocrit
trend. Patient was instructed to continue to hold ASA until
being seen by primary care physician.
.
#L Hip Pain: Patient complained of subacute history of L lateral
thigh/hip pain s/p fall in . Plain films of the L hip at
the time were negative. Repeat plain film of the L hip during
this admission showed no evidence of fracture, with diffuse
osteopenia. Exam was notable for reduced sensation along L
lateral aspect of the thigh. Consideration was given to possible
neuropathy (TIIDM vs. myeloma). Given fall risk, patient may
benefit from bisophosphonate therapy as well as VIT D repletion.
Initiation of these therapies were deferred to the out-patient
setting.
.
#MM: stable, in remission per prior labs. Low-normal serum TP,
abscence of urine proteinuria argues against heavy burden of
myeloma heavy or light chain disease. A UPEP returned with
monoclonal gammopathy, concerning for indolentj/smoldering
secretory light-chain disease. Consideration for repeat BM
biopsy and potential chemotherapeutic options were deferred to
the patient's out-patient oncologist.
.
#CV: Patient remained normotensive, hemodynamically stable on
admission. Given ARF, home Valsartan and Lasix were held during
admission. Home dose carvedilol and statin were continued.
Patient was discharged on half-dose of home Lasix (discharge
dose was 40mg po qd). She was advised to discontinue Valsartan,
with scheduled follow-up with primary care. Of note patients BPs
were stably 120-140/60-70 in the setting of held
Valsartan/Lasix.
.
#TIIDM: History of modestly elevated A1C (most recently 6.3;
. No evidence of nephropathy on urine analysis (TP/Cre <
0.2). Plasma glucose remained within normal limits during
admission.
.
#Hypothyroidism: TSH during admission was 0.1 (TSH 2.9 in
. Unclear contribution of hyperthyroidism to
neuro-psychiatric symptoms (hallucinations) or anemia. Her
Levothyroxine dose was reduced from 88mcg to 50mcg with a plan
to recheck TFTs in the out-patient setting.
.
#Gout: Stable. Allopurinol was renally dosed on admission. Serum
and urine uric acid were modestly elevated.
.
#Psych: Patient has history of visual hallucinations (unclear
etiology, ?cerebrovascular disease) and recently diagnosed
depression. Mental status exam during admission was notable for
reduced memory recall. Home Risperdal was continued for visual
hallucinations (patient reported one transient episode of VH).
Home dose Zoloft was continued for depression.
.
#Mental Status: Day of discharge, nurse was concerned for
possibility of delirium. On formal mental status examination,
patient was alert and oriented to person, place, and date. She
demonstrated appropriate attention (spelled 'WORLD' backwards),
intact calculation, and repetition. Her speech was notable for
mild perseveration, but no paraphasic errors were noted. A
neurological exam was normal at the time. The patient reported
being 'upset' re: an IV placed for Mg repletion, and her affect
and mood were consistent. Given the findings of her mental
status and neurological examination there was low concern for
delirium or an acute neurologic process. She was considered safe
for discharge.
## MEDICATIONS ON ADMISSION:
Allopurinol po qd
Carvedilol 12.5mg po BID
Lasix 40mg po BID
Levothyroxine 88mcg po qd
PPI 40mg po qd
Risperidone 0.25mg po qd
Sertraline 25mg po qd
Simvastatin 10mg po qd
Valsartan 320mg po qd
ASA 81mg qd
Colace/Senna PRN
## DISCHARGE MEDICATIONS:
1. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Sertraline 50 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. Risperidone 0.25 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
## 7. ALLOPURINOL MG TABLET SIG:
One (1) Tablet PO once a day.
8. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
## PRIMARY DIAGNOSES:
Acute Renal Failure
Gastrointestinal Bleeding
## SECONDARY DIAGNOSES:
Multiple Myeloma
Hypothyroidism
Depression
Gout
Hypertension
Hyperlipidemia
## DISCHARGE INSTRUCTIONS:
You were admitted to the for further evaluation of renal
failure and anemia. Your renal failure was felt to be secondary
to dehydration. Your anemia was felt to be secondary to a
combination of possible bleeding in your gut as well as your
other medical conditions. You received a blood transfusion
during your admission. Additional investigation of a possible
bleeding source in your gut will be deferred to your primary
care physician. Finally, given your L hip pain you received an
x-ray of the L hip which showed no evidence of fracture.
.
During your admission on new medications were started. Your home
Valsartan, Furosemide, and Aspirin were held. These medications
were restarted on discharge. You should take your Furosemide
(water pill) once a day. Please discontinue your Valsartan until
you see your primary care physician. Please continue to hold
your Aspirin until you see your primary care physician.
.
If you experience worsening abdominal pain, change in the color
of your stools (evidence of blood, dark or black stool),
diarrhea, nausea, vomiting, chest pain, chest pressure,
shortness of breath, decreased urine output, fevers, chills,
worsening hip pain, difficulty walking, or any symptom that
concerns you please contact your primary care physician or
return to the hospital.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14080963", "visit_id": "26771796", "time": "2131-08-20 00:00:00"} |
15425638-DS-9 | 1,815 | ## HISTORY OF PRESENT ILLNESS:
Ms. is year old female with a history of
diabetes, hyperlipidemia, obesity, a prior history of renal cell
carinoma s/p nephrectomy ago and fallopian tube cancer,
who has been transferred from the for further workup
of a renal mass concerning for a possible metastatic renal
carcinoma.
She presented to the on , with a severe headache
and nausea x 1 day. The patient reported that she had never had
a headache like that in the past which is why she went to the
ED. This progressed to squeezing headache, which spread
throughout her head and increased in intensity to a . She
was found to be hypertensive to the 210's and admitted. One day
later, she began to have hematuria. She reported no vision
changes, no chest pain, no nausea, vomiting, no history of MI or
CAD. She reported frequency, urgency w/o dysuria and was started
on Ceftriaxone q24h (received 1 dose) for presumed UTI (Cx grew
50-100k mixed flora).
Started on lisinopril 10 mg and norvasc 2.5 mg. On transfer, her
blood pressures remained poorly controlled with SBPs in 170s.
Labs were drawn which showed WBC 5.5, HgB 12.1, HcT 37.0 and
platelet 312. Chemistries were within normal limits.
At OSH, she underwent a Dopper evaluation of the right kidney,
looking for evidence of renal artery stenosis. She was found to
have the suggestion of a renal mass on the study. A contrast
enhanced MRI of the solitary kidney showed an infiltrative tumor
involving the upper and interpolar right kidney, with invasion
into the collecting system, intrarenal vasculature and right
renal vein, with enlarged infrahilar lymph nodes in the chest
and some subcentimeter prominent nodes in the retroperitoneum.
The left nephrectomy bed was clear. She was transferred to the
for further workup of a possible metastatic renal cell
carcinoma.
Of note, patient has never had hypertension previously. Two
months prior, BP 135/85 in clinic and PCP just wanted to follow.
She's taken her BPs near daily at home since then with systolics
always in 120's.
On the floor, patient is comfortable, in NAD. She denies any
dyspnea, chest pain, sweating with headaches, intermittent
headaches/sweating
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies cough, shortness of breath. Denies chest pain or
tightness, palpitations. Denies nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits.
## PAST MEDICAL HISTORY:
1. Type 2 diabetes.
Well controlled on metformin. Most recent hemoglobin A1c was 6.0
in . c/b by lower extremity neuropathy.
2. Hyperlipidemia, not on statins due to myalgias.
LDL of 89, HDL of 67, triglycerides 151 and cholesterol 186 in
.
3. Fallopian tube cancer - Underwent TAHBSO and omentectomy in
for fallopian cancer and pathology revealed a stage
III carcinoma of the fallopian tube. Between and
, she received six cycles of Carboplatinum and
Taxol. In , it was noted that her CA-125 had started to
rise. In , it was 28 and in , it was 51. She underwent a
CT which revealed an enlarged retroperitoneal lymph node. A
subsequent PET CT demonstrated a cluster of mildly enlarged
lymph nodes, each measuring less than 2 cm, located in the right
common iliac region. The pt underwent an exploratory laparotomy,
pelvic lymph node dissection, panniculectomy and ventral
herniorrhaphy on . Metastatic carcinoma was present in 3
of 7 pelvic lymph nodes. The patient was assessed as having
recurrent stage IIIB, grade 2 fallopian tubal carcinoma. She
received her six cycles of chemotherapy with Carboplatinum and
Taxol from to . Sees Dr. at
the every six months for her physical exam and labs and
sees Dr. at the from Oncology annually.
4. Hypothyroidism.
5. Renal cell carcinoma
Status post left nephrectomy in , with no known recurrences.
6. Atypical Nevi
Followed closely by dermatology team. Noted to have well
over 200 nevi, many of which are larger than 6mm.
## FAMILY HISTORY:
Mother has disease and RA, died at aged of sepsis.
Father died age from a "blood clot" s/p MVA. A paternal aunt
had colon CA. has Graves disease. Granddaughter has
hypothyroidism.
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear
## NECK:
supple, JVP not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
## GU:
Foley draining grossly bloody urine
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Small (1cm), soft, nontender inguinal nodes bilaterally.
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear
## NECK:
supple, JVP not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
## GU:
Foley draining grossly bloody urine
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. Small (1cm), soft, nontender inguinal nodes bilaterally.
## STUDIES:
CT CHEST NON CON
## IMPRESSION:
1. Mediastinal and probable bilateral hilar lymphadenopathy,
fully described
above.
2. Scattered bilateral pulmonary nodules measuring up to 5 mm
in the right
lower lobe should be followed up with CT in months given
this patient's
history of malignancy.
3. Ectatic ascending aorta, measuring up to 3.8 cm in caliber.
## BRIEF HOSPITAL COURSE:
Ms. is year old female with a history of
diabetes, hyperlipidemia, obesity, a prior history of renal cell
carinoma and fallopian tube cancer, who has been transferred
from the for further workup of a renal mass
concerning for a possible metastatic renal carcinoma and
hypertensive emergency.
## HYPERTENSIVE EMERGENCY:
Patient presented to the outside
hospital with elevated BPs of 210/87. There was possible
evidence of end-organ damage due to hematuria/headaches and
elevated creatinine to 1.1-1.3(from baseline of 0.8 according to
records). TSH returned normal. Head CT scan done in the
outside hospital showed no acute abnormalities. Upon discharge
from , BP was moderately controlled with lisinopril 20
daily and norvasc 2.5 daily with SBPs in the 140s.
## RENAL MASS:
At the outside hospital, MRI of the abdomen
demonstrated a large infiltrative tumor involving the upper pole
and interpolar region of the right kidney highly worrisome for
renal cell carcinoma. There were also enlarged infrahilar lymph
nodes in the chest and some subcentimeter prominent nodes in the
retroperitoneum. Given this patient's past history of renal cell
carcinoma, this was concerning for a metastastases of the
patient's renal cell carcinoma. Also on the differential was a
metastases of the patient's fallopian tube cancer. The patient
underwent a chest CT in order to evaluate for matastases. The
results showed pulmonary nodules and hilar and mediastinal
adenopathy. She is to follow up with oncology in ,
with further review of the imaging.
## UTI:
Patient reported urgency and frequency w/o dysuria at the
outside hospital. During her admission at the OSH, she developed
gross hematuria. The hematuria was thought to be a consequence
of her hypertensive emergency. She was started on ceftriaxone
and received 1 day prior to transfer. She received an
additional dose of ceftriaxone during her hospitalization at
and was discharged with a day of ciprofloxacin for
completion of a 3 day course for uncomplicated UTI.
## HYPOTHYROIDISM:
Patient has history of hypothyroidism. We
continued synthroid daily.
## DIABETES:
Patient has a history of well controlled diabetes on
metformin. We stopped her metformin during her hospitalization
and she was started on an insulin sliding scale. We did not
restart her metformin upon discharge due to her elevated
creatinine (1.3). The decision to restart her metformin was
deferred to her outpatient providers based upon subsequent tests
of her renal function.
## ATYPICAL NEVI:
Patient has multiple atypical nevi, which are
followed by dermatology.
## TRANSITIONAL ISSUES:
- During her stay, her metformin was d/ced due to her
(creatinine was elevated to 1.3 upon discharge, from a baseline
of 0.8). This is believed to be secondary to hypertensive
emergency and expected to resolve upon BP control. Please review
her labs (to be collected on and determine if
it is appropriate to restart her metformin.
-As she had completed day course of ceftriaxone for her
urinary tract infection, she will be discharged on one day
supply of ciprofloxacin.
-Please f/u CT chest for further information on staging for new
mass seen on MRI.
-Please continue lisinopril and norvasc accordingly for blood
pressure control for patient.
-Please follow up results of TSH and CT chest
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Levothyroxine Sodium 112 mcg PO DAILY
2. MetFORMIN (Glucophage) 850 mg PO BID
3. Ascorbic Acid mg PO DAILY
4. Aspirin 81 mg PO DAILY
5. Calcium Carbonate 500 mg PO DAILY
6. Vitamin D 400 UNIT PO DAILY
7. Multivitamins 1 TAB PO DAILY
8. Fish Oil (Omega 3) 1000 mg PO 2 CAPSULES IN AM AND 1 CAPSULE
AT DINNER
## DISCHARGE MEDICATIONS:
1. Ciprofloxacin HCl 250 mg PO Q12H
RX *ciprofloxacin 250 mg 1 tablet(s) by mouth twice daily Disp
#*2
## TABLET REFILLS:
*0
2. Levothyroxine Sodium 112 mcg PO DAILY
3. Multivitamins 1 TAB PO DAILY
4. Ascorbic Acid mg PO DAILY
5. Aspirin 81 mg PO DAILY
6. Calcium Carbonate 500 mg PO DAILY
7. Fish Oil (Omega 3) 1000 mg PO 2 CAPSULES IN AM AND 1 CAPSULE
AT DINNER
8. Vitamin D 400 UNIT PO DAILY
9. Amlodipine 2.5 mg PO DAILY
RX *amlodipine 2.5 mg 1 tablet(s) by mouth once daily Disp #*15
## TABLET REFILLS:
*0
10. Lisinopril 20 mg PO DAILY
RX *lisinopril 20 mg 1 tablet(s) by mouth once daily Disp #*15
Tablet Refills:*0
11. Outpatient Lab Work
please check chem 10 and CBC on
## DISCHARGE DIAGNOSIS:
- Hypertensive Emergency
- Renal mass concerning for Renal cell carcinoma
- Urinary tract infection
## DISCHARGE INSTRUCTIONS:
Dear
was a pleasure having you here at the
. You initially presented to the with
a headache, which was found to be secondary to elevated blood
pressures. You were transferred from the for further
evaluation of a renal mass that was identified on MRI. Upon
your discharge, your blood pressure was well controlled with
oral anti-hypertensive medications. You were also treated for a
urinary traction infection, you need to complete one more day of
ciprofloxacin. You had a chest CT scan for staging of the renal
mass; the results of which are currently pending. You will need
to meet with your outpatient oncologists for further evaluation
of the renal MRI finding and discussion of appropriate
therapies. Please keep your follow up appointments below.
Please come to the and get your blood drawn on in
advance of your appointments on .
Best Regards,
Your Medicine Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15425638", "visit_id": "24135485", "time": "2127-12-10 00:00:00"} |
17904720-DS-15 | 1,340 | ## HISTORY OF PRESENT ILLNESS:
Mr. is y.o. man with a history of
obstructive/restrictive lung disease, diastolic heart failure
(EF 70% , hypertension and hyperlipidemia who presented to
the ED this morning complaining of fever, chills and shaking. He
woke this morning and felt generally unwell. He then took his
grandson, to school, returned home, and his sxs worsened. He
sat in a chair and felt feverish/rigors (temperature not taken)
and started shaking without loss of consciousness or any seizure
activitiy. At this point he felt SOB. He states that he felt
very anxious and was worried he might die. Pt states that he has
been experiencing cough productive of white sputum for the past
few years that has actually improved over the past week. He uses
oxygen at home as needed for SOB and has increased his use over
the past few days, but denies SOB currently. Pt also reports
increasing use of his albuterol inhaler over the past 2 days. Pt
denies night sweats, abdominal pain, diarrhea, dysuria,
orthopnea, PND. He does have vomiting after all solids and
liquids X years which is not new.
.
Pt also states he has been experiencing left sided neck/shoulder
pain that radiates down his arm to his elbow for the past 4
days. Pt has experienced light headedness but he says this is
normal and been going on for year. Pt denies chest pain.
Pt has a history of GERD and esophageal spasm and states that he
has lost .
.
In the ED, initial vs were: T 100.3 P 80 BP 201/146 R 36 O2 sat
97% NC. He was given: ASA 325mg, Ceftriaxone 1G and Azithromycin
500mg,
Tylenol 1G. His BP immediately normalized to 120s and he desated
to 89%/RA.
## PAST MEDICAL HISTORY:
1. Diastolic Heart Failure
2. Obstructive/Restrictive Lung Disease
3. Hyperlipidemia
4. Hypertension
5. BPH s/p TURP in
6. PBC dx in
7. GERD
8. Esophageal spasm
9. Gout
10. Pericardial effusion and tamponade in
11. Anemia
## FAMILY HISTORY:
Mother and father both had HTN and died after falls; biological
daughter is healthy.
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
NC/AT, sclera anicteric, oropharynx clear, dry mucous
membranes
## NECK:
JVP not elevated, hepatojugular reflex not appreciated
## LUNGS:
high pitched LUL expiratory noise
## CV:
Regular rate and rhythm with no murmurs, rubs, gallops of
thrills appreciated. Heart sounds distant.
## ABDOMEN:
Normal bowel sounds, soft, +epigastric TTP, distended
(baseline per patient)
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## NEURO:
CN X-XII grossly in tact
## MOTOR:
proximal arms and legs
## PERTINENT RESULTS:
Admission labs:
09:40AM BLOOD WBC-9.3 RBC-4.86 Hgb-14.8 Hct-45.9 MCV-95
MCH-30.4 MCHC-32.2 RDW-15.2 Plt
09:40AM BLOOD Neuts-84.7* Lymphs-10.2* Monos-3.3
Eos-1.6 Baso-0.2
09:40AM BLOOD Glucose-99 UreaN-16 Creat-1.1 Na-138
K-4.5 Cl-99 HCO3-27 AnGap-17
06:25AM BLOOD ALT-17 AST-34 CK(CPK)-68 AlkPhos-199*
TotBili-0.8
09:15PM BLOOD CK-MB-5 cTropnT-0.01
06:25AM BLOOD CK-MB-NotDone cTropnT-0.01
09:53AM BLOOD Lactate-2.0
09:40AM URINE Color-Yellow Appear-Clear Sp
09:40AM URINE Blood-TR Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-8.0 Leuks-NEG
09:40AM URINE Bacteri-OCC Yeast-NONE
blood culture pending
urine legionella negative
joint fluid : NGTD at discharge, gram stain with polys only
urine culture negative
Discharge labs:
06:25AM BLOOD WBC-7.5 RBC-4.32* Hgb-12.8* Hct-40.9
MCV-95 MCH-29.7 MCHC-31.4 RDW-14.7 Plt
01:22AM BLOOD Neuts-82.0* Lymphs-12.6* Monos-4.9
Eos-0.1 Baso-0.3
06:08PM BLOOD PTT-98.8*
08:50AM BLOOD PTT-77.2*
06:25AM BLOOD Glucose-128* UreaN-22* Creat-1.0 Na-138
K-4.0 Cl-98 HCO3-31 AnGap- y.o. man with a history of obstructive/restrictive lung
disease, diastolic heart failure (EF 70% , hypertension and
hyperlipidemia who presented to the ED complaining of fever,
chills and shaking.
.
# CAP: Patient with infiltrate, cough, ?fever suggestive of
pna. In addition to CAP, given vomiting, could be aspiration,
however with distribution more likely to be a more typical
pathogen. With hx of COPD, could have a component of
bronchoconstriction though no wheezes on exam. Mr. was
thus treated with Azithromycin for 5 days and discharged on
Cefpodoxine after being treated with Ceftriaxone in order to
complete a 7 day course. His respiratory status improved though
he intermittently required his baseline oxygen at night. We
suggest a repeat CXR in 6 weeks.
.
# Neck/shoulder/arm pain: Could be referred pain from LLL pna as
resolved with pna treatment. Patient was ruled out for an MI.
.
# pseudogout: Mr. developed right knee pain and fever to
100.4 overnight from . Cultures were sent. He then
developed right knee pain and swelling. 60cc were drained by
rheumatology c/w pseudogout. Mr. was on
which was transitioned to Prednisone and then stopped prior to
discharge per discussion with Rheumatology.
.
# coagulopathy: , and PTT were elevated when checked prior
to arthrocentesis. This was thought to be likely due to
malnutrition due to vomiting and Heparin SC respectively. The
coags were downtrending at discharge and patient was given 5mg
Vitamin K X1. The coags should be monitored as an outpatient.
.
# chronic dCHF: Patient's lasix was restarted on daily (versus
BID dosing per pharmacy) as per Dr. . He was
continued on betablocker and asa. Discharge weight was 142lbs
which seemed at his baseline.
.
# vomiting: Speech and swallow evaluation showed no aspirating
however recommended outpatient barium swallow to complete his
work-up. Patient was continued on BID PPI.
.
# Code: full (confirmed)
.
# Communication: Patient, (daughter)
# Dispo: Patient was seen by prior to discharge and refused
cane or walking assistance. He was discharged with home
services.
## MEDICATIONS ON ADMISSION:
Furosemide 40mg 2X/day
Protonix 1X/day
Nadolol 40 mg/day
Oxybutinin extended release 5mg/day
Hydrocortisone 2.5% 2X/day
Iron supplement (not recently filled)
.
## DISCHARGE MEDICATIONS:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
2. Cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO twice a day
for 5 doses.
Disp:*5 Tablet(s)* Refills:*0*
3. Nadolol 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
4. Oxybutynin Chloride 5 mg Tablet Extended Rel 24 hr Sig: One
(1) Tablet Extended Rel 24 hr PO once a day.
5. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for constipation.
Disp:*60 Tablet(s)* Refills:*0*
8. Outpatient Lab Work
## DISCHARGE CONDITION:
Mentating well, ambulating independently with cane
Off of oxygen, 95% on RA
## DISCHARGE INSTRUCTIONS:
You were admitted to and
you were found to have a pneumonia. While you were here you
were treated with antibiotics. You also had a gout flare of
your right knee. Fluid was drained by Rheumatology.
You continued to have vomiting with food. Your doctor should
consider a swallow evaluation as an outpatient.
You should CONTINUE to take:
Protonix 40g twice a day
Nadolol 40 mg a day
Oxybutinin extended release 5mg daily
You should START taking:
Cefpodoxine 200mg twice a day through
Use Docusate and Senna for constipation.
You should CHANGE:
Decrease Furosemide to 40mg daily.
Be sure to make the appointments below with your doctors.
You should have a repeat chest x-ray in 6 weeks.
You will need your labs checked this week as stated on the
prescription.
Call your doctor if your weight increases by more than 4 pounds.
Your weight was 142 pounds at discharge.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17904720", "visit_id": "24992374", "time": "2125-11-11 00:00:00"} |
12692675-RR-2 | 260 | CT OF THE HEAD
## HISTORY:
New left facial droop and left-sided weakness.
There are no comparison studies.
On the unenhanced CT, there is a hyperdense MCA distally in the right. No
obscuration of the lentiform nucleus is seen. There are small vessel ischemic
sequelae in the subcortical and periventricular white matter. There is a
calcific focus in the right corona radiata which could represent a cavernoma
versus sequela of prior infection.
CTA of the head demonstrates abrupt occlusion of the right MCA compatible with
an acute occlusive thrombus in the distal M1 segment.
There is flow in the M2 branches on the right which is likely from
leptomeningeal collaterals.
The remaining intracranial vasculature reveals no hemodynamically significant
stenosis.
CTA of the neck demonstrates a calcific plaque at the origin of the right ICA.
There is no hemodynamically significant stenosis. A large calcific plaque is
also seen in the left proximal ICA, there is no hemodynamically significant
stenosis on the left. There is a small calcific plaque at the origin of the
left vertebral artery which does not appear to be hemodynamically significant.
There is a mismatch between the MTT and CBV images in the right MCA territory
suggesting ischemic penumbra.
Incidentally noted, there is a small 7-mm nodule in the right thyroid.
## IMPRESSION:
Acute occlusive clot on the right MCA with large area of mismatch in the right
MCA territory between the mean transit time and the CBV. Mild stenosis at the
origin of the ICAs bilaterally. Findings were discussed with Dr.
at 5:17 p.m. .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12692675", "visit_id": "27902657", "time": "2182-12-09 14:39:00"} |
18943220-DS-12 | 1,338 | ## CHIEF COMPLAINT:
Chest pain, Shortness of breath
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
1. Urgent coronary artery bypass graft x3; left internal mammary
artery to left anterior descending artery, and saphenous vein
graft to ramus and posterior descending arteries.
2. Mitral valve replacement with a 27 mm mechanical
valve.
## HISTORY OF PRESENT ILLNESS:
Mrs. is yo current smoker who has had minimal
past medical care. On she presented to an outside hosptal
with intermittent SSCP which was worse with exertion. She
presented with hypertension, SBP>200 and frothy pink sputum. She
was given lasix and lisinopril. She ruled in for a NSTEMI, and
was taken for cardiac cath, report not in chart but per report
, 100%LCx,90%oRCA, 90%mRCA.
## PAST MEDICAL HISTORY:
CAD
- Mitral Regurgitation
- Obesity
- Hypertension
- Peripheral arterial disease
- COPD
## FAMILY HISTORY:
No Premature coronary artery disease
## NECK:
Supple [x] Full ROM [x]
## CHEST:
Lungs coarse rhonch bilat with productive cough, no
wheezes, no rales
## HEART:
RRR [x] Irregular [] Murmur [x] grade systolic
murmur loudest at apex
## ABDOMEN:
Soft [x] obese,non-distended [x] non-tender [x] bowel
sounds +[x]
## EXTREMITIES:
Warm [x], well-perfused [x] No Edema []
## FEMORAL RIGHT:
2+ Left:2+-cath site w/small ecchymotic
area, no hematoma
## DP RIGHT:
dopp Left:dopp
Right:dopp Left:dopp
## CAROTID U/S :
1. No significant right ICA or CCA
stenosis. 2. Approximately 40% left ICA stenosis.
.
## VEIN MAPPING :
The greater saphenous veins are patent
throughout their entire course, please see digitized images on
PACS for formal sequential measurements.
.
## PREBYPASS:
No atrial septal defect is seen by 2D
or color Doppler. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Right
ventricular chamber size and free wall motion are normal. There
are complex (>4mm) atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Moderate (2+) mitral regurgitation is seen. MR
increased to 3+ will increase in BP vs. ischemia. Due to the
eccentric nature of the regurgitant jet (posterior directed),
its severity may be significantly underestimated (Coanda
effect). The mitral valve tenting height is 13 mm and the
tenting area is 1.9 cm2. First POSTBYPASS Period:
Biventricular systolic function is preserved. There is a ring
annuloplasty in the mitral position. However MR remains moderate
in quantity and is still posteriorly directed. Second
## POSTBYPASS:
Biventricular systolic function remains normal.
There is a well seated, well functioning bileaflet mechanical
valve in the position. MR is present which is normal in
quantity and location (washing jets) for this type of
prosthesis. TR is mild. The remaining study is unchanged from
prebypass.
.
08:15AM BLOOD WBC-9.5 RBC-3.16* Hgb-9.3* Hct-28.9*
MCV-91 MCH-29.3 MCHC-32.1 RDW-15.6* Plt
08:30AM BLOOD WBC-9.3 RBC-3.34* Hgb-9.6* Hct-30.2*
MCV-90 MCH-28.9 MCHC-32.0 RDW-15.9* Plt
08:15AM BLOOD PTT-57.7*
08:30AM BLOOD PTT-58.4*
12:35AM BLOOD PTT-45.3*
01:50PM BLOOD PTT-36.3
06:40AM BLOOD PTT-34.0
07:00AM BLOOD PTT-40.1*
04:30AM BLOOD PTT-40.9*
08:50AM BLOOD PTT-38.2*
01:55PM BLOOD PTT-38.7*
12:50PM BLOOD PTT-37.4*
06:00AM BLOOD PTT-72.9*
04:21AM BLOOD PTT-48.0*
08:15AM BLOOD UreaN-22* Creat-0.7 Na-141 K-4.2 Cl-101
08:30AM BLOOD Glucose-88 UreaN-24* Creat-0.8 Na-139
K-4.1 Cl-102 HCO3-28 AnGap-13
## BRIEF HOSPITAL COURSE:
Mrs. was transferred from outside hospital with a
myocardial infarction and cardiac cath that revealed severe
three vessel coronary artery disease. Upon admission she was
medically managed and underwent appropriate work-up prior to
surgery. On she was brought to the operating room where
she underwent 1. Urgent coronary artery bypass graft x3; left
internal mammary artery to left anterior descending artery, and
saphenous vein graft to ramus and posterior descending arteries.
Mitral valve replacement with a 27 mm mechanical valve.
The cardiopulmonary bypass time was 168 minutes with a cross
clamp of 141 minutes. She tolerated the operation well and
following surgery he was transferred to the CVICU for invasive
monitoring in stable condition. She remained hemodynamically
stable, sedation was weaned, awoke neurologically intact and was
extubated. All other tubes, lines and drains were removed per
cardiac surgery protocol without complication. She was started
on Beta-blockers, diuretics and these were titrated as needed.
On POD1 she was transferred from the ICU to the stepdown floor
for continued recovery. Chest tubes and pacing wires were
discontinued without complication. Heparin bridge was started
with coumadin on POD2 for her mechanical valve, INR goal
2.5-3.5. She received a course of Keflex for erythema at
site. She was evaluated by the physical therapy service for
assistance with strength and mobility. By the time of discharge
on POD 12 the patient was ambulating freely, the wound was
healing and pain was controlled with oral analgesics. The
patient was discharged home with in good condition with
appropriate follow up instructions.
## MEDICATIONS ON ADMISSION:
Medications at home:
1) fish oil
2) garlic tab
Medications on transfer:
1) Lisinopril 5 mg PO Daily
2) Aspirin 325 mg PO Daily
3) Atorvastatin 80 mg PO Daily
4) Plavix 75 mg PO Daily
5) Lovenox 80 mg SC Twice Daily
6) Metoprolol tartrate 25 mg PO Twice Daily
7) Acetaminiphen 650 mg PO Q 4 hours PRN Pain
## DISCHARGE MEDICATIONS:
1. Aspirin EC 81 mg PO DAILY
RX *aspirin 81 mg 1 tablet,delayed release ( ) by mouth
daily Disp #*30
## TABLET REFILLS:
*0
2. Atorvastatin 80 mg PO DAILY
RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30
Tablet
## REFILLS:
*0
3. Metoprolol Tartrate 25 mg PO TID
RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth three times a
day Disp #*90
## TABLET REFILLS:
*0
4. Guaifenesin mL PO Q6H:PRN cough
RX *guaifenesin [Adult Tussin Chest Congestion] 100 mg/5 mL
liquid(s) by mouth every six (6) hours Disp #*1 Bottle
Refills:*0
5. Furosemide 40 mg PO BID Duration: 7 Days
RX *furosemide 40 mg 1 tablet(s) by mouth twice a day Disp #*14
Tablet Refills:*0
6. Potassium Chloride 20 mEq PO Q12H Duration: 7 Days
RX *potassium chloride [Klor-Con] 20 mEq 1 packet by mouth twice
a day Disp #*14 Packet Refills:*0
7. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain
RX *tramadol 50 mg 1 tablet(s) by mouth every four (4) hours
Disp #*60 Tablet Refills:*0
8. Ranitidine 150 mg PO BID
RX *ranitidine HCl 150 mg 1 capsule(s) by mouth twice a day Disp
#*60 Tablet Refills:*0
## DISCHARGE DIAGNOSIS:
- Myocardial infarction, coronary artery disease s/p coronary
artery bypass graft x 3
- Mitral valve regurgitation s/p Mitral valve replacement
- Acute systolic Congestive heart failure
Past medical history:
- Obesity
- Hypertension
- Peripheral arterial disease
- COPD
## DISCHARGE CONDITION:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesia
## INCISIONS:
Sternal - eschar at inferior pole, no drainage or erythema
Leg - healing well, no erythema or drainage.
## DISCHARGE INSTRUCTIONS:
1. Please shower daily including washing incisions gently with
mild soap, no baths or swimming, and look at your incisions
2). Please NO lotions, cream, powder, or ointments to incisions
3). Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart
4). No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
5). No lifting more than 10 pounds for 10 weeks
## FEMALES:
Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns . Answering service will contact on call
person during off hours**
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18943220", "visit_id": "27827180", "time": "2147-04-11 00:00:00"} |
14343967-RR-16 | 109 | ## EXAMINATION:
TIB/FIB (AP AND LAT) SOFT TISSUE RIGHT
## HISTORY:
with firecracker that exploded near his right leg-
wound to lower leg // rule out foreign body
## FINDINGS:
No fracture or periosteal reaction is detected within the lower extremity. No
suspicious focal lytic or sclerotic lesion is identified. The proximal and
distal tibio-fibular joints remain congruent. Mild soft tissue subcutaneous
emphysema is noted adjacent to the fibula, without radio-opaque foreign body
or concerning soft tissue calcification. Limited assessment of the knee and
ankle joints is grossly unremarkable.
## IMPRESSION:
Superficial skin wound involving the lateral right calf without evidence of
osseous involvement or radiopaque retained foreign body.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14343967", "visit_id": "N/A", "time": "2162-08-29 00:59:00"} |
12783515-RR-22 | 252 | ## EXAMINATION:
CT ANGIOGRAPHY HEAD AND NECK
## HISTORY:
with headache yesterday, increasingly altered mental
status, nonfocal neuro exam // Stroke? Dissection? Intracranial bleed?
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 6.0 s, 6.0 cm; CTDIvol = 22.6 mGy (Body) DLP =
135.8 mGy-cm.
3) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 17.4 mGy (Body) DLP =
8.7 mGy-cm.
4) Spiral Acquisition 4.7 s, 36.7 cm; CTDIvol = 15.2 mGy (Body) DLP = 556.2
mGy-cm.
Total DLP (Body) = 701 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## HEAD CT:
No acute hemorrhage mass effect midline shift or hydrocephalus. Hypodensities
in the white matter indicate moderate changes of small vessel disease.
## CTA NECK:
Scattered vascular calcifications are identified. Bilateral retropharyngeal
course of internal carotid arteries is incidentally noted. No vascular
occlusion is seen. No stenosis by NASCET criteria. The left vertebral artery
appears to be arising directly from the aorta, a normal variation.
## CTA HEAD:
Bilateral fetal posterior cerebral arteries are noted with consequently small
vertebrobasilar system, a normal variation. No vascular occlusion or stenosis
seen. No large vessel occlusion is identified. No aneurysm is identified.
There is a 1.4 cm cyst in the midline thyroid isthmus.
## IMPRESSION:
1. CT head shows small vessel disease. No acute hemorrhage.
2. Patent cervical and intracranial arteries without large vessel occlusion or
high-grade stenosis. No aneurysm identified.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12783515", "visit_id": "N/A", "time": "2166-12-18 22:55:00"} |
19301174-RR-27 | 97 | PORTABLE CHEST FILM AT 10:56.
## CLINICAL INDICATION:
status post right thoracotomy with right
upper lobectomy, question pneumothorax.
Comparison is made to the patient's previous study dated at 12:01.
Portable chest film at 10:56 is submitted.
## IMPRESSION:
The small right apical pneumothorax is stable. Surgical skin staples are seen
overlying the right lateral hemithorax. The right hemidiaphragm remains
elevated and there is patchy basilar opacity likely reflecting atelectasis.
Left lung is clear. No evidence of pulmonary edema. Heart remains enlarged,
likely reflecting cardiomegaly, although pericardial effusion cannot be
excluded. Mediastinal contours are stable.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19301174", "visit_id": "20569411", "time": "2129-07-19 10:40:00"} |
12700774-RR-11 | 159 | ## INDICATION:
man with new diagnosis of lung cancer.
## FINDINGS:
Two 2 mm measuring enhancing nodules are identified in the right
parietal lobe. Further 1-2 mm measuring nodules are seen in the left high and
basal frontal lobe. All foci of enhancement are associated with FLAIR
hyperintense perifocal edema. There is no evidence of hemorrhage.
Otherwise, the cerebral sulci, ventricles, and extra-axial CSF-containing
spaces have normal size and configuration. There is no shift of the midline
structures. The brain parenchyma demonstrates preserved gray-white matter
differentiation. There is no evidence of acute infarction or intracranial
hemorrhage. No abnormality is noted with regard to basal ganglia, brainstem,
cerebellum, and craniocervical junction. There are normal flow voids of the
major intracranial vessels. The visualized paranasal sinuses and mastoid air
cells are clear. The orbits and osseous structures are unremarkable.
## IMPRESSION:
Four very small enhancing nodules in the left frontal and right
parietal lobe which likely represent metastases.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12700774", "visit_id": "21257300", "time": "2180-12-20 20:02:00"} |
10099869-RR-51 | 87 | ## EXAMINATION:
TIB/FIB (AP AND LAT) RIGHT
## INDICATION:
year old man with R tibia fx // assess fx
## FINDINGS:
An external fixator is in place, obscuring areas of the tibia and fibula.
There is diffuse bony demineralization. The proximal fibular diaphyseal
fracture demonstrates moderate callus, however the fracture line is still
partially evident.
There is a gap within the proximal tibial diaphysis, from resection of prior
sclerotic bone. The lateral tibial plateau fracture is again seen.
## IMPRESSION:
Interval fibular fracture healing. No evidence of tibial healing.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10099869", "visit_id": "N/A", "time": "2185-05-28 12:14:00"} |
14175995-RR-18 | 106 | ## INDICATION:
female with altered mental status. Question
intracranial hemorrhage.
## FINDINGS:
There is no intracranial hemorrhage, mass effect, edema, or shift
of normally midline structures. The gray-white matter differentiation is
preserved. There is stable prominence of the ventricles and sulci, compatible
with age-related involution. Suprasellar and basilar cisterns are patent.
With the exception of trace aerosolized fluid layering in the sphenoid sinus
on the left, paranasal sinuses and mastoid air cells are well aerated.
Cavernous carotid calcifications are present. Globes and soft tissues are
intact.
## IMPRESSION:
1. No CT evidence of acute intracranial process.
2. Trace sphenoid sinus disease.
3. Age-related involution.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14175995", "visit_id": "23834890", "time": "2164-08-26 19:11:00"} |
13086241-DS-14 | 1,291 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
1. esophagectomy.
2. Buttressing of intrathoracic anastomosis with
pericardial fat.
3. Esophagogastroduodenoscopy.
## HISTORY OF PRESENT ILLNESS:
The patient is a male with locally advanced
esophageal cancer. He underwent chemoradiation therapy who is
admitted for esophagectomy.
## PAST MEDICAL HISTORY:
Hypertension
Degenerative disc disease,
Herpes simplex virus 2
## PSH:
Fusion of lumbar vertebrae in
J-tube placement on
## VS:
T: 98.6 HR: 94 SR BP: 122/85 RR 18 Sats: 97% RA
## GENERAL:
year old male in no apparent distress
## HEENT:
normocephalic, mucus membranes moist
## CARD:
RRR normal S1,S2 no murmur
## RESP:
decreased breath sounds with no crackles
## GI:
benign. J-tube site clean no erythema
## INCISION:
Right thoracotomy site clean dry intact
## CXR:
right upper lobe segmental atelectasis.
No evidence of pneumothorax after right-sided chest tube
removal.
## :
Tiny new left apical pneumothorax after pigtail
catheter removal. Bibasilar atelectasis.
## :
There is a tiny right pneumothorax. Right subcutaneous
emphysema is unchanged. Pneumoperitoneum is again noted. Cardiac
size is top normal. Widened mediastinum is unchanged. Moderate
left pleural effusion is probably unchanged with adjacent
atelectasis. Right chest tube remains in place. NG tube tip is
in unchanged position, at T12 level. Right central catheter tip
is in the low SVC.
Chest CT
1. Changes of esophagectomy, with multiple loculated
right
hydropneumothoraces and that demonstrates communication with
esophageal
anastomosis in neoesophagus, concerning for leak.
2. Moderate-to-large left pleural effusion with left lower lobe
collapse.
3. Splenic aneurysm coiling, with small medial infarction.
Esophagus
## :
1. No extraluminal blush to suggest leak. No evidence
of contrast holdup with free passage of the gastroesophageal
junction and brisk opacification of the duodenum
## :
Faint contrast blush adjacent to posterior wall of
neoesophagus, diffusing into right pleural effusion on delayed
images, concerning for a small leak.
WBC-10.4 RBC-3.02* Hgb-9.8* Hct-29.1 Plt
WBC-10.0 RBC-2.97* Hgb-9.5* Hct-28.4 Plt
Hct-25.0*
WBC-13.6* RBC-2.06* Hgb-7.1* Hct-20.7 Plt
WBC-9.6 RBC-2.66* Hgb-9.3* Hct-26.5 Plt
Glucose-100 UreaN-20 Creat-0.5 Na-137 K-4.2 Cl-104
HCO3-27
Glucose-124* UreaN-23* Creat-0.6 Na-141 K-4.5 Cl-107
HCO3-26
PLEURAL Triglyc-543
PLEURAL Triglyc-184
Micros
UA/UCx neg
tissue 3+pmn's 1+GNR's, GPC's in pairs and clusters
thymic fat 1+ pmns GPCs from broth (low #'s)
tissue(conduit) 3+PMN's strep (low #'s)
BAL 3+PMN's no orgs
## BRIEF HOSPITAL COURSE:
Mr. is a year-old male who was taken to the operating
room for a minimally-invasive esophagectomy,
buttressing of intrathoracic anastomosis with thymic fat, and
esophagogastroduodenoscopy. He was extubated
in the operating room, and transferred to the TSICU for close
monitoring with a right chest-tube to wall suction, JP drain,
NGT and Bupivacaine-Dilaudid Epidural managed by the acute pain
service, and Foley catheter. He transferred to the floor on
hemodynamically stable.
## EVENTS:
on he developed fevers, leukocytosis and
increased pain. A barium and Chest CT showed anastomotic leak.
He was transfer to the ICU for close monitoring. His chest tube
and JP drain were draining contrast. His CXR showed a left
pleural effusion. Interventional pulmonology performed a
thoracentesis for 800 mL and placed a pigtail. He was taken to
the operating room on Right thoracotomy, Debridement of
esophagogastric anastomosis and recreation of esophagogastric
anastomosis. Wrapping of anastomosis with intercostal muscle.
Decortication of lung. Esophagogastroduodenoscopy and
Bronchoscopy with bronchoalveolar lavage. He transfer to the
SICU with an NGT, 3 CTs and 2 JP drains adjacent to the
anastomosis.
## ID:
he was pan-cultured BC x 4 with no growth. Tissue from OR
grew VIRIDANS STREPTOCOCCI. He was started on Vancomycin and
Zosyn and once the cultures were final the Vanco was
discontinued and Zosyn he completed a 10 day course.
## RESPIRATORY:
Pulmonary toilet was maintained with incentive
spirometry, nebulizers and early mobilization. He titrated off
oxygen with saturations of 93%.
## CHEST TUBES:
posterior tube developed a small chyle leak which
was self limiting. Left pigtail was removed . The
posterior, anterior and basilar chest were converted to
pneumostat. The anterior and basilar were removed and
the posterior chest tube following fat challenge with
no chyle leak.
## CHEST FILMS:
followed by serial chest films Resolving right
upper lobe segmental atelectasis.
## CV:
On he developed SVT 150's which progressed to
Atrial fibrillation with hypotension. Amiodarone 150 mg bolus
converted to sinus rhythm 70-80's. Amiodarone load of 1 g was
given then discontinued. He remain in sinus rhythm throughout
his hospital course and was hemodynamically stable.
## GI:
He was continued on a bowel regime and PPI. NGT was flushed
frequently to maintain patency on intermittent low-wall suction
and removed & .
## NUTRITION:
He was seen by nutrition. He tolerated tube feeds,
Replete full strength 125 mL x 18 hrs. He was changed to
Vivonex for the chyle leak and on resumed Replete full
strength. He was discharged on Osmololite 1.5 cal 125 x 18 hrs.
On full liquid diet was initiated and he tolerated
small amounts.
## RENAL:
His renal function normal with good urine output.
Electrolytes were replete. Foley was removed he voided.
## HEME:
transfused 2 units PRBC for HCT which
remain stable throughout his hospital course.
## ENDOCRINE:
Fingerstick blood sugars were < 150.
## PAIN:
The Bupivacaine Epidural managed by the acute pain service
was removed on . Dilaudid PCA was transition to Roxicet
via J-tube on with good pain control.
## ACCESS:
HE was seen by the IV team for use of his Right
port-a-cath which was easily accessed. Chest films reveals
terminates in the low SVC.
## PROPH:
SubQ heparin and SCD's were utilized for VTE prophylaxis.
## DISPOSITION:
He continued to make steady progress. He was seen
by physical therapy and was discharged to home with Home Health
. He will follow-up with Dr. as
an outpatient.
## DISCHARGE MEDICATIONS:
1. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every eight (8) hours as needed for nausea.
Disp:*10 Tablet, Rapid Dissolve(s)* Refills:*0*
2. sennosides-docusate sodium 8.6-50 mg Tablet Sig: One (1)
Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. oxycodone 5 mg/5 mL Solution Sig: mL PO every four (4)
hours as needed for pain.
Disp:*500 mL* Refills:*0*
4. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. acetaminophen 650 mg/20.3 mL Solution Sig: One (1) dose PO
Q6H (every 6 hours) as needed for pain.
## FACILITY:
Diagnosis:
Esophageal cancer
Hypertension
Degenerative disc disease,
Herpes simplex virus 2
## PSH:
Fusion of lumbar vertebrae in
J-tube placement on
## DISCHARGE INSTRUCTIONS:
Call Dr. if you experience:
-Fevers greater than 101.5 or chills
-Increased shortness of breath, cough or chest pain
-Incisions develops drainage
-Increased or difficulty swallowing
-Increased abdominal pain
-Nausea (take antinausea medication) or vomiting
-Check daily weights. Keep a log.
## FEED TUBE SITE:
Leave open to air. Clean site daily.
-Should J-tube clog use papain and water warm.
## CHEST TUBE SITE:
with a bandaid until healed. Should site drain
cover with a clean dressing and change as need to keep site
clean and dry
## ACTIVITY:
-Shower daily. Wash incision with mild soap & water rinse, pat
dry
-No lifting greater than 10 pounds.
-No driving until seen in followup and while on narcotics for
pain.
-Walk times a day for minutes increase to a Goal of 30
minutes daily.
Pain
-Roxicet via J-tube as instructed.
-Acetaminophen 650 mg evry 6 hrs for pain
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13086241", "visit_id": "26268757", "time": "2160-09-16 00:00:00"} |
11768345-RR-33 | 229 | ## INDICATION:
woman with persistent inflammatory arthritis, in the
right greater than left knee. History of positive PPD. Extent of synovitis.
## FINDINGS:
The anterior and posterior cruciate ligaments are intact. The
medial and lateral collateral ligaments are intact. The popliteus tendon is
intact.
There is mild tendinosis of the patellar tendon at the patellar insertion
(8:14). The distal quadriceps tendon is normal in morphology and signal
intensity. The medial and lateral patellar retinacula are intact.
There is physiologic amount of joint fluid, however, there is frond-like
synovial proliferation, in keeping with synovitis. There is mild edema along
the infrapatellar plica.
This study was not optimized for evaluation of menisci, however, medial and
lateral menisci are grossly intact.
In the patellofemoral compartment, there is profound cartilage loss, with
denuded appearance of the lateral patellar facet, patellar apex, and
pronounced cartilage loss in the medial patellar facet. There are subchondral
cysts in the lateral and medial patellar facet. Evaluation of the trochlear
cartilage demonstrates partial-thickness defect in the trochlear notch (8:12).
There is no subjacent bone marrow edema.
The cartilage in the medial and lateral compartments is thinned, but probably
intact.
Following gadolinium administration, there is synovial enhancement, mostly of
the suprapatellar joint synovium.
There is no cyst.
## IMPRESSION:
1. Physiologic amount of joint fluid with synovitis.
2. Profound patellofemoral cartilage loss.
3. Mild patellar tendonosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11768345", "visit_id": "N/A", "time": "2183-04-08 09:52:00"} |
15616719-RR-39 | 137 | ## CT CHEST WITH CONTRAST:
There are no enlarged supraclavicular, axillary,
mediastinal or hilar lymph nodes. The aorta is of normal caliber without
evidence of acute aortic pathology. The main pulmonary artery is of normal
caliber and there is no evidence of pulmonary embolus. There is a small amount
of fluid in the superior pericardial recesses which has been stable since . The previously noted left basilar segmental pulmonary embolus is no
longer visualized. The lungs are clear without focal consolidation, pleural
effusion or pneumothorax. There is minimal bibasilar atelectasis. The
airways are patent to the subsegmental levels. There is a small left pleural
effusion.
This study is not tailored for evaluation of subdiaphragmatic structures, but
limited views are unremarkable.
## OSSEOUS STRUCTURES:
There are no concerning osseous lesions.
## IMPRESSION:
No evidence of pulmonary embolus or acute pathology.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15616719", "visit_id": "N/A", "time": "2191-10-13 06:52:00"} |
17889075-RR-69 | 193 | ## INDICATION:
man with known brain mass status post seizure with
left-sided facial weakness and left arm weakness. Please evaluate for
intracranial hemorrhage or cerebrovascular event.
## FINDINGS:
Compared to the MRI from , there are unchanged right
frontal, left parieto-occipital and left frontal masses consistent with
melanoma metastases. There is unchanged left centrum semiovale vasogenic
edema compared to the MRI from . Compared to the MRI,
unchanged edema surrounding the three mass lesions. There is no evidence of
midline shift or intracranial herniation. There is mild sulcal effacement at
the left frontal and parietal lobe. There is unchanged entrapment of the
occipital horn of the left lateral ventricle. The ventricular size is
unchanged compared to the MRI two days ago. Unchanged ventriculostomy of the
temporal horn of the left lateral ventricle. The gray-white matter
differentiation is preserved. There is no evidence of acute infarction. The
paranasal sinuses and mastoid air cells are clear and well aerated. No
fractures or soft tissue abnormalities are identified.
## IMPRESSION:
No acute change compared to the MRI from , including
no evidence of infarction or intracranial hemorrhage. Metastasis and
associated edema better assessed on recent MRI from .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17889075", "visit_id": "N/A", "time": "2114-03-25 09:57:00"} |
14143013-DS-21 | 1,966 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
Left first toe wound
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
:
Left common femoral artery cutdown with thromboembolectomy of
the profunda and primary closure of the artery.
## HISTORY OF PRESENT ILLNESS:
Mr. is a man with no medical contact in
the
past years who developed left great toe pain and wound over
the past weeks and ultimately presented to the
emergency department where he was evaluated by podiatry and
vascular surgery and found to have only dopplerable distal
pulses
as well as a left toe ulceration. He was started on IV heparin
as well as broad-spectrum parenteral antibiotics and a plain
film
showed possible suggestion of osteomyelitis. While in the ED he
was noted to be in atrial fibrillation as well as hypertensive
with systolics in the 210s.
## PAST MEDICAL HISTORY:
No known medical history, patient has not been under medical
care in years.
## WOUND:
[]CD&I- left groin wound indurated, unchanged. []no
erythema/induration [x]abnormal--Dry gangrene to first left toe.
necrotic wound to left head of first metatarsal.
## PULSES:
R: / /d / d L: p // nd/nd
## CONCLUSION:
The left atrial volume index is SEVERELY increased. The right
atrium is mildly enlarged. There is no evidence
for an atrial septal defect by 2D/color Doppler. The estimated
right atrial pressure is mmHg. There is
normal left ventricular wall thickness with a normal cavity
size. There is a small area of regional left
ventricular systolic dysfunction (see schematic) and
preserved/normal contractility of the remaining segments.
Quantitative biplane left ventricular ejection fraction is 55 %
(normal 54-73%). There is no resting
left ventricular outflow tract gradient. No ventricular septal
defect is seen. Diastolic function could not be
assessed. Normal right ventricular cavity size with normal free
wall motion. The aortic sinus diameter is
normal for gender with normal ascending aorta diameter for
gender. The aortic arch diameter is normal with a
normal descending aorta diameter. The aortic valve leaflets (3)
appear structurally normal. No masses or
vegetations are seen on the aortic valve. There is no aortic
valve stenosis. There is no aortic regurgitation.
The mitral valve leaflets appear structurally normal with no
mitral valve prolapse. No masses or vegetations
are seen on the mitral valve. There is trivial mitral
regurgitation. The pulmonic valve leaflets are not well
seen. The tricuspid valve leaflets appear structurally normal.
No mass/vegetation are seen on the tricuspid
valve. There is physiologic tricuspid regurgitation. There is
moderate pulmonary artery systolic hypertension.
There is no pericardial effusion.
## IMPRESSION:
Regional left ventricular systolic dysfunction c/w
CAD. Normal right ventricular
cavity size and systolic function. No structural cardiac source
of embolism identified. Moderate
pulmonary hypertension.
EMR
## BRIEF HOSPITAL COURSE:
Mr. is a man with no medical contact in the
past years who developed left great toe pain and wound over
the past weeks and ultimately presented to the
emergency department where he was evaluated by podiatry and
vascular surgery and found to have only dopplerable distal
pulses
as well as a left toe ulceration. He was admitted on
and started on IV heparin as well as, broad-spectrum parenteral
antibiotics. A plain film foot xray was done which showed
possible suggestion of osteomyelitis.
Additionally, while in the ED he was noted to be in atrial
fibrillation as well as hypertensive with systolic BPs in the
210s. Vascular Medicine/Cardiology was consulted to evaluate and
manage these issues. They started him on a regimen which
ultimately included Chlorthalidone 25mg daily, amlodipine 5mg
daily, carvedilol 25mg BID, lisinopril 20mg daily. He was also
initiated on atorvastatin. They also completed a TTE which
showed overall normal LV function but with inferior HK/AK c/w
prior MI. Since he has good functional status without concerning
sx they did not believe further risk stratification with stress
test was required and he was cleared for any potential vascular
surgery.
On , patient underwent a left common femoral artery
cutdown with a profundal embolectomy to assist with blood flow
to the left foot on. He tolerated the procedure well and after a
brief stay in PACU he was transferred to the vascular surgery
floor where he remained for the rest of his admission. He was
quickly normalized and tolerated a regular diet and was able to
void on his own QS.
Unfortunately, this procedure did not improve flow and he is
without dopplerable signals in the left foot. Patient will
require a left above knee amputation in the near future,
however, at this time he would like to manage this
conservatively and see if the foot heals on its own. It was felt
that the patient may not be fully comprehending the risk of
delaying surgery as he expressed many grandiose thoughts about
healing himself. As he is at high risk for a systemic infection,
the family, psychiatry and social work were consulted to assist
in establishing capacity for decision-making over concern for
patient's ability to understand the risks of delaying surgery.
Patient's family has been involved in his care and have been
present for social work meetings. The decision was made to allow
Mr. to go to a STR and he agrees that if the infection
worsens he is amenable to returning for surgery.
His toe infection continues to persist and he will continue on
antibiotics for 2 weeks (Bactrim).
He has been placed on apixaban and ASA since his embolectomy and
should remain on it for vascular patency.
Patient will require a follow up appointment with Dr. to
discuss surgical planning in one week. He is transferred to a
short term rehab in an improved and stable condition.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. This patient is not taking any preadmission medications
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever
2. amLODIPine 5 mg PO DAILY
3. Apixaban 5 mg PO BID
4. Aspirin 81 mg PO DAILY
5. Atorvastatin 80 mg PO QPM
6. CARVedilol 25 mg PO BID
7. Chlorthalidone 25 mg PO DAILY
8. Haloperidol 0.5 mg PO BID
9. Lisinopril 20 mg PO DAILY
10. Sulfameth/Trimethoprim DS 2 TAB PO BID Duration: 14 Days
continue until
## PRIMARY:
Peripheral arterial disease with acute on chronic lower
extremity ischemia; hypertension; non-healing wounds
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Mr. ,
It was a pleasure taking care of you at
. You were admitted to the hospital after surgery
on your leg. This surgery was done to improve blood flow to
your leg. You tolerated the procedure well and are now ready to
be discharged from the hospital. Please follow the
recommendations below to ensure a speedy and uneventful
recovery.
In addition, it will be important to keep your follow up
appointments as you will most likely require an additional
surgery to prevent a foot infection from traveling to other
parts of your body. Your follow up appointment will review
risks and benefits of surgery and next steps for your care.
Vascular Leg Surgery Discharge Instructions
## WHAT TO EXCEPT:
It is normal feel tired for weeks after your surgery
It is normal to have leg swelling.
Your leg will feel tired and sore. This usually passes
within a few weeks.
Your incision will be sore, slightly raised, and pink. Any
drainage should decrease or stop with in the first 2 weeks.
If you are home, you will likely receive a visit from a
Visiting Nurse . Members of your health care team will
discuss this with you before you go home.
## MEDICATIONS:
Before you leave the hospital, you will be given a list of all
the medicine you should take at home. If a medication that you
normally take is not on the list or a medication that you do not
take is on the list please discuss it with the team!
It is very important that you take Aspirin every day! You
should never stop this medication before checking with your
surgeon
## PAIN MANAGEMENT:
It is normal to feel some discomfort/pain following surgery.
This pain is often described as soreness.
You may take Tylenol (acetaminophen ) as needed for pain.
You will also receive a prescription for stronger pain medicine,
if the Tylenol doesnt work, take prescription medicine.
Narcotic pain medication can be very constipating, please also
take a stool softner such as Colace. If constipation becomes a
problem, your pharmacist can suggest additional over the counter
medications.
Your pain medicine will work better if you take it before your
pain gets to severe.
Your pain should get better day by day. If you find the pain
is getting worse instead of better, please contact your surgeon.
## ACTIVITY:
Do not drive until your surgeon says it is okay. In general,
driving is not allowed until
-the staples in your leg have been taken out
-your leg feels strong
-you have stopped taking pain medication and feel you could
respond in an emergency
Walking is good because it helps your muscles get stronger and
improves blood flow. Start with short walks. If you can, go a
little further each time, letting comfort be your guide.
Try not to go up and downstairs too much in the first weeks.
Use stairs only once or twice a day until your incision is fully
healed and you are back to your usual strength.
Avoid things that may constrict blood flow or put pressure on
your incision, such as tight shoes, socks or knee highs.
Do not take a tub bath or swim until your staples are removed
and your wound is healed.
When you sit, keep your leg elevated to reduce swelling.
If swelling in your leg is getting worse, lie down with your
leg up on a pillows. If your swelling continues, please call
your surgeon. You may be instructed to use special elastic
bandages or stockings.
Try not to sit in the same position for a long while. For
example, go on a long car ride.
You may go outside. But avoid traveling long distances until
you see your surgeon at your next visit.
You may resume sexual activity after your incisions are well
healed.
Your incision
Your incision may be slightly red around the stitches or
staples. This is normal.
It is normal to have a small amount of clear or light red
fluid coming from your incision.
This will decrease and stop in a few days. If it does not stop,
or if you have a lot of fluid coming out., please call your
surgeon.
You may shower 48 hours after your surgery. Do not let the
shower spray right on the incision, Let the soapy water run
over the incision, then rinse. Gently pat the area dry. Do not
scrub the incision, Do not apply ointment or lotions to the
incision.
You do not need to cover the incision if there is no drainage,
If there is a small amount of drainage, put a small sterile
gauze or Bandaid over the incison.
It is normal to feel a firm ridge along the incision, This
will go away as your wound heals.
Avoid direct sun exposure to the incision area for 6 months.
This will help keep the scar from becoming discolored.
Over months, your incision will fade and become less
prominent.
Diet and Bowels
It is normal to have a decreased appetite. Your appetite will
return over time. Follow a well-balanced, health healthy diet,
without too much salt and fat.
Prescription pain medicine might make you constipated. If
needed, you may take a stool softener (such as Colace) or gentle
laxative (ask your pharmacist for recommendations).
Drinking more fluid may also help.
If you go 48 hours without a bowel movement, or having pain
moving your bowels, call your primary care physician.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14143013", "visit_id": "20439542", "time": "2132-01-18 00:00:00"} |
13528306-RR-6 | 197 | ## EXAMINATION:
CT HEAD WITHOUT CONTRAST
## HISTORY:
pedestrian struck, head laceration, combative in the
emergency department, altered mental status post, hypotensive.
## DOSE:
DLP: 892 mGy-cm; CTDI: 48 mGy
## HEAD CT:
There is a large frontal scalp hematoma extending to the vertex with
subcutaneous air suggesting laceration. No underlying skull fracture is
detected. There is no evidence of acute intracranial hemorrhage, edema, mass
effect or shift of normally midline structures. A right temporal
intraparenchymal coarse calcification is noted, possibly dystrophic. The
gray-white matter interface is preserved without evidence of acute major
vascular territorial infarct. The ventricles and sulci are normal in size and
configuration for the patient's age. The basal cisterns appear patent. The
orbits and globes are unremarkable. There is atherosclerotic calcification of
the bilateral carotid siphons. There is mild mucosal thickening of the
bilateral maxillary sinuses. The remainder of the imaged paranasal sinuses,
middle ear cavities and mastoid air cells are clear bilaterally.
## IMPRESSION:
1. No evidence of acute intracranial process.
2. Large frontal scalp hematoma and laceration without underlying skull
fracture.
## NOTIFICATION:
The findings were discussed by Dr. with Dr. in
person on at 7:06 , during discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13528306", "visit_id": "20813943", "time": "2178-11-04 18:17:00"} |
13671107-RR-32 | 96 | ## EXAMINATION:
BILAT UP EXT VEINS US
## INDICATION:
year old man with stroke, bilateral upper extremity swelling//
DVT?
## FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The bilateral internal jugular and axillary veins are patent, show normal
color flow and compressibility.
The bilateral brachial, basilic, and cephalic veins are patent, compressible
and show normal color flow and augmentation.
There is subcutaneous edema, which is more pronounced in the left upper
extremity.
## IMPRESSION:
Left greater than right subcutaneous edema, without evidence of deep vein
thrombosis in the bilateral upper extremity veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13671107", "visit_id": "22907089", "time": "2142-07-08 14:35:00"} |
11189964-RR-85 | 175 | ## INDICATION:
female with weight loss and epigastric discomfort.
Please evaluate pancreas.
## FINDINGS:
No focal hepatic mass lesion is identified, although evaluation is
slightly limited secondary to shadowing from biliary air after sphincterotomy.
The extrahepatic biliary duct measures 8 mm and is little overall changed
since . Patient is status post cholecystectomy. The pancreatic
head and neck appear within normal limits; however, the body and tail not well
evaluated given overlying bowel gas. The abdominal aorta is not focally
dilated throughout its course. There is no intra-abdominal ascites. The
spleen is normal in size and echotexture measuring 8.4 cm. The left kidney
measures 9 cm. The right kidney measures 9.1 cm. No mass, stones, or
hydronephrosis demonstrated within the kidneys. A tiny 7 x 7 x 5 mm cyst is
present in the lower pole of the left kidney is little overall changed since
CT from .
## IMPRESSION:
No pancreatic lesions are identified within the head, and proximal body
although the distal body and tail are not well evaluated given overlying bowel
gas.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11189964", "visit_id": "N/A", "time": "2134-06-28 08:47:00"} |
18154124-RR-39 | 281 | ## EXAMINATION:
CT-guided lymph node biopsy
## INDICATION:
year old man with history of large B cell lymphoma presenting
with recurrent hypercalcemia, lymphadenopathy. PET CT completed with
"multiple retroperitoneal and mesenteric lymph nodes are not significantly
changed in size, however are increased in FDG avidity, currently with an SUV
max of 11.2 in a left periaortic lymph node. 5a." Heme Onc
requesting biopsy of highest SUV node // biopsy (not FNA) of high SUV node.
LYMPHOMA PROTOCOL FOR PATHOLOGY
## PROCEDURE:
CT-guided retroperitoneal lymph node biopsy.
## OPERATORS:
Dr. , radiology fellow and Dr. ,
attending radiologist. Dr. supervised the trainee during
the key components of the procedure and reviewed and agrees with the trainee's
findings.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.5 s, 17.0 cm; CTDIvol = 20.1 mGy (Body) DLP = 315.3
mGy-cm.
2) Stationary Acquisition 12.3 s, 1.4 cm; CTDIvol = 127.9 mGy (Body) DLP =
184.2 mGy-cm.
Total DLP (Body) = 510 mGy-cm.
## SEDATION:
Moderate sedation was provided by administering divided doses of 1
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 22
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
## FINDINGS:
Pre-procedure noncontrast CT of the abdomen was obtained and demonstrated
multiple retroperitoneal lymph nodes similar to prior PET-CT. Correlation was
made with PET-CT dated and the most FDG avid retroperitoneal
lymph node which was a 2.8 x 3.0 left para-aortic node was (series 3, image
41) selected for biopsy.
## IMPRESSION:
1. Successful CT-guided core-biopsy of the retroperitoneal lymph node.
2. Samples were sent for pathology, cytogenetics and flow cytometry.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18154124", "visit_id": "23993752", "time": "2135-04-05 11:10:00"} |
17481329-RR-53 | 218 | ## INDICATION:
Query common bile duct stone.
## FINDINGS:
There is evidence of a left small basal pleural effusion (series 6, image 12).
There is edema and fluid seen around the distal body and tail of the pancreas.
There is also edema in the anterior pararenal space, bilaterally, although
more prominent on the left side. Findings may represent edematous
pancreatitis. The pancreas enhances normally however with no evidence for
focal necrosis, cyst, or mass. The pancreatic duct is normal.
No intrahepatic biliary dilatation. No focal liver lesion.
Multiple gallstones are demonstrated in the gallbladder. The common bile duct
measures 7 mm with no intraluminal filling defect identified. The common bile
duct tapers to a normal caliber at the level of the head of the pancreas.
The spleen and both adrenal glands are unremarkable. There are renal cysts
identified bilaterally. There are no retroperitoneal masses or adenopathy.
No free fluid. No osseous lesions.
Multiplanar 2D and 3D reformats were essential in demonstrating the edema
around the distal body and tail of the pancreas in keeping with acute
pancreatitis (MIP image, series 122, image 1).
## IMPRESSION:
1. Findings suggestive of acute pancreatitis of the distal body and tail of
pancreas.
2. Cholelithiasis. No evidence for common bile duct stone.
Findings communicated by telephone to Dr on pager at 3:40pm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17481329", "visit_id": "25362393", "time": "2137-08-23 17:18:00"} |
13297353-RR-35 | 192 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST Q311 CT SPINE
## HISTORY:
with Head strike, neck pain, Syncope// bleed?
Fracture? PNA? Edema? bleed? Fracture? PNA? Edema?
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.5 s, 21.5 cm; CTDIvol = 22.7 mGy (Body) DLP = 488.1
mGy-cm.
Total DLP (Body) = 488 mGy-cm.
## FINDINGS:
Alignment is anatomic.No fractures are identified. There are multilevel
degenerative changes most notable and severe at the C4-7 levels. Bridging
large anterior osteophytes from the C4 to C7 levels are demonstrating
compatible DISH. The right C3-4 facet joints are nearly fused. Multilevel
central canal narrowing is most pronounced at C5-6 with moderate narrowing due
to a disc osteophyte complex. Bilateral moderate to severe neural foraminal
narrowing, most pronounced C3-4 is due to facet hypertrophy and uncovertebral
spurring. There is no prevertebral soft tissue swelling. There is no evidence
of infection or neoplasm. The thyroid is unremarkable. Lung apices are
clear.
## IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Severe multilevel degenerative changes with evidence of DISH and mild to
moderate central canal and moderate to severe bilateral neural foraminal
narrowing.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13297353", "visit_id": "28352476", "time": "2188-08-09 15:04:00"} |
15530925-RR-17 | 364 | ## HISTORY:
male presents with back pain and weakness with an
elevated white blood cell count.
## FINDINGS:
Bone marrow signal is diffusely hypointense on both T1 and
T2-weighted imaging which may relate to the patient's renal disease.
## THORACIC:
Sagittal alignment is satisfactory. There is mild multilevel
degenerative disc disease with no cord compression or abnormal cord signal.
No abnormal intraspinal collections are present within the thoracic spine.
## LUMBAR:
Centered at the L3-4 disc level is a 3.4 x 1.2 x 0.7 cm heterogeneous
lesion, in the posterior spinal canal on the left side extending to the
midline, which results in severe canal narrowing and moderate intrathecal
crowding. The collection is centered within the left posterolateral epidural
space and extends into the left neural foramen. While there is no increased
bone marrow signal abnormality, there is extensive abnormality throughout the
posterior paraspinal musculature where there appear to be multiple small fluid
collections ranging between 5 and 15 mm in size. Additionally, there is
signal abnormality extending along the left iliopsoas muscle with what appears
to be an additional 11-mm fluid collection on the left side. There are
multiple prominent retroperitoneal lymph nodes, the largest measuring 11 x 15
mm.
## IMPRESSION:
1. The findings suggest a 3-cm posterior epidural space occupying lesions
centered at L3-4 resulting in severe canal narrowing with moderate intrathecal
crowding. Assessment is limited due to lack of IV contrast administration, and
this can be seen with infection with or without hemorrhage, the latter
component being a possibility due to small foci of increased T1W signal. TO
correlate with labs and clinically and consider spine/NS consult. Intradural
extension cannot be excluded as the dura is not clearly identifiable on the
axial T2W images. Mass lesion is less likely; however cannot be completely
excluded given the dark T2 siganl and lack of IV contrast. There are small
fluid collections throughout the left posterior paraspinal musculature
extending anteriorly into the left iliopsoas muscle. Follow up if no
intervention is contemplated. No bone marrow signal abnormalities to suggest
osteomyelitis.
2. Diffusely hypointense bone marrow signal abnormality likely related to the
patient's chronic kidney disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15530925", "visit_id": "29592482", "time": "2147-01-24 18:54:00"} |
10942537-DS-18 | 908 | ## ALLERGIES:
Zocor / cefepime / ciprofloxacin / voriconazole
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Transjugular liver biopsy -
## HISTORY OF PRESENT ILLNESS:
Mr. is a y/o male with relapsed AML s/p RIC allo in
, s/p DLI, s/p 3 cycles decitabine, now on clinical trial
protocol of nivolumab (last dose C2D8) presenting
with transaminitis, concerning for immune hepatitis vs gvhd
Patient feels well and denies any GI symptoms, including
abdominal pain, nausea, vomiting, diarrhea, and constipation.
His energy levels are normal, and he endorses good appetite and
mood. He was admitted due to elevation of his LFTs concerning
for a recurrence of hepatitis, for which he was recently
discharged.
He currently denies chest pain, shortness of breath, cough,
abdominal pain, and leg pain.
## PAST ONCOLOGIC HISTORY:
- Presented to PCP in for annual physical and pre-op
clearance for rotator cuff surgery and was incidentally found
to be have leukopenia with WBC 1.9 and thrombocytopenia with
platelet count 66k.
- : Bone marrow biopsy at consistent with AML
- : Admitted to for induction with 7+3
- : Admitted for Allo SCT (MRD, ABO matched, donor CMV-
and recipient CMV+) with TLI/ATG/clofarabine conditioning
(reduced intensity) on clinical trial , D0=
His course was generally uncomplicated. Was off
immmunesuppression by
Past medical History:
Acute Myelogenous Leukemia as above
- Rotator Cuff Injury - Right side - , has not had
surgery yet, followed by surgeon
- Hyperlipidemia
- Hx Tobacco
- Low normal B12 level
- s/p Cholecystectomy
- s/p Hemorroidectomy
## FAMILY HISTORY:
Father had "pre-leukemia," received regular transfusions and
died
in . Brother died of lung cancer last year.
## HEENT:
MMM, no OP lesions, no lymphadenopathy
## CV:
RR, NL S1S2 no S3S4 MRG
## PULM:
CTAB, no adventitious sounds
## GI:
BS+, soft, NTND, no masses or hepatosplenomegaly
## LIMBS:
No edema, clubbing, tremors, or asterixis
## SKIN:
No rashes or skin breakdown
## NEURO:
motor and sensory grossly intact
## HEENT:
MMM, no OP lesions, no lymphadenopathy
## CV:
RR, NL S1S2 no S3S4 MRG
## PULM:
CTAB, no adventitious sounds
## GI:
BS+, soft, NTND, no masses or hepatosplenomegaly
## LIMBS:
No edema, clubbing, tremors, or asterixis
## SKIN:
No rashes or skin breakdown
## NEURO:
motor and sensory grossly intact
## TRANSJUGULAR LIVER BIOPSY :
1. Right atrial pressure of 5 mm Hg and balloon-occluded portal
pressure
measurement of 13 mm Hg.
2. 4 18G core biopsies of the liver acquired through
transjugular access.
## IMPRESSION:
Moderately complex transjugular liver biopsy due to the
patient's mid left
convex thoracic scoliosis. , we were able to successfully
obtained both
wedged hepatic pressures, right atrial pressure and trans
jugular level biopsy
specimens. No immediate complications noted.
## BRIEF HOSPITAL COURSE:
Mr. is a y/o male with relapsed AML s/p RIC allo in
, s/p DLI, s/p 3 cycles decitabine, now on clinical trial
protocol of nivolumab (last dose C2D8) presenting
with transaminitis, concerning for immune hepatitis vs gvhd, s/p
transjugular liver biopsy ( )
## # HEPATITIS:
Was recently started on nivolumab, which is known
to cause immune hepatitis. He was previously admitted due to
nausea and vomiting (discharged , and found to have
transaminitis from immune hepatitis. He was treated with
methylpred IV 50 mg x2 and discharged on a prednisone taper,
which resulted in good improvement of his LFTs. However, now his
LFTs have worsened again, despite not restarting nivolumab,
which raises concern for an alternate pathology such as GVHD. We
continued his home prednisone 60 mg daily. Hepatology was
consulted. S/p transjugular liver biopsy with on ,
pathology and flow cytometry pending.
## # RELAPSED AML:
S/p allo SCT with relapse, DLI and subsequent
decitabine, then started protocol nivolumab with last
dose. Last dose of nivolumab was (C2D8), at which
time he developed grade 3 hepatic toxicity requiring admission,
and the drug was stopped. From Dr. : "As per
discussion with study team we can delay his treatment up to 4
weeks and he can stay on study as long as he is able to come off
steroids before next dose.
He underwent BMBx today to see if he is benefiting from the
study
medication." Continued his home atova and valacyclovir
prophylaxis in setting of high-dose steroids.
## # PANCYTOPENIA:
Likely underlying malingancy. Received
platelet transfusions prn.
## # HYPOPHOSPHATEMIA:
Continued his home phosphorous 250 mg PO BID
## # CODE:
Presumed Full
# EMERGENCY CONTACT: (wife)
Transitional issues:
- Transjugular liver biopsy performed , results pending on
discharge
- F/up in clinic on
- No medication changes
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Phosphorus 250 mg PO BID
2. Ondansetron 8 mg PO Q8H:PRN nausea
3. Pantoprazole 40 mg PO Q24H
4. PredniSONE 60 mg PO DAILY
5. Atovaquone Suspension 1500 mg PO DAILY
6. ValACYclovir 1000 mg PO Q24H
## DISCHARGE MEDICATIONS:
1. Atovaquone Suspension 1500 mg PO DAILY
2. Ondansetron 8 mg PO Q8H:PRN nausea
3. Pantoprazole 40 mg PO Q24H
4. Phosphorus 250 mg PO BID
5. PredniSONE 60 mg PO DAILY
6. ValACYclovir 1000 mg PO Q24H
## DISCHARGE DIAGNOSIS:
Primary diagnosis:
Hepatitis
Relapsed Acute Myeloid Leukemia s/p allo SCT with relapse
Pancytopenia
Hypophosphatemia
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted due to elevation in your liver function tests,
which we were concerned could caused by medication or graft
versus host disease. A liver biopsy was performed on .
The procedure went well without complications. You also required
intermittent platelet transfusions to support your platelet
counts.
You will be seen in on for
follow-up. You will also have follow-up appointments on
and .
It was a pleasure to care for you. We wish you all the best.
Sincerely,
Your team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10942537", "visit_id": "29621887", "time": "2119-04-27 00:00:00"} |
12551668-DS-16 | 846 | ## HISTORY OF PRESENT ILLNESS:
yo G1 at gestation transferred to with concern
for chorioamniotisis. She reported a recent history of fatigue
and malaise. On the day of presentation, she woke up with right
lower quadrant abdominal pain and cramping. She had no vaginal
bleeding or leakage of fluid. She was seen at an urgent care
center and had a UA showing +1 leucocytes. She was treated with
ceftriaxone to cover a possible pyelonephritis. She also was
noted to have a temperature to 100.7 s associated
chills. She then was sent to for
obstetric evaluation. A renal ultrasound was normal and an
abdominal ultrasound showed no evidence of appendicitis. Her
exam was notable for fundal tenderness, concerning for
chorioamniotis, so she was transferred to for further
evaluation by the service.
## PAST MEDICAL HISTORY:
Prenatal course:
- Rh+/Ab neg/RI/RPRNR/HIV neg
- LR ERA
- normal full fetal survey
- GBS positive
## OB/GYN HX:
- G1PO
- no h/o abnormal paps, STIs
## PSH:
no prior abdominal surgery
## GEN:
WD, WN in NAD
## PULM:
non-labored, no respiratory distress
## ABD:
soft, mild tenderness to palpation in RLQ, ND, gravid
uterus
## NEURO:
A&Ox3, no focal neurologic deficits
On discharge:
Gen - NAD
Abd - soft, gravid, NT, normoactive bowel sounds
Ext- calves nontender, nonedematous
## ANAEROBIC CULTURE (PRELIMINARY):
NO GROWTH.
MRI of abdomen/pelvis:
Final Report
## EXAMINATION:
MRI of the abdomen and pelvis.
## INDICATION:
Right lower quadrant pain with leukocytosis.
## TECHNIQUE:
T1 and T2 weighted multiplanar images of the abdomen
and pelvis
were acquired within a 1.5 Tesla magnet without the use of IV
contrast.
## COMPARISON:
Ultrasound examination from .
## FINDINGS:
Included views of the lung bases are clear. There is no
pericardial or pleural
effusion. The heart size is normal.
Noncontrast-enhanced views of the liver and gallbladder are
within normal
limits. There is no intra or extrahepatic bile duct dilation.
There is no
cholelithiasis.
The spleen size is normal. No concerning splenic mass
identified.
The pancreas is normal. There is no pancreatic duct dilation.
The kidneys are symmetric in size. There is no hydronephrosis or
hydroureter.
The adrenal glands are normal.
The stomach and intra-abdominal loops of small and large bowel
are normal in
caliber. The cecum is oriented superiorly, with the terminal
ileum the
residing within the right upper quadrant (series 5, image 16).
The appendix is
not well seen, however, no secondary signs of appendicitis are
detected. There
is no ascites.
The abdominal aorta and iliac branches are normal in caliber,
demonstrating
appropriate flow voids on T2 weighted sequences, and high signal
intensity on
time-of-flight series.
A single intrauterine pregnancy is demonstrated. The fetus is in
vertex
position. The cervix is closed. The ovaries are normal.
The bladder is compressed by the uterus, but appears normal.
There is no mesenteric, retroperitoneal, or intrapelvic
lymphadenopathy.
There are no osseous lesions concerning for malignancy or
infection.
## IMPRESSION:
1. No acute intra-abdominal or intrapelvic process detected.
2. Cecum oriented superiorly into the right upper quadrant.
Appendix not
visualized. No secondary signs of appendicitis.
3. Single intrauterine pregnancy. Closed cervix. Normal ovaries.
4. Normal kidneys. No hydroureteronephrosis.
## BRIEF HOSPITAL COURSE:
Ms. was admitted to the antepartum service for
evaluation of her abdominal pain.
For her abdominal pain, her labs were notable for a leukocytosis
of 22 on arrival. She had normal LFTs and a UA was not
concerning for infection. She had an abdominal ultrasound and
MRI of the pelvis and abdomen with no evidence of appendicitis
or other acute intra-abdominal process. The general surgery
service was consulted and agreed that Ms. was unlikely
to have appendicitis or other significant
gastrointestinal abdominal pathology given absence of
nausea/anorexia and failure to visualize indication of
intra-abdominal pathology on cross sectional
imaging. Given the clinical concern for chorioamnionitis, an
amniocentesis was performed. A preliminary gram stain was
negative for micro-organisms. She was given supportive care with
IV hydration and her symptoms and luekocytosis improved.
On initial arrival, she was also noted to be having preterm
contractions on arrival. Fetal wellbeing was reassuring with a
reactive NST. Her cervix was long an closed, unchanged from her
prior exam prior to transfer. Given her persistent contractions
and initially concerning presentation, she was given a course of
betamethsone and made betamethasone complete on .
After observation on the antepartum floor, her abdominal pain
resolved. She remained afebrile. She was able to tolerate a
regular diet. She had reassuring NSTs. She was discharged home
in good condition with outpatient follow-up.
## DISCHARGE MEDICATIONS:
1. Prenatal Vitamins 1 TAB PO DAILY
## DISCHARGE DIAGNOSIS:
abdominal pain
preterm contractions
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the hospital for evaluation of abdominal
pain. You had an amniocentesis, which showed no evidence of
infection. You had an ultrasound of the abdomen and an MRI,
which showed no evidence of infection or other acute process.
You were also noted to have preterm contractions. You were given
betamethasone, a steroid which helps the baby's lungs among
other benefits. Your contractions and cervical exam remained
stable and you are now safe to be discharged home.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12551668", "visit_id": "22474856", "time": "2161-06-26 00:00:00"} |
13819116-RR-22 | 253 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
female with history of subdural hematoma, now
presenting following fall. Evaluation for interval change in hemorrhage, new
hemorrhage or fracture.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.9 cm; CTDIvol = 47.6 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
The previously characterized small extra-axial collection along the right
temporal lobe is not visualized on this study, and likely secondary to
artifact. There is no evidence of intracranial hemorrhage, acute large
territorial infarction,edema,or mass. There is prominence of the ventricles
and sulci, compatible with age related involutional changes. Periventricular
and subcortical hypodensities are nonspecific, though likely reflects sequela
of chronic small vessel ischemic disease. Dense atherosclerotic calcification
are noted in the bilateral carotid siphons and distal vertebral arteries.
There is no evidence of fracture. There are multiple mucous retention cysts
noted in the bilateral maxillary sinuses. The left-sided mastoid air cells
are partially opacified. The visualized portion of the remaining paranasal
sinuses, right-sided mastoid air cells, and middle ear cavities are clear.
Evidence of bilateral lens replacement, however the visualized portion of the
orbits is otherwise unremarkable.
## IMPRESSION:
1. Previously characterized small extra-axial collection along the right
temporal lobe is not visualized on this study, and likely secondary to
artifact.
2. No evidence of intracranial hemorrhage, fracture, or infarction.
3. Stable appearance of chronic age related changes, including cortical
atrophy and chronic small vessel ischemic disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13819116", "visit_id": "27277408", "time": "2144-04-04 08:56:00"} |
16159717-RR-61 | 78 | ## INDICATION:
with shoulder pain, fell one week ago with hand
paresthesias.
## MR LEFT SHOULDER:
Rotator cuff is intact with preserved muscle bulk. No
evidence of degenerative tendinopathy. No joint effusion. The labrum is
grossly normal on this non-arthrographic study. Bone marrow signal is normal
throughout the visualized osseous structures. The biceps tendon is normally
situated without evidence of abnormal signal. Small axillary lymph nodes are
non- pathologically enlarged by MR criteria.
## IMPRESSION:
Normal shoulder MRI.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16159717", "visit_id": "N/A", "time": "2160-06-30 17:01:00"} |
12700774-RR-20 | 197 | ## CLINICAL HISTORY:
man with metastatic NSCL cancer to brain. Status
post radiation.
## STUDY:
MRI head without and with contrast.
## FINDINGS:
The tiny enhancing nodules in the right parietal lobe noted in the
prior study are not seen on the present study. The tiny enhancing nodules
noted in the left high frontal lobe and left basifrontal lobe in the prior
study are less apparent on the present study with decreased associated FLAIR
hyperintensity.
The cerebral sulci, ventricles, and extra-axial CSF-containing spaces have
normal size and configuration for patient's age. There is no shift of the
midline structures. There is no evidence of acute infarct or intracranial
hemorrhage. There are normal flow voids of the major intracranial vessels.
The visualized paranasal sinuses and mastoid air cells are clear. The orbits
and osseous structures are unremarkable.
## IMPRESSION:
The tiny enhancing nodules in the right parietal lobe noted in the
prior study are not seen on the present study. The tiny enhancing nodules
noted in the left high frontal lobe and left basifrontal lobe in the prior
study are less apparent on the present study with decreased associated FLAIR
hyperintensity. These likely represent response to treatment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12700774", "visit_id": "N/A", "time": "2181-02-25 09:30:00"} |
18945886-RR-10 | 136 | ## INDICATION:
woman with history of gallstone ileus and large
stones in the gallbladder. Surgical resection would be difficult given
scarring in the area.
## FINDINGS:
Twelve fluoroscopic images were obtained without the presence of a
radiologist. Contrast was injected in the common bile duct. The common bile
duct is normal in caliber measuring 8 mm. Contrast flowed into the cystic
duct which outlined a large stone within the gallbladder. There is extension
of contrast outside of the gallbladder lumen that is poorly localized by these
images but apparently correponds to a cholecystoduodenal fistula as described
in the GI endoscopy note in OMR.
## IMPRESSION:
Large gallbladder stones with contrast extending beyond the expected contours
of the gallbladder lumen, which apparently corresponds to a cholecystoduodenal
fistula.
For further details, please refer to GI endoscopy note in OMR.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18945886", "visit_id": "27179362", "time": "2175-11-03 14:57:00"} |
15442918-RR-151 | 218 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
year old woman with breast ca on chemotherapy. Recent onset of
productive cough and significant fatigue// please eval for infection
## FINDINGS:
The lungs are well inflated, there is mild elevation of the right
hemidiaphragm, unchanged since prior radiograph. The cardiac silhouette is
normal, the mediastinal contour is obscured by the right sided hilar opacity
with air bronchograms. The left hilar structures are normal. The pleural
surfaces are normal, and there is no pleural effusion or pneumothorax. A
right-sided port is seen with its tip in the distal SVC.
## IMPRESSION:
The right sided hilar opacity with air bronchograms may represent pneumonia in
the correct clinical setting. However, the location and appearance of this
opacity may also correspond with prior radiation therapy, or malignancy.
## RECOMMENDATION(S):
If there is clinical site concern for pneumonia, we
recommend treating with antibiotics and repeating a chest x-ray in no more
than 6 weeks. Close follow-up is recommended. If the patient does not
respond to treatment, or develops worsening symptoms, proceeding to CT of the
chest would be recommended at that time to further characterize this opacity.
## NOTIFICATION:
The findings were discussed with , N.P. by
, M.D. on the telephone on at 11:58 am, 5 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15442918", "visit_id": "20843212", "time": "2186-02-18 11:27:00"} |
11942367-RR-15 | 670 | ## HISTORY:
female with question of gastric volvulus at outside
hospital.
## CT CHEST WITH IV CONTRAST:
Bilateral thyroid nodules are noted, the largest
measuring approximately 19-mm long on the right and 14-mm long on the left.
Atherosclerotic calcifications are noted along the aortic arch and the origin
of the left subclavian and right brachiocephalic arteries. The aortic annular
calcifications as well as coronary artery calcifications are also noted. The
patient has a left pectoral pacemaker with a lead terminating in the right
atrium and two leads terminating in the right ventricle from a left subclavian
approach. The heart is not enlarged and there is no pericardial effusion.
While the current study is not targeted towards evaluation of the pulmonary
arteries, no central pulmonary embolism is noted.
Since the prior CT of 20 hours ago, there has been interval placement of an NG
tube which terminates within the intrathoracic stomach, above the diaphragm.
There has been interval decompression of previously seen gastric volvulus with
obstruction of the stomach and esophagus. Currently, nearly the entire
stomach is located above the diaphragm, with unchanged left-sided location of
the esophagus. The stomach is nondistended and contains a small air-fluid
level. The esophagus is no longer distended with fluid, although a small
amount of oral contrast is noted within the esophagus.
There is adjacent atelectasis of the left lower lobe as well as dependent
atelectatic changes in the posterior right lung and posterior left upper lobe.
There is tiny pleural effusion on the left. No mediastinal, hilar or axillary
lymph node enlargement is seen meeting CT size criteria for adenopathy.
## CT ABDOMEN WITH IV CONTRAST:
5-mm hypodensity along the dome of the liver is
too small to accurately characterize but likely represents a tiny cyst (2:42).
Relative hypoattenuation of the liver along the falciform ligament could
represent area of fatty infiltration. The patient is status post
cholecystectomy. Trace fluid is noted along the splenic hilum. Otherwise,
the spleen and splenule appear unremarkable. The pancreas is noted to be
atrophic and contains a 9-mm hypodense region, likely representing a cyst. No
dilatation of the main pancreatic duct is noted. The common bile duct is not
dilated. The adrenal glands appear normal. Subcentimeter hypodensities in
the right kidney are too small to accurately characterize but likely represent
cysts. A 2.9 cm cystic structure in the lower pole of the left kidney may be
continuous with the collecting system and contains layering high density,
probably representing a caliceal diverticulum.
The pylorus is located within the abdomen. The small bowel appears
unremarkable. There is colonic diverticulosis, without evidence for
diverticulitis. No free air or free fluid is noted within the abdomen. There
is diastasis of the rectus muscles, with small fat-containing paraumbilical
hernia. Atherosclerotic calcifications are noted along the abdominal aorta
and the origin of the major abdominal vessels. Coarse calcifications along
the root of the mesentery could represent calcified lymph nodes (2:65).
## CT PELVIS WITH IV CONTRAST:
The urinary bladder is essentially empty, with a
Foley catheter in place. The rectum appears unremarkable. There is sigmoid
diverticulosis, without evidence for diverticulitis. There is trace fluid
within the pelvis. No pelvic lymphadenopathy is noted. Bilateral small fat-
containing inguinal hernias are noted.
## OSSEOUS STRUCTURES:
Note is made of diffuse osteopenia as well as S-shaped
scoliosis of the thoracolumbar spine with multilevel degenerative change. No
focal region of bony destruction is seen concerning for malignancy.
## IMPRESSIONS:
1. Since the outside hospital CT of 20 hours prior, there has been interval
placement of an NG tube into the intrathoracic stomach, with decompression of
previously seen gastric volvulus.
2. There is adjacent atelectasis of the left lower lobe as well as tiny left
pleural effusion. Tiny perisplenic and trace pelvic fluid.
3. Coronary artery disease with pacemaker in place.
4. Incidentally noted 9-mm pancreatic cyst.
5. Thyroid nodules could be further evalued by ultrasound.
6. Colonic diverticulosis.
7. Diastasis of the rectus muscles, with small fat-containing paraumbilical
hernia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11942367", "visit_id": "22363453", "time": "2172-06-07 00:13:00"} |
11791996-RR-38 | 98 | ## FINDINGS:
Bilateral pigtail pleural catheters are present, unchanged in
position on the left, but markedly more laterally located on the right
compared to the prior exam. No definite pneumothorax is identified, but there
is a prominent lucency in the right upper quadrant of the abdomen, which could
potentially represent a basilar right pneumothorax. Cardiomediastinal
contours are stable in appearance, and appearance of the lungs is remarkable
for patchy and linear areas of atelectasis, slightly improved on the left and
slightly worse on the right. Position of right pleural catheter has been
communicated by phone to Dr. .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11791996", "visit_id": "21896053", "time": "2189-07-22 04:58:00"} |
12727680-RR-31 | 81 | ## EXAMINATION:
KNEE (3 VIEWS) LEFT
## INDICATION:
year old man with left knee pain// left knee pain
## FINDINGS:
Right total knee arthroplasty is noted. No evidence of hardware complication.
There is moderate degenerative change of the left knee with tricompartmental
osteophytes and medial joint space narrowing. Degenerative changes most
severe in the patellofemoral compartment. There is no joint effusion. There
is no fracture. There are no suspicious bony lesions. There is no radiopaque
foreign body.
## IMPRESSION:
Moderate left knee osteoarthritis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12727680", "visit_id": "N/A", "time": "2118-02-17 13:54:00"} |
10052992-RR-49 | 287 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old man with history of colon cancer, cirrhosis, now with
dizziness // acute process
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
Total DLP (Head) = 684 mGy-cm.
## FINDINGS:
There is hypodensity of the right temporal lobe (series 4, image 11 ; series
5, image 67) without associated volume loss were ex vacuo dilatation of the
adjacent ventricle. Hypodensity of the left occipital lobe is also noted,
which remained represent volume averaging through a prominent sulcus (series
4, image 14; series 5, image 85). Given the patient's clinical history, these
could represent age-indeterminate infarct for which further evaluation with
MRI is recommended. No underlying mass-effect is identified.
There are periventricular and subcortical white matter hypodensities, which
are nonspecific, but likely represents chronic microvascular ischemic changes.
The ventricles and sulci are prominent, consistent with involutional changes.
There is no evidence of fracture. Mucosal thickening of the anterior
ethmoidal air cells. Otherwise, the visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
## IMPRESSION:
1. Hypodensity of the right temporal lobe and left occipital lobe are noted,
without underlying mass effect, potentially representing age-indeterminate
infarcts given the patient's clinical history and without prior imaging for
comparison. Further evaluation with MRI with and without contrast (given the
patient's history of HCC and colon cancer) is recommended, if there are no
contraindications.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 12:22 , 20 minutes
after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10052992", "visit_id": "27263182", "time": "2126-09-20 10:04:00"} |
16649023-RR-170 | 252 | ## INDICATION:
Persistent postoperative ileus. Postop day 7, status post
laparoscopic ventral hernia repair.
## FINDINGS:
The included portions of the lung bases demonstrate mild
atelectasis. The heart is enlarged, and there are coronary artery
calcifications. There is a small hiatal hernia.
Within the abdomen, the liver, spleen, pancreas, adrenal glands, and kidneys
appear unremarkable. Incidental note is made of a splenule (2:27). The
patient is status post cholecystectomy. Loops of large bowel are of normal
size and caliber. There is diffuse colonic diverticulosis.
Multiple dilated loops of small bowel are seen within the mid abdomen.
Several of these abut the anterior mesh from hernia repair. A relatively
acute angulation of bowel with suggestion of tethering is seen in the right
lower quadrant (2:65, 302b:41). There is a small amount of fat stranding
surrounding the postoperative bed and in the anterior abdominal subcutaneous
tissues. No significant fluid collection or evidence of abscess formation is
seen. No free air or lymphadenopathy is identified.
Within the pelvis, distal loops of large bowel and rectum are of normal size
and caliber. The bladder is collapsed around the Foley catheter. The
prostate gland is unremarkable. No free air, free fluid, or lymphadenopathy
is seen. Again note is made of diverticulosis without evidence of
diverticulitis.
No concerning osseous lesion is seen.
## IMPRESSION:
Status post ventral hernia repair with multiple dilated loops of
small bowel. Relatively acute angulation in the right lower quadrant could
indicate adhesion. No intra-abdominal fluid collection or evidence of
abscess.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16649023", "visit_id": "26707965", "time": "2150-09-27 13:01:00"} |
12301379-RR-31 | 173 | ## INDICATION:
year old man with FALL out of bed // eval for interval
change/ICH s/p fall
## FINDINGS:
Compared to prior, there is a new low-density fluid collection layering along
the left convexity causing adjacent mass effect. A smaller low density
collection is seen along we right frontal and parietal lobes. Chronic left PCA
MCA infarct again seen. The appearance of the posterior fossa is similar
images from a suboccipital craniectomy. Fluid still remains within the
resection cavity. Overall ventricular size and configuration is decreased
from prior. There is a similar degree of mass effect on the quadrigeminal
plate cistern.
There is no acute fracture. A small right mucous retention cysts in the
maxillary sinus again seen..
## IMPRESSION:
New low-density fluid collections layering along the left greater than right
convexity causing adjacent local mass effect, of uncertain significance
differentials include chronic subdural collections following decrease in
ventricular size or traumatic subdural hygroma.
## NOTIFICATION:
Findings discussed with Dr. the telephone on at 02:30, 5 min after they were made.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12301379", "visit_id": "25425109", "time": "2137-01-18 01:27:00"} |
18559633-RR-73 | 395 | ## EXAMINATION:
MRI of the Pelvis
## INDICATION:
year old man with left perianal induration with 7 external
openings, draining purulent drainage. Assess for fistula disease.
## FINDINGS:
There is extensive abnormal enhancement and T2 hyperintensity within the
subcutaneous tissues of the left gluteal fold. In this region, tiny
discontinuous foci of non enhancement compatible with pockets of fluid within
the area of inflammation with the largest measuring 6 x 5 mm (series 1002,
image 97) are noted. There is no large drainable fluid collection.
Subcutaneous enhancement and inflammation extends superiorly to the left
posterior aspect of the anal verge where it extends as an area of linear
enhancement up to the internal anal sphincter at 5 o'clock position (series
1002, image 73). No well-defined fistulous tract identified. There are
additional subcutaneous areas of abnormal enhancement involving the right and
left superior gluteal folds (series 1002, image 54) extending into the
bilateral perineal soft tissues, more pronounced on the right (series 1002,
image 71).
Incidental note is made of a 9 mm T2 hypointense lesion in the right lateral
peripheral zone of the prostatic apex with hyperenhancement (series 4, image
2). This needs further evaluation starting with a urology consult and a
dedicated pelvic MRI as clinically warranted.
There are small bilateral hydroceles.
No lymphadenopathy in the imaged portion of the pelvis
No suspicious bony lesion seen. There is enhancement involving the bilateral
ischial tuberosities, likely enthesopathy.
## IMPRESSION:
1. Diffuse subcutaneous cellulitis involving the left gluteal fold with tiny
discontinuous pockets of fluid without a large drainable abscess. Other
scattered focal areas of inflammation are also noted in the bilateral gluteal
subcutaneous fat.
2. A thin linear area of inflammation extends from the left gluteal cleft to
the internal anal sphincter at the level of the anal verge, without
visualization of a well-defined fistula.
3. 9 mm lesion in the right prostate peripheral zone, inadequately assessed on
this non-dedicated examination, urologic consultation and PSA correlation is
suggested.
## RECOMMENDATION(S):
9 mm lesion in the right prostate peripheral zone,
inadequately assessed on this non dedicated examination, urologic consultation
and PSA correlation is suggested. If after workup further imaging is needed,
a dedicated prostate MRI could be obtained.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 3:24 pm, 5 minutes
after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18559633", "visit_id": "N/A", "time": "2152-11-14 10:58:00"} |
15877362-RR-173 | 93 | ## INDICATION:
with recent fall, dizziness and chest pain on palpation,
evaluate for rib fractures, pneumonia.
## FINDINGS:
Aortic arch calcifications are again noted. Lung volumes are slightly low,
accentuating the cardiac silhouette, unchanged and likely within normal
limits. There is no focal lung consolidation. There is no pulmonary vascular
congestion or pulmonary edema. There is no pneumothorax or pleural effusion.
Mild S-shaped scoliosis is noted.
## IMPRESSION:
No acute cardiopulmonary process. No obvious rib fracture, however note that
chest radiographs are not sensitive for the detection of subtle or
nondisplaced rib fractures.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15877362", "visit_id": "29044342", "time": "2203-12-14 11:18:00"} |
19190289-RR-32 | 489 | ## CLINICAL INFORMATION:
The patient is a female with a history of
hepatic ductal stones, status post extraction and multiple dilations for bile
duct stricture at the anastomosis of hepatojejunostomy. A request was made to
repeat a cholangiogram with dilation, or possible tube removal.
## OPERATORS:
Dr. and Dr. attending radiologist who was
present and supervised during the whole procedure.
## PROCEDURE:
1. Cholangiogram.
2. Biliary ductal stricture dilation.
3. Exchange of internal-external biliary draining catheter.
## ANESTHESIA:
General anesthesia was applied.
## PROCEDURE AND FINDINGS:
After the risks and benefits of the procedure as well
as general anesthesia were explained, informed consent was obtained. The
patient was brought to the angiography suite and placed supine on the imaging
table. The epigastric was prepared and draped in the usual sterile fashion.
The external portion of the existing PTBD catheter was cut, and 0.035
guidewire was passed into biliary ducts through the existing catheter with its
tip ended in the jejunum. Over the wire, the existing PTBD catheter was
removed and a sheath was advanced into the biliary duct
over the wire. Contrast injection demonstrated a stenosis of the left
hepatic duct close to the hepatojejunal anastomosis and a suggestion of a
filling defect within the left hepatic duct. There was contrast flow through
the stenosis down towards the jejunum. Based on these diagnostic findings it
was decidede to attempt stone removal. A basket was advanced through the
sheath and opened in the left hepatic duct, but no stones or sludge were
removed. The filling defect was no longer identified and most likely was
related to an air bubble. The guidewire was removed and replaced with
an 0.018 wire, the tip of the wire was positioned in the jejunum. Over the
wire, an 8 mm x 2 cm cutting balloon was advanced into the hepatic duct, and
the balloon was deployed at the stenosis of left hepatojejunal anastomosis.
Contrast injection demonstrated slightly improvement of the stenosis. After
removal of the cutting balloon catheter, the 0.018 control wire was removed
and replaced with the wire with its tip ended in the jejunum. The
sheath was then removed, and a Flexima biliary catheter was advanced
into left hepatic duct over the wire to its tip ended in the jejunum.
The wire was then removed. A locking loop was formed at the tip of
the biliary catheter inside the jejunum. Contrast injection demonstrated the
patency of the internal and external draining of the biliary catheter.
There were no immediate complications.
## IMPRESSION:
1. Cholangiogram demonstrated stenosis at the left hepatojejunal anastomosis
and no significant improvement after dilatation with cutting balloon.
2. An internal- external Flexima biliary catheter was placed through the left
hepatic duct across the hepatojejunal anastomosis.
PFI. Persistent stricture at left hepatic duct, no definitive large stones
visible, the stricture dilated was 8 mm cutting balloon with no significant
improvement, and a internal-external biliary draining catheter was
placed. End PFI.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19190289", "visit_id": "23515551", "time": "2173-12-15 07:39:00"} |
12557337-DS-10 | 1,210 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
purulent abdominal JP drainage concerning for infection.
## HISTORY OF PRESENT ILLNESS:
h/o IDDM (A1C 6.8), left breast cancer and s/p SSM
with TE recon, neoadjuvant/adjuvant chemo complicated by left TE
infection requiring explant and MRSA bacteremia requiring
extended course of Daptomycin, who on underwent bilateral
flap reconstruction with retrorectus polypropylene mesh
placement.
.
Postoperatively she had asymptomatic sinus tachycardia which
self-resolved. She was discharged home on POD6 with 1 week of
antibiotics.
.
Since surgery she felt some left breast superior pole
fullness and tightness. This acutely worsened the last 2
days. addition, on she began having lower abdominal
pain bilaterally which began as soreness which progressively
worsened to sharp pains. Her abdominal JP drain initially put
out
serosanguineous fluid, then serous, and then became purulent
. Denies fevers.
## PAST MEDICAL HISTORY:
Breast CA, left
IDDM (AIC 6.8)
HTN
BRCA gene mutation
.
## PSH:
Bilateral Mastectomy
Bilateral Tissue expander placement
Left tissue expander explant
## FAMILY HISTORY:
The Family History was reviewed and is,non-contributory for a
past history of infection or immunocompromised state.
## PHYSICAL EXAM:
On exam, afebrile and appears well. Left breast superior pole
fullness, possible fat necrosis. Bilateral flaps well
perfused and healing well. Umbilicus erythematous without overt
purulence. Abdominal incision healing well. Abdominal JP drain
milky purulence.
## 10:37 AM ABSCESS SOURCE:
LEFT abd JP.
GRAM STAIN (Final :
3+ per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
3+ per 1000X FIELD): GRAM POSITIVE COCCI.
PAIRS AND CLUSTERS.
## FLUID CULTURE (PRELIMINARY):
STAPH AUREUS COAG +. MODERATE GROWTH.
Oxacillin RESISTANT Staphylococci MUST be reported as
also
RESISTANT to other penicillins, cephalosporins,
carbacephems,
carbapenems, and beta-lactamase inhibitor combinations.
RIFAMPIN should not be used alone for therapy.
## SENSITIVITIES:
MIC expressed
MCG/ML
STAPH AUREUS COAG +
|
CLINDAMYCIN
-----
<=0.25 S
ERYTHROMYCIN
-----
=>8 R
GENTAMICIN
-----
<=0.5 S
LEVOFLOXACIN
-----
4 R
OXACILLIN
-----
=>4 R
RIFAMPIN
-----
<=0.5 S
TETRACYCLINE
-----
<=1 S
TRIMETHOPRIM/SULFA
-----
<=0.5 S
VANCOMYCIN
-----
1 S
## URINALYSIS:
10:02AM URINE Color-Straw Appear-HAZY* Sp
10:02AM URINE Blood-NEG Nitrite-NEG Protein-20*
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NORMAL pH-7.5
Leuks-TR*
10:02AM URINE RBC-0 WBC-12* Bacteri-FEW* Yeast-NONE
Epi-10 TransE-<1
10:02AM URINE CastHy-24*
10:02AM URINE Mucous-OCC*
.
## BRIEF HOSPITAL COURSE:
h/o IDDM (A1C 6.8), left breast cancer and s/p SSM
with TE recon, neoadjuvant/adjuvant chemo complicated by left TE
infection requiring explant and MRSA bacteremia requiring
extended course of Daptomycin, who on underwent bilateral
flap reconstruction with retrorectus polypropylene mesh
placement. Postoperatively she had asymptomatic sinus
tachycardia which self-resolved. She was discharged home on POD6
with 1 week of antibiotics. Since surgery she felt some left
breast superior pole fullness and tightness which progressively
worsened. addition, on she began having lower
abdominal pain bilaterally which began as soreness which
progressively worsened to sharp pains. Her abdominal JP drain
initially put out serosanguineous fluid, then serous, and then
became purulent . No fevers. She was admitted for IV
antibiotics and started on vancomycin and cefepime. A culture of
the JP bulb fluid was obtained and sent and an ID consult was
requested. ID suggested the d/c of IV cefepime with gm stain
results. JP fluid had improved appearance by HD#4. The culture
was finalized as MRSA sensitive to Bactrim. ID recommended a 14
day course of antibiotics. She was discharged home on HD#4 with
Bactrim and JP drain. She will follow up with ID and Dr.
.
## MEDICATIONS ON ADMISSION:
Acetaminophen 650 mg PO Q6H
Atenolol 50 mg PO DAILY
Cyclobenzaprine 5 mg PO TID:PRN spasm
Ibuprofen 400 mg PO Q8H
Glargine 20 Units Bedtime
Lisinopril 10 mg PO DAILY
MetFORMIN XR (Glucophage XR) 1500 mg PO DAILY Do Not Crush
Sertraline 25 mg PO QHS
## DISCHARGE MEDICATIONS:
1. OxyCODONE (Immediate Release) mg PO Q4H:PRN Pain -
Moderate
RX *oxycodone 5 mg tablet(s) by mouth Every hours Disp
#*20 Tablet Refills:*0
2. Sulfameth/Trimethoprim DS 2 TAB PO BID Duration: 11 Days
RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 2 tablet(s) by
mouth twice a day Disp #*44 Tablet Refills:*0
3. Acetaminophen 650 mg PO Q6H
4. Atenolol 50 mg PO DAILY
5. Cyclobenzaprine 5 mg PO TID:PRN spasm
6. Ibuprofen 400 mg PO Q8H
7. Glargine 20 Units Bedtime
8. Lisinopril 10 mg PO DAILY
9. MetFORMIN XR (Glucophage XR) 1500 mg PO DAILY
Do Not Crush
10. Sertraline 25 mg PO QHS
## DISCHARGE DIAGNOSIS:
Young diabetic female who presents with purulent abdominal JP
drainage concerning for infection
## DISCHARGE INSTRUCTIONS:
1. You may leave your incisions open to air .
2. Clean around the drain site(s), where the tubing exits the
skin, with soap and water.
3. Strip drain tubing, empty bulb(s), and record output(s)
times per day.
4. A written record of the daily output from each drain should
be brought to every follow-up appointment. Your drains will be
removed as soon as possible when the daily output tapers off to
an acceptable amount.
5. You may shower daily. No baths until instructed to do so by
Dr. .
.
## ACTIVITY:
1. You may resume your regular diet.
2. DO NOT lift anything heavier than 5 pounds or engage
strenuous activity until instructed by Dr. .
.
## MEDICATIONS:
1. Resume your regular medications unless instructed otherwise
and take any new meds as ordered.
2. You may take your prescribed pain medication for moderate
to severe pain. You may switch to Tylenol or Extra Strength
Tylenol for mild pain as directed on the packaging.
3. Take Colace, 100 mg by mouth 2 times per day, while taking
the prescription pain medication. You may use a different
over-the-counter stool softener if you wish.
4. Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high fiber.
.
Call the office IMMEDIATELY if you have any of the following:
## 1. SIGNS OF INFECTION:
fever with chills, increased redness,
swelling, warmth or tenderness at the surgical site, or unusual
drainage from the incision(s).
2. A large amount of bleeding from the incision(s) or
drain(s).
3. Fever greater than 101.5 oF
4. Severe pain NOT relieved by your medication.
.
Return to the ER if:
* If you are vomiting and cannot keep fluids or your
medications.
* If you have shaking chills, fever greater than 101.5 (F)
degrees or 38 (C) degrees, increased redness, swelling or
discharge from incision, chest pain, shortness of breath, or
anything else that is troubling you.
* Any serious change your symptoms, or any new symptoms
that concern you.
.
DRAIN DISCHARGE INSTRUCTIONS
You are being discharged with drains place. Drain care is a
clean procedure. Wash your hands thoroughly with soap and warm
water before performing drain care. Perform drainage care twice
a day. Try to empty the drain at the same time each day. Pull
the stopper out of the drainage bottle and empty the drainage
fluid into the measuring cup. Record the amount of drainage
fluid on the record sheet. Reestablish drain suction.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12557337", "visit_id": "23353271", "time": "2182-08-11 00:00:00"} |
12325549-RR-7 | 315 | ## HISTORY:
man for left lower abdominal mass biopsy, and for
possible drainage of hepatic lesion, question abscess.
## PROCEDURE:
The risks and benefits of the procedure were explained to the
patient, and written informed consent was obtained. A preprocedure timeout
using two patient identifiers was performed. The areas overlying the liver
and the left lower quadrant of the abdomen where prepped and draped in a
sterile fashion.
CT FLUOROSCOPIC GUIDED BIOPSY OF LEFT LOWER ABDOMINAL MASS:
Under CT
fluoroscopic guidance, a suitable spot overlying the mass was chosen.
Approximately 5 cc of 1% lidocaine was used as local anesthetic. Under CT
fluoroscopic guidance, a 17 gauge introducer needle was introduced into the
mass and its location confirmed with CT fluoroscopy. An 18-gauge core biopsy
needle system was then used to obtain two 18-gauge core biopsy samples.
## CT GUIDED HEPATIC DRAINGE:
Under CT fluoroscopic guidance, an 8
pigtail catheter was advanced into the low density collection in the right
lobe of the liver, and location was confirmed. Upon aspiration, dark bloody
material was aspirated. Appearance was inconsistent with mixed pus. The
catheter repositioned continued to obtain blood. Sample was sent for
cultures. We pulled the pigtail catheter from this collection as it is
unlikely to represent an abscess.
Findings were discussed with Dr. . on at 5:00 p.m.
Moderate sedation consisting of divided doses of Versed and fentanyl under
continuous hemodynamic monitoring was provided by the Radiology nursing staff
for a total intra-service time of approximately 40 minutes.
Dr. , the attending radiologist, was present and supervised the
procedure.
## IMPRESSION:
1. Technically successful CT fluoroscopic guided biopsy of left lower
abdominal mass. Two samples were obtained and sent to pathology.
2. Attempted drainage of hepatic lesion yielded bloody material with
consistency of blood. Unlikely to represent pus. However, sample was still
sent to microbiology. No drainage catheter was placed in this lesion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12325549", "visit_id": "N/A", "time": "2118-08-25 15:39:00"} |
11707322-DS-11 | 627 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
abdominal pain and tachycardia
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Left VATS mediastinal mass biopsy
## HISTORY OF PRESENT ILLNESS:
Ms is a wk pregnant who was recently
evaluated for an incidentally found mediastinal mass. She had an
MRI finding 5 cm anterior mediastinal mass and
lymphadenopathy in the AP window, suggesting thymic neoplasm or
lymphoma. She then underwent a core needle biopsy of the
mediastinal mass . She returns to clinic to discuss
findings and plan for treatment of her mass. She currently
denies
any SOB, DOE, chest pain, sweats, fevers, cough or other sx.
## BP:
139/77. Heart Rate: 133. Weight: 175.4 (With Clothes; With
## NECK:
No : clear ausc
## COR:
RRR, tachy, no murmur
## BRIEF HOSPITAL COURSE:
Mrs. was admitted to the hospital and taken to the
Operating Room where she underwent a left VATS mediastinal lymph
node biopsy. She tolerated the procedure well and returned to
the PACU in stable condition. She maintained dtable
hemodynamics and her pain was well controlled.
Following transfer to the Surgical floor she continued to make
good progress. Her chest tube drained minimally and was removed
on post op day #1. Her port sites were dry and she was able to
use her incentive spirometer effectively. She was able to
tolerate a regular diet modestly and ambulate independently. She
had no complaints of abdominal pain, contractions or vaginal
bleeding. After an uneventful recovery she was discharged to
home on and will follow up with the Oncology service
tomorrow to discuss pathology and further treatment. She will
also be seen in the Thoracic Clinic in 2 weeks for a post op
evaluation.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen 325-650 mg PO Q6H:PRN headache, pain
2. Prenatal Vitamins 1 TAB PO DAILY
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q6H
2. Prenatal Vitamins 1 TAB PO DAILY
3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
4. Docusate Sodium 100 mg PO BID
5. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
RX *oxycodone 5 mg tablet(s) by mouth every four (4) hours
Disp #*40 Tablet Refills:*0
6. Magnesium Oxide 400 mg PO TID
RX *magnesium oxide 400 mg 1 tablet(s) by mouth three times a
day Disp #*6 Tablet Refills:*0
## DISCHARGE INSTRUCTIONS:
* You were admitted to the hospital for a mediastinal biopsy and
you've recovered well. You are now ready for discharge.
* Continue to use your incentive spirometer 10 times an hour
while awake.
* Check your incisions daily and report any increased redness or
drainage. Cover the area with a gauze pad if it is draining.
* Your chest tube dressing may be removed in 48 hours. If it
starts to drain, cover it with a clean dry dressing and change
it as needed to keep site clean and dry.
* You will continue to need pain medication once you are home
but you can wean it over a few weeks as the discomfort resolves.
Make sure that you have regular bowel movements while on
narcotic pain medications as they are constipating which can
cause more problems. Use a stool softener or gentle laxative to
stay regular.
* No driving while taking narcotic pain medication.
* Take Tylenol mg every 6 hours in between your narcotic.
* Continue to stay well hydrated and eat well to heal your
incisions
* Shower daily. Wash incision with mild soap & water, rinse, pat
dry
* No tub bathing, swimming or hot tubs until incision healed
* No lotions or creams to incision site
* Walk times a day and gradually increase your activity as
you can tolerate.
Call Dr. if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, chest pain or any other symptoms
that concern you.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11707322", "visit_id": "26903568", "time": "2187-09-25 00:00:00"} |
13390436-RR-19 | 210 | ## INDICATION:
with left hemorrhagic stroke. Evaluate for
progression.
## NON-CONTRAST HEAD CT:
Large left frontoparietal intraparenchymal hemorrhage
measures 6 x 4 cm in greatest axial dimension. There is a hematocrit level
suggesting acute bleeding seen along the inferior aspect of the hemorrhage.
Surrounding vasogenic edema is moderate. There is no definite underlying mass
or arteriovenous malformation. The adjacent sulci are effaced, however, there
is no significant mass effect with minimal, if any, rightward midline shift.
No intraventricular extension of hemorrhage. Slight prominence of the
ventricles is likely related to age-related involutional changes. No
additional areas of hemorrhage are identified. The basal cisterns are well
preserved. The carotid siphons are moderately calcified. Osseous structures
and soft tissues are normal.
## IMPRESSION:
Large left frontoparietal intraparenchymal hemorrhage with no
significant mass effect, and grossly unchanged compared to the outside
hospital CT performed three hours prior. Given the lobar distribution, the
differential diagnosis includes amyloid angiopathy, underlying mass of AVM, or
aneurysm. Comparison with concurrent CTA demonstrates no evidence of these
entities at this time. An MRI and repeat CTA could be obtained when the
hemorrhage has resolved to evaluate for amyloid angiopathy, underlying mass or
vascular malformation.
Findings were posted to the ED dashboard at the time of the exam.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13390436", "visit_id": "28663025", "time": "2172-05-15 14:33:00"} |
17577701-DS-6 | 644 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
year old female presented after two weeks of acutely
worsening
headaches. The patient has had headaches for months, but as of
recently, they became unrelenting and she was concerned she
possibly had an aneurysm. The patient brought herself to where a demonstrated a large 3x4x3cm left
cerebellar
mass with vasogenic edema and mild compression of the fourth
ventricle. She was administered 10mg of Decadron prior to her
transfer to .
## PAST MEDICAL HISTORY:
No known history. Patient has not seen a doctor in years.
## FAMILY HISTORY:
Mother and father have diabetes but are otherwise healthy.
## MENTAL STATUS:
Awake and alert, cooperative with exam, normal
affect.
## ORIENTATION:
Oriented to person, place, and date.
## LANGUAGE:
Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.
## II:
Pupils equally round and reactive to light, 3 to 2mm
bilaterally. Visual fields are full to confrontation.
## III, IV, VI:
Extraocular movements intact bilaterally without
nystagmus.
## V, VII:
Facial strength and sensation intact and symmetric.
## VIII:
Hearing intact to voice.
## XI:
Sternocleidomastoid and trapezius normal bilaterally.
## XII:
Tongue midline without fasciculations.
## MOTOR:
Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power throughout. No pronator drift
## SENSATION:
Intact to light touch, proprioception
Toes downgoing bilaterally
## COORDINATION:
normal on finger-nose-finger, rapid alternating
movements, heel to shin
-----
## MOTOR:
TrapDeltoidBicepTricepGrip
IPQuadHamATEHLGast
Left5 5 5 5 5 5
[x]Sensation intact to light touch
[x]Coordination intact - heel to shin and finger to nose intact
[x]+Rapid hand movements
## PERTINENT RESULTS:
Please see OMR for pertinent results.
## BRIEF HOSPITAL COURSE:
who was found to have a left cerebellar lesion at an OSH.
She was transferred to and admitted to the Neurosurgery
floor.
#Cerebellar lesion
She was started on Dexamethasone 4mg Q6H. MRI was done on .
Dexamethasone was decreased to 2mg TID. Neuro and radiation
oncology were consulted. CTA/CTV was obtained. Her steroid
dosage was changed to Dexamethasone 6mg daily in the morning per
Dr . She remained neurologically stable. She will be
discharged home on and return for surgical resection on
.
## DISCHARGE MEDICATIONS:
1. Acetaminophen-Caff-Butalbital TAB PO Q6H:PRN Pain -
Moderate
RX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg 1 tablet(s)
by mouth every 6 hours as needed for pain Disp #*20 Tablet
## REFILLS:
*0
2. Dexamethasone 6 mg PO DAILY
RX *dexamethasone 6 mg 1 tablet(s) by mouth every morning Disp
#*5
## TABLET REFILLS:
*0
3. Docusate Sodium 100 mg PO BID
4. Famotidine 20 mg PO BID
RX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*10
Tablet Refills:*0
5. Senna 8.6 mg PO BID:PRN Constipation - First Line
## DISCHARGE DIAGNOSIS:
Cereballar mass
Cerebral edema
Cerebral compression
## DISCHARGE INSTRUCTIONS:
Medications
**Please do NOT take any blood thinning medication (Aspirin,
Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon.
* You may use Acetaminophen (Tylenol) for minor discomfort if
you are not otherwise restricted from taking this medication.
* You have been discharged on Dexamethasone, this can cause high
blood sugars, but you have not required insulin administration.
Call your physician if you experience frequent urination,
blurred vision, excessive fatigue, increased thirst.
## WHAT YOU EXPERIENCE:
* You may experience headaches.
When to Call Your Doctor at for:
* Fever greater than 101.5 degrees Fahrenheit
* Nausea and/or vomiting
* Extreme sleepiness and not being able to stay awake
* Severe headaches not relieved by pain relievers
* Seizures
* Any new problems with your vision or ability to speak
* Weakness or changes in sensation in your face, arms, or leg
Call and go to the nearest Emergency Room if you experience
any of the following:
* Sudden numbness or weakness in the face, arm, or leg
* Sudden confusion or trouble speaking or understanding
* Sudden trouble walking, dizziness, or loss of balance or
coordination
* Sudden severe headaches with no known reason
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17577701", "visit_id": "23992793", "time": "2186-07-05 00:00:00"} |
19906885-RR-44 | 101 | ## INDICATION:
year old female with vaginal bleeding after D/C for molar
pregnancy. Evaluate for retained products, other signs of molar preg
## FINDINGS:
The uterus measures 9.5 x 6.4 x 8.1 cm. Multiple fibroids are seen including a
posterior 3.0 x 3.9 x 3.1 cm fibroid in the fundus. The endometrial contains
vascularized echogenic material concerning for retained products of
conception. The ovaries are normal bilaterally. There is no pelvic free fluid.
## IMPRESSION:
1. Vascularized echogenic material within the endometrial cavity concerning
for retained products of conception. Recommend gynecological consultation.
2. Fibroid uterus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19906885", "visit_id": "N/A", "time": "2146-07-13 14:17:00"} |
19779220-RR-11 | 273 | ## HISTORY:
female with epigastric and right upper quadrant pain.
## FINDINGS:
The hepatic architecture is normal in appearance. No focal liver lesion is
identified. No intrahepatic biliary dilatation is seen. The extrahepatic
common bile duct is dilated measuring up to 1.3 cm in diameter. A ill defined
hypoechoic structure is seen at the distal terminus of the CBD at the level of
the ampulla. This structure measures 1.2 cm in diameter. A small neoplasm
cannot be excluded. The pancreatic duct is not dilated measuring 1 mm. The
pancreas is only partially visualized as it is partially obscured from view by
overlying bowel gas.
There are numerous gallstones seen within the gallbladder. The gallbladder is
not dilated and there is no gallbladder wall edema. No pericholecystic fluid
is seen.
The spleen is normal measuring 8.2 cm. No hydronephrosis is seen. The right
kidney measures 9.4 cm and the left kidney measures 10.8 cm. The aorta is
somewhat atherosclerotic however no aneurysm is visualized. The IVC is
unremarkable. No ascites is seen in the upper abdomen.
## IMPRESSION:
1. Dilated extrahepatic common bile duct. A small ill-defined hypoechoic
mass-like area at the distal terminus of the CBD at the level of the of
ampullary is noted and a neoplasm at this location cannot be excluded. An
MRCP is recommended for further characterization. No intrahepatic biliary
dilatation is seen.
2. Cholelithiasis with no sign of cholecystitis.
3. Atherosclerotic aorta with no AAA.
## NOTIFICATION:
Findings of extrahepatic common bile duct dilatation were
discovered at 14:30 on and were conveyed by telephone to Dr.
14:40 on the same day.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19779220", "visit_id": "N/A", "time": "2161-09-09 13:33:00"} |
16296345-RR-15 | 297 | ## EXAMINATION:
SKULL APANDLAT/C-SP/CXR/ABD SLG VIEWS MR SCREENING
## INDICATION:
year old man with unknown past medical history appearing
evaluate for metal foreign objects for pre MRI screening.
## METAL:
Patient is status post left parietal craniotomy with surgical staples
overlying the left parietal scalp. Note is made of dental amalgam. The
endotracheal tube terminates approximately 5 cm above the carina. The
orogastric tube terminates in the expected location of the gastric body.
There is a right internal jugular central venous catheter terminating in the
region of the distal SVC. There is a Foley catheter in the bladder. Allowing
for external monitoring wires, no other radiopaque foreign bodies seen.
## CHEST:
Low lung volumes and apparent semi upright positioning limit evaluation. Mild
prominence of the cardiac silhouette and widened appearance of the mediastinum
likely secondary to semi upright positioning and low lung volumes. Lung bases
are partially obscured by the diaphragm due to semi upright positioning.
Streaky density is again seen in the apical left upper lobe, corresponding to
a spiculated lesion on the CTA neck. There is no evidence for
pulmonary edema and no sizable pleural effusion.
## ABDOMEN:
There is gas throughout nondilated small bowel loops as well as gas distending
the stomach. There may be relative paucity of gas in the colon. The bowel is
better assessed on the torso CT performed earlier on the same day. Small
amount of radiodense contrast remains present in the bowel from the earlier
torso CT.
## IMPRESSION:
1. Left craniotomy hardware, left parietal scalp staples, dental amalgam,
endotracheal tube, orogastric tube, right internal jugular central venous
catheter, and Foley catheter are identified. No other radiopaque foreign
body.
2. Streaky density in the upper lobe of the left lung in the region of the
known spiculated pulmonary lesion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16296345", "visit_id": "21522544", "time": "2138-12-26 13:55:00"} |
17836650-RR-28 | 378 | ## INDICATION:
woman with basal ganglia bleed
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 1.7 s, 27.7 cm; CTDIvol = 18.7 mGy (Body) DLP = 517.9
mGy-cm.
2) Spiral Acquisition 4.3 s, 67.7 cm; CTDIvol = 18.4 mGy (Body) DLP =
1,244.8 mGy-cm.
3) Spiral Acquisition 1.8 s, 29.2 cm; CTDIvol = 18.8 mGy (Body) DLP = 548.7
mGy-cm.
4) Stationary Acquisition 7.1 s, 0.5 cm; CTDIvol = 39.1 mGy (Body) DLP =
19.6 mGy-cm.
Total DLP (Body) = 2,331 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS W AND W/O CONTRAST, ADDL SECTIONS)
## NECK, THORACIC INLET, AXILLAE:
The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
## MEDIASTINUM:
Mediastinal lymph nodes are not enlarged.
## HILA:
Hilar lymph nodes are not enlarged.
## HEART:
The heart is not enlarged and there is mild coronary arterial
calcification. There is no pericardial effusion.
## VESSELS:
Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber. Multiple
bilateral pulmonary emboli are seen. Specifically, thrombus is seen in the
right upper lobar, right lower lobar, and right lower segmental and
subsegmental branches, and in the left lingular lobar and lower lobar and
submental branches.
## PULMONARY PARENCHYMA:
There is no evidence of infection or malignancy. There
is a calcified granuloma in the left upper lobe. No large or worrisome
pulmonary nodules. There is mild bibasilar atelectasis. There is mild
paraseptal emphysema.
## AIRWAYS:
The airways are patent to the subsegmental level bilaterally.
## PLEURA:
There is no pleural effusion.
## CHEST WALL AND BONES:
There is no worrisome lytic or sclerotic lesion.
## UPPER ABDOMEN:
Please see separately submitted Abdomen and Pelvis CT report
for subdiaphragmatic findings.
## IMPRESSION:
1. Bilateral pulmonary emboli extending from multiple right and left lobar
branches into the segmental and subsegmental branches, with no evidence of
right heart strain or pulmonary infarct.
2. No primary or metastatic intrathoracic malignancy.
3. Please see separate report of CT Abdomen and Pelvis performed same day for
description of subdiaphragmatic findings.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 10:30 pm, 1 minute after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17836650", "visit_id": "21555104", "time": "2190-11-09 09:13:00"} |
13601466-DS-9 | 1,391 | ## ALLERGIES:
tramadol / beta blockers>dizzy / beta blockers>dizzy
## HISTORY OF PRESENT ILLNESS:
F with PMH of PVD, frequent falls, HTN, HLD, anemia, CAD,
CLL, left shoulder fracture presenting with back pain s/p
unwitnessed fall last night. Patient states that she was at home
on her toilet when she felt unsteady and fell forward. She hit
her head on the ground. She try to call for help on the phone
but her phone was not working. She scooted around on her
buttocks. Her came this morning and found her on the floor.
She was alert and oriented. She denies any loss of consciousness
or amnesia and says that she remembers the whole thing. She says
that she has some pain in her low back and left shoulder. No
headache, vision changes, chest pain, neck pain, abdominal pain,
urinary or fecal incontinence, history of seizures, numbness,
paralysis. She denies any blood thinners. Has been going to
for evaluation of increasing falls.
## PAST MEDICAL HISTORY:
-Benign paroxysmal vertigo, right ear
-B12 DEFICIENCY ANEMIA
-CORONARY ARTERY DISEASE
-COMPRESSION FRACTURES
- ESOPHAGUS
-HIATAL HERNIA
-HYPERCHOLESTEROLEMIA
-LYMPHOCYTIC COLITIS
-MEMORY LOSS
-RIGHT THIGH MASS
-BACK PAIN
-HYPERTENSION
-OSTEOPOROSIS
-CHRONIC LYMPHOCYTIC LEUKEMIA
-THYROID NODULE
-HERNIA
-THYROID NODULE
-CHRONIC LYMPHOCYTIC LEUKEMIA
-BREAST CANCER
-GAIT DISTURBANCE
-H/O PANCREATIC LESION
-H/O PELVIC MASS
-H/O L SHOULDER FX
-H/O FALLS
## FAMILY HISTORY:
-She reports that her father and her mother both suffered from
lung cancer.
## HEENT:
No scleral icterus, mucus membranes dry. left frontal
scalp abrasion
## PULM:
Clear to auscultation b/l, left chest wall tenderness
## ABD:
Soft, nondistended, nontender, no rebound or guarding,
## EXT:
No edema, warm and well perfused, right ankle bruise
without pain.
## HEENT:
MMM, no tracheal deviation, EOMI
## RESP:
Normal effort, no distress
## ABDOMEN:
Soft, nondistended, nontender, no rebound or guarding
## EXT:
Warm, well perfused, no edema
## CHEST (PORTABLE AP):
Limited study due to rotation. Bibasilar airspace opacities may
reflect atelectasis, though infection or aspiration is difficult
to exclude.
## CT HEAD W/O CONTRAST:
1. No acute intracranial process.
2. Small left parietal subcutaneous hematoma. Mild left lateral
supraorbital soft tissue swelling. No underlying fractures.
CT ABD & PELVIS WITH CONTRAST:
1. Mildly displaced acute fractures of the posterolateral left
eighth through tenth ribs.
2. Otherwise, no acute intra-abdominal or intrathoracic process.
3. Multiple additional chronic findings as described above.
## CT C-SPINE W/O CONTRAST:
No acute fracture or traumatic malalignment.
## BRIEF HOSPITAL COURSE:
Ms. is a year old female who presented to the
Emergency Department for evaluation on cute care surgery was consulted and imaging was completed on
arrival. As a result of her fall, she was found to have
sustained right side rib fractures. While in the emergency
department she reported significant pain and required
supplemental oxygen. She was therefore admitted to the inpatient
unit for respiratory toileting and pain control.
During her inpatient stay, the patient remained alert and
oriented at baseline. Her oxygen saturations were monitored
closely and on HD2 she was weaned to room air. Her diet was then
advanced and she tolerated a regular diet without difficulty.
Pain was controlled with oral Tylenol and ibuprofen. Oxycodone
was offered for severe pain, however the patient declined. The
patient was then seen and evaluated by physical and occupational
therapy who recommended discharge to rehab facility.
At the time of discharge, the patient was doing well. She was
afebrile and her vital signs were stable. The patient was
tolerating a regular diet, ambulating, voiding without
assistance, and her pain was well controlled. The patient was
discharged to a rehab facility. Discharge teaching was
completed, and follow up appointments were scheduled and
reviewed with reported understanding and agreement.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Anastrozole 1 mg PO DAILY
2. Atorvastatin 80 mg PO QPM
3. calcium citrate-vitamin D3 315 mg- 250 unit oral DAILY
4. cyanocobalamin (vitamin B-12) 1000 mcg oral DAILY
5. Lisinopril 5 mg PO DAILY
6. Multivitamins 1 TAB PO DAILY
7. Ranitidine 300 mg PO QHS
8. Aspirin 81 mg PO DAILY
9. cholecalciferol (vitamin D3) 25 mcg oral DAILY
10. Ibuprofen 200 mg PO BID:PRN Pain - Mild
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO TID
transition to prn when pain levels decreased.
2. Lidocaine 5% Patch 1 PTCH TD QAM
okay for 4% strength over the counter.
3. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain -
Moderate
may cause drowsiness
RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp
#*3 Tablet Refills:*0
4. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second
Line
5. Anastrozole 1 mg PO DAILY
6. Aspirin 81 mg PO DAILY
7. Atorvastatin 80 mg PO QPM
8. calcium citrate-vitamin D3 315 mg- 250 unit oral DAILY
9. cholecalciferol (vitamin D3) 25 mcg oral DAILY
10. cyanocobalamin (vitamin B-12) 1000 mcg oral DAILY
11. Ibuprofen 200 mg PO BID:PRN Pain - Mild
12. Lisinopril 5 mg PO DAILY
13. Multivitamins 1 TAB PO DAILY
14. Ranitidine 300 mg PO QHS
## DISCHARGE DIAGNOSIS:
Right sided rib fractures
## ACTIVITY STATUS:
Out of Bed with assistance to chair or
wheelchair.
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the Acute Care Surgery service on
after a fall sustaining right sided rib fractures . You were
given pain medication and encourage to take deep breaths. You
were seen and evaluated by physical therapy who recommend
discharge to rehab. You are now doing better, tolerating a
regular diet, and ready to be discharged home to continue your
recovery. Please note the following discharge instructions:
Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain in not improving within hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
Please resume all regular home medications, unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than lbs until you follow-up with your
surgeon.
Avoid driving or operating heavy machinery while taking pain
medications.
* Your injury caused right side rib fractures which can
cause severe pain and subsequently cause you to take shallow
breaths because of the pain.
* You should take your pain medication as directed to stay
ahead of the pain otherwise you won't be able to take deep
breaths. If the pain medication is too sedating take half the
dose and notify your physician.
* Pneumonia is a complication of rib fractures. In order to
decrease your risk you must use your incentive spirometer 4
times every hour while awake. This will help expand the small
airways in your lungs and assist in coughing up secretions that
pool in the lungs.
* You will be more comfortable if you use a cough pillow to
hold against your chest and guard your rib cage while coughing
and deep breathing.
* Symptomatic relief with ice packs or heating pads for short
periods may ease the pain.
* Narcotic pain medication can cause constipation therefore you
should take a stool softener twice daily and increase your fluid
and fiber intake if possible.
* Do NOT smoke
* If your doctor allows, non-steroidal drugs
are very effective in controlling pain ( ie, Ibuprofen, Motrin,
Advil, Aleve, Naprosyn) but they have their own set of side
effects so make sure your doctor approves.
* Return to the Emergency Room right away for any acute
shortness of breath, increased pain or crackling sensation
around your ribs (crepitus).
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13601466", "visit_id": "28420868", "time": "2127-04-09 00:00:00"} |
11640542-DS-10 | 908 | ## ALLERGIES:
tetracycline / ibuprofen / acetaminophen / oxycodone
## CHIEF COMPLAINT:
L arm pain with changing L proximal humerus enchondroma
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Resection L proximal humerus chondrosarcoma and reconstruction
with APC.
## HISTORY OF PRESENT ILLNESS:
Mr. is a very pleasant
gentleman with Ollier's disease. He has had
significant involvement of his left upper extremity and right
lower extremity for many years. In the recent past, he was
being
evaluated for a finger enchondroma with Dr. . This
was somewhat concerning for risk of malignancy and so he had
that
removed, but in the workup for that, he had a bone scan. This
revealed increased activity compared to the other enchondromas
with a lesion in his left proximal humerus. He had an MRI of
that area. On followup MRI, it seemed that the cartilaginous
neoplasm in his right proximal humerus was quite a bit larger,
especially with a component that was posterior to the glenoid
and
so concern was definitely raised about chondrosarcoma and he is
now coming here for further treatment and evaluation. He has
been under Dr. Dr. care at and is now coming here for further orthopedic oncology
care as he is now adult age.
He does have pain in his left shoulder that is related to lack
of
motion. It is better when he has some movement in it and
changes
position. It bothers him a lot at sleep because of that. It
wakes him up at rest from a deep sleep, the pain is about a
and with activity it is more like a 1 or . It has been a
little more symptomatic in the past couple of months, then he
recalls it being in the past. Nothing else can be related to
it.
None of the other areas of enchondromas in his other
musculoskeletal system are terribly symptomatic to him.
## PAST MEDICAL HISTORY:
Benign heart murmur
Ollier's disease
## FAMILY HISTORY:
Significant for cancer in grandmother and
grandfather. His sister has petit mal seizures. His
grandmother
has osteoporosis as well as osteoarthritis.
## RESP:
Breathing comfortably on RA
## LUE:
Dressing c/d/i. No erythema or drainage. In sling
SILT ax/r/u/m distribution
Motor intact elbow flexion/extension, wrist flexion/extension,
EPL, FPL, IO.
2+ radial pulse.
## BRIEF HOSPITAL COURSE:
Mr. was admitted to the hospital following resection of L
proximal humerus chondrosarcoma and reconstruction with APC.
Pre-operatively an intra-scalene nerve catheter was placed by
APS and a foley was placed prior to the operation. He was placed
in a sling post-operatively with instructions for no AROM/PROM
of the shoulder. On POD#1 foley was removed and he was voiding
independently. On POD#2 nerve catheter was removed. His hospital
course was otherwise uneventful. On POD#2 he was tolerating PO,
pain controlled on PO medications, voiding independently, and
passing gas. He was deemed appropriate for home discharge at
this time.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY Duration: 13 Days
RX *aspirin [Aspir-81] 81 mg 1 tablet(s) by mouth daily Disp
#*14 Tablet Refills:*0
2. Cyclobenzaprine 5 mg PO TID:PRN spasm
A common side effect is drowsiness, so do not take if you're
already drowsy.
RX *cyclobenzaprine 5 mg 1 tablet(s) by mouth every 8 hours Disp
#*15 Tablet Refills:*0
3. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*60
## CAPSULE REFILLS:
*0
4. Senna 8.6 mg PO BID:PRN constipation
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp
#*60 Tablet Refills:*0
5. OxyCODONE (Immediate Release) mg PO Q4H:PRN Pain -
Moderate
RX *oxycodone 5 mg tablet by mouth every 4 hours Disp #*120
Capsule Refills:*0
## DISCHARGE DIAGNOSIS:
Ollier's disease
L proximal humerus presumed chondrosarcoma
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted to the hospital for removal of left proximal
humerus chondrosarcoma and reconstruction. Following discharge
home, please keep the following instructions in mind.
## ACTIVITY:
Non weight bearing left upper extremity. Please keep
in sling at all times except for hygiene. You may freely move
your elbow, wrist, and hand but no active or passive range of
motion of the shoulder.
## DRESSING/WOUND:
Your incision was closed with dissolvable
sutures thus there will be no suture removal. Keep a dressing on
the incision for the first week following surgery except for
bathing. You may remove the dressing to bathe but then replace
once drying. Please call the clinic if you notice increasing
redness, drainage, or swelling as this may indicate an
infection.
## SHOWERING:
You may shower starting on . Allow the water
to rinse over the incision and pat dry. Do not submerge the
wound in a bath, swimming pool, or other body of water until
cleared by your surgeon.
## MEDICATIONS:
You will be discharged with a prescription for a
narcotic, oxycodone, for pain control. Do not drive while taking
this medication. This medication can cause constipation so
please take Colace and Senna which may be purchased OTC to
avoid. Please also take Aspirin 81mg daily to help prevent a
blood clot in your arm as you aren't using it as much as usual.
You may stop Aspirin on
Follow-up in clinic with Dr. has been set up for you
for wound check.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11640542", "visit_id": "21208285", "time": "2126-04-09 00:00:00"} |
12892798-RR-94 | 395 | ## INDICATION:
year old woman with new hyperglycemia, ? endocrine tumor //
year old woman with new hyperglycemia, ? endocrine tumor
## DOSE:
DLP: 721.80 mGy-cm (abdomen and pelvis.
## IV CONTRAST:
150 mL CT of the abdomen pelvis dated .
## LOWER CHEST:
Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. A
subcentimeter hypodensity in the right lobe of the liver is too small to fully
characterize, but likely represents a cyst or biliary hamartoma. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is within normal limits, without stones or gallbladder wall thickening.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is some interdigitating
fat present. There is no peripancreatic stranding.
## SPLEEN:
The spleen shows normal size. A subcentimeter hypodensity in the
posterior upper spleen is too small to fully characterize, but likely
represents a cyst.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of stones, focal renal lesions or hydronephrosis. There
are no urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
## GASTROINTESTINAL:
Small bowel loops demonstrate normal caliber, wall
thickness and enhancement throughout. Colon and rectum are within normal
limits. Appendix is not visualized.
## RETROPERITONEUM:
There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. There is no significant
calcium burden in the abdominal aorta and great abdominal arteries.
## PELVIS:
The urinary bladder and distal ureters are unremarkable.. There is no evidence
of pelvic or inguinal lymphadenopathy. There is trace free fluid in the
pelvis, likely within physiologic range.
## REPRODUCTIVE ORGANS:
Uterus and adnexal regions appear unremarkable.
## BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. Abdominal and pelvic wall is within
normal limits.
## IMPRESSION:
1. No evidence of neuroendocrine tumor.
2. Sub-cm hypodensity in the right lobe of the liver is too small to fully
characterize, but likely represents a cyst or biliary hamartoma.
3. Sub-cm hypodensity in the spleen is too small to fully characterize, but
likely represents a cyst.
## NOTIFICATION:
These findings were discussed with Dr. By Dr.
telephone at 4:21pm on , approximately 40 minutes after discovery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12892798", "visit_id": "22519305", "time": "2167-02-20 13:56:00"} |
15508759-RR-24 | 564 | ## INDICATION:
woman with weight loss.
## CT CHEST WITH CONTRAST:
There are no pathologically enlarged axillary lymph
nodes. Prominent subcarinal lymph nodes measure 12 x 9 mm with multiple
prominent precarinal, pretracheal and AP window nodes, most of which do not
meeting CT criteria for pathologic enlargement. Prominent bilateral hilar
lymph nodes measure up to 8 mm in short axis. The heart is normal in size with
scattered atherosclerotic coronary calcifications. There is no pericardial or
pleural effusion. The thoracic aorta demonstrates scattered atherosclerotic
calcifications but is of normal caliber. A few hypoattenuating thyroid
nodular lesions are identified bilaterally, measuring up to 13 mm, some of
which are partly calcified.
Lung windows reveal apical scarring bilaterally with mild, right greater than
left, apical centrilobular emphysema. A few scattered pulmonary nodules are
identified, the largest a 4- mm nodule, (2:36) in the right middle lobe. Two
adjacent 2- mm nodules are present in the right upper lobe (2:22). There are
multiple scattered foci of opacities, most prominent in the
dependent lower lobes bilaterally.
## CT ABDOMEN WITH CONTRAST:
A 10 x 8 mm round hypoattenuating lesion in hepatic
segment III (2:71) cannot be classified as a cyst. A similar smaller 5-mm
lesion is present in hepatic segment VI (2:78). There are a few dependent
small gallstones within the gallbladder. The spleen measures 12.7 cm, near
the upper limits of normal, and demonstrates no focal lesion. The pancreas
and adrenal glands appear unremarkable. The kidneys enhance symmetrically and
excrete contrast normally without hydronephrosis. There is partial
duplication of the left collecting system and in the proximal lower pole
ureter is an apparent 10-mm soft tissue filling defect. There is mild right
upper pole renal cortical scarring. Additionally, in the interpolar right
kidney, is a 1.4 cm ill defined hypodense focus (2:74), incompletely
characterized. The abdominal aorta demonstrates atherosclerotic
calcifications, though it is of normal caliber. There are no pathologic
enlarged mesenteric or retroperitoneal lymph nodes. Intra-abdominal loops of
large and small bowel are of normal caliber and there is no free air or free
fluid.
## CT PELVIS WITH CONTRAST:
The rectum, sigmoid colon, and adnexa are
unremarkable. An apparent subtle round focus of enhancement in the bladder,
measuring approximately 2.4 cm,(519b:34) may simply represent contrast
excretion, though a mass cannot be excluded. There is no free pelvic fluid or
pathologically enlarged lymph nodes.
Bone windows reveal moderate to severe multilevel lumbar degenerative facet
changes. A 1-cm lucent lesion is present in the right aspect of the L1
vertebral body.
## IMPRESSION:
1. 10-mm filling defect within the proximal left lower pole ureteral moiety
concerning for neoplastic process and MR urogram is recommended for further
evaluation. The potential bladder mass can be evaluated during the same study.
2. Small pulmonary nodules as described. Recommendations for follow-up depend
on further outcome of neoplastic work-up as follow-up in 6 months would be
necessary if neoplasm was discovered.
3. Scattered foci of lung opacities may represent infection vs
aspiration. Prominent mediastinal and hilar lymph nodes may be reactive.
4. Hypoattenuating right renal lesion will be further evaluated on MR urogram.
5 Lucent L1 lesion may represent a hemangioma, though this is unclear in the
setting of possible urothelial malignancy.
6. Hypoattenuating hepatic and thyroid lesions incompletely characterized.
Results posted to radiology communication dashboard.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15508759", "visit_id": "N/A", "time": "2192-08-31 15:47:00"} |
13376841-RR-33 | 181 | ## HISTORY:
man status post fall with reported C5 fracture.
## FINDINGS:
There is a non-displaced fracture of the right C5 lateral mass
which extends into the transverse foramen (3:53). There is no prevertebral
soft tissue swelling. Minimal retrolisthesis of C4 on C5, and of C5 on C6, is
likely due to degenerative changes. There are multilevel degenerative
changes, which include a C3-C4 disc osteophyte complex that indents the thecal
sac and may slightly indent the ventral cord. However, resolution of
intraspinal detail on CT is limited.
There is left mastoid tip air cell opacification. Imaged portions of the
lungs are slightly obscured by respiratory motion artifact; however, no gross
abnormalities are identified.
## IMPRESSION:
1. Right lateral mass fracture of C5 extending into the transverse foramen.
An MRA with axial T1 fat suppresed images can be obtained to evaluate for
vertebral artery dissection, if clinically warranted.
2. Multilevel degenerative changes.
These findings and recommendations were discussed with Dr. by
Dr. at 3:07 p.m., on , 10 minutes after initial discovery
of the findings at 2:57 pm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13376841", "visit_id": "28182503", "time": "2175-04-28 09:24:00"} |
17499017-RR-155 | 403 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## INDICATION:
Evaluate for intra-abdominal infection, including abscess
## DOSE:
DLP: 1279 mGy cm
## LUNG BASES:
Please refer to the chest CT obtained on the same day.
## ABDOMEN:
There is 5.0 x 4.4 x 4.8 cm intrahepatic fluid collection in the
left lobe of the liver. Bile ducts in the left lobe are dilated, similarly to
prior. Left hepatic vein is thrombosed, new since prior. There is another
fluid collection measuring 6.9 x 5.6 x 6.4 cm inferior to the right lobe of
the liver and another fluid collection measuring 7.5 x 2.9 x 3.9 cm inferior
to the left lobe of the liver. Patient is status post Whipple procedure,
segment 3 hepatectomy, splenectomy, pancreatectomy, right adrenalectomy, and
cholecystectomy. Left adrenal gland is nodular and enlarged, similar to
prior. The splenule or nodule in the left anterior abdomen measuring 1.7cm
(2:49) and another in the right adrenal bed measuring 1 cm are similar to
prior. Kidneys are unremarkable. The abdominal aorta is normal in caliber.
The enlarged lymph nodes at the gastrohepatic ligament measures 1.5cm, stable
from prior. There are multiple enlarged mesenteric, retroperitoneal and
external iliac chain lymph nodes, similar to prior. No free air is seen. The
remaining stomach is unremarkable. Loops of small and large bowel demonstrate
no signs of ileus or obstruction.
## PELVIS:
Gas is noted in the bladder. Prostate is unremarkable.
## BONES/ SOFT TISSUE:
No worrisome lytic or blastic osseous lesion is seen.
There is generalized subcutaneous tissue edema. Lipoma is noted in the left
gluteal muscles.
## IMPRESSION:
1. New intrahepatic fluid collection in the left lobe of the liver, which may
represent liver abscess or postoperative changes, if there was surgery or RFA
in that area. Please correlate with any history of procedures since the last
study.
2. Two additional pockets of fluid pockets inferior to the liver.
3. Left hepatic vein thrombosis, new since prior.
4. Patient is status post Whipple procedure, segment 3 hepatectomy,
splenectomy, pancreatectomy, right adrenalectomy, and cholecystectomy.
5. Stable diffuse lymphadenopathy and enlarged nodular left adrenal gland,
consistent with metastatic disease.
6. Gas in bladder. Please correlate with history of prior instrumentation.
## NOTIFICATION:
The findings regarding fluid collection and left hepatic vein
thrombosis were discussed by Dr. with on the telephone on
at 11:40am, 5 minutes after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17499017", "visit_id": "20271830", "time": "2153-08-27 22:07:00"} |
16998761-RR-21 | 175 | ## EXAMINATION:
LEFT BREAST ULTRASOUND GUIDED CYST ASPIRATION
## FINDINGS:
Benign appearing clustered macro cyst measuring 4.2 cm in greatest dimension
at 3 o'clock position, 1 cm from the nipple.
## PROCEDURE:
The procedure, risks, benefits and alternatives were discussed
with the patient and written informed consent was obtained.
## TIME-OUT CERTIFICATION:
Performed using three patient identifiers. Allergies
and/or Medications: Reviewed prior to the procedure.
## DESCRIPTION:
Using ultrasound guidance, aseptic technique a 21 gauge needle
was advanced to the clustered macrocysts at 3:00 1cm. 17 cc of clear yellowish
cyst fluid was aspirated, the fluid was discarded due to lack of suspicion.
The needle was removed and hemostasis was achieved. Collapsed of the cysts
was verified on ultrasound post aspiration images.
Estimated blood loss: < 0.1 Cc.
## NO IMMEDIATE COMPLICATIONS.
POST PROCEDURE DIAGNOSIS:
Aspirated left breast cyst.
## IMPRESSION:
Technically successful US-guided aspiration of the right breast cyst.
Findings reviewed with the patient at the completion of the aspiration. Annual
mammography is recommended.
Standard post care instructions were provided to the patient.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16998761", "visit_id": "N/A", "time": "2127-09-13 12:36:00"} |
14985054-RR-25 | 239 | ## INDICATION:
female with acute left flank and left lower quadrant
pain. Study to evaluate for renal stone.
## CT ABDOMEN:
With the exception of minimal dependent atelectasis on the right,
lung bases are clear. Partially visualized heart and pericardium appear
unremarkable. The liver, gallbladder, spleen, pancreas, and adrenal glands
appear unremarkable within limitation of non-contrast study.
Multiple sub-3-mm non-obstructing stones are present within the left kidney.
There is a 4-mm left ureterovesicular junction (UVJ) stone with upstream
hydronephroureter. Left kidney also demonstrates diffusely decreased
attenuation as compared to the right, compatible with edema due to
obstruction. Right kidney demonstrates no focal lesions or radiopaque stones.
There is no hydronephrosis or hydroureter on the right.
Small and large bowel loops within the abdomen are normal in caliber. The
appendix is unremarkable. There is no mesenteric or retroperitoneal
lymphadenopathy. There is no free air or free fluid.
## CT PELVIS:
A 4-mm left UVJ stone is as described. There are no right UVJ or
vesicular stones. The bladder, uterus, rectum, and sigmoid colon appear
unremarkable. There is no inguinal or pelvic sidewall lymphadenopathy. There
is no free fluid within the pelvis.
## BONE WINDOW:
No concerning lytic or blastic lesions.
## IMPRESSION:
1. 4-mm left ureterovesicular junction stone with upstream mild left
hydronephroureter. Multiple additional sub-3-mm non-obstructing left renal
stones as described. No stones in the right kidney.
2. No diverticulitis or appendicitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14985054", "visit_id": "N/A", "time": "2122-09-30 15:23:00"} |
16105004-RR-64 | 384 | ## EXAMINATION:
CT C-SPINE W/CONTRAST Q312 CT SPINE
## INDICATION:
year old man with metastatic neuroendocrine tumor with
DOTATATE scan showing new lytic lesions in C3 and C4// please evaluate lytic
lesion in C3 and C4 for extent and for risk of fracture please evaluate
lytic lesion in C3 and C4 for extent and for
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 8.1 s, 26.2 cm; CTDIvol = 34.3 mGy (Body) DLP = 873.5
mGy-cm.
2) Spiral Acquisition 2.1 s, 3.1 cm; CTDIvol = 11.2 mGy (Body) DLP = 31.3
mGy-cm.
3) Spiral Acquisition 2.1 s, 3.1 cm; CTDIvol = 11.2 mGy (Body) DLP = 31.3
mGy-cm.
Total DLP (Body) = 936 mGy-cm.
## FINDINGS:
Centered in the right C3-C4 facet, corresponding to region of increased
gallium uptake on PET-CT of are well corticated lucencies
measuring up to 5 mm with surrounding sclerosis of the C3 inferior and C4
superior facets (series 6, image 54). No evidence of osseous expansion or
aggressive features. Associated trace air is seen within the facet. No
evidence of abnormal enhancement or surrounding soft tissue. Overall the
findings are most consistent with degenerative change.
No other suspicious osteolytic or blastic lesions are identified within the
cervical spine. Cervical alignment is anatomic. Vertebral body heights are
preserved. No evidence of fracture. The craniocervical junction and anterior
atlantodental interval are within expected limits. Degenerative changes are
most prominent at C5-C6 where a posterior disc osteophyte complex results in
at least mild spinal canal narrowing with mild to moderate bilateral neural
foraminal narrowing. At C6-C7, there is moderate left neural foraminal
narrowing.
There is no cervical lymphadenopathy by size criteria. The thyroid is
unremarkable. The cervical vessels appear patent. Visualized lung apices are
clear.
## IMPRESSION:
1. Centered in the right C3-C4 facet corresponding to region of increased
gallium uptake on PET-CT of are well corticated lucencies
measuring up to 5 mm with surrounding sclerosis of the C3 inferior and C4
superior facets.
2. There is no evidence of associated soft tissue or abnormal enhancement. No
aggressive osseous erosion or expansion is identified.
3. Overall, the findings are most compatible with degenerative change.
Follow-up examination could be performed to document stability.
4. Additional findings as described above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16105004", "visit_id": "N/A", "time": "2164-08-31 13:28:00"} |
16426569-RR-115 | 131 | ## INDICATION:
y/o F w/ recurrent follicular lymphoma, treatment-related MDS
to AML, severe MR, pulmonary hypertension, and idiopathic cardiomyopathy with
EF s/p pacemaker placement with improved EF, admitted for planned
Decitabine. Course c/b febrile neutropenia, pre-syncopal episodes, L tinnitus
with associated acute left sensorineural hearing loss, severe unilateral L
throat pain c/f fungal infection, and volume overload requiring IV diuresis.
Increased O2 requirement following episode of rigors yesterday// Evaluate for
evidence of aspiration or other new infiltrates, vascular
## IMPRESSION:
The right-sided pacemaker is unchanged. Left-sided Port-A-Cath projects to
the SVC and is also unchanged. Lungs are low volume. Small left pleural
effusion is unchanged. Patchy parenchymal opacity in the left lower lobe is
stable. Cardiomediastinal silhouette is unchanged. No pneumothorax.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16426569", "visit_id": "27680137", "time": "2120-06-28 09:46:00"} |
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