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12167901-DS-19 | 1,994 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
lead and pacemaker extraction
Temporary pacer
Pacer insertion left chest
## HISTORY OF PRESENT ILLNESS:
Mr is an man with complete heart block s/p dual
chamber pacemaker with RV lead revision
and recent device infection in , hypertension,
dyslipidemia, GERD, and BPH, who presented today with continued
device infection for lead and device extraction. The procedure
was prolonged due to significant fibrosis of the pacer leads,
and he was noted to have purulent material that was extracted
and sent to the microbiology lab for analysis. Given his history
of complete heart block and hypotension with his ventricular
escape rhythm, a temporary screw-in external pacemaker was
placed in the right IJ. Intra-operative TEE was unremarkable,
but he did require Neosynephrine in the OR for hypotension that
was thought to be due to the prolonged anesthesia. Given the
significant infection, the wound was left open, to close by
secondary intention, with plan to treat with IV antibiotics over
the weekend and re-implant a pacemaker next week.
.
With regards to the recent device infection in ,
this was initially treated with IV vancomycin, but that was
discontinued due to development of fever and rash. He was
instead treated with a full course of IV linezolid. The site was
noted to have significantly improved, and he was seen in
clinic at the end of at which point the site was
considered to be healed. Per the patient, the site was stable
for over 3 months, but he then developed a new area of erythema
over the left lateral aspect of the pocket, with blistering. He
was seen for this complaint in clinic on . He denies
any fevers or chills but has been experiencing pain at the
pacemaker site with his usual activity. His WBC was 5.1 with a
normal differential on , and he was admitted today for
lead and device extraction for continued infection versus new
pocket site infection.
.
On arrival to the CCU, the patient was hypotensive with SBP in
the . He received a 200cc NS IVF bolus with improvement to
the . He complains of left-sided chest pain as well as pain
and tingling in his fingers bilaterally, left worse than right.
There is no weakness or numbness of the hands. The pains are
intermittent. ECG showed V-pacing at 60 bpm. STAT TTE showed no
obvious effusion or depressed ventricular function, and STAT CXR
was also unremarkable. His external pacemaker rate was increased
from 60 to 80 bpm. IV Linezolid was started for possible
septicemia. He did not require any further IVF or vasopressor
support.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. All of the other review of systems were
negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
## 2. CARDIAC HISTORY:
-CABG:
None.
-PERCUTANEOUS CORONARY INTERVENTIONS: None.
-PACING/ICD: Sensi SEDR01)
3. OTHER PAST MEDICAL HISTORY:
* Complete heart block status post initial permanent pacemaker
implantation in with subsequent RV lead revision and
generator change in (Dual Chamber
Sensia SEDR01).
* Device infection in , initially treated with IV
vancomycin, which was discontinued due to development of fever
and rash. Then treated with full course of IV linezolid.
* Hypertension.
* Hyperlipidemia.
* GERD.
* BPH.
## FAMILY HISTORY:
His father died of emphysema, and his mother had diabetes. All
five grown children are well and healthy. No family history of
early MI, arrhythmia, cardiomyopathies, or sudden cardiac death;
otherwise non-contributory.
## GENERAL:
WD/WN elderly man in NAD. Oriented x3. Mood, affect
appropriate.
## HEENT:
NC/AT. PERRL/EOMI. Sclera anicteric. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. MMM, OP clear.
## NECK:
Supple, JVP not measurable RIJ temporary pacer.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. RRR, normal S1-S2, but muffled heart sounds. No m/r/g.
## LUNGS:
No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
## ABDOMEN:
Soft, NT/ND. No HSM or tenderness. No abdominial
bruits.
## EXTREMITIES:
WWP, no c/c/e. No femoral bruits.
## SKIN:
No rashes or lesions.
## NEURO:
Awake, A&Ox3, moving all extremities appropriately.
## WOUND CULTURE (PRELIMINARY):
SENSITIVITIES REQUESTED BY . .
STAPHYLOCOCCUS, COAGULASE NEGATIVE. RARE GROWTH.
ANAEROBIC CULTURE (Final : NO ANAEROBES ISOLATED.
Blood Cx and NGTD
ECHO
The left atrium is markedly dilated. The left atrium is
elongated. No spontaneous echo contrast or thrombus is seen in
the body of the left atrium or left atrial appendage. No atrial
septal defect is seen by 2D or color Doppler. Left ventricular
wall thicknesses and cavity size are normal. There is moderate
global left ventricular hypokinesis (LVEF = 35 - 40 %). The
right ventricle displays mild to m oderate global free wall
hypokinesis. There are complex (>4mm) atheroma in the aortic
arch. There are complex (>4mm) atheroma in the descending
thoracic aorta. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen. The tricuspid
leaflets and pulmonic leaflets are not well seen. There is a
trivial/physiologic pericardial effusion. Dr. was
notified in person of the results in the operating room at the
time of the study.
After lead extraction, there were no significant changes and no
signs of an enlarging pericardial effusion.
ECHO
There is symmetric left ventricular hypertrophy. The left
ventricular cavity is very small. Left ventricular systolic
function is hyperdynamic (EF>75%). There is no pericardial
effusion.
## CXR:
Since yesterday, right-sided dual-chamber pacemaker still ends
in expected
position. There is no pneumothorax. Small bilateral pleural
effusion
increased, still tiny. Hyperinflation is unchanged. The
cardiomediastinal
silhouette is stable. There is no other change.
## ECG:
Baseline artifact. Sinus or atrial paced or ventricular paced
rhythm.
Since the previous tracing of atrial pacing is probably
new at a faster
rate.
## BRIEF HOSPITAL COURSE:
man with complete heart block s/p dual chamber pacemaker
with RV lead revision and recent device infection who presented
with continued device infection for lead and device extraction,
found to have significant infection of the pacer pocket and lead
fibrosis, now s/p external temporary pacemaker placement and
awaiting treatment with IV antibiotics prior to re-implantation
of permanent pacemaker.
.
# Infected pacemaker - He was seen for this complaint in
clinic on . He denies any fevers or chills but has been
experiencing pain at the pacemaker site with his usual activity.
His WBC was 5.1 with a normal differential on , and he was
admitted on for lead and device extraction. On arrival to
the CCU, the patient was hypotensive with SBP in the . He
received a 200cc NS IVF bolus with improvement to the . He
complained of left-sided chest pain as well as pain and tingling
in his fingers bilaterally, left worse than right. There is no
weakness or numbness of the hands. The pains are intermittent.
ECG showed V-pacing at 60 bpm. STAT TTE showed no obvious
effusion or depressed ventricular function, CXR was also
unremarkable. His external pacemaker rate was increased from 60
to 80 bpm. He was started on IV Linezolid. He did not require
any further IVF or vasopressor support. The patient underwent
pacer and lead extraction on without complication. A
temporary pacer was also placed after removal. The patient
remained stable and blood cx were NGTD. He was seen by ID who
recommended 2 weeks of linezolid from pacer extraction .
The patient had a new pacemaker placed on without
complication. CXR showed no PTX and leads in proper position.
His wound culture eventually grew coag-neg staph. The patient
will have both ID and EP follow-up with weekly labs. The
patient remained afebrile and pacemaker was working properly.
# complete heart block (rhythm) - See above for management of
pacemaker. The patient had his lead and pacer extracted on
. A temporary external pacemaker in right IJ was placed.
He was monitored on tele. A new pacemaker was placed on
without complication.
# coronaries - The patient has no known CAD or findings of CAD
on ECG. He remained chest pain free. He was continued on home
ASA.
.
# pump - The patient had an intra-op EF 35-40% with moderate
global LV hypokinesis. He remained clinically euvolemic.
# hypertension - The patient's anti-hypertensives were intially
held secondary to his hypotension. Once his pressures had
stabilzed he was restarted on lisinopril 10mg and home
metoprolol succinate 12.5mg at the time of discharge.
# dyslipidemia - stable, continued home statin
.
# diabetes - stable, continued home Actos and ISS. He was also
continued on a diabetic diet.
# GERD - stable, continued home H2B
# BPH - His flomax was initally held secondary to hypotension,
but restarted once stable.
## MEDICATIONS ON ADMISSION:
Lisinopril 20mg daily
Lovastatin 20mg daily
Metoprolol succinate 12.5mg daily
Actos 15mg daily
Zantac 150mg daily PRN
Flomax 0.4mg daily
Aspirin 325 mg daily
Vitamin C 500mg daily
Vitamin B12 500mcg daily
Glucosamine-Chondroitin 500mg-400mg daily
Loratadine 10mg QHS
Multivitamin daily
Aleve 220mg daily PRN
Vitamin E 400unit daily
## DISCHARGE MEDICATIONS:
1. Aspirin 325 mg Tablet
## SIG:
One (1) Tablet PO DAILY (Daily).
## 2. TYLENOL MG TABLET SIG:
Tablets PO four times a day as
needed for pain.
3. Lovastatin 20 mg Tablet Sig: One (1) Tablet PO daily ().
4. Pioglitazone 15 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) as needed for indigestion.
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
## SIG:
0.5 Tablet Sustained Release 24 hr PO once a day.
7. Ascorbic Acid mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Vitamin E 400 unit Tablet Sig: One (1) Tablet PO once a day.
9. Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Loratadine 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
## 11. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY
(Daily).
12. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
13. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Outpatient Lab Work
Please draw CBC on omes to see Dr. ,
results to the ID fellow Dr. at
15. Outpatient Lab Work
Please check CBC by on and call results to ID
fellow, Dr. at at .
## 16. LINEZOLID MG TABLET SIG:
One (1) Tablet PO Q12H (every
12 hours) for 9 days: last day .
Disp:*18 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
Complete Heart Block
Pacemaker site infection
## DISCHARGE INSTRUCTIONS:
You had a pacemaker pocket infection that necessitated the
pacemaker to be removed and another pacemaker was placed on the
right side of your chest. You are on Linezolid antibiotic to
treat this infection. You will be seen by Dr. in 1
week to look at the new pacemaker and the old pacemaker site.
While you are on the antibiotics, you will need to have weekly
labs checked. This can be done by the . A plastic surgeon saw
your left chest wound. They feel that it will heal well and
deferred care to Dr. .
New medicines:
## 1. LINEZOLID:
an antibiotic to treat the pocket infection.
Please follow the dietary restrictions given to you by Dr.
.
2. Please decrease your Lisinopril to 10 mg at night. This may
be increased again by Dr. .
.
Please do not take any showers until Dr. you to.
You may take a bath and wash your hair but don't get the pacer
dressings wet. If the dressings fall off, cover with dry sterile
gauze and tape. NO lifting more than 5 pounds with your right
arm, no lifting that arm over your head.
.
Please call Dr. you have any fevers, chills,
sweating, increasing redness or pain at either pacer site, light
headedness, chest pain or any other worrying symptoms.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12167901", "visit_id": "22673565", "time": "2171-05-23 00:00:00"} |
10824694-RR-158 | 100 | ## INDICATION:
year old woman with stool burden, constipation// year old
woman with stool burden, constipation
## FINDINGS:
There are no abnormally dilated loops of large or small bowel.
There is no free intraperitoneal air.
Osseous structures are notable for posterior fusion hardware of lower lumbar
spine. There are surgical clips overlying the right hemiabdomen and left
upper quadrant. There is suture material in the left mid abdomen and left
lower quadrant.
Otherwise, there are no unexplained soft tissue calcifications or radiopaque
foreign bodies. There is a moderate colonic stool burden.
## IMPRESSION:
Moderate colonic stool burden. Nonobstructive bowel gas pattern.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10824694", "visit_id": "N/A", "time": "2159-02-16 09:25:00"} |
11965139-RR-15 | 182 | ## EXAMINATION:
STROKE PROTOCOL (BRAIN W/O) T7 MR HEAD
## HISTORY:
with right PCA occlusion, nausea and vomiting.//
Stroke? Infarct?
## FINDINGS:
The exam is severely degraded by motion artifact. Within these confines:
There is a small foci in the left periventricular frontal white matter that
demonstrates hyperintensity on diffusion image (4: 23) with suggested
hypointensity on ADC map, and hyperintensity on T2/FLAIR sequence. Question
right occipital punctate focus of trace diffusion hyperintensity without
definite ADC hypodensity.
There is prominence of the ventricles and sulci suggestive of involutional
changes. Periventricular and subcortical T2 and FLAIR hyperintensities are
noted which may represent small vessel ischemic changes. There is
encephalomalacia versus brain parenchymal volume loss in the left superior
parietal lobe.
Limited imaging the orbits demonstrate left lens replacement postoperative
changes.
## IMPRESSION:
1. Study is severely degraded by motion.
2. Punctate left periventricular frontal acute to subacute infarct without
definite evidence of hemorrhagic transformation.
3. Question punctate right occipital acute to subacute infarct versus artifact
without definite evidence of hemorrhagic transformation.
4. Atrophy, probable small vessel ischemic changesand probable chronic
infarcts as described.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11965139", "visit_id": "28842470", "time": "2161-02-03 02:26:00"} |
15080747-RR-3 | 499 | ## EXAMINATION:
CTA HEAD AND CTA NECK PQ147 CT HEADNECK
## INDICATION:
History: with possible lacunar infarct// ?thrombus
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 49.0 mGy (Head) DLP =
24.5 mGy-cm.
3) Spiral Acquisition 4.8 s, 37.7 cm; CTDIvol = 31.0 mGy (Head) DLP =
1,169.9 mGy-cm.
Total DLP (Head) = 1,997 mGy-cm.
## CT HEAD WITHOUT CONTRAST:
There is no evidence of infarction, hemorrhage, edema, or mass. The
ventricles and sulci are normal in size and configuration.
There is mild-to-moderate mucosal thickening of the right maxillary sinus.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are unremarkable.
## CTA HEAD:
There is a 6 x 8 x 6 mm inferiorly oriented aneurysm arising from the left
cavernous internal carotid artery, demonstrating a 3 mm neck (3:227, 602:33).
The right ACA A1 segment is hypoplastic, likely congenital. The vessels of
the circle of and their principal intracranial branches appear
otherwise normal without stenosis, occlusion, or aneurysm formation. The
dural venous sinuses are patent.
## CTA NECK:
There is a congenitally dominant left vertebral artery. There is
short-segment irregularity/beading the right internal carotid artery (453:25).
Mild irregularity of the congenitally dominant left vertebral artery V3
segment may represent fibromuscular dysplasia or focal dissection, series 3,
image 170. The carotid and vertebral arteries and their major branches appear
otherwise normal with no evidence of stenosis or occlusion. There is no
evidence of internal carotid stenosis by NASCET criteria.
## OTHER:
The visualized portion of the lungs are clear. There is a 0.6 cm hypodense
nodule of the posterior left thyroid lobe for which follow-up imaging is
recommended. There is no lymphadenopathy by CT size criteria.
## IMPRESSION:
1. No acute intracranial abnormality.
2. Left cavernous ICA aneurysm measuring up to 8 mm.
3. Short-segment irregularity/beading of the left vertebral artery, V3 segment
is nonspecific and may represent a focal region of fibromuscular dysplasia
versus tortuosity with dissection being a less likely consideration. Mild
beading with irregularity of the right internal carotid artery could also be
seen in the setting of fibromuscular dysplasia.
4. Mild-to-moderate inflammatory changes of the right maxillary sinus.
## NOTIFICATION:
Thyroid nodule. No follow up recommended.
Absent suspicious imaging features, unless there is additional clinical
concern, College of Radiology guidelines do not recommend further
evaluation for incidental thyroid nodules less than 1.0 cm in patients under
age or less than 1.5 cm in patients age or .
## SUSPICIOUS FINDINGS INCLUDE:
Abnormal lymph nodes (those displaying
enlargement, calcification, cystic components and/or increased enhancement) or
invasion of local tissues by the thyroid nodule.
, et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White
Paper of the ACR Incidental Findings Committee". J
12:143-150.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15080747", "visit_id": "21671949", "time": "2122-12-29 08:40:00"} |
10625972-RR-18 | 259 | CT ABDOMEN AND PELVIS WITHOUT CONTRAST
## INDICATION FOR STUDY:
Kidney and bladder stones.
## ABDOMEN WITHOUT CONTRAST:
The lung bases are low visualized, pericardium
unremarkable. The liver, spleen, pancreas, and adrenal glands are
unremarkable on this non-intravenous contrast enhanced study. Right kidney is
unremarkable. In the left kidney, three stones are seen. The largest is in
the medial aspect of the collecting system and measures 6.5 mm. Two
additional nonobstructing stones measuring 1-2 mm were also noted in the left
kidney. No solid masses are seen on this non-enhanced study.
## PELVIS WITH CONTRAST:
Two stones are present in the bladder. The largest
stone measures approximately 14.3 x 14.5 mm. The smallest stone measures 12 x
7 mm in size. No additional stones are noted within the bladder. Several
small calcifications are identified within the prostate gland. The bladder
wall is slightly thickened but the bladder is not well distended. No free
fluid or adenopathy is noted in the pelvis. No enlarged inguinal adenopathy
is noted.
## BONE WINDOWS:
A severe scoliosis deformity is noted with posterior fixation
devices securing the posterior vertebral elements.
## REFORMATTED IMAGES:
Sagittal and coronal reformatted images confirm the
presence of small nonobstructing stones in the left kidney and two large
stones in the bladder.
## IMPRESSION:
1. Three small stones in the left kidney, the largest of which is 6.5 mm and
is not causing obstruction and present in the medial aspect the collecting
system.
2. Two bladder stones, the largest of which is approximately 14.5 mm in
diameter.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10625972", "visit_id": "N/A", "time": "2174-06-27 13:13:00"} |
18419496-RR-32 | 236 | ## EXAMINATION:
INJ/ASP MAJOR JT W/FLUORO
## INDICATION:
year old man with Left shoulder stiffness years s/p L RC
Repair, DM2) // L Injection: 0.5% marcaine 3 cc + kenalog 80 1cc
## PROCEDURE:
The procedure was supervised by Dr. , the attending
radiologist, who was present for the critical portions of the procedure.
The risks, benefits, and alternatives were explained to the patient and
written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
3 cc 1% Lidocaine was used to achieve local anesthesia. Under intermittent
fluoroscopic guidance, a 20-gauge spinal needle was advanced into the left
glenohumeral joint. Appropriate position was confirmed by the injection of a
small amount of water soluble contrast. A mixture of 3 cc of 0.5% Bupivacaine
and 2 cc of Kenalog was injected, dispersing the contrast.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient experienced improvement in symptoms immediately following the
procedure.
The patient tolerated the procedure well and left the department in stable
condition. There were no immediate complications or complaints.
## FINDINGS:
The patient is noted to be status post rotator cuff repair with suture anchors
noted within the humeral head.
## IMPRESSION:
1. Imaging Findings - status post rotator cuff repair.
2. Procedure - Technically successful therapeutic injection into the left
glenohumeral joint.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18419496", "visit_id": "N/A", "time": "2186-11-25 12:31:00"} |
16305137-RR-32 | 153 | ## INDICATION:
female with abdominal pain and large adnexal cyst.
## LMP:
.
Transabdominal and transvaginal ultrasound was performed, the latter for
better visualization of the endometrium and adnexa.
## FINDINGS:
The uterus is retroflexed measuring 6.5 x 5.3 x 4.9 cm. The
endometrium is thickened measuring 1.8 cm. The left ovary is normal in size
and appearance with normal venous and arterial waveforms. The right ovary
contains a large simple-appearing cyst measuring 4.3 x 4.2 x 3.2 cm. Only a
thin rind of ovarian tissue remains with normal-appearing arterial and venous
waveforms. There is no free pelvic fluid.
## IMPRESSION:
1. Large simple appearing right ovarian cyst measuring 4.3 cm. Normal
arterial and venous waveforms are demonstrated in the thin rind ovarian tissue
which remains. No evidence of ovarian torsion.
2. Thickened endometrium. Please correlate with patient's menstrual history.
3. No free pelvic fluid.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16305137", "visit_id": "N/A", "time": "2123-01-27 01:27:00"} |
13058449-DS-16 | 1,390 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
uterine artery embolization
endometrial biopsy
## HISTORY OF PRESENT ILLNESS:
Ms. is a yo woman with asthma, fibroids,
menorrhaghia, and uticaria on Xolair injections, who presents
with three days of increasing shortness of breath found to have
worsening anemia and multiple new PEs.
She states she was in her normal state of health until about
three weeks ago when she began to have severe shortness of
breath
with exertion. At that time she thought it was secondary to
asthma as was using her inhaler very frequently. She felt like
she somewhat improved.
She then noted she was having increased vaginal bleeding. She
has
had heavy periods all her life and years ago was diagnosed
with
iron deficiency requiring IV iron. Over the last week she began
to have prolonged bleeding sometimes lasting hours. She also
noted very large blood clots described as the size of both her
hands.
Shortly after the increased bleeding she found her shortness of
breath with exertion increasing to the point she couldn't walk a
few feet without having to stop. This prompted her to come to
the
ED.
On review of systems she noticed her right leg was swollen over
the last week. She denies any travel recently, denies any family
history of clots. She endorses a 5 pound weight loss over the
last month. Denies fevers, chills. She tells me she had been
planning to have a pelvic ultrasound and endometrial biopsy.
.
## PAST MEDICAL HISTORY:
Asthma
Urticaria
menorrhaghia
fibroids
.
## FAMILY HISTORY:
Mother died of MI, had diabetes and HTN, manic
depression. Father died of MI. No family history of clotting or
bleeding disorders.
## EYES:
PERLL, EOMI, no conjuctival injection, anicteric
## ENT:
no sinus tenderness, MMM, oropharynx without exudate or
lesions, no supraclavicular or cervical lymphadenopathy, no JVD,
no carotid bruits, no thyromegaly or palpable thyroid nodules
## RESPIRATORY:
CTA b/l with good air movement throughout
## CARDIOVASCULAR:
RR, S1 and S2 wnl, no murmurs, rubs or gallops
## GASTROINTESTINAL:
nd, +b/s, soft, nt, no masses or HSM
## EXTREMITIES:
no cyanosis, clubbing or edema
## SKIN:
warm, no rashes/no jaundice/no skin ulcerations noted
## NEUROLOGICAL:
Alert, oriented to self, time, date, reason for
hospitalization. Cn II-XII intact. strength throughout.
No
sensory deficits to light touch appreciated. No pass-pointing
on
finger to nose. 2+DTR's-patellar and biceps. No asterixis, no
pronator drift, fluent speech.
## GU:
no catheter in place
## GENERAL:
Alert, sitting in bed, more comfortable
## EYES:
Anicteric, pupils equally round
## ENT:
Ears and nose without visible erythema, masses, or trauma.
Oropharynx without visible lesion, erythema or exudate
## CV:
Heart regular, no murmur, no S3, no S4. No JVD.
## RESP:
Lungs clear to auscultation with good air movement
bilaterally. Breathing is non-labored
## GI:
Abdomen soft, distended, diffusely tender to deep palpation
## EXT:
Warm and well perfused. equal circumference.
## NEURO:
Alert, oriented, face symmetric, gaze conjugate with
EOMI,
speech fluent, moves all limbs
## IMAGING/STUDIES:
================
abdominal u/s:
7.8 cm hyperechoic mass in the right hepatic lobe consistent
with hemangioma given the peripheral discontinuous enhancement
seen on prior CT.
B/L u/s:
1. Nonocclusive thrombus extending from the right distal femoral
to the right proximal popliteal vein.
2. No evidence of deep venous thrombosis in the left lower
extremity.
##
PELVIC U/S:
1. Enlarged fibroid uterus, mildly increased
compared to prior.
2. The endometrium is not visualized secondary to multiple
fibroids.
## CTA CHEST:
1. Extensive pulmonary emboli involving the lobar pulmonary
arteries to all lung lobes bilaterally, with extension into the
distal segmental and subsegmental pulmonary arteries. No CT
evidence of right heart strain.
2. A 6.6 cm hypodense lesion in the posterior right hepatic dome
is incompletely imaged and characterized though likely a
hemangioma. Comparison with available priors would be helpful.
Otherwise, recommend nonemergent right upper quadrant ultrasound
for further evaluation.
## MRI PELVIS:
1. No deep vein thrombosis.
2. Myxoid degeneration of uterine fibroid.
## IMPRESSION:
There is distension of small bowel loops up to 3.5 cm with
several air-fluid levels, though air and stool is seen within
the large bowel which is also slightly prominent. These
findings are most suggestive of a postoperative ileus, though a
partial small-bowel obstruction is not entirely excluded. If
there is high concern for obstruction, a CT can be obtained.
There is no free air. There is no pneumatosis. There is no
radiopaque foreign body.
Endometrial biopsy :
Scant strips of benign surface endometrium
Discharge labs:
07:15AM BLOOD WBC-9.0 RBC-3.50* Hgb-7.1* Hct-25.4*
MCV-73* MCH-20.3* MCHC-28.0* RDW-22.8* RDWSD-58.7* Plt
09:05AM BLOOD Glucose-86 UreaN-10 Creat-0.8 Na-139
K-4.3 Cl-101 HCO3-25 AnGap-13
## BRIEF HOSPITAL COURSE:
Ms. is a yo woman with asthma, fibroids,
menorrhaghia, and uticaria on Xolair injections, who presents
with three days of increasing shortness of breath due to
worsening anemia and multiple new PEs. She is now s/p
endometrial biopsy, uterine artery embolization, with
hospitalization complicated by post op ileus and post op anemia.
#Pulmonary Emboli/DVT
At this time no clear cause other than OCP use and obesity, as
well as possibly omalizumab use. Given bleeding discussed below,
she was started on heparin on admission. She was found to have
significant clot burden on CTA as well as DVT, with slight BNP
bump and TTE with RV pressure overload. She was hemodynamically
stable during hospitalization. she was seen by vascular medicine
during her hospitalization and will be following up with them as
outpatient. She will likely need a minimum of 6 months
anticoagulation given clot burden. Prior auth for apixiban 5mg
BID was completed and she was discharged on the apixaban.
Determination of duration will be discussed at her outpatient
visits - but likely 6 months. She will follow up in
clinic.
#Iron deficiency Anemia
#acute blood loss anemia
#menorrhagia
Likely secondary to fibroids. Has been increasing over the past
month. She was to get a vaginal ultrasound and endometrial
biopsy as outpatient. Fe studies show ferritin 8.6 indicative of
significant Fe deficiency anemia. While during admission she had
only spotty, a few days PTA she had heavy bleeding with large
clots at home despite OCP resulting in significant anemia
requiring 2 transfusions during hospitalization. OCP is no
longer an option for her given VTE and she may suffer from even
more significant bleeding now that she is off OCP and on
systemic anticoagulation, necessitating further management of
her menorrhagia. Therefore, pt underwent endometrial bx by gyn
followed by uterine artery embolization by on . She was
also started on provera 10mg to help control bleeding.
#Post op ileus
She developed fever and abdominal distension on - at which
time KUB showed dilated loops of bowel. She also has chronic
constipation. She was treated supportively and slowly improved,
with daily bowel movements and tolerating a diet.
#hypothyroidism:
-continued home levothyroxine
## #LIVER LESION:
found to be hemangioma on RUQ U/S during
admission.
#Uticaria
Continue home medications, recommend discussing risk/benefit of
continuing with omalizumab given VTE.
## TRANSITIONAL ISSUES:
==================
[]f/u with gyn and vascular medicine, scheduled
[]apixiban 5mg BID for at least 6 months
[]consider discontiuation of omalizumab
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Cetirizine 10 mg PO DAILY
2. Loratadine 10 mg PO DAILY
3. Montelukast 10 mg PO DAILY
4. Ferrous Sulfate 325 mg PO DAILY
5. Levothyroxine Sodium 75 mcg PO DAILY
6. Cryselle (28) (norgestrel-ethinyl estradiol) 0.3-30 mg-mcg
oral DAILY
## DISCHARGE DIAGNOSIS:
pulmonary embolism
anemia, blood loss
DVT
fibroids
Post operative ileus
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
were admitted to with shortness of breath. were
found to have blood clots in your leg and lungs, as well as low
blood/hemoglobin levels. were started on a blood thinner to
treat your clots, given blood transfusions, and underwent a
procedure called uterine artery embolization to treat your heavy
bleeding from your fibroids.
It is very important that take your medications as
prescribed and follow up closely with your doctors. have
appointments upcoming with gyn and vascular medicine as outlined
below.
Since we stopped your birth control pills - if become
sexually active - need to use an alternative form of birth
control, such as condoms.
Other medications:
Make sure take the apixaban - eliquis - every day twice
daily.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13058449", "visit_id": "27811383", "time": "2145-08-09 00:00:00"} |
15565786-RR-14 | 444 | ## EXAMINATION:
CT abdomen and pelvis with and without contrast.
## NO PO CONTRAST; HISTORY:
with R flank pain, RLQ abdominal
painNO PO contrast // eval for acute process
## CTU:
Multidetector CT of the abdomen and pelvis were acquired
prior to and after intravenous contrast administration with the patient in
prone position. The non-contrast scan was done with low radiation dose
technique. The contrast scan was performed with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.0 s, 54.5 cm; CTDIvol = 5.1 mGy (Body) DLP = 276.9
mGy-cm.
2) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 36.1 mGy (Body) DLP =
18.1 mGy-cm.
3) Spiral Acquisition 5.0 s, 54.5 cm; CTDIvol = 6.0 mGy (Body) DLP = 327.5
mGy-cm.
Total DLP (Body) = 622 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:
A subcentimeter hypodensity is present within the interpolar left
kidney, measuring 8 mm and too small to completely characterize, but
statistically most likely represents a cyst (604B:26). Otherwise, there is no
evidence of focal renal lesions or hydronephrosis. There is no perinephric
abnormality.No nephro- or ureterolithiasis is present. The ureters are well
opacified throughout their course to the level of the bladder.
## GASTROINTESTINAL:
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 normal.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The visualized reproductive organs are unremarkable.
Dominant follicles are present in the bilateral ovaries.
## 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.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. No acute pathology in the abdomen or pelvis.
2. Specifically, no evidence of nephroureterolithiasis. The appendix is
normal.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15565786", "visit_id": "N/A", "time": "2178-12-26 23:29:00"} |
10388429-RR-91 | 542 | ## INDICATION:
Followup of AAA after stenting.
## CT ANGIOGRAM:
Ascending aorta is unremarkable. There is prominent plaque at
the origin of the left subclavian artery, probably with less than 50%
stenosis. The descending thoracic aorta at the inferior thorax maximally
measures 4.0 cm, which is stable from . The suprarenal aneurysm just below
the level of the diaphragm maximally measures 5 cm with extensive plaque. The
infrarenal aorta is normal in caliber with a short focus of posterior plaque.
When measurements of the aorta are compared to comparable measurements from
, no appreciable change.
The right common and external iliac stent and the left aortofemoral bypass
graft to the distal femoral arteries are both patent.
The celiac trunk and SMA are patent at their origins. The is not well
demonstrated. A replaced right hepatic artery from the SMA and a replaced left
hepatic artery off the left gastric artery are noted. There is one right renal
artery, which is patent. There are two left renal arteries going to the
superior and inferior poles of the left kidney. The origin of the renal artery
to the superior pole of the left kidney is mildly stenotic.
## CT CHEST:
There is a small nodule on the right thyroid. There is no
mediastinal lymphadenopathy. Right hilar lymph node measures 15 mm in short
axis, of uncertain significance. Right apical lung scarring and left lower
lobe lung atelectasis are noted. The lungs are otherwise clear without
pleural effusion. Significant coronary artery calcifications vs stents are
noted, with poor opacification of the origin of the RCA (this is not a gated
cardiac assessment; motion significantly degrades this assessment).
## CT ABDOMEN:
The liver is mildly enlarged with mild biliary duct dilatation in
both lobes of uncertain significance. The gallbladder is distended without
obvious calcified stones. The pancreas is diminutive in size after patient's
known pancreatic debridement. The spleen demonstrates calcified granulomas
the largest of which is 6 mm, previously 4 mm. Bilateral adrenal glands are
unremarkable. The right kidney has a small hypoattenuation that is too small
to characterize. The left kidney is atrophic. The small bowel is grossly
within normal limits. The patient has a colonic resection with an intact
colocolonic anastomosis. There is no free fluid and no free air. No
mesenteric or retroperitoneal lymphadenopathy is present. Ventral diastasis is
present after multiple abdominal surgeries with evidence of abdominal wall
grafting.
## CT PELVIS:
Air in the bladder is possibly secondary to recent
catheterization, but clinical correlation is recommended. The uterus and
adnexa are within normal limits. There is diverticulosis without inflammatory
changes in the colon. The rectum is unremarkable.
## BONE WINDOWS:
An old transverse process fracture of L3 is noted. There are
no lytic or sclerotic lesions suspicious for malignancy.
3D Reconstructions and reformatted images were created in the Advanced Imaging
lab.
## IMPRESSION:
1. Stable descending thoracic aortic aneurysm and stable suprarenal aneurysm.
2. The right common iliac stent and left aortofemoral bypass graft to the
distal femorals are both patent.
3. Stenotic origin to the left renal artery.
4. The liver is mildly enlarged with mild biliary duct dilatation of
uncertain significance.
5. Air in the bladder, possibly secondary to recent catheterization but
clinical correlation is recommended.
6. Sigmoid colon diverticulosis without evidence of diverticulitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10388429", "visit_id": "N/A", "time": "2170-05-20 10:55:00"} |
13847814-RR-20 | 98 | ## EXAMINATION:
ABDOMEN (SUPINE AND ERECT)
## INDICATION:
year old man with ulcerative colitis s/p ostomy now with new pancreatic Ca,
abd pain/distension and decreased ostomy output // SBO
## IMPRESSION:
There are multiple dilated loops of small bowel measuring up to 6 cm with
multiple air-fluid levels. This appears more extensive than on the CT from
. Given patient with right lower quadrant ostomy in colectomy this
could be either obstruction or ileus. However, given increase in air-fluid
levels obstruction is of concern
## NOTIFICATION:
d/w on at 10:52 , 5 mins after observaton of
findings
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13847814", "visit_id": "21325300", "time": "2110-09-29 21:37:00"} |
16311268-RR-23 | 211 | ## INDICATION:
History of ANCA-associated vasculitis and tracheobronchomalacia
on CT chest. Extent of tracheobronchomalacia.
## FINDINGS:
This is a very limited exam and not suitable for identifying subtle
lung findings. The thyroid gland is unremarkable. There are no enlarged
supraclavicular, axillary, mediastinal or hilar lymph nodes. The heart and
pericardium are unremarkable. There is no pericardial effusion. Previously
noted lower lobe mucus plugging has mostly resolved. Geographic ground-glass
opacity in the left lower lobe and right upper lobes have nearly resolved.
There still remains patchy ground-glass opacities in the lower lobes
bilaterally which may be due to persistent infection; however, may also be due
to expiratory phase of imaging. There is no large focal consolidation,
pleural effusion or pneumothorax. The esophagus is patulous in the upper
third.
This study is not tailored for evaluation of subdiaphragmatic structures, but
limited views are unremarkable.
There are no concerning bony lesions.
## IMPRESSION:
This is a technically limited exam. Compared to the prior study,
there has been improvement in mucus plugging of airways as well as near
resolution of geographic ground-glass opacities in the left lower and right
upper lobe. Persistent patchy ground-glass opacities in the lower lobe may
represent an infectious or inflammatory process versus expiratory phase of
imaging.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16311268", "visit_id": "N/A", "time": "2121-03-21 12:15:00"} |
12503324-RR-46 | 112 | ## RENAL ULTRASOUND:
Right kidney measures 9.6 cm and left kidney measures 10.5 cm. No
hydronephrosis or large calculi are noted. Again extending off the upper pole
of the left kidney is a 4.7 x 5.6 x 4.2 cm anechoic simple-appearing cyst
which is slightly increased in size from the exam. No irregular
septations or mural nodularity is noted on today's exam. No other concerning
renal lesions are present. The bladder appears unremarkable.
## IMPRESSION:
Slight interval increase in size to upper pole left renal cyst which on
today's exam displays no concerning sonographic features. Given this
appearance, no further follow up is needed.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12503324", "visit_id": "N/A", "time": "2196-10-23 09:27:00"} |
19793286-RR-18 | 68 | ## INDICATION:
Patency of fallopian tubes
## FINDINGS:
The uterine cavity appears normal. There was delayed incomplete filling of
the left fallopian tube without free spill of contrast. No filling of the
right fallopian tube or free spill of contrast from the right fallopian tube.
## IMPRESSION:
Incomplete filling of the left fallopian tube with no free spill noted. No
filling or free spill of the right fallopian tube.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19793286", "visit_id": "N/A", "time": "2133-11-20 13:51:00"} |
17019564-DS-21 | 1,211 | ## ALLERGIES:
oxycodone / peanut / latex
## HISTORY OF PRESENT ILLNESS:
with h/o OCD, anorexia nervosa, anxiety with history of SI
and suicidal attempts, h/o depression and paranoia admitted
as transfer from after a suicidal
attempt via hanging. She has had a recent admission to for
transaminitis in the setting of anorexia nervosa. She was
discharged from that admission on to an eating disorder
unit at a facility in , where she left prior to
admission. Upon admission, her weight was 62% IBW with BMI of 13
and QTc normal. Pt is poor historian with significant mutism in
setting of malnutrition and psychosis.
## PAST MEDICAL HISTORY:
Eating Disorders-Bulimia
Anorexia Nervosa, binge purging type, severe
Anxiety
Fear of eating foods as concern that will lead to "damage to her
skin"
Alcohol abuse
related to anorexia nervosa.
Celiac Disease- anti-tissue transglutaminase was greater than
assay on last admission. No history of biopsy-proven celiac
disease.
Suicide attempt
## FAMILY HISTORY:
No family history of liver disease.
## GENERAL:
NAD, cachectic, lanugo, Dobhoff tube in place, very
paranoid, speaks anxiously
## HEENT:
AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,
MMM, good dentition
## NECK:
nontender supple neck, no LAD, no JVD
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## LUNG:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## ABDOMEN:
nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
## EXTREMITIES:
no cyanosis, clubbing or edema, moving all 4
extremities with purpose
## PULSES:
2+ DP pulses bilaterally
## SKIN:
warm and well perfused, no excoriations or lesions, no
rashes
## TELE:
8h: no acute events, HR within target
## GENERAL:
NAD, cachectic, lanugo, responding to questions but
occasionally suspicious or evasive, anxious affect
## HEENT:
AT/NC, dry MM, now opening both eyes
## CV:
RRR. Normal S1 and S2. no murmurs
## ABDOMEN:
Slightly firm, mild tenderness, moderate distension,
+BS in 4 quadrants.
## EXTREMITIES:
warm, no edema, wasted, 2+ pulses bilaterally
## SKIN:
warm and well perfused, no excoriations or lesions, no
rashes
## NEURO:
A&Ox3, hearing impaired, no other focal deficits
## URINE CULTURE:
ESCHERICHIA COLI. >100,000
ORGANISMS/ML..
PRESUMPTIVE IDENTIFICATION.
Cefazolin interpretative criteria are based on a dosage
regimen of 2g every 8h.
## SENSITIVITIES:
MIC expressed in
MCG/ML
ESCHERICHIA COLI
|
AMPICILLIN
-----
=>32 R
AMPICILLIN/SULBACTAM-- 8 S
CEFAZOLIN
-----
<=4 S
CEFEPIME
-----
<=1 S
CEFTAZIDIME
-----
<=1 S
CEFTRIAXONE
-----
<=1 S
CIPROFLOXACIN
-----
=>4 R
GENTAMICIN
-----
<=1 S
MEROPENEM
-----
<=0.25 S
NITROFURANTOIN
-----
<=16 S
PIPERACILLIN/TAZO
-----
<=4 S
TOBRAMYCIN
-----
<=1 S
TRIMETHOPRIM/SULFA
-----
<=1 S
## EEG:
IMPRESSION: This is a normal EEG in the awake
state. No focal or
epileptiform features were seen. Note is made of a resting
tachycardia.
BRAIN MRI:IMPRESSION:
Unremarkable MRI of the brain. No evidence of hypoxic ischemic
injury.
## BRIEF HOSPITAL COURSE:
female with anorexia nervosa and recent admission
who presents after inpatient psychiatric admission for suicide
attempt (via hanging).
In brief summary, patient was placed on an eating disorder
protocol with tube feeds via Dobhoff, eventually transitioning
to po intake. She was also treated for mutism, psychosis, and
depression with lorazepam standing regimen and Zyprexa qHS, and
she became more interactive throughout admission. Her weight on
admission was 33.6 kg and was 43.2 at discharge
Acute Issues
============
# Anorexia nervosa with severe malnutrition: Recent discharge
from on and failed admission to inpatient program in
on . She returned after suicide attempt. BMI 13 on
admission to . Here, she was enrolled in eating disorder
protocol and received tube feeds via Dobhoff tube. Psychiatry,
nutrition and social work were consulted and were following her
case. She was started on olanzapine for weight gain as well as
paranoid/delusional/disorganized thoughts. In addition,
guardianship was obtained from her mother ( ). Daily
weights were checked for weight gain as well, with the goal of
70% of ideal body weight, or 38.5 kg. Patient taking solid food
with ensure supplement for remaining half of calories required
for each meal. Weight responded to the regimen, and pt was
44.8kg upon discharge.
## # MUTISM, WITHDRAWN BEHAVIOR:
Shortly after admission, patient
became mute and refused to open eyes or follow commands. This
was suspicious for psychosis vs severe malnutrition (various
metabolic derangements including hypoglycemia), however, based
on physical exam, this appeared to be largely voluntary. Anoxic
brain injury following attempting hanging also possible,
however, mental status initially was relatively normal, making
delayed anoxic injury less likely. She had an EEG on
that was normal, as was MR brain normal. In consultation with
psychiatry, she was continued on the olanzapine as above, with
addition of lorazepam, with good response. She began
intermittently refusing olanzapine, and had to be transitioned
to IM dosing. Her regimen on discharge was 5mg olanzapine at
1200 and 2200, offered PO initially and given IM if refused, and
1mg lorazepam IV at 0800 and 1600.
## # SUICIDE ATTEMPT:
Initially admitted by
inpatient psychiatry. Patient was not actively suicidal on
admission. She had 1:1 sitter throughout admission. MRI brain
and EEG did not reveal evidence of anoxic brain injury.
## # TACHYCARDIA:
Thought to be secondary to malnutrition and
dehydration vs anxiety/agitation. She remained on telemetry,
which showed sinus tachycardia that was not persistent
throughout admission. Tachycardia was responsive to fluid
boluses of 500cc's of NS. Electrolytes were repleted as needed.
Tachycardia was no longer being recorded on telemetry by the
time of discharge.
## # BACTERIAL UTI:
Pt was found to have a catheter-associated UTI,
which grew E. coli. Subsequently, her catheter was removed, and
she was started on po Bactrim suspension for 10 days. She
remained afebrile without a significant leukocytosis.
Chronic Issues
==============
## # HISTORY OF ANXIETY:
She was given lorazepam PRN.
## # CELIAC DISEASE:
Anti-tissue transglutaminase was greater than
assay on last admission. She will require GI endoscopy in the
future for biopsy for definitive diagnosis of celiac disease,
which will be managed as an outpatient. She was given a
gluten-free diet.
## # TRANSAMINITIS:
Pt underwent extensive work-up previously,
including hepatic biopsy, which was negative, during last
hospitalization. Transaminitis though to be secondary to
anorexia nervosa with possible component of celiac's disease
contributing.
=============
Transitional issues:
- ongoing anorexia nervosa
- suicidal ideation with attempts
- celiac disease without confirmed endoscopic biopsy, can
consider biopsy in outpatient follow-up
- transaminitis of indefinite origin.
## MEDICATIONS ON ADMISSION:
Lorazepam 1 mg PO Q6H PRN anxiety
## DISCHARGE MEDICATIONS:
1. OLANZapine (Disintegrating Tablet) 7.5 mg PO QHS
2. 1 mg PO QID psychosis
## DISCHARGE DIAGNOSIS:
Anorexia Nervosa
Suicidal attempt
Mutism
Malnutrition
Urinary tract infection
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
It was a pleasure taking care of you at
. You were admitted to our hospital as a transfer
from after a suicide attempt. During
your treatment here, you were seen by a psychiatrist, and you
were under direct supervision by a 1:1 sitter due to the
concerns for a repeated suicidal attempt. In addition, we
managed your eating disorder with a "refeeding protocol" in
which we administered nutrition via a temporary feeding tube.
For this, a nutrition team oversaw your nutritional needs. In
addition, you were found to have a urinary tract infection which
we treated with antibiotics.
After a medicine team managed your medical concerns, including a
fast heart rate, malnutrition, and urinary tract infections, you
were transferred to a psychiatry team who managed your anxiety,
eating disorder, and suicidal ideation.
We wish you all the best,
Your team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17019564", "visit_id": "28886843", "time": "2184-12-17 00:00:00"} |
14827421-RR-71 | 106 | ## HISTORY:
with recent fall and shoulder injury with worsening
pain. // Fracture
## FINDINGS:
There is a 2 cm fracture fragment superior to the humeral head, likely
secondary to prior greater tuberosity fracture seen on priors. The
glenohumeral joint appears congruent. Mild widening of the glenohumeral joint
may be secondary to joint effusion or deltoid atony. There are mild
degenerative changes of the AC joint. There are healed rib fractures on the
left side. No suspicious lytic or sclerotic lesions are identified.
## IMPRESSION:
2 cm fracture fragment superior to the humeral head, likely secondary to prior
greater tuberosity fracture. No definite new fracture or dislocation seen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14827421", "visit_id": "N/A", "time": "2194-04-21 23:39:00"} |
18257430-DS-14 | 1,482 | ## HISTORY OF PRESENT ILLNESS:
year-old woman with COPD who in Pulmonary Clinic on the day
of admission and was found to have hypoxia with an oxygen
saturation of 82% on room air, 94% on 3L. From Clinic, she was
sent to the ED for further evaluation and management.
Dr. pulmonologist notes that the patient was given a
Z-pack and a 2 week prednisone taper for COPD exacerbation 2.5
weeks prior to admission. Other
plans had included pulmonary rehab for airway clearance. They
had discussed induced to rule out infections
complicating bronchiectasis. Another consideration would be
chronic steroids.
She is an active smoker and does not use supplemental oxygen at
home. She is independent of all ADLs at home, but does have an
assistant, named , who helps with IADLs. Patient notes
that she has had to clear her throat more often recently. She
denies fevers, chills, cough, shortness of breath, chest pain,
or any other symptoms. She has reduced her smoking down to 3
cigarettes daily.
## ED VS:
T 98, HR 106, BP 114/96, RR 20, O2sat 84% on room air,
94% on 3L. Received 1L NS, Solumedrol 125mg IV, Duonebs x3,
Azithromycin 500mg.
## REVIEW OF SYSTEMS:
(+) Per HPI and has memory problems.
(-) Denies night sweats, weight change, visual changes, oral
ulcers, bleeding nose or gums, palpitations, orthopnea, PND,
lower extremity edema, hemoptysis, nausea, vomiting, abdominal
pain, diarrhea, constipation, melena, BRBPR, dysuria, hematuria,
easy bruising, skin rash, myalgias, joint pain, back pain,
numbness, weakness, dizziness, vertigo, headache, or depression.
## PAST MEDICAL HISTORY:
- COPD (PFTs in with FEV1 0.77 (40% predicted), FVC
0.91 (33%) and FEV1/FVC 118%. Spirometry limited by poor patient
cooperation)
- Bronchiectasis on CT
- Developmental Delay
- Bipolar disorder
- Gastroesophageal reflux disease
- History of SBO in the past complicated by Aspiration PNA and
intubation ( )
- Glenohumeral joint arthritis
- Diabetes mellitus, type II
## FAMILY HISTORY:
(Per OMR) Mother lived to her mid- then suffered an MI.
Father lived to his mid- before dying of natural causes. Pt
is unable to state her family history.
## HEENT:
EOMI, MMM, no oral lesions
## CHEST:
Upper airway sounds, no rhonchi, no rales, no wheezing.
## CV:
Tachy, regular, normal S1 and S2, no murmurs
## ABD:
Soft, nontender, nondistended, bowel sounds present
## SKIN:
No rashes or other lesions
## EXT:
No lower extremity edema
## NEURO:
Alert, oriented x3, CN intact, sensory intact
throughout, strength BUE/BLE, fluent speech, normal
coordination
## SENSITIVITIES:
MIC expressed in
MCG/ML
STAPH AUREUS COAG +
|
CLINDAMYCIN
-----
R
ERYTHROMYCIN
-----
=>8 R
GENTAMICIN
-----
<=0.5 S
LEVOFLOXACIN
-----
=>8 R
OXACILLIN
-----
=>4 R
RIFAMPIN
-----
<=0.5 S
TETRACYCLINE
-----
<=1 S
TRIMETHOPRIM/SULFA
-----
<=0.5 S
VANCOMYCIN
-----
1 S
MR & W/O CONTRAST Study Date of
## IMPRESSION:
1. Large disc herniation at L4-5 level indenting the thecal sac
and resulting in moderate spinal stenosis with severe left
subarticular recess narrowing and moderate right subarticular
recess narrowing.
2. Multilevel mild degenerative changes at other levels.
3. No evidence of discitis or osteomyelitis or epidural or
paraspinal abscess in the lumbar region.
CHEST (PA & LAT) Study Date of
The right PICC line tip is at the level of proximal right
atrium/cavoatrial junction, might be pulled back for about 1.5
cm. There are new bilateral opacities, in particular in the
lower lobes and also in the right upper lung, which may
represent interval development of multifocal infection
accompanied by small bilateral pleural effusions.
Cardiomediastinal silhouette is unchanged. There is mild
interstitial prominence, which might be consistent with minimal
interstitial edema, but no overt pulmonary edema is currently
seen.
## BRIEF HOSPITAL COURSE:
This is a year-old woman with mental retardation, advanced
COPD, and bronchiectasis who presented with hypoxia from her
Pulmonologist Office. This was thought to be related to a COPD
exacerbation. She improved with prednisone, levofloxacin, and
bronchodilators, however, then worsened again while in the
hospital with increasing tachypnea, oxygen requirement and
coarse breath sounds. CXR revealed a multifocal pneumonia.
She was started on IV abx via a picc line for
acquired pneumonia. A sputum culture revealed MRSA and
her antibiotics were narrowed to Vancomycin for a planned 14 day
course. Vancomycin IV to complete . Her vanc trough was
therapeutic on . She was cleared by Speech and swallow
during the admission. Her WBC was improved with antibiotics,
but she does have a new leukocytosis at the time of discharge
due to the initiation of prednisone for COPD the day prior to
discharge.
# COPD, with acute exacerbation
She is currently being treated with scheduled nebulizers
(albuterol/ipratropium), Advair. Steroids were held initially
due to the MRSA pneumonia, but were started on , with a
planned taper. She had an expected leukocytosis on the day of
discharge following her starting steroids. She remains afebrile.
.
# Lumbar back pain; hx of Spondylosis
During the admission, she complained of severe lumbar back pain,
which was worse with movement. Record review showed that pt has
hx of lumbar back pain for which she has been seen in Spine
Center. MRI lumbar spine was performed to r/o infectious
etiology of pain given her concurrent MRSA pneumonia; there was
no evidence of infection, but with significant underlying
disease. She was treated with lidoderm, ativan prn muscle
spasm, tylenol, and oxycodone mg po q 4hr prn. She was
comfortable and denying pain at the time of discharge.
.
# Sinus tachycardia
Unclear etiology; likely multifactorial due to illness, anxiety,
pain.
Tolerating diet without issue. Appears euvolemic. HR did not
respond to fluid challenge.
.
# Diarrhea
Likely due to antibiotics. C-diff negative. Improved.
.
# Bipolar disorder
# Depression
# Anxiety
- Clonazepam 0.5 mg PO/NG QAM; Clonazepam 1 mg PO/NG QHS
- Olanzapine 5 mg PO BID
- Sertraline 150 mg PO/NG DAILY
- traZODONE 75 mg PO/NG HS
.
## DISP:
discharged to for ongoing care
## MEDICATIONS ON ADMISSION:
(Off of med record... pt does not know her meds)
Mobic 15mg PO Daily for arthritis pain
Tiotropium 18mcg inhaled Daily
Ipratropium-Albuterol (Duoneb) 3ml inhaled nebs QID
Advair 500-50mcg inhaled BID
Metformin 500mg PO Daily
Calcarb 600 with Vitamin D 600mg PO Daily
Lidoderm 5% patch Daily
Olanzapine 5mg PO QAM and QHS
Trazodone (Desyrel) 75mg PO QHS for depression
Clonazepam 0.5mg PO QAM and 1mg PO QHS
Sertraline 150mg PO QAM
Docusate 100mg PO BID prn constipation
Albuterol 90mcg inhaled Q6HRS prn SOB
Senna 8.6mg PO TID prn constipation
Acetaminophen 650mg PO TID prn pain or fever
Guaifenesin 600mg PO Daily
Pantoprazole 40mg PO BID
## DISCHARGE MEDICATIONS:
1. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) inj
Injection TID (3 times a day).
2. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig:
One (1) INH Inhalation twice a day.
3. olanzapine 5 mg Tablet Sig: One (1) Tablet PO twice a day: at
QAM and QHS.
4. trazodone 50 mg Tablet Sig: 1.5 Tablets PO at bedtime.
5. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO once a day.
6. clonazepam 1 mg Tablet Sig: One (1) Tablet PO at bedtime.
7. sertraline 50 mg Tablet Sig: Three (3) Tablet PO once a day.
8. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
9. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Calcium Antacid mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO TIDAC.
11. Vitamin D-3 400 unit Capsule Sig: One (1) Capsule PO twice a
day.
12. vancomycin in D5W 1 gram/200 mL Piggyback Sig: One (1)
infusion Intravenous Q 12H (Every 12 Hours) for 6 days: Last day
= .
13. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as
needed for pain: 0n 12 hours/off 12 hours. Apply to lower back.
14. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
## NEBULIZATION SIG:
One (1) neb Inhalation every four (4) hours as
needed for shortness of breath or wheezing.
15. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 mL Solution
for Nebulization Sig: One (1) neb Inhalation every six (6)
hours.
16. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) INH Inhalation once a day.
17. oxycodone 5 mg Tablet Sig: Tablets PO Q6H (every 6
hours) as needed for pain for 3 days.
18. prednisone 20 mg Tablet Sig: taper Tablet PO DAILY (Daily):
2 tabs po q day x 2 days, 1 tab po q day x 4 days, 0.5 tab po q
day x 4 days.
## DISCHARGE DIAGNOSIS:
COPD exacerbation and Bronchiectasis
Multifocal Pneumonia, MRSA
Lumbar back pain; hx of Spondylosis
Sinus tachycardia
Mental retardation
Diarrhea
Bipolar disorder
Depression
Anxiety
## DISCHARGE INSTRUCTIONS:
You were admitted because of a COPD exacerbation and you
subsequently developed a MRSA pneumonia. You were treated with
antibiotics. You are being discharged to a rehab which will
help you get ready to return to home.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18257430", "visit_id": "26750608", "time": "2120-05-08 00:00:00"} |
10577647-DS-29 | 1,486 | ## ALLERGIES:
vancomycin / Erythromycin Base
## HISTORY OF PRESENT ILLNESS:
year old female with a history of longstanding DM (c/b
gastroparesis, neuropathy, proteinuria without significantly
impaired GFR), HTN, depression, recurrent UTIs (urethral
diverticulum), obesity and recent admission for gastroparesis
flare complicated by Enterococcal UTI now presenting
with abdominal pain. Pt reports that at 3AM
yesterday, she developed acute abdominal pain. She describes the
pain as affected her entire abdomen. She subsequently developed
nausea and vomiting, and ultimately had 4 episodes of
vomitus consisting of recently eaten food. She states that her
current pain is consistent with her previous episodes of
gastroparesis flare.
In the ED, initial vitals were: 98.1 99 182/101 28 100%
- Labs were significant for: WBC 16.5 (87%N), H/H 11.2/34.6, Na
138, BUN/Cr , lactate 2.3, Positive UA consistent with
known Enterococcal UTI
- No imaging was obtained.
- The patient was given:
07:34 IV HYDROmorphone (Dilaudid) 1 mg
07:34 IV Ondansetron 4 mg
07:49 IV FoLIC Acid 1 mg
07:49 IV Thiamine 100 mg
07:49 IVF 1000 mL NS 1000 mL
10:02 IV HYDROmorphone (Dilaudid) 1 mg
11:19 IV HYDROmorphone (Dilaudid) 1 mg
14:30 IV HYDROmorphone (Dilaudid) 1 mg
14:30 IV Metoclopramide 10 mg
18:09 IV Ondansetron 4 mg
18:09 IV HYDROmorphone (Dilaudid) 1
18:09 PO/NG Lisinopril 40 mg
18:09 PO NIFEdipine CR 90 mg
18:09 PO/NG Atenolol 12.5 mg
- Vitals prior to transfer were:
Summary of admissions over recent months: ,
,
,
.
Upon arrival to the floor, pt reports continued abdominal pain,
but denies nausea or vomiting. Pt reports last BM was the day
prior to presenting to the ED and was normal. Pt reports passing
flatus. Pt denies fevers, chills, dysuria, urinary frequency,
cough.
## - IDDM (TYPE 2):
HbA1c 8.7% ( ), complicated by
gastroparesis diagnosed in
- GERD
- Hypertension
- Depression
- Obesity
- Recurrent urinary tract infections due to urethral
diverticulum
- Chronic back pain
## FAMILY HISTORY:
Mother - DM
Father - died of Alzheimer's
Siblings - sister with DM
## GENERAL:
Morbidly obese woman, alert, oriented, writhing in pain
## NECK:
Unable to evaulate JVP due to habitus
## CV:
Regular rate and rhythm, normal S1 + S2
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## ABDOMEN:
Obese, Soft, tender diffusely,
## EXT:
Warm, well perfused, 2+ pulses
## GENERAL:
Alert, oriented obese F, tired appearing, no acute
distress
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## CV:
RRR, normal s1/s2, soft systolic murmur over LUSB
## ABDOMEN:
obese, normoactive bowel sounds, no ttp
## EXT:
Warm, well perfused, no clubbing, cyanosis or edema
## ADMISSION LABS:
======================
07:15AM BLOOD
Plt
07:15AM BLOOD
07:15AM BLOOD Plt
07:15AM BLOOD
07:15AM BLOOD
07:15AM BLOOD
07:23AM BLOOD
## URINE STUDIES:
======================
12:50PM URINE Sp
12:50PM URINE
12:50PM URINE
12:50PM URINE
04:46PM URINE Sp
04:46PM URINE
04:46PM URINE
01:25PM URINE Sp
01:25PM URINE Protein->600
01:25PM URINE
## OTHER PERTINENT LABS:
======================
01:32PM BLOOD
Plt
01:32PM BLOOD Plt
01:32PM BLOOD
01:32PM BLOOD
## ===============
1:25 PM URINE SOURCE:
.
URINE CULTURE (Final :
MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
AND/OR GENITAL CONTAMINATION.
## IMAGING/STUDIES:
===============
None this admission
## DISCHARGE LABS:
=================
05:30AM BLOOD
Plt
05:30AM BLOOD
05:30AM BLOOD
05:30AM BLOOD year old female with a history of longstanding DM (c/b
gastroparesis, neuropathy, proteinuria without significantly
impaired GFR), HTN, depression, recurrent UTIs (urethral
diverticulum), obesity and recent admission for gastroparesis
flare complicated by Enterococcal UTI now presenting
with possible recurrent gastroparesis flare. Patient was made
NPO at admission, and initially received significant narcotic
pain medications. Case was discussed with GI fellow (GI team
knows her well) and recommended stopping narcotic pain
medications. In addition, they advised outpatient gastric
emptying study. On patient tolerated a regular diet
without pain and successfully had a BM. Safely discharged to
home on .
## # DIABETIC GASTROPARESIS FLARE:
Pt presents with her usual
pattern of abdominal pain when having a gastroparesis flare.
Pt's exam is unconcerning for an acute abdomen. Her case was
discussed with GI fellow who recommended discontinuing
narcotics, and obtaining outpatient gastric emptying study,
advancing diet. On patient noted she was back to
baseline, was tolerating regular diet; had a BM. On ,
patient discharged safely home with plan for outpatient gastric
emptying study, PCP and GI followup. home narcotics were
discontinued including Tramadol, and narcotics
discontinued. No records in system of diagnosis of
Gastroparesis and it may have been while patient on narcotic
pain medications. Ensure that gastric emptying study is
performed off of narcotics. Any future admissions via the ED
should first treat patient with significant bowel regimen, and
avoid narcotics as these may exacerbate her abdominal pain.
# Leukocytosis: Patient w/leukocytosis at admission, afebrile
and denies infectious symptoms such as fevers, chills, dysuria,
cough. Patient has chronic leukocytosis per review of OMR
(baseline around 15). Prior has been negative.
Consider outpatient heme/onc referral for further evaluation.
## # ENTEROCOCCAL UTI:
During hospitalization ending , pt
grew resistant Enterococcus in her urine and was discharged on a
14 day course of Daptomycin ending . She was also sent with
course of PO flagyl as C. diff prophylaxis given a recent CDT
positive stool on . In addition, she was found to have
Enterobacter in her urine , which was deemed to be a
colonizer and was untreated. During this admission, she had a
contaminated UCx (mixed flora), but was completely asymptomatic
and s/p full course of Daptomycin (for prior UTI) prior to this
admission, so no further abx were necessary.
## # TYPE 2 DIABETES MELLITUS:
Continued home Lantus and SSI, dose
adjusted to 80% per protocol when NPO; Continued Gabapentin for
neuropathic pain. At discharge, patient should follow her home
sliding scale regimen. HgbA1c 6.8 as of .
## # HYPERTENSION:
continued home atenolol, lisinopril, nifedipine
# Chronic Stable Asthma: continued home Flovent, albuterol PRN
# Urinary Incontinence: continued home Bethanechol 25 mg PO QID
## =====================
# CODE STATUS:
Full code
# CONTACT: (daughter,
- with PCP
- with Gastroenterology
- Patient to see PCP , at which time social work and
clinical RN services may be setup as outpatient.
- narcotics stopped, patient should NOT take her home
Tramadol. PCP to arrange an outpatient gastric emptying study
prior to her GI appointment to confirm whether or not she has
true gastroparesis vs narcotic induced gastroparesis.
- Consider referral to H/O for evaluation of chronic
leukocytosis
- Medications stopped: daptomycin (14d course completed),
metronidazole (C diff prophylaxis no longer needed now that
patient off daptomycin), tramadol (needs to be off this
medication prior to gastric emptying study)
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen mg PO Q8H:PRN pain
2. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB/wheeze
3. Atenolol 12.5 mg PO DAILY
4. Bethanechol 25 mg PO QID
5. Daptomycin 350 mg IV Q24H
6. Docusate Sodium 100 mg PO DAILY:PRN constipation
7. Fluticasone Propionate 110mcg 2 PUFF IH BID
8. Gabapentin 600 mg PO TID
9. Lisinopril 40 mg PO DAILY
10. Metoclopramide 10 mg PO QIDACHS
11. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H
12. NIFEdipine CR 120 mg PO DAILY
13. Pantoprazole 40 mg PO Q12H
14. Polyethylene Glycol 17 g PO DAILY:PRN constipation
15. TraMADOL (Ultram) 50 mg PO DAILY:PRN pain
16. Senna 8.6 mg PO BID:PRN constipation
17. Sertraline 150 mg PO DAILY
18. Prochlorperazine 25 mg PR Q12H:PRN nausea
19. Glargine 50 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H:PRN pain/discomfort
2. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB/wheeze
3. Atenolol 12.5 mg PO DAILY
4. Bethanechol 25 mg PO QID
5. Docusate Sodium 100 mg PO DAILY:PRN constipation
6. Fluticasone Propionate 110mcg 2 PUFF IH BID
7. Gabapentin 600 mg PO TID
8. Lisinopril 40 mg PO DAILY
9. Metoclopramide 10 mg PO QIDACHS
10. NIFEdipine CR 120 mg PO DAILY
11. Pantoprazole 40 mg PO Q12H
12. Polyethylene Glycol 17 g PO DAILY:PRN constipation
13. Senna 8.6 mg PO BID:PRN constipation
14. Sertraline 150 mg PO DAILY
15. Glargine 50 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
16. Prochlorperazine 25 mg PR Q12H:PRN nausea
## SECONDARY:
Diabetes Mellitus Type II
Morbid Obesity
## DISCHARGE INSTRUCTIONS:
Ms. ,
You came to with nausea,
vomiting and abdominal pain. It appears that the cause of your
symptoms is a combination of narcotic pain medications which
slow the emptying of your stomach and the movement of your
bowels, and a possible condition called gastroparesis. During
your hospitalization of your pain medications were stopped
besides Tylenol, and your condition improved. After discharge,
please follow up with the gastroenterology doctors and avoid
narcotic medications including tramadol as these will slow the
movement of your bowels and increase your pain, nausea and
vomiting.
It has been a pleasure caring for you, and we wish you the
best.
Kind regards,
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10577647", "visit_id": "20023305", "time": "2145-08-25 00:00:00"} |
12266695-RR-8 | 173 | ## INDICATION:
Diabetes, decubitus ulcer on right, fissure on left, question of
osteomyelitis.
## RIGHT FOOT:
No fracture, dislocation or degenerative change can be
appreciated, however, a soft tissue defect is seen overlying the posterior
aspect of the heel. There is slight periostitis noted along the posterior
margin of the calcaneus. No cortical destruction is noted. No radiopaque
foreign body or soft tissue calcifications.
## LEFT FOOT:
No fracture, dislocation or degenerative change is seen. No radiopaque
foreign body or soft tissue calcifications. No lytic or sclerotic bone lesion
is seen. A mottled lucent appearance of the posterior aspect of the calcaneus
with slight erosion at the Achilles insertion could be compatible with early
osteomyelitis.
## IMPRESSION:
1. Slight periostitis of the right calcaneus. No erosions or rarefaction of
the trabecula. However, given that the overlying ulcer can be probed to bone,
osteomyelitis cannot be excluded.
2. In the left foot, mottled appearance to the trabecular pattern in the
posterior calcaneus is concerning for osteomyelitis. Consider MRI.
Findings discussed with Dr. on @ 3:42 pm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12266695", "visit_id": "26840816", "time": "2171-09-26 17:11:00"} |
11055094-RR-74 | 100 | ## EXAMINATION:
CHEST (AP AND LAT)
## INDICATION:
History: with ?pna diagnosed at urgent care // eval for pna
## FINDINGS:
Cardiac silhouette size is moderately enlarged, as seen previously.
Mediastinal and hilar contours are unchanged. There is mild pulmonary
vascular congestion without frank pulmonary edema. Persistent elevation of
the right hemidiaphragm is noted. Streaky opacities are seen in the lung
bases most suggestive of atelectasis. A trace right pleural effusion is
likely present. No pneumothorax. No acute osseous abnormalities.
## IMPRESSION:
Chronic elevation of the right hemidiaphragm with streaky bibasilar opacities
likely reflective of atelectasis. No focal consolidation. Mild pulmonary
vascular congestion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11055094", "visit_id": "N/A", "time": "2155-04-07 14:35:00"} |
19274248-RR-30 | 440 | ## EXAMINATION:
CTA CHEST WITH CONTRAST
## INDICATION:
yo man w/ fully treated tuberculosis s/p RIPE
from (f/b Dr. at , last + sputum cx as
c/b NSTEMIs, NSVT, history of gastric cancer (s/p resection f/b and
chronic low back pain recently admitted and for invasive
pulmonary aspergillosis c/b parapneumonic effusion s/p R tunneled pleural
catheter ( ) on voriconazole presenting with progressive shortness of
breath over one month and pre-syncope.// Please evaluate for PNA, abscess,
size of R-sided effusion
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 6.1 s, 39.4 cm; CTDIvol = 9.0 mGy (Body) DLP = 347.4
mGy-cm.
Total DLP (Body) = 347 mGy-cm.
## HEART AND VASCULATURE:
Pulmonary vasculature is well opacified to the
segmental level without filling defect to indicate a pulmonary embolus.
Evaluation to the subsegmental level is limited. The diameter of the
ascending aorta is again in the upper limit of normal, measuring up to 4.0 cm
in diameter. There is no evidence of dissection or intramural hematoma.
Otherwise, the great vessels are within normal limits. The heart is within
normal limits. No substantial pericardial effusion is seen.
## AXILLA, HILA, AND MEDIASTINUM:
Several prominent but not pathologically
enlarged paratracheal and subcarinal nodes are noted. No axillary,
mediastinal, or hilar lymphadenopathy is present. No mediastinal mass is
seen.
## PLEURAL SPACES:
A posterior approach thoracostomy catheter is present within a
moderately-sized loculated pleural effusion, associated with pleural
enhancement. Several air locules are seen within the effusion. A trace
effusion is present on the left.
## LUNGS/AIRWAYS:
Fibrosis with numerous destructive cavitations are again seen
involving the right middle lobe. Consolidations involving the right apex are
similar allowing for differences in inspiratory effort. Comparison with the
prior study there are multifocal airspace and patchy consolidations primarily
involving the lower lobes, but also seen in the left upper lobe, predominately
within the dependent portions of the lungs. The patulous trachea is patent to
the level of the segmental bronchi bilaterally.
## BASE OF NECK:
Visualized portions of the base of the neck show no abnormality.
## ABDOMEN:
Included portion of the upper abdomen a prominent gallbladder and
multiple low attenuating liver lesions.
## BONES:
Multilevel degenerative changes of the thoracic spine without
suspicious osseous abnormality.? There is no acute fracture.
## IMPRESSION:
1. Progressive bilateral multifocal consolidations in a background of
significant fibrosis and destructive changes in the right middle lobe,
suggestive of multifocal pneumonia most notable in the lower lobes. Given the
dependent location of these changes, this may be secondary to aspiration.
2. Persistent right loculated pleural effusion with catheter in place.
3. No evidence of pulmonary embolism to the segmental level.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19274248", "visit_id": "25633511", "time": "2131-04-23 13:11:00"} |
19972351-RR-44 | 272 | ## INDICATION:
Epigastric pain that radiating to back for three days plus
nausea, query AAA, pancreatitis, cholecystitis.
## CT ABDOMEN WITH INTRAVENOUS CONTRAST:
In the imaged portion of the thorax,
there is bibasilar dependent atelectasis, but no mass, pleural effusion, or
pneumothorax. The imaged portion of the heart and great vessels appear normal
and there is no pericardial effusion.
In the abdomen, the liver, gallbladder, spleen, adrenals, stomach, and
abdominal loops of small bowel and large bowel appear normal and there is no
pathologic lymphadenopathy, free air, or free fluid. There are vascular
calcifications, but the aorta is of normal diameter (measuring 2.1 cm). The
kidneys symmetrically enhance and excrete contrast. There are bilateral non-
enhancing hypodensities, stable from the prior exams, likely simple cysts.
CT OF THE PELVIS WITH INTRAVENOUS CONTRAST:
Suture material is seen in the
region of the cecum status post laparoscopic appendectomy but otherwise pelvic
loops of bowel appear grossly unremarkable. The bladder and distal ureters
appear normal. The uterus is bulky and there is endometrial thickening with a
prominent fluid- filled endometrial cavity. The adnexa appear normal. There
is no pelvic lymphadenopathy, free air, or free fluid.
## MUSCULOSKELETAL:
There is no suspicious lytic or blastic lesion, but mild
multilevel degenerative changes are seen at numerous spinal levels.
## IMPRESSION:
1. No CT evidence for pancreatitis, cholecystitis, or abdominal aortic
aneurysm.
2. Prominent fluid-filled endometrial cavity and endometrial thickening
concening for endometrial cancer in a post-menopausal woman; recommend
appropriate work-up to exclude cancer.
3. Incidental findings include stable bilateral renal cysts.
## COMMENT:
Results posted to Record of Notifications of Critical Radiology
Findings for follow up.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19972351", "visit_id": "22357721", "time": "2111-05-03 15:43:00"} |
13973123-RR-108 | 127 | ## INDICATION:
Fall one week ago. Ataxia.
## FINDINGS:
There is no acute hemorrhage, edema, mass effect, or acute large
territorial infarction. Prominent ventricles and sulci suggest age-related
involutional changes. Prominent periventricular white matter hypodensities
are consistent with chronic small vessel ischemic disease. Two subcentimeter
areas of hypodensity one located in the left internal capsule and the other
located in the external capsule are unchanged and most likely represent areas
of chronic small vessel infarcts. The basal cisterns are patent, and there is
preservation of gray-white differentiation.
There is no fracture. The paranasal sinuses and middle ear cavities are
clear. Absence of most of the right mastoid air cells is likley post
surgical. The left mastoid air cells are clear.
## IMPRESSION:
No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13973123", "visit_id": "20648376", "time": "2189-10-26 11:53:00"} |
15606926-RR-64 | 474 | ## INDICATION:
Recent J-tube placement and Billroth II for gastric ulcer
perforation. Concern for small-bowel obstruction or perforation.
## ABDOMEN:
Small bilateral pleural effusions are present, with adjacent compressive
atelectasis (2:2). The heart is mildly enlarged. There is no pericardial
effusion. Severe atherosclerotic calcifications are seen at the aortic valve
and coronary vessels (2:7). The proximal ascending thoracic aorta is
prominent, measuring 35 mm (2:1).
There is a small hiatal hernia (2:15).
A 3.3 x 2.8 cm well-circumscribed hypodense lesion within the left hepatic
lobe (2:26) has enlarged since the examination, most likely
a cyst. A tiny calcification within the right lobe (2:21) is unchanged. An
ill-defined subcentimeter hypodensity at the inferior aspect of the right
hepatic lobe (2:10) and two adjacent subcentimeter lesions are slightly
increased in size since , but remain too small for further
characterization. There is no intra- or extra-hepatic bile duct dilation.
Gallstones are present within an otherwise normal-appearing gallbladder (2:32,
27). The pancreas, adrenal glands, kidneys, and spleen are within normal
limits.
The patient is status post partial gastrectomy and Billroth II. Oral
contrast, introduced from a J-tube terminating within the mid jejunum,
refluxes into the stomach via the gastrojejunostomy, and into the duodenal
limb (301B:25). There is no evidence of obstruction.
A trace amount of hyperdense material lining the anterior surface of the left
hepatic lobe (2:20) and posterior to the spleen (2:16) is likely contrast
material. This finding more likely related to contrast spillage prior to the
current examination, as there is lack of free intraperitoneal air or free
simple fluid.
## PELVIS:
Numerous iliac surgical clips denote prior lymph node dissection.
The uterus is surgically absent. No adnexal masses are detected. A Foley
catheter terminates within a collapsed bladder. There is no intrapelvic free
fluid or lymphadenopathy. Sigmoid diverticulosis is present.
## OSSEOUS STRUCTURES:
There is no acute fracture. No concerning blastic or
lytic lesions are identified. Severe multilevel degenerative changes are seen
throughout the thoracolumbar spine, including a mild wedge compression
deformity at T12, with neighboring endplate sclerosis, loss of disc height
superiorly and inferiorly, and extensive anterior and posterior osteophytosis.
There is grade 1 anterolisthesis of L4 over L5, with loss of intervertebral
disc height, vacuum phenomenon ( ), and moderate thecal sac narrowing.
The patient is status post total right hip arthroplasty, with no evidence of
hardware failure or loosening. (301B:35).
## IMPRESSION:
1. No acute intra-abdominal process. Specifically, no bowel obstruction or
free air. Patent gastrojejunostomy anastomosis.
2. Trace contrast material lining the anterior surface of the left hepatic
lobe and posterior to the spleen is likely old spillage, as there is lack of
free intraperitoneal air or simple fluid on the current examination.
3. Cholelithiasis.
4. Small bilateral pleural effusions with adjacent compressive atelectasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15606926", "visit_id": "22573702", "time": "2149-07-29 00:40:00"} |
16345529-RR-163 | 94 | ## FINDINGS:
Suboptimal examination due to patient motion. There is no evidence
of acute hemorrhage, edema, mass effect or recent infarction. The gray-white
matter differentiation is preserved. Areas of periventricular white matter
hypodensities likely represents sequela of chronic small vessel ischemic
disease and appears similar in extent and distribution as compared to the
prior examination. The ventricles and sulci are normal in size and
configuration for the patient's age. No concerning osseous lesion is seen.
The visualized paranasal sinuses are clear.
## IMPRESSION:
No evidence of acute intracranial abnormality given patient
motion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16345529", "visit_id": "25731241", "time": "2163-10-17 13:31:00"} |
12011488-RR-25 | 66 | ## INDICATIONS:
man with submucosal mass in the stomach on EGD.
## BONE WINDOWS:
There is a sclerotic focus in the left acetabulum, probably a
bone island, which is unchanged. There are no suspicious lytic or blastic
lesions.
## IMPRESSION:
1. No evidence of metastatic disease.
2. Resolution of inflammatory change and hydronephrosis involving the left
kidney.
3. Large simple right-sided renal cyst without suspicious features.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12011488", "visit_id": "N/A", "time": "2133-05-04 13:16:00"} |
19428864-RR-43 | 221 | ## EXAMINATION:
INJ/ASP MAJOR JT W/FLUORO
## INDICATION:
year old woman with adhesive capsulitis, request for injection
of the right joint with Marcaine without epi and 80mg kenalog.
## PROCEDURE:
The risks, benefits, and alternatives were explained to the
patient and written informed consent obtained.
A pre-procedure timeout confirmed three patient identifiers.
Under fluoroscopic guidance, an appropriate spot was marked. The area was
prepared and draped in standard sterile fashion.
3 cc of 1% Lidocaine was used to achieve local anesthesia. Under intermittent
fluoroscopic guidance, a 22-gauge needle was advanced into the right
glenohumeral joint. Appropriate position was confirmed by the injection of a
small amount of water soluble contrast. A mixture of 3 cc of 0.25%
bupivacaine and 80mg of Kenalog was injected, dispersing the contrast.
The needle was removed, hemostasis achieved, and a sterile bandage applied.
The patient experienced improvement in symptoms following the procedure.
The patient tolerated the procedure well and left the department in good
condition. There were no immediate complications or complaints.
## FINDINGS:
Intraprocedural frontal fluoroscopic images of the right shoulder demonstrated
free flow of intraarticular contrast.
## IMPRESSION:
1. Imaging Findings- as above.
2. Procedure - Technically successful therapeutic injection into the right
glenohumeral joint.
The procedure was supervised by Dr. attending radiologist,
who was present for the critical portions of the procedure.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19428864", "visit_id": "N/A", "time": "2147-01-23 14:51:00"} |
11611745-RR-24 | 110 | ## HISTORY:
New left PICC line.
CHEST, SINGLE AP PORTABLE VIEW.
Rotated positioning.
A left subclavian PICC line is present -- the tip is not optimally visualized
but appears to lie in the region of the cavoatrial junction. A left
subclavian central line present, tip over proximal SVC. No pneumothorax
detected.
As before, the left hemidiaphragm is elevated, obscuring the cardiac
silhouette. There is hazy opacity at the right lung base, with improved
atelectasis at the right base. Opacity at the right base may relate to a
layering effusion. The left hemidiaphragm is elevated with patchy opacity at
the left base, also slightly improved. Small left effusion. Spinal rods
noted.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11611745", "visit_id": "26465792", "time": "2137-11-08 09:52:00"} |
13627190-RR-65 | 150 | ## INDICATION:
History: with med nail in L femur// loose hardware
## FINDINGS:
Patient is status post ORIF of the left femur. Again seen is expansile
lucent, lytic lesions involving the mid shaft of the femur which is increased
in size as compared to the prior study. Oblique linear lucency through the
medial aspect is again seen, slightly more conspicuous on the current study,
consistent with pathologic fracture.
There are 2 nails through the distal femur, the superior more has migrated
laterally as compared to the prior study dd, with approximately 1.7 cm outside
and lateral to the bone.
## IMPRESSION:
Expansile lytic lesion in the left femoral shaft has increased in size
compared to the prior study. Pathologic fracture seen medially is more
conspicuous than on the prior study.
1 of the nails in the distal femur has migrated laterally with approximately
1.7 cm outside of the bone.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13627190", "visit_id": "25247128", "time": "2123-03-09 13:48:00"} |
16645342-DS-13 | 905 | ## ALLERGIES:
shellfish derived / Iodine and Iodide Containing Products
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
s/p CABGx1 Sternal Wound debridement
## HISTORY OF PRESENT ILLNESS:
Delightful year old gentleman
with pmh of CAD and multiple stents, most recently noted to have
patent RCA and OM stents and in-stent stenosis in LAD stent
so PCI and new stent placement was performed then. He
later developed return of his angina and cath showed LAD 70%
in-stent restenosis with an FFR of 0.76. So he underwent CABGX1
(lima-LAD) on and had uneventful recovery. His Effient
was restarted postoperatively. He recently noted sternal
drainage and during his 1month postop check today, his sternal
incision was debrided. He developed some bleeding and wound was
again evaluated, cauterized with good effect, dressed and he was
discharged home with plan for Doxycycline and to follow up
with wound VAC. He called this evening to report that his
sternal dressing had become saturated after 4hours. He denies
sternal clicks/pops, fever, chills, dyspnea, dizziness,
palpitations or other bleeding sources. His glucose has been
well controlled (90-168) since surgery. His last Effient dose
was .
## PAST MEDICAL HISTORY:
Coronary Artery Disease
Diabetes Mellitus, poorly controlled
Hyperlipidemia
Hypertension
Myocardial Infarction
## FAMILY HISTORY:
Father with MI at
Twin brother with MI and CABGx3
## GENERAL:
WDWN in NAD, obese
## SKIN:
Warm, Dry and intact
## NECK:
Supple [X] Full ROM [X]
## CHEST:
Lungs clear bilaterally [X]
## STERNUM:
middle incision open (1.5 cm wide x 2 cm deep x 4cm
long) and lower pole open (3 cm deep x 5cm long x 2.5 cm wide).
both wounds have very slow trickle, non pulsatile blood from
upper poles that significantly slowed with 45min of manual
pressure. otherwise, red,beefy granulation tissue and typical
fat
noted in wound beds. Sternum stable w/o click/pops
## HEART:
RRR, NlS1-S2, No M/R/G
## EXTREMITIES:
Warm [X], well-perfused [X] No Edema
## PORTABLE CXR:
Lung volumes are low, both the left and the
right hemidiaphragm a elevated. No larger pleural effusions are
seen.
Borderline size of the cardiac silhouette. No pulmonary edema,
no pneumonia,
no pneumothorax. The alignment of the sternal wires is
unremarkable.
## BRIEF HOSPITAL COURSE:
The patient was admitted to C-surg after discovering wound
dehiscence in the mid-portion and lower pole of the incision. In
the clinic the mid portion and lower
pole now 4cmx2cm and 2cm deep. Mid portion is 6cm x 2cm and 3 cm
deep. Wound cleaned with healthy bloody tissue exposed. After
debriding the patient the patient continued to have
coagulopathic ooze. The patient was admitted for observation and
wet to dry dressings were applied. A wound VAC was placed prior
to discharge. The patient was discharged home on hospital day 3
and will continue on 10 days of doxycycline. He will see Dr.
in clinic in 1 week.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild
2. Aspirin 81 mg PO DAILY
3. Metoprolol Succinate XL 200 mg PO DAILY
4. Pantoprazole 40 mg PO Q24H
5. Ranitidine 150 mg PO BID
6. TraMADol 50 mg PO Q4H:PRN Pain - Moderate
7. Glargine 20 Units Breakfast
Insulin SC Sliding Scale using HUM Insulin
8. Atorvastatin 80 mg PO QPM
9. MetFORMIN (Glucophage) 1000 mg PO BID
10. empagliflozin 10 mg oral DAILY
11. Prasugrel 10 mg PO DAILY
12. Victoza 2-Pak (liraglutide) 0.6 mg/0.1 mL (18 mg/3 mL)
subcutaneous DAILY
13. Doxycycline Hyclate 100 mg PO Q12H
14. Baclofen 10 mg PO TID:PRN Muscle Spasms
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO QID:PRN Pain - Mild
2. Glargine 20 Units Breakfast
Insulin SC Sliding Scale using HUM Insulin
3. Aspirin EC 81 mg PO DAILY
4. Atorvastatin 80 mg PO QPM
5. Baclofen 10 mg PO TID:PRN Muscle Spasms
6. Doxycycline Hyclate 100 mg PO Q12H
RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth twice a day
Disp #*20 Tablet Refills:*0
7. empagliflozin 10 mg oral DAILY
8. MetFORMIN (Glucophage) 1000 mg PO BID
9. Metoprolol Succinate XL 200 mg PO DAILY
10. Pantoprazole 40 mg PO Q24H
11. Prasugrel 10 mg PO DAILY
12. Ranitidine 150 mg PO BID
13. TraMADol 50 mg PO Q4H:PRN Pain - Moderate
RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp
#*30 Tablet Refills:*0
14. Victoza 2-Pak (liraglutide) 0.6 mg/0.1 mL (18 mg/3 mL)
subcutaneous DAILY
## DISCHARGE DIAGNOSIS:
s/p CABGx1 Sternal Wound debridement
## DISCHARGE CONDITION:
Alert and oriented x3, non-focal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
1+ Edema
## DISCHARGE INSTRUCTIONS:
Please shower daily -wash incisions gently with mild soap, no
baths or swimming, look at your incisions daily
Please - NO lotion, cream, powder or ointment to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics
Clearance to drive will be discussed at follow up appointment
with surgeon
No lifting more than 10 pounds for 10 weeks
Encourage full shoulder range of motion, unless otherwise
specified
**Please call cardiac surgery office with any questions or
concerns . Answering service will contact on call
person during off hours**
## DRESSINGS:
Keep VAC in placed
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16645342", "visit_id": "27731836", "time": "2117-09-11 00:00:00"} |
11391086-RR-36 | 190 | ## HISTORY:
Right sacral fracture or metastatic disease.
## CT PELVIS:
Helical imaging was performed through the pelvis without
intravenous or oral contrast. Sagittal and coronal reformats were prepared.
## FINDINGS:
There is no fracture or dislocation. There is loss of
intervertebral disc height between L5 and S1 with endplate sclerosis. There
is severe loss of joint space at the femoral acetabular joints along the
medial superior surfaces bilaterally, more pronounced on the right than left
(400B:38). There is subchondral sclerosis. In the posterior acetabula
bilaterally (2:72) there is subchondral cyst formation. There are
degenerative changes at the pubic symphysis with enthesophyte formation.
There are small enthesophytes arising off the greater trochanters bilaterally.
The appearance of the sacroiliac joints appears unremarkable. There is no
fracture of the sacral ala.
Limited views of the pelvis demonstrate mild sigmoid diverticulosis. There is
a normal visualized appendix. The bladder is decompressed. There is no free
air, free fluid, or significant adenopathy.
## IMPRESSION:
1. No CT evidence for bony lesions. If there remains concern for bony
lesions, MRI would be recommended.
2. No fractures.
3. Bilateral hip degenerative changes. Lumbar spine degenerative changes.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11391086", "visit_id": "N/A", "time": "2189-02-04 13:23:00"} |
19160437-RR-19 | 227 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
year old woman with AIH/PBC cirrhosis// screening
## LIVER:
The hepatic parenchyma appears coarsened and heterogeneous. The
contour of the liver is nodular, consistent with cirrhosis. There is no focal
liver mass, however sensitivity to small lesions is reduced by the diffuse
nodularity and background heterogeneity of the hepatic parenchyma. The main
portal vein is patent with hepatopetal flow. The right and left portal veins
are diminutive with slow hepatopetal flow. There is no ascites.
## BILE DUCTS:
There is no intrahepatic biliary dilation.
## GALLBLADDER:
Cholelithiasis is re-demonstrated within a contracted
gallbladder.
## PANCREAS:
The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
## KIDNEYS:
Limited views of the kidneys show no hydronephrosis.
Right kidney: 11.1 cm. A simple cyst is visualized within the upper pole of
the right kidney measuring 1.5 x 1.5 x 1.1 cm.
Left kidney: 9.6 cm
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
1. Cirrhotic liver, without evidence of focal lesion, splenomegaly or ascites.
The ultrasound is somewhat limited for adequate assessment of small lesions
due to the markedly nodular and heterogeneous parenchyma.
2. Diminutive, difficult to assess portal veins demonstrating appropriate
direction of flow.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19160437", "visit_id": "N/A", "time": "2133-04-14 07:32:00"} |
17610192-RR-43 | 404 | ## EXAMINATION:
CT abdomen and pelvis without contrast
## INDICATION:
year old man with PMH of frequent kidney stones p/w flank pain
and hematuria. also has known renal cyst // eval for nephrolithiasis,
obstruction, hydronephrosis. please protocolize as appropriate to evaluate for
renal/ureteral stones
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogeneous hypoattenuation throughout,
consistent with hepatic steatosis. There is no evidence of focal lesions
within the limitations of an unenhanced scan. 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 within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. There is a small accessory spleen.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size. A 1.1 cm left lower
pole renal cyst is unchanged. A 9 mm hyperdense lesion in the right lower pole
is not significantly changed, and had no suspicious features on renal
ultrasound from . Multiple punctate nonobstructing stones are
again seen in the right kidney. There is a 3 mm stone at the left
ureterovesicular junction (2:80, 601b:33). There is new left mild
hydronephrosis and hydroureter. There is no perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. Diverticulosis of the sigmoid
colon is noted, without evidence of wall thickening and fat stranding. The
appendix is not visualized.
## PELVIS:
The urinary bladder is unremarkable. There is no free fluid in the
pelvis.
## REPRODUCTIVE ORGANS:
The prostate and seminal vesicles are unremarkable.
Coarse calcification in the midline prostate likely reflects the sequela of
previous inflammation. .
## 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.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. 3 mm obstructing left ureterovesicular junction stone with mild left
hydroureteronephrosis.
2. Multiple punctate nonobstructing stones in the right kidney.
3. Hepatic steatosis.
4. Diverticulosis, with no evidence of acute diverticulitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17610192", "visit_id": "N/A", "time": "2185-01-07 15:07:00"} |
19231576-RR-45 | 110 | ## EXAMINATION:
ART EXT (REST ONLY)
## INDICATION:
year old woman with diabetes, cold feet at night, getting
worse, R/O PVD // r/o PVD
## FINDINGS:
On the right side, triphasic Doppler waveforms were seen in the common
femoral, superficial femoral, popliteal, posterior tibial, and dorsalis pedis
arteries. The right ABI was 1.21 at rest.
On the left side, triphasic Doppler waveforms were seen in the common femoral,
superficial femoral, popliteal, posterior tibial, and dorsalis pedis arteries.
The left ABI and was 1.11 at rest.
Pulse volume recordings showed symmetric amplitudes bilaterally at all levels.
## IMPRESSION:
No evidence of arterial insufficiency to the lower extremities bilaterally at
rest.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19231576", "visit_id": "N/A", "time": "2148-04-26 12:46:00"} |
14965907-DS-11 | 774 | ## ALLERGIES:
Sulfa (Sulfonamide Antibiotics) / Lactose / Ciprofloxacin
## PAST MEDICAL HISTORY:
PMH
1. Anemia.
2. Constipation.
3. Urethral dilatations
4. diverticulitis
5. ureteral obstruction
PSH
1. S/P T&A
2. cystoscopy with left ureteral stent
## FAMILY HISTORY:
No history of Crohns, IBS, colon cancer.
## GENERAL:
Tolerating Clears, Passing Flatus
## WOUND:
Old ileostomy site with sero-sang drainage, wicks removed
and covered with a dry sterile dressing on morning rounds.
## BRIEF HOSPITAL COURSE:
The patient was admitted to the inpatient ward after an
ileostomy takedown. She tolerated this procedure well and
remained stable on the floor. The patient was started on clear
liquids on post-operative day one which she tolerated well. On
post-operative day two the patient had yet to have adequate
return of bowel function. She remained of clear liquids however
was tolerating pain medications by mouth and her Foley was
removed and she was voiding on her own. Dr. was very
concerned about Mrs. as she had gained a large amount of
weight since her pervious procedure. The patient reported
emotional eating to cope with life stressors. Social work was
consulted as well as nutrition, both teams met with the patient
prior to discharge. On the morning of post-operative day three
the patient had passed gas and she was started on a regular
diet. The patient was discharged home with proper
medical/surgical follow-up.
## DISCHARGE MEDICATIONS:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain for 7 days.
3. oxycodone 5 mg Tablet Sig: Tablets PO Q4H (every 4 hours)
as needed for pain for 5 days: Please do not drink alcohol or
drive a car whlie taking this medication.
Disp:*45 Tablet(s)* Refills:*0*
## DISCHARGE INSTRUCTIONS:
You were admitted to the inpatient ward after an ileostomy
takedown. This procedure went well, you have pased gas,
tolerated a regular diet and you are now ready to be discharged.
Please continue to eats small frequent meals and monitor your
bowl function. Please monitor your bowel function closely. You
may or may not have had a bowel
Movement prior to your discharge which is acceptable, however it
is important that you have a bowel movement in the next
days. After anesthesia it is not uncommon for patients to have
some decrease in bowel function but your should not have
prolonged constipation. Some loose stool and passing of small
amounts of dark, old appearing blood are explected however, if
you notice that you are passing bright red blood with bowel
movments or having loose stool without improvement please call
the office or go to the emergency room if the symptoms are
severe. If you are taking narcotic pain medications there is a
risk that you will have some constipation. Please please call
the office if you have symptomsof constipation. f you have any
of the following symptoms please call the office for advice or
go to the emergency room if severe: increasing abdominal
distension, increasing abdominal pain, nausea, vomiting,
inability to tolerate food or liquids, prolonges loose stool, or
constipation. You may have some loose stools as firstand
occational incontinence of small amounts of stool, this is
because your rectal spincter has not been used for quite some
time. Please call the office for advice if this is needed.
Please leave the wound from your old ileostomy site covered with
s dry sterile dressing. You may shower,let the warm soapy water
run over the area and then cover. You should watch this wound
for signs and symptomsof infection including: increased redness,
increased pain, increased drainage that is
white/green/thick/malodorous, increased warmth at the site, if
you develop a fever, or if you have increased pain. Please call
the office if you develop these symptoms or go to the emergency
room if they are severe.
You will be given a small amount of the pain medication
oxycodone. Please take this as prescribed, do not drink alcohol
while taking this medication. Please take tylenol is written if
needed, do not take more than 4000mg of tylenol daily. Donot
drink alcohol while taking tylenol.
It is important to continue to follow a low calorie diet. It is
important to follow recommendations from nutrition and follow-up
with your primary care provider to help you think of stratigies
to manage your wieght. After you have recovered from surgery, it
will be a good idea to start a low impact excersise program to
help you manage your wieght. Please clear begining any excersise
program with Dr. .
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14965907", "visit_id": "23525982", "time": "2127-02-16 00:00:00"} |
11296936-RR-346 | 432 | ## INDICATION:
Patient with fever to 103 and abdominal pain, evaluate for reason
for abdominal pain such as pancreatitis or abscess.
## FINDINGS:
Evaluation of soft tissue and vasculature are somewhat limited due to
suboptimal contrast-enhanced study from manual injection of IV contrast.
## LOWER CHEST:
Ground glass opacities are noted in the bilateral lung bases. A
small focal consolidation is seen in the right medial lung base. The heart is
moderately enlarged with coronary artery and aortic valve calcification.
Previous small pleural effusions have resolved.
## LIVER:
The liver enhances homogeneously without suspicious focal lesions.
There is no intrahepatic biliary duct dilatation. The gallbladder is
decompressed and the portal vein is patent.
## PANCREAS:
The pancreas enhances homogeneously without evidence of
pancreatitis. Known hypodense lesions within the pancreatic body are again
demonstrated, largest measuring 10 mm, previously characterized as IPMNs on
MRI from .
## SPLEEN:
The spleen is homogeneous and normal in size.
## ADRENALS:
The adrenal glands are unremarkable.
## KIDNEYS:
The kidneys again demonstrate multiple cortical and medullary
hypodensities, suggestive of lithium induced nephropathy. They enhance
homogeneously and excrete contrast promptly without evidence of
hydronephrosis.
## GI TRACT:
Diffusely dilated loops of small bowel measuring up to 4.5cm with
air-fluid levels with gradual decrease in caliber and a relative transition
point seen in the right lower quadrant (2:58). There is distal decompression
of the remaining small bowel and colon. There is no evidence of wall
thickening, pneumatosis, or intra-abdominal free air. The appendix is normal.
## VASCULAR:
The aorta is of normal caliber without aneurysmal dilatation. The
IVC and major abdominal vessels are patent.
## RETROPERITONEUM AND ABDOMEN:
There is no retroperitoneal or mesenteric lymph
node enlargement. No ascites or free air is seen. Note is made of a small
fat containing umbilical hernia.
## PELVIC CT:
The urinary bladder and terminal ureters are normal. No pelvic
wall or inguinal lymph node enlargement is seen. A penile prosthesis with
pump is in place.
## OSSEOUS STRUCTURES:
No blastic or lytic lesion suspicious for malignancy is
present. Diffuse sclerosis compatible with renal osteodystrophy is again
noted.
## IMPRESSION:
1. Dilated loops of small bowel measuring up to 4.5 cm with air-fluid levels
with a relative transition point seen in the right lower quadrant and
decompressed distal bowel. Findings concerning for small bowel obstruction.
2. Focal consolidation is seen in the right mid lung, which may represent
atelectasis or a supervening infection in the appropriate clinical setting.
Bibasilar ground-glass opacities likely represents edema and/or atelectasis.
Previous small pleural effusions have resolved.
Finding were communicated with by telephone at 6:30pm on
day of exam.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11296936", "visit_id": "26682784", "time": "2150-06-19 08:20:00"} |
17041034-RR-5 | 93 | ## HISTORY:
year old man with sepsis and PICC line
## FINDINGS:
Right subclavian PICC has been placed with tip ending in proximal right
atrium.
There is no pneumothorax.
Right lung parenchyma is well inflated and clear.
Left lung is well inflated, but with small pleural effusion on the left base.
Heart and aorta are normal.
The left upper border of the mediastinum is mildly enlarged, probably for
enlargment of central vein.
## IMPRESSION:
The PICC line is in standard position.
There is a small left basal pleural effusion
Central vein appear mildly enlarged
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17041034", "visit_id": "28189368", "time": "2125-07-27 00:03:00"} |
18398415-RR-19 | 97 | ## DOSE:
3 min 5 seconds of fluoro time
## ESOPHAGUS:
The esophagus was not dilated. There was no esophageal web, ring, or
stricture. There was no esophageal mass. The esophageal mucosa appears within
normal limits.
There was a moderate-sized axial hiatal hernia. There was gastroesophageal
reflux. Mild tertiary contractions are noted
## STOMACH:
Views of the stomach show appropriate mucosal folds. No focal lesion is
identified. No evidence of gastric outlet obstruction, and barium passes
freely into the duodenum.
## IMPRESSION:
1. Moderate-sized axial hiatal hernia with gastroesophageal reflux.
2. Mild tertiary contractions of the esophagus
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18398415", "visit_id": "N/A", "time": "2160-03-07 09:53:00"} |
15439394-RR-47 | 116 | ## INDICATION:
woman with pedestrian struck.
## HEAD CT WITHOUT CONTRAST:
There is no comparison. There is no acute
intracranial hemorrhage, mass effect, or shift of normally midline structures,
or significant loss of gray-white differentiation. There is a 1 cm
hypodensity in the periventricular white matter in the right frontal lobe,
which is nonspecific, however, could represent prior lacunar infarct or
chronic small vessel ischemia. There is minimal mucosal thickening in the
ethmoid sinus. Otherwise, the surrounding osseous and soft tissue structures
are unremarkable.
## IMPRESSION:
No acute intracranial hemorrhage or mass effect. Small
hypodensity in the right frontal white matter, which is nonspecific, however,
could due to prior lacunar infarct or chronic small vessel ischemia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15439394", "visit_id": "N/A", "time": "2196-05-07 15:00:00"} |
11153020-RR-12 | 111 | ## CLINICAL HISTORY:
Chronic myeloid leukemia and hepatitis C with cirrhosis.
## ABDOMINAL ULTRASOUND:
The liver is enlarged and somewhat irregular consistent with known cirrhosis.
No focal masses are seen within the liver. Normal portal blood flow was
present. Normal hepatic venous and arterial flow is also demonstrated.
The spleen was enlarged measuring 15.3 cm. The texture was unremarkable.
The gallbladder is free of stones. The common duct measures 5 mm, which is
normal.
Both right and left kidneys are normal. There is no free fluid within the
abdomen.
Appearances are little changed since the prior CT of .
## IMPRESSION:
No liver masses. Echogenic liver consistent with known cirrhosis, enlarged
spleen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11153020", "visit_id": "N/A", "time": "2164-01-11 09:35:00"} |
14799353-RR-140 | 154 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
History: with AMS s/p head strike // bleed?
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.7 cm; CTDIvol = 48.1 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
There is no evidence of acute fracture, large territory infarction,
intracranial hemorrhage,edema,or mass effect. There is prominence of the
ventricles and sulci suggestive of involutional changes.
There is minimal soft tissue edema in the left forehead. Old bilateral nasal
bone fractures are seen. There is also an old fracture of the right lamina
papyracea.
There is partial opacification of bilateral maxillary sinuses as well as
bilateral ethmoidal sinuses. Mastoid air cells, and middle ear cavities are
clear. The visualized portion of the orbits are normal.
## IMPRESSION:
No acute intracranial abnormality.
Old bilateral nasal bone fractures and old fracture of the right lamina
papyracea.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14799353", "visit_id": "N/A", "time": "2179-02-28 17:48:00"} |
18824198-DS-29 | 1,470 | ## ALLERGIES:
Amoxicillin / Alphagan P / acetaminophen
## CHIEF COMPLAINT:
Right renal pelvic cancer
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
1. Laparoscopic right radical nephrectomy and total
ureterectomy.
2. Robot-assisted laparoscopic repair of cystorrhaphy.
## HISTORY OF PRESENT ILLNESS:
with history of bladder cancer s/p TURBT, found to have
right renal pelvic tumor.
## PAST MEDICAL HISTORY:
Cholangiocarcinoma s/p resection and radiation complicated by
gastric outlet obstruction, cholangitis s/p PTC x 2, and
ascites.
Remote h/o hypertension and hypercholesterolemia, cataracts,
bladder cancer s/p cystoscopic resection
## PAST SURGICAL HISTORY:
Appendectomy, CBD excision with cholecystectomy and Roux-en-Y
hepatico-jejunostomy ( ), Gastrojejunostomy ( ), PTC x 2,
multiple paracentesis, cystoscopy with resection of bladder
polyp, L total hip replacement with subsequent revision
## NOTED :
CAD, s/p MI HTN; HPL; OA; OSA, wears
BiPap at night;
L-sided rib fxs; 2 PEs and cholangiocarcinoma, s/p
excision and radiation; diverticulosis, bladder polyps followed
by urologist in .
## NOTED :
appy arthroscopic L knee surgery, removal
of L foot neuroma kidney stone surgery multiple eye
surgeries, including R trabeculectomy, R retina welding, R
capsulotomy, cataract removals; revision of L hip CBD
excision, CCY, and RnY hepaticojejunostomy bladder
polyp removal and cauterization IVC filter
colonoscopy w polypectomy colonoscopy , B/L PTBD
placement , PTC w biliary dilation .
Therapeutic paracentesis ,
.
liver biopsy
## FAMILY HISTORY:
negative for malignancy; father and sister with DM
## PHYSICAL EXAM:
WdWn male NAD, AVSS
Interactive, cooperative
Abdomen soft, slightly distended/protuberant and with multiple
well healed surgical scars c/w prior surgeries. JP drain has
been removed. He is appropriately tender along incisions that
are c/d/i w/out evidence hematoma, infection. He has abdominal
binder.
Extremities w/out edema or pitting and no report of calf pain
## BRIEF HOSPITAL COURSE:
Mr. was admitted to Urology after undergoing laparoscopic
right radical nephrectomy and total ureterectomy with
robot-assisted laparoscopic repair of cystorrhaphy. No
concerning intraoperative events occurred; please see dictated
operative note for details. The patient received perioperative
antibiotic prophylaxis. The patient was transferred to the floor
from the PACU in stable condition. On POD0, pain was well
controlled on PCA, hydrated for urine output >30cc/hour,
provided with pneumoboots and incentive spirometry for
prophylaxis, and ambulated once. On POD1, the patient was
restarted on home medications, basic metabolic panel and
complete blood count were checked, pain control was transitioned
from PCA to oral analgesics, diet was advanced to a clears/toast
and crackers diet. On POD2, JP was removed without difficulty
and diet was advanced as tolerated.
He developed some mid-afternoon bloating not associated with
nausea and went from feeling "like a rock-star" to generally
weak and ill. He diet was pulled back to clears and he was kept
overnight for further observation. He was not having any flatus
but did have bowel sounds in all four quadrants... although
faint. On POD3 he was reporting significant improvement. His
diet was again advanced to regular/heart- healthy and the
remainder of the hospital course was relatively unremarkable.
The patient was discharged in stable condition, eating well,
ambulating independently, Foley catheter in place, and with pain
control on oral analgesics.
On exam, incision was clean, dry, and intact, with no evidence
of hematoma collection or infection. The patient was given
explicit instructions to follow-up in clinic with Dr. in
about 10 days for cystogram and trial of void/Foley removal. He
will follow-up with Dr. his PCP as advised. He was
discharged on half his pre-admission doses of lasix and
spirinolactone and will review his medication requirements with
Dr. his PCP. All questions for Mr. and wife
were answered.
## ALLERGIES:
alphagan, amoxicillin
fentanyl 12 mcg/hour Patch 72 hr Apply one patch every 72 hours
albuterol sulfate (Prescribed by Other Provider)
90 mcg HFA Aerosol Inhaler 2 HFA(s) inhaled every six (6) hours
as needed for wheezing : Hasn't used in 2 months
ciprofloxacin 250 mg Tablet 1 Tablet(s) by mouth every
hours
fluticasone [Flovent HFA] (Prescribed by Other Provider)
110 mcg/Actuation Aerosol 2 Aerosol(s) inhaled twice a day as
needed for wheezing : Hasn't used in 2 months
furosemide 20 mg Tablet 2 Tablet(s) by mouth twice a day
pantoprazole 40 mg Tablet, Delayed Release (E.C.)1 Tablet(s)
by mouth daily
prednisolone acetate [Pred Forte] (Prescribed by Other
Provider)
1 % Drops, Suspension 1 in the right eye once a day
ursodiol 300 mg Capsule 1 Capsule(s) by mouth twice a day
Melatonin Oral 3 mg every day at bedtime
multivitamin Tablet 1 Tablet(s) by mouth DAILY (Daily)
zinc (OTC) 50 mg Tablet 1 Tablet(s) by mouth per day
Vitamin C Oral 500 mg every day
Spironolactone Oral 100 mg every day a.m
traMADol Oral 50 mg every 4 hours as needed for pain for
breakthru pain
Prochlorperazine Oral 5 mg 3 times per day as needed for
nausea and vomiting
## DISCHARGE MEDICATIONS:
1. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*2*
2. Meladox 3 mg Tablet Extended Release Sig: One (1) Tablet
Extended Release PO QHS (once a day (at bedtime)): Meladox
(melatonin) 3 mg Oral QHS .
3. ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
4. zinc sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
5. ascorbic acid mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours) as needed for
wheezing.
7. fentanyl 12 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
8. fluticasone 110 mcg/actuation Aerosol Sig: Two (2) Puff
Inhalation BID (2 times a day) as needed for wheezing.
9. oxycodone 5 mg Tablet Sig: Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
10. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for breakthrough pain.
## 11. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY
(Daily).
12. prednisolone acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic DAILY (Daily).
13. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. spironolactone 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): This is HALF your pre-admission dose.
15. furosemide 20 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day): This is HALF your pre-admission dose.
## PREOPERATIVE DIAGNOSIS:
Right renal pelvic cancer.
## POSTOPERATIVE DIAGNOSIS:
Right renal pelvic cancer.
## DISCHARGE INSTRUCTIONS:
-Please also refer to the provided written instructions on
post-operative care, instructions and expectations made
available from Dr. office.
-Resume your pre-admission/home medications except as noted.
ALWAYS call to inform, review and discuss any medication changes
and your post-operative course with your primary care doctor.
- your pre-admission doses have been resumed with regard to
LASIX and SPIRINOLACTONE.
-Given your liver concerns, avoid ACETAMINOPHEN (Tylenol)
products as instructed.
-Do not lift anything heavier than a phone book (10 pounds) or
drive until you are seen by your Urologist in follow-up
-Resume all of your pre-admission/home medications except as
noted. Do not take Aspirin or Non-steroidal anti-inflammatories
(ibuprofen, etc.) unless advised to do so.
-Call your Urologist's office today to schedule/confirm your
follow-up appointment in 3 weeks AND if you have any questions.
-Do not eat constipating foods for weeks, drink plenty of
fluids to keep hydrated
-No vigorous physical activity or sports for 4 weeks or until
otherwise advised
-Tylenol should be your first line pain medication, a narcotic
pain medication has been prescribed for breakthrough pain >4.
Replace Tylenol with narcotic pain medication.
-Max daily Tylenol (acetaminophen) dose is 4 grams from ALL
sources, note that narcotic pain medication also contains
Tylenol
-If you have been prescribed IBUPROFEN (the ingredient of Advil,
Motrin, etc.) , you may take this and Tylenol together
(alternating) for additional pain control
-----
please try TYLENOL
FIRST and take the narcotic pain medication as prescribed if
additional pain relief is needed.
-Ibuprofen should always be taken with food. Please discontinue
taking and notify your doctor should you develop blood in your
stool (dark tarry stools)
-You may shower normally but do NOT immerse your incisions or
bathe
-Do not drive or drink alcohol while taking narcotics and do not
operate dangerous machinery
-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication.
Discontinue if loose stool or diarrhea develops. Colace is a
stool-softener, NOT a laxative
-If you have fevers > 101.5 F, vomiting, or increased redness,
swelling, or discharge from your incision, call your doctor or
go to the nearest emergency room.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18824198", "visit_id": "27216985", "time": "2160-09-22 00:00:00"} |
17164822-RR-27 | 95 | ## INDICATION:
Intermenstrual bleeding. Evaluate for endometrial lesion.
## FINDINGS:
The uterus measures 10.4 x 5.7 x 7.3 cm. The endometrium is normal
and measures 8 mm in thickness. There is a left slightly exophytic fibroid
measuring 1.8 x 1.5 x 1.6 cm. Tiny punctate calcifications are noted in the
lower endometrium which are of no clinical significance. Both ovaries
demonstrate normal follicular activity. There is a trace amount of free fluid
in the pelvis within the normal physiologic range.
## IMPRESSION:
1. Fibroid uterus.
2. Normal endometrium and ovaries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17164822", "visit_id": "N/A", "time": "2175-03-20 09:34:00"} |
15799257-RR-36 | 559 | ## EXAMINATION:
CT abdomen and pelvis with contrast
## INDICATION:
year old man with stage II gastric cancer s/p gastrectomy//
evaluate for disease recurrence
## ONCOLOGY 2 PHASE:
Multidetector CT of the abdomen and pelvis was
done as part of CT torso with IV contrast. A single bolus of IV contrast was
injected and the abdomen and pelvis were scanned in the portal venous phase,
followed by scan of the abdomen in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.4 cm; CTDIvol = 4.8 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 31.4 s, 0.2 cm; CTDIvol = 415.3 mGy (Body) DLP =
83.1 mGy-cm.
3) Spiral Acquisition 11.7 s, 61.9 cm; CTDIvol = 9.7 mGy (Body) DLP = 603.6
mGy-cm.
4) Spiral Acquisition 5.7 s, 30.2 cm; CTDIvol = 10.8 mGy (Body) DLP = 329.8
mGy-cm.
Total DLP (Body) = 1,018 mGy-cm.
## LOWER CHEST:
Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
## HEPATOBILIARY:
The liver is enlarged and macronodular in contour, consistent
with known HCV cirrhosis. Again seen is a geographic area of hypodensity in
segment 3 of the liver, slightly improved from prior, and likely representing
a retraction injury from prior surgical intervention or scarring. A linear
scar in the right hepatic lobe is unchanged. A subcentimeter hypodensity in
the caudate lobe is unchanged, likely representing a hepatic cyst or biliary
hamartoma. There is no evidence of new focal lesions. There is no evidence
of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within
normal limits. There is no ascites.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen is enlarged up to 14.5 cm, not significantly changed.
There is a small accessory spleen at the splenic hilum.
## 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:
Patient is status post partial gastrectomy with Roux-en-Y
gastrojejunostomy. Small bowel loops demonstrate normal caliber, wall
thickness, and enhancement throughout. The colon and rectum are within normal
limits. The appendix is normal.
## 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 normal.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. The portal vein, splenic vein and SMV are patent. Perisplenic
varices are similar prior.
## BONES:
Multilevel degenerative changes in the lower thoracic and lumbar spine
are not significantly changed. There is no evidence of worrisome osseous
lesions or acute fracture.
## SOFT TISSUES:
Bilateral inguinal hernias containing fat are noted.
## IMPRESSION:
1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.
2. Cirrhosis with splenomegaly. No ascites.
3. Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15799257", "visit_id": "N/A", "time": "2158-05-07 10:21:00"} |
15398544-RR-15 | 159 | DIGITAL LEFT BREAST DIAGNOSTIC MAMMOGRAM AND BREAST ULTRASOUND
## INDICATION:
Abnormal screening mammogram.
The patient's prior mammograms have not yet been received. Report from prior
mammogram at suggest a nodule, probably a lymph node in
the upper outer quadrant of the left breast.
Additional left breast views were obtained. There are scattered
fibroglandular densities. A 5-mm density is present in the upper outer
quadrant of the left breast. Some of the views suggest that it is a poorly
circumscribed. There are no other masses.
Ultrasound of the left breast was performed and showed no solid or cystic
masses in the upper outer quadrant of the left breast.
## IMPRESSION:
1. Awaiting prior outside mammograms.
2. Somewhat irregular 5-mm density in the upper outer quadrant of the left
breast, significance should become apparent with comparison to prior
mammograms.
If prior mammograms are unavailable, biopsy could be indicated. This was
reviewed with the patient.
BI-RADS 0 -- assessment incomplete.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15398544", "visit_id": "N/A", "time": "2130-10-07 13:00:00"} |
14861499-RR-66 | 408 | ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
year old woman with RA and fibrosis also on Methotrexate. Last
CT was in // Progression? Methotrexate toxicity?
## FINDINGS:
Supraclavicular and right axillary lymph nodes are normal size ; left axilla
was obscured by the pacemaker generator artifact. This study is not designed
for subdiaphragmatic diagnosis but shows there is no adrenal mass. Patient has
had cholecystectomy.
Right lobe of the thyroid is mildly larger than the left, but neither has a
dominant nodule. Atherosclerotic calcification is moderately severe in the
proximal head and neck vessels, present at least the right coronary artery,
and probably in the LAD obscured by a coronary stent. Transvenous right
atrial and right ventricular pacer leads follow their expected courses.
Thoracic aorta is not enlarged. Calcification in the aortic valve is mild to
moderate.
Pericardium is physiologic. There is no appreciable pleural effusion or
thickening.
Previous central lymphadenopathy has decreased substantially, most pronounced
in the prevascular station where the largest node, 6 x 9 mm, 02:16, was 9 x 12
mm when last imaged, . Involution includes partially calcified
subcarinal nodes, 13 mm across today, 18 mm in . Largest mediastinal node
currently is in the right lower paratracheal station, 12 x 16 mm, 02:17,
previously 13 x 19 mm. Borderline enlargement of the intra pericardial right
pulmonary artery, 27 mm, 02:21, has increased since , previously
25 mm.
Extensive peripheral interstitial pulmonary abnormality characterized by large
honeycomb cysts and traction bronchiectasis most evident at the lung bases has
progressed substantially since when subpleural honeycombing was less
pronounced and there were large areas of ground-glass opacifIcation,
subsequently resolved. These are the findings of late stage fibrosing
nonspecific interstitial pneumonitis, morphologically indistinguishable from
UIP, but given the previous time course, likely to progress at a much slower
pace if at all.
There are no lung nodules concerning for malignancy--although a small nodule
would be difficult to detect among the coarse pulmonary fibrosis--no pulmonary
edema or consolidation. There are no bone lesions in the chest cage suspicious
for malignancy.
## IMPRESSION:
Considerable progression over years in moderate to severe pulmonary
fibrosis. The disappearance of previous areas of ground-glass opacification
and the relatively slow pace of the disease are most characteristic of
fibrosing nonspecific interstitial pneumonitis. Improvement in central
adenopathy also attests to diminished inflammation. Interval increase in
pulmonary artery caliber however may reflect developing pulmonary
hypertension.
Coronary atherosclerosis. Aortic valvular calcification could be
hemodynamically significant.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14861499", "visit_id": "N/A", "time": "2162-03-02 14:16:00"} |
18042666-RR-12 | 268 | ## INDICATION:
Patient is a female with nausea and abdominal pain.
Please evaluate for etiologies of nausea and abdominal pain.
## EXAMINATION:
CT of the abdomen and pelvis with intravenous contrast.
## FINDINGS:
CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST:
The lung bases are clear with no pulmonary nodules, opacities, or pleural
effusions identified. Within the right lobe of the liver best seen on (3:16
and 3:7) there are tiny subcentimeter hypodensities that is too small to
accurately characterize, however, likely represent simple cysts. The
gallbladder, spleen, pancreas, both adrenal glands, both kidneys, small and
large bowel are normal. There is no evidence of abdominal free fluid or free
air. There is no mesenteric or retroperitoneal lymphadenopathy.
CT OF THE PELVIS WITH INTRAVENOUS CONTRAST:
Within the pelvic cul-de-sac,
there is a moderate amount of pelvic free fluid that measures simple fluid.
Just adjacent to the pelvic free fluid, a significant amount of higher
attenuation fluid is seen within the vagina. Hypodensity in the endometrial
cavity is nonspecific on CT. The rectum, sigmoid colon, uterus, bladder are
normal. There is no inguinal or pelvic lymphadenopathy.
## BONE WINDOWS:
There are multilevel degenerative changes most prominent at the
levels of L3-L4 and L4-L5 with posterior disc bulges.
## IMPRESSION:
1. No evidence of bowel obstruction or other etiology of nausea and abdominal
pain.
2. Small amount of pelvic free fluid within the cul- de- sac. Higher density
fluid in the vagina may represent blood; correlation with patient's
menstrual cycle is recommended. Pelvic ultrasound can be performed if further
evaluation of the pelvic organs is clinically indicated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18042666", "visit_id": "N/A", "time": "2169-05-11 06:28:00"} |
12381849-DS-9 | 1,505 | ## ALLERGIES:
vancomycin / erythromycin base / Bactrim / ibuprofen / Augmentin
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Right and left heart cath
## HISTORY OF PRESENT ILLNESS:
w/ severe AS presents after fall today after losing his
balance, which is a chronic problem, and striking his head (no
LOC). The patient has poor balance at baseline, which may also
be due to macular degeneration. This morning the patient states
that his foot "gave out" from under him and fell backwards,
unclear if he felt dizzy/lightheaded, hitting his head against
the floor. He denies having had severe headache or neck pain
after the fall this am, and denies having associated chest pain
or dyspnea. He received 2 4cm linear lacerations to the scalp,
and reports tetanus within the last years.
Of note, the patient had a fall on (four days before
admission): while he was trying to hang curtains by getting up
on a chair, he fell and hit the back of his head, along with the
forehead. He had a headache in the occiput on (day after
the fall), which subsided. He does not recall if he had
dizziness/lightheadedness, SOB, or CP before the fall. He denies
losing consciousness or feeling like he was about to pass out.
He denies recent illness. No other symptoms including CP, SOB,
abd pain.
Patient went to see Dr. and transferred here for
TAVR evaluation and cath. Per , multiple recent falls at
home from "getting dizzy", denies LOC this am but does report
?LOC over last weekend. Known severe AS- looks like he sees
locally. PPM interrogated in clinic this am.
Per , patient to have L/RHC cath and ECHO.
In the ED initial vitals were: 98.3 50 133/88 18 100% RA
## EKG:
v paced, hr
Labs/studies notable for: hgb 10, plt 106, u/a negative,
negative cxr, no rib fracture seen, ct head and neck negative
except for degenerative changes in the c-spine
Patient was given: no medications
Vitals on transfer:
On the floor, patient hemodynamically stable and neurologically
intact, answering all questions appropriately and fully
oriented.
## PAST MEDICAL HISTORY:
Severe AS
HTN
HLD
Macular degeneration
## FAMILY HISTORY:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
## GENERAL:
WDWN in NAD. Oriented x3. Mood, affect appropriate.
## HEENT:
NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.
Two small lacerations over right occiput, with stitches in
place.
## NECK:
Supple with JVP flat at clavicle.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. Regular rhythm and rate, normal S1, S2, systolic
ejection murmur best heard over RUSB
## LUNGS:
No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheezes or
rhonchi.
## ABDOMEN:
Soft, NTND. No HSM or tenderness.
## EXTREMITIES:
No c/c/e. No femoral bruits.
## SKIN:
No stasis dermatitis, ulcers, scars, or xanthomas.
## PULSES:
Distal pulses palpable and symmetric
## NEURO:
CN intact; motor strength in all extremities;
sensory intact to light touch in all extremities and face.
## GENERAL:
WDWN in NAD. Oriented x3. Mood, affect appropriate.
## HEENT:
NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.
Two small lacerations over right occiput, with stitches in
place.
## NECK:
Supple with JVP flat at clavicle.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. Regular rhythm and rate, normal S1, S2, systolic
ejection murmur best heard over RUSB radiating to carotids
## LUNGS:
No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheezes or
rhonchi.
## ABDOMEN:
Soft, NTND. No HSM or tenderness.
## EXTREMITIES:
No c/c/e. No femoral bruits.
## SKIN:
No stasis dermatitis, ulcers, scars, or xanthomas.
## PULSES:
Distal pulses palpable and symmetric
## NEURO:
CN intact; motor strength in all extremities;
sensory intact to light touch in all extremities and face.
## - CXR :
No acute cardiopulmonary process. No evidence of
acute fracture. If suspicion
for rib fracture persists, dedicated rib radiographs can be
obtained.
## - CT C-SPINE WO/CON :
No acute fracture. Mild
anterolisthesis of C2 on C3 which is likely
degenerative. Other degenerative changes as detailed above.
## - CT HEAD WO/CON :
Small amount of blood products layering
along the anterior falx, with a focal maximum thickness of 3 mm,
consistent with a small subdural hematoma. No other areas of
blood products are seen.
- TTE :
The left atrium is elongated. The estimated right atrial
pressure is mmHg. There is mild symmetric left ventricular
hypertrophy with normal cavity size and regional (image quality
not ideal but no obvious abnormalities)/global systolic function
(LVEF>55%). Tissue Doppler imaging suggests an increased left
ventricular filling pressure (PCWP>18mmHg). The right
ventricular cavity is mildly dilated with normal free wall
contractility. The ascending aorta is mildly dilated. The aortic
arch is mildly dilated. There are focal calcifications in the
aortic arch. The descending thoracic aorta is mildly dilated.
There are three aortic valve leaflets. There is degenerative
fusion of the left and non coronary cusps and partial fusion of
the non and the right. There is severe aortic valve stenosis
(valve area 0.7cm2). Mild (1+) aortic regurgitation is seen. The
mitral valve leaflets are focally calcified at the leaflet tips.
There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. The estimated pulmonary artery systolic
pressure is normal. There is no pericardial effusion.
## IMPRESSION:
Mild symmetric left ventricular hypertrophy with
normal cavity size and systolic function. Increased PCWP. Severe
aortic valve stenosis with appearance suggesting rheumatic
etiology. Dilated thoracic aorta.
## - CARDIAC CATH :
1. No angiographically-apparent high grade flow-limiting
epicardial coronary artery stenoses, although
mild atherosclerosis was visible.
2. Hemodynamically well compensated aortic stenosis with minimal
right ventricular diastolic dysfunction,minimal pulmonary
hypertension, mild elevation of PCW, and preserved cardiac index
and stroke volume index.
## RECOMMENDATIONS:
1. Reinforce primary preventative measures against CAD. 2.
Additional plans per the Structural Heart Team.
## BRIEF HOSPITAL COURSE:
M with PMH HTN, HLD, and severe AS s/p fall without LOC
admitted for work-up of falls and TAVR eval. Repeat TTE
confirmed severe AS with appearance suggesting rheumatic
etiology. Cardiac surgery and TAVR teams evaluated patient. RHC
showed normal filling pressures and LHC without notable coronary
disease.
## # FALL:
Patient has a long-standing history of imbalance and
previous falls, thought to be multifactorial, attributed by
patient by possibly being dizzy and having macular degeneration.
The fall is concerning for possibly worsening AS. Fall likely
not due to ischemia, given no history of ACS symptoms and EKG
showing A-V paced with J-point elevation in leads II, III, aVF,
Trops neg x2. Patient's falls do not appear to be
cardiac-associated, although he underwent a full cardiac work-up
for possible TAVR.
## # TAVR EVAL:
Patient may benefit from a full TAVR evaluation in
the setting of chronic falls and episodes of dizziness, likely
due to worsening AS. TTE shows severe aortic stenosis (.7 cm2),
which might have rheumatic etiology. Cardiac cath revealed no
angiographically-apparent high grade flow-limiting epicardial
coronary artery stenoses, although mild atherosclerosis was
visible.
## # SUBDURAL HEMATOMA:
On CT head, evidence of small subdural
hematoma along anterior falx. Patient was evaluated and cleared
by Neurosurgery. On exam, neurologically intact. Monitored for
neurological deficits, none noted.
## # HTN:
Continued Amlodipine 7.5 mg PO DAILY, Atenolol 50 mg PO
DAILY
## # HLD:
Continued Simvastatin 40 mg PO QPM
## # INSOMNIA:
Continued TraZODone 100 mg PO QHS:PRN insomnia
## # GERD:
Continued Pantoprazole 40 mg PO Q24H
## TRANSITIONAL ISSUES:
- Patient will be contacted by TAVR team to complete TAVR
workup. Has had TTE and catheterization, will require carotid
ultrasound as well as the rest of the TAVR workup.
- Patient was minimally orthostatic (his baseline); inpatient
recommended home with home .
- Please consider geriatric recommendations at follow up PCP
## :
please consider Fe, B12 studies for anemia;
consider 1,000 units Vit D; consider fractionating atenolol to
BID and amlodipine to BID; consider stopping trazadone.
- Regarding gait, geriatrics recommended referral to Dr.
Gait ( ).
- if any neurologic changes, consider repeat head imaging
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list may be inaccurate and requires
futher investigation.
1. Amlodipine 7.5 mg PO DAILY
2. Atenolol 50 mg PO DAILY
3. Pantoprazole 40 mg PO Q24H
4. Simvastatin 40 mg PO QPM
5. TraZODone 100 mg PO QHS:PRN insomnia
## DISCHARGE MEDICATIONS:
1. Amlodipine 7.5 mg PO DAILY
2. Atenolol 50 mg PO DAILY
3. Pantoprazole 40 mg PO Q24H
4. Simvastatin 40 mg PO QPM
5. TraZODone 100 mg PO QHS:PRN insomnia
## PRIMARY DIAGNOSIS:
severe aortic stenosis
recurrent falls
subdural hematoma
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you during your stay at .
You were admitted after a series of falls, and an evaluation for
replacement of your aortic valve was initiated. You had a
cardiac echo and catheterization. Ultimately, it was decided
that you should have a surgery for aortic valve surgery (TAVR)
planned as an outpatient. You will be contacted by the TAVR team
next week to plan this.
Wishing you well,
Your Cardiology Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12381849", "visit_id": "26927563", "time": "2133-10-17 00:00:00"} |
15264525-RR-5 | 235 | ## HISTORY:
Question of a paraspinal mass on chest x-ray. Evaluate paraspinal
mass.
## FINDINGS:
There is no paraspinal mass. The contour noted on the prior chest radiograph
appears to represent the left atrial contour.
Coronary artery calcifications are present. The heart is borderline in size,
without pericardial effusion. The great vessels are unremarkable. No
pathologically enlarged mediastinal, hilar, or axillary lymph nodes are
identified by CT size criteria. The thyroid gland is enlarged, without
discrete nodularity.
There is a nodular opacity within the right upper lobe in the posterior
segment (4:58), which measures approximately 9 mm. There are additional 3-mm
pulmonary nodules within the right upper lobe (4:31, 43), and a 4-mm nodule
within the lingula (4:120). There is no pleural effusion. The airways are
patent to the subsegmental level.
This examination is not tailored for subdiaphragmatic evaluation. A small
hiatal hernia is noted. There is nonspecific bilateral perinephric stranding.
No suspicious osseous lesions are identified.
## IMPRESSION:
1. No evidence of a paraspinal mass, with the density noted on the prior
chest radiograph likely reflecting the left atrial contour.
2. Scattered pulmonary nodules bilaterally, with a nodular opacity in the
right upper lobe measuring up to 9 mm. A followup CT in three months is
recommended.
3. Nonspecific bilateral perinephric stranding, and correlation with a UA is
suggested.
Findings were communicated to Dr. at 3:37 p.m.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15264525", "visit_id": "21983925", "time": "2181-02-27 14:10:00"} |
12246707-RR-21 | 143 | ## INDICATION:
year old woman with aspiration PNA with rapid afib. // Please
assess for pleural effusion vs worsening PNA.
## FINDINGS:
New moderate right and moderate to large left pleural effusions obscure the
lower lungs which are incompletely aerated. PA and lateral chest radiographs
would help assess consolidation or atelectasis. A 1.2 x 0.5 cm
well-circumscribed opacity projecting over the posterior right fifth rib is a
sclerotic bone lesion or a pulmonary nodule. There is no pulmonary vascular
congestion or pneumothorax. Mild cardiomegaly is stable. Thoracic aorta is
tortuous, heavily calcified, and unchanged since . The esophageal stent
has not migrated since .
## IMPRESSION:
1. New moderate right and moderate to large left pleural effusions. PA and
lateral view radiographs could help delineate the relative contributions of
effusion, collapse, and consolidation.
2. New right upper lobe lung nodule or sclerotic bone lesion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12246707", "visit_id": "22235712", "time": "2182-12-26 05:40:00"} |
18811973-RR-48 | 340 | ## INDICATION:
Nausea, vomiting, CVAT/LUQ tenderness. Evaluate for masses,
collections, hydronephrosis.
## FINDINGS:
There is dependent atelectasis in the lung bases. No pleural
effusions or nodules are present.
## CT ABDOMEN:
A vague rounded area of hyperattenuation measuring 2-cm within
hepatic segment (2:19) is less pronounced than on the prior exam, possibly
a transient hepatic attenuation difference. Previously noted similar appearing
lesion in the left lobe of the liver is not seen on the current exam. Mild
central intrahepatic biliary duct prominence is noted, but no extrahepatic
biliary dilatation is seen. The gallbladder is unremarkable and the portal
vein is patent. The patient is status post splenectomy. In the splenic bed
there is a stable 2.5 x 2.0 cm accessory splenule. The pancreas and adrenal
glands are normal. There is no evidence of hydronephrosis, stones or mass. A
2.2 x 1.7 cm parapelvic cyst without complex features is identified in the
right kidney, new from .
The stomach and small bowel are unremarkable. There is no mesenteric or
retroperitoneal adenopathy. The aorta is non aneurysmal. The main
intra-abdominal vessels are grossly patent. There is no ascites, abdominal
free air or wall hernia.
## CT PELVIS:
The bladder is normal. There is no pelvic free fluid. The uterus
and adnexa are within normal limits. No pelvic wall or inguinal
lymphadenopathy is identified.
## OSSEOUS STRUCTURES:
There are severe degenerative changes in the spine in the
setting of marked S type scoliosis. There is diffuse fatty atrophy of the
pelvic muscles on the right.
## IMPRESSION:
1. No acute intraabdomial pathology. New right parapelvic renal cyst shows no
complex features.
2. Hyperattenuating area within segment of the liver is less pronounced
on the current exam, possibly a vascular anomaly or transient hepatic
attenuation difference. Previously noted hyperattenuating area in the left
lobe of the liver is not seen on the current exam.
3. Accessory spleen in the splenic bed, marked degenerative changes in the
setting of severe scoliosis and fatty atrophy of the right pelvic musculature
are stable from .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18811973", "visit_id": "27865584", "time": "2182-02-07 21:18:00"} |
15097184-DS-15 | 1,409 | ## HISTORY OF PRESENT ILLNESS:
Patient is a yo woman with PMHx sig. for DM2, CAD, HTN who
presents with 2 weeks of nausea, vomiting, and failure to thrive
since her L eye vitrectomy + membrane peel for recurrent retinal
detachment on . She had a lot of pain after her surgery,
went to the ED. She was given dimox and Rx for oxycodone. Dr.
has seen her a couple times in the office, no issues were
found. She has been using the eye drops. She had continued
pain in her L eye. Per daughter, all week she has not been
eating/drinking, has been nausea/vomiting. Without the
oxycodone, she has intense L eye pain. Yesterday afternoon, she
was coming out of the bathroom, felt that her legs were weake,
and she was shaking. Her children were able to catch her before
she feel.
In the ED, initial VS were: 99.5 66 142/63 18 100% RA. Exam was
notable for left eye chemotic, fixed mid-dilated pupil, steamy
cornea with small hyphema, IOP 37. Labs were notable for lip
228, Na 125, Cl 82, Cr 1.3. The patient received levothyroxine
75 mcg, oxycodone, zofran, and various eye drops. Ophtho was
consulted, gave recommendations.
## (+) PER HPI PLUS:
constipation, decreased urine output
(-) Denies fever, chills, night sweats. Denies headache, sinus
tenderness, rhinorrhea or congestion. Denies chest pain or
tightness, palpitations. Denies cough, shortness of breath.
Denies diarrhea or abdominal pain. No dysuria, urinary
frequency. All other review of systems negative.
## PAST MEDICAL HISTORY:
1. Coronary artery disease status post myocardial infarction.
anterior wall MI in , s/p PTCA of the LAD, D1, OM1,
PDA in 95, RCA in 96. Cath in showed no flow limiting
lesion with 60% mLAD and 80% D1.
2. Type 2 diabetes.
3. Hypertension.
4. Hypercholesterolemia.
5. DVT x2, one years ago and one in the year . She has
been on Coumadin therapy ever since then
## FAMILY HISTORY:
Not relevant to this admission.
## HEENT:
L eyelid swollen, L eye chemosis and injected, MMM
## NECK:
no LAD, no JVD
## CARDIOVASCULAR:
RRR normal s1, s2, no murmurs appreciated
## RESPIRATORY:
Clear to auscultation bilaterally, no wheezes,
rales or rhonchi
## ABD:
normoactive bowel sounds, soft, mild TTP in epigastrium,
non distended
## EXTREMITIES:
No edema, 2+ DP pulses
## INTEGUMENT:
Warm, moist, no rash or ulceration
## PSYCHIATRIC:
appropriate, pleasant, not anxious
## DISCHARGE LABS:
06:54AM
WBC-10.6 RBC-3.45* Hgb-10.8* Hct-30.3* MCV-88 Plt
Glucose-163* UreaN-18 Creat-1.2* Na-133 K-4.5 Cl-97 HCO
AnGap- yo woman with PMHx sig. for DM2, CAD, HTN who presents with 2
weeks of nausea, vomiting, and failure to thrive since her L eye
vitrectomy + membrane peel for recurrent retinal detachment on
.
## # ANGLE-CLOSURE GLUACOMA:
Patient was seen in consultation by
ophthalmology and was treated initially with Cosopt 1 gtt in L
eye q 30 minutes x 2 hours, then BID; Alphagan 1 gtt l eye q 30
minutes x 2 hours, then BID; Xalatan 1 gtt L eye q 30 minutes x
2 hours, then QHS; Prednisolone acetate 1 % 1 gtt Q hour left
eye while awake, then QID; Polysporin ointment QID. Diamox and
Combigan were stopped. Residual pain was treated with Percocet.
The patient's eye pain improved overall, although she continued
to have intermittent severe pain that was attributed to
fluctuations in pressures within her eye. She will follow-up
with Ophthalmology on for consideration for
further surgical interventions.
## # NAUSEA/VOMITING:
Thought to be secondary to pain from
glaucoma. Improved with control of pain and re-hydration. She
tolerated a regular diet for 24 hours prior to discharge, and
her associated hyponatremia resolved.
# History of DVT, on coumadin: Patient missed several doses of
Coumadin prior to admission and had a subtherapeutic INR. As her
nausea improved Coumadin was re-started. Her next INR is due to
be checked on , with results faxed to her PCP. She was
continued on her home dose of 4mg.
## # CORONARY ARTERY DISEASE:
EKG with new Q waves in V3-V4 since
. CEs negative x 2. Patient was continued on Atenolol,
Lipitor, Imdur, and Lisinopril.
## MEDICATIONS ON ADMISSION:
ATENOLOL - 25 mg Tablet - 0.5 Tablet(s) by mouth once a day
ATORVASTATIN [LIPITOR] - (Prescribed by Other Provider) - 80 mg
Tablet - 1 Tablet(s) by mouth once a day
BRIMONIDINE-TIMOLOL [COMB ] - 0.2 %-0.5 % Drops - 1 (One)
drop(s) topical 2x/day left eye
DARBEPOETIN ALFA IN POLYSORBAT [ARANESP (POLYSORBATE)] -
(Prescribed by Other Provider) - 60 mcg/mL Solution - 60
micrograms SC every 2 weeks to maintain HGB levels between
g/dL.
FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth twice a day
INSULIN GLARGINE [LANTUS] - (Prescribed by Other Provider; Dose
adjustment - no new Rx) - 100 unit/mL Solution - 55 units SC
daily
INSULIN LISPRO [HUMALOG] - (Prescribed by Other Provider) - 100
unit/mL Solution - by sliding scale three times a day
ISOSORBIDE MONONITRATE - 30 mg Tablet Extended Release 24 hr - 1
Tablet(s) by mouth once daily if you feel dizzy after taking the
tablet, discontinue it.
LEVOTHYROXINE - 75 mcg Tablet - 1 (One) Tablet(s) by mouth once
a day
LISINOPRIL - 2.5 mg Tablet - 1 Tablet(s) by mouth daily
NITROGLYCERIN - 0.4 mg Tablet, Sublingual - 1 Tablet(s)
sublingually q 5 minutes for three total if pain not resolved
after three tablets, seek emergent care
OXYCODONE - 5 mg Tablet - 1 Tablet(s) by mouth every four (4)
hours as needed
PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s) by mouth once a day
PREDNISOLONE ACETATE - 1 % Drops, Suspension - 1 drop(s) topical
every hour left eye while awake
PROMETHAZINE - 12.5 mg Suppository - 1 Suppository(s) rectally
every 12 hours as needed for nausea
TOLTERODINE [DETROL] - 2 mg Tablet - 1 Tablet(s) by mouth twice
a day
WARFARIN - 4 mg Tablet - 1 Tablet(s) by mouth once a day
Medications - OTC
CALCIUM CARBONATE-VITAMIN D3 [CALCIUM 600 + D(3)] - 600 mg-400
unit Tablet - 1 Tablet(s) by mouth twice a day
## SIG:
One (1) Drop
Ophthalmic every twelve (12) hours: To left eye.
Disp:*2 week's supply* Refills:*2*
2. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic every
twelve (12) hours: To left eye.
Disp:*2 week's supply* Refills:*2*
3. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic at
bedtime: To left eye.
Disp:*2 week's supply* Refills:*2*
4. bacitracin-polymyxin B 500-10,000 unit/g Ointment Sig: One
(1) Appl Ophthalmic Q6H (every 6 hours).
Disp:*2 week's supply* Refills:*2*
5. atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
6. atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. folic acid 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr
## SIG:
One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
9. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
11. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
12. tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO BID (2 times a day).
14. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
15. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
16. warfarin 2 mg Tablet Sig: Two (2) Tablet PO Once Daily at 4
.
17. prednisolone acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic QID (4 times a day).
Disp:*2 week's supply* Refills:*2*
18. insulin glargine 100 unit/mL Cartridge Sig: (55)
units Subcutaneous once a day.
## 19. PERCOCET MG TABLET SIG:
Tablets PO every hours
as needed for pain for 5 days.
Disp:*30 Tablet(s)* Refills:*0*
20. Outpatient Lab Work
Please have your INR checked on and have the
results faxed to at .
## DISCHARGE DIAGNOSIS:
Acute angle closure glaucoma
Dehydration
## DISCHARGE INSTRUCTIONS:
You were admitted with nausea, vomiting and dehydration and were
found to have acute angle closure glaucoma. You were treated
with IV fluids and several eyedrops, and your eye pain began to
improve.
Other than the eyedrop regimen, no changes are being made to
your home medications at discharge.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15097184", "visit_id": "29058106", "time": "2126-12-09 00:00:00"} |
11397722-RR-38 | 315 | ## INDICATION:
male with prostate and penile cancer post-partial
penectomy, recurrent UTI and hematuria.
.
## FINDINGS:
Some atelectasis is noted at the lung bases, with mild
bronchiectasis in the left lower lobe. Calcifications are noted in the
thoracic aorta and mitral annulus. Trace pericardial effusion persists.
## ABDOMEN:
3.8 x 2.7 cm conglomerate mass in the right renal mid pole is
incompletely assessed without contrast, but shows some lobulation and internal
heterogeneity atypical for simple cyst. Contrast-enhanced CT from
demonstrated features suspicious for malignancy. Again seen are two
nonobstructing stones measuring 3 and 4 mm in the right mid pole (2:27). In
the left kidney, there is a stable multiseptated thin-walled cyst in the
middle pole, as well as additional simple cysts. There is no evidence of
hydronephrosis.
Mild fullness of the left adrenal gland persists, without definite nodularity.
The right adrenal is normal. The liver, gallbladder, pancreas, and spleen are
unremarkable on this non-contrast examination. The stomach and small bowel
are normal.
## PELVIS:
Diffuse colonic diverticulosis is present, without acute
inflammation. Coarse calcifications are noted in the prostate. A Foley
catheter is present in a collapsed bladder. Prior perivesical stranding has
almost completely resolved. Again noted is a right posterolateral bladder
diverticulum.
Calcifications are noted in the abdominal aorta and iliac arteries. Scattered
mesenteric and retroperitoneal lymph nodes are not pathologically enlarged.
Pelvic lymph nodes appear slightly more prominent than before, measuring up to
9 mm in short axis. The patient is post-partial penectomy.
There is no free intraperitoneal air or fluid.
Again noted are moderate degenerative changes of the thoracolumbar spine, with
persistent wedge compression deformity of L3 and grade 1 retrolisthesis of
L3-L4. No osseous lesions are suspicious for malignancy.
## IMPRESSION:
1. Persistent right renal mass, suspicious for RCC.
2. Unchanged right nonobstructing stones.
3. Prominent pelvic lymph nodes, recommend attention on subsequent
examinations.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11397722", "visit_id": "29142082", "time": "2124-03-20 14:50:00"} |
13595646-DS-19 | 989 | ## CHIEF COMPLAINT:
admission for C1 of HD MTX
## HISTORY OF PRESENT ILLNESS:
Mr. is a pleasant w/ HTN, DL, prostate ca s/p
prostatectomy, and double-hit DLBCL w/ secondary intravascular
lymphoma s/p 6C da-EPOCH-R who presents for HD MTX for CNS
prophylaxis. He has held his bactrim and is taking his sodium
bicarb tabs qid since . He denied any acute complaints,
stating he had met Dr. and felt "very good" after
having a conversation with her.
## REVIEW OF SYSTEMS:
12 point ROS reviewed in detail and negative except for what is
mentioned above in HPI
## PAST ONCOLOGIC HISTORY:
========================
- , C1 DA-EPOCH.
- , Rituximab(delayed due to large tumor burden and
given slowly over 2 days). Remained in hospital through nadir
which was supported by Neupogen; discharged on .
- , LP with IT MTX for CNS prophylaxis
- , C2 DA-EPOCH/Rituxan, dose level 1. Prednisone
given once per day. POC placed prior to cycle.
- , Rituxan
- , C3 DA-EPOCH, dose level 2. Prednisone given once
per day.
- , Rituxan
- , PET scan shows no FDG avid adenopathy.
- , C4 DA-EPOCH, dose level 3(Adriamycin kept at dose
level 2). Prednisone given once per day.
- , Rituxan
- , C5 DA-EPOCH, dose level 4(Adriamycin kept at dose
level 2; Vincristine capped at 2 mg total dose).
- , C6 DA-EPOCH, dose level 4(Adriamycin kept at dose
level 2; Vincristine capped at 2 mg total dose).
## PAST MEDICAL HISTORY:
--"Double hit" lymphoma(as well as P53)
-- HTN
-- Prostate cancer status post prostatectomy
-- HLD
-- Allergic rhinosinusitis
-- Nasal polyps
## FAMILY HISTORY:
- Brother with multiple myeloma s/p autologous transplant
- Sister with MDS dx with sideroblastic anemia)
- Sister deceased from metastatic lung cancer
## GENERAL:
NAD, Resting in bed comfortably
## HEENT:
MMM, no OP lesions
## CV:
RR, NL S1S2 no S3S4 No MRG
## PULM:
CTAB, No C/W/R, No respiratory distress
## ABD:
BS+, soft, NTND, no peritoneal signs
## LIMBS:
WWP, no , no tremors
## SKIN:
No notable rashes on extremities
## NEURO:
CN III-XII intact, strength b/l intact
## PSYCH:
Thought process logical, linear, future oriented
## ACCESS:
double lumen R chest port site intact w/o overlying
erythema, accessed and dressing C/D/I
## GEN:
NAD, Resting in bed comfortably
## HEENT:
MMM, no OP lesions. Lower eyelids swollen
## CV:
RR, NL S1S2 no S3S4 No MRG
## PULM:
CTAB, No C/W/R, No respiratory distress
## ABD:
BS+, soft, NT/ND, no peritoneal signs
## LIMBS:
WWP, no , no tremors
## SKIN:
No notable rashes on extremities
## NEURO:
CN III-XII intact, strength b/l intact
## PSYCH:
Thought process logical, linear, future oriented
## ACCESS:
double lumen R chest port site intact
## ASSESSMENT AND PLAN:
w/ HTN, DL, prostate ca s/p
prostatectomy, and double-hit DLBCL w/ secondary intravascular
lymphoma s/p 6C da-EPOCH-R who presents for C1 HD MTX for CNS
prophylaxis.
## #DLBCL, DOUBLE HIT:
Has now completed 6C of da-EPOCH-R and
admitted to receive high dose methotrexate infusion as part of
CNS prophylaxis. He tolerated infusion well without acute events
[24 hr level = 1.0 and 48 hr = 0.15]. He was discharged with a
3D course of oral Leucovorin. He has an RX for PO sodium
bicarbonate in preparation for C2 of HD MTX. Advised to continue
holding Bactrim for now but will continue taking Acyclovir as
prescribed. We obtained MRI (pelvis) instead of L femur;
however, in speaking with radiology on , they visualized
the L femur well and as such, will comment on this on their full
report which is pending at discharge. He will have his labs
checked locally on and will be seen outpatient per Dr.
on with plan to be re-admitted on the same date.
## #FVO:
asymptomatic, up 5lbs from admission weight, expect
improvement outpatient.
## #PERIPHERAL NEUROPATHY:
Suspect chemotherapy-induced, grade I.
Not interfering w/ ADL, continue to monitor outpatient.
## #HYPERTENSION:
Normotensive throughout hospital course. No
longer on any anti-hypertensives.
## =============
#ACCESS:
POC
#Contact:
#Code Status: FC
## #DISPOSITION:
Discharged locally for labs and
for provider visit with Dr.
on Admission:
The Preadmission Medication list is accurate and complete.
1. Acyclovir 400 mg PO Q12H
2. Docusate Sodium 100 mg PO DAILY
3. Famotidine 20 mg PO BID
4. Polyethylene Glycol 17 g PO DAILY:PRN constipation
5. Sulfameth/Trimethoprim SS 1 TAB PO DAILY
6. B Complex 1 (vitamin B complex) oral DAILY
7. LORazepam 0.5 mg PO QHS:PRN insomnia
8. Multivitamins W/minerals 1 TAB PO DAILY
9. Senna 8.6 mg PO DAILY
10. Magnesium Oxide 400 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Sodium Bicarbonate 1300 mg PO QID
START MEDICATION ON UNTIL YOUR RE-ADMISSION ON
## 2. OUTPATIENT LAB WORK
ICD 10:
C83.30 dx: DLBCL
please draw: CBC/DIFF; BUN; Creatinine; Alk Phos; ALT; AST;
Total Bili; Albumin; LD; Uric Acid; Process STAT and fax results
to @
3. Acyclovir 400 mg PO Q12H
4. B Complex 1 (vitamin B complex) oral DAILY
5. Docusate Sodium 100 mg PO DAILY
6. Famotidine 20 mg PO BID
7. LORazepam 0.5 mg PO QHS:PRN insomnia
8. Magnesium Oxide 400 mg PO DAILY
9. Multivitamins W/minerals 1 TAB PO DAILY
10. Polyethylene Glycol 17 g PO DAILY:PRN constipation
11. Senna 8.6 mg PO DAILY
12. HELD- Sulfameth/Trimethoprim SS 1 TAB PO DAILY This
medication was held. Do not restart Sulfameth/Trimethoprim SS
until outpatient team tells you to do so
## 13.OUTPATIENT LAB WORK
ICD 10:
.30 dx: DLBCL
please draw: CBC/DIFF; BUN; Creatinine; Alk Phos; ALT; AST;
Total Bili; Albumin; LD; Uric Acid; Process STAT and fax results
to @
## PRIMARY DIAGNOSES:
==================
#Diffuse large B cell lymphoma
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted to receive C1 HD MTX chemotherapy. You
tolerated this well and will be discharged home. You will follow
up in two weeks for your next cycle of high dose methotrexate.
You will get labs drawn locally on . Please call us
in the meantime with any questions or concerns. It was a
pleasure taking care of you.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13595646", "visit_id": "26490749", "time": "2176-06-08 00:00:00"} |
10472107-RR-102 | 94 | ## INDICATION:
year old hypoxic// eval effusion
## FINDINGS:
Monitoring and support devices are centrally unchanged when compared to the
prior study from earlier in the same day.
There is left retrocardiac density as well as hazy opacity in the lower left
lung, suggestive of atelectasis and pleural effusion. Subsegmental
atelectasis is seen at the right lung base, somewhat progressive when compared
to the prior study. The heart is at the upper limits of normal in size. The
aorta is atherosclerotic.
## IMPRESSION:
Increasing subsegmental atelectasis at the right lung base. Left lung appears
unchanged.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10472107", "visit_id": "24126677", "time": "2179-06-30 17:25:00"} |
13158454-RR-493 | 435 | ## EXAMINATION:
CTA HEAD AND CTA NECK Q16 CT NECK.
## INDICATION:
year old woman with Carotid Stenosis // Eval, Please scan to
arch.
## DOSE:
Total DLP: 2089.40 mGy-cm.
## CT HEAD WITHOUT CONTRAST:
There is no evidence of acute infarction,hemorrhage,edema,ormass. Multiple
focal hypodensities in the bilateral frontoparietal lobes probably reflect
chronic infarcts, unchanged from prior. Periventricular and subcortical white
matter hypodensity is nonspecific, but likely reflect sequelae of chronic
small vessel ischemic disease. Prominence of the ventricles and sulci are
suggestive of involutional changes.
The visualized portion of the paranasal sinuses, andmiddle ear cavities are
clear. The left mastoid air cells are partially opacified. Bilateral lens
implants are noted.
## CTA HEAD:
The vessels of the circle of and their principal intracranial branches
appear normal without stenosis, occlusion, or aneurysm. Atherosclerotic
calcification of the cavernous and supraclinoid internal carotid arteries is
noted without high-grade stenosis. A right fetal posterior cerebral arteries
incidentally noted. The dural venous sinuses are patent.
## CTA NECK:
Bilateral carotid and vertebral artery origins are patent.
Predominantly noncalcified plaque in the proximal right internal carotid
artery results in 50% stenosis by NASCET criteria. Calcified and noncalcified
plaque at the origin of the left internal carotid artery results in greater
than 70% stenosis by NASCET criteria.
The left vertebral artery is nearly occluded at its origin, with distal
reconstitution but diffuse irregularity along most of the course of the V2
segment. The V3 and V4 segments appear patent without stenosis. The right
vertebral artery is patent throughout its course.
## OTHER:
Emphysematous changes and probable fibrotic lung changes are demonstrated at
the lung apices. There is a small right pleural effusion that is partially
imaged. Post sternotomy changes are noted. There is a right internal jugular
central venous catheter. Patient is status post CABG, a left chest wall
pacemaker device is partially imaged. There is multilevel cervical
spondylosis. The visualized portion of the thyroid gland is within normal
limits. There is no lymphadenopathy by CT size criteria.
## IMPRESSION:
1. No acute intracranial process. Chronic small vessel ischemic changes are
redemonstrated.
2. Patent circle of without evidence of stenosis,occlusion,or aneurysm.
3. Greater than 70% stenosis of the proximal left internal carotid artery by
NASCET criteria. Precise measurement is limited due to extensive calcified
plaque.
4. 50% stenosis of the proximal right internal carotid artery by NASCET
criteria.
5. Near occlusion of the origin of the left vertebral artery, with
irregularity throughout the V1 and V2 segments, likely reflecting
atherosclerotic disease.
6. Emphysematous and likely fibrotic changes are seen in the lung apices,
along with a small right pleural effusion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13158454", "visit_id": "N/A", "time": "2197-01-09 08:06:00"} |
18496896-RR-9 | 239 | ## INDICATION:
man with autoimmune pancreatitis, evaluate.
## FINDINGS:
CT ABDOMEN WITH AND WITHOUT CONTRAST:
The heart and pericardium are
unremarkable. There is no pericardial effusion. The lung bases are clear.
There are small hypodensities within the right lobe of the liver that are too
small to characterize but most likely represent cysts and are unchanged from
the prior study. The portal vein is patent. There is a small amount of
pneumobilia within the left lobe, likely from common bile duct stent
placement. There is no intra- or extra-hepatic biliary dilatation. The
gallbladder is unremarkable. The pancreas appears largely unchanged from the
prior study with mild enlargement of the pancreatic head consistent with
autoimmune pancreatitis. There is no stranding, pancreatic ductal dilatation,
or pseudocyst seen. The spleen and adrenal glands are unremarkable. There is
a large parapelvic cyst arising from the right kidney that is unchanged. The
kidneys otherwise enhance and excrete contrast symmetrically without any focal
lesions or hydronephrosis. The stomach, small and intra-abdominal large bowel
are unremarkable. There is no lymphadenopathy, free fluid, or free air within
the abdomen.
## OSSEOUS STRUCTURES:
There are no suspicious lytic or sclerotic lesions.
## IMPRESSION:
1. Stable appearance of pancreatic head swelling with no associated
stranding, pseudocyst, or ductal dilatation.
2. Common bile duct stent in place with small amount of associated
pneumobilia.
3. Small hypodensities within the liver, too small to characterize, most
likely cysts.
4. Right parapelvic cyst.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18496896", "visit_id": "N/A", "time": "2151-07-22 09:22:00"} |
16029344-RR-38 | 197 | ## HISTORY:
woman, with GBM, and history of pulmonary embolism. On
anticoagulation. Now rule out hemorrhage.
## FINDINGS:
There is new focal hyperintensity within the tumor mass just
posterior to the right occipital horn, compatible with new intraparenchymal
hemorrhage in the known GBM. A small amount of intraventricular hyperdensity
layering in the right temporal and occipital horns, compatible with new
intraventricular hemorrhage. There is no acute subarachnoid hemorrhage. No
significant changes in the ventricular are noted compared to the
study to suggest developing hydrocephalus. There is no shift of
normally midline structures.
Mild periventricular white matter hypodensities are compatible with chronic
microvascular ischemic disease. Encephalomalacia is again noted in the right
parietal lobe with right parietal craniotomy, compatible with history of GBM
and subsequent surgical intervention. The visualized paranasal sinuses are
clear. The mastoid air cells are well-developed and clear. There is no acute
fracture.
## IMPRESSION:
1. Small amount of new right-sided intraparenchymal and intraventricular
hemorrhage, without shift of normally midline structures or developing
hydrocephalus.
2. Unchanged encephalomalacia in the right parietal lobe and unchanged right
parietal craniotomy.
Dr. discussed the findings with the ED team Dr.
shortly after the preliminary interpretation of the study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16029344", "visit_id": "29977774", "time": "2185-05-12 20:59:00"} |
14508643-RR-85 | 98 | ## HISTORY:
Nausea, vomiting, diarrhea, faint right lower lobe.
## FINDINGS:
The heart size is mildly enlarged but unchanged. The aortic knob is
calcified. Mediastinal and hilar contours are within normal limits. The
pulmonary vascularity is not engorged. The lungs are hyperinflated with
flattening of the diaphragms compatible with COPD. No focal consolidation,
pleural effusion or pneumothorax is identified. Diffuse demineralization the
osseous structures is noted. Clips in the right upper quadrant of the abdomen
are present. On the lateral view, rounded calcifications within the upper
abdomen are within a tortuous splenic artery.
## IMPRESSION:
No acute cardiopulmonary abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14508643", "visit_id": "23830726", "time": "2129-08-10 16:26:00"} |
15226686-RR-19 | 72 | ## INDICATION:
year old woman with low back pain.
## IMPRESSION:
5 non rib bearing lumbar type vertebral bodies are identified. Vertebral body
heights and alignment are preserved. Anterior fusion of L5-S1 is unchanged.
There is moderate degenerative disc disease at L4-L5. A small ossific
fragment along the anterior superior endplate of L5 is unchanged and may
represent a limbus vertebrae. There is no dynamic instability on
flexion-extension views.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15226686", "visit_id": "N/A", "time": "2140-11-26 12:35:00"} |
14288592-RR-80 | 404 | ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
year old woman with lung nodules// follow up lung nodules
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 6.1 s, 32.2 cm; CTDIvol = 9.1 mGy (Body) DLP = 294.6
mGy-cm.
Total DLP (Body) = 295 mGy-cm.
## CHEST PERIMETER:
Thyroid is unremarkable. Supraclavicular and axillary lymph
nodes are not pathologically enlarged. Specifically excluding the breasts
which require mammography for evaluation, there are no soft tissue
abnormalities elsewhere in the chest wall concerning for malignancy.
## CARDIO-MEDIASTINUM:
Moderate hiatus hernia is unchanged. Above that level
esophagus is mildly patulous.
Atherosclerotic calcification is moderate in head and neck vessels and severe
in coronary arteries. Aortic valvular calcification is minimal. Ascending
thoracic aorta is normal caliber. Mild dilatation of the descending thoracic
aorta to maximum diameter 35 mm at the level of the left inferior pulmonary
vein and 31 mm is stable. Pericardium is physiologic.
## LUNGS, AIRWAYS, PLEURAE:
Biapical pleuroparenchymal scarring is stable.
Cluster small peripheral nodules, right upper lobe, has been present
since and continues to involute compared to .
Mixed density lesion at the same level in the left upper lobe, 5:74,
previously noted as new and of concern is smaller today than it was in .
Irregularly shaped, 9 x 10 mm ground-glass lesion, right upper lobe, 5:109, is
less radiodense today than it was in , when it was also larger, 9
x 12 mm.
Region of heterogeneous subpleural glass opacities in the lateral segment of
the right middle lobe, 5:174, is more pronounced, probably inflammatory, not
malignant.
4 mm ground-glass lesion, left apex, 05:48, unchanged since is
too small to warrant further evaluation.
8 mm wide ground-glass lesions superior segment left lower lobe, 5:88, is less
radiodense today than it was in .
Tracheobronchial tree is normal to subsegmental levels. No pleural
abnormality.
## CHEST CAGE:
Multiple thoracic vertebral compression fractures, severe in T8,
moderate in T10 through 12, unchanged since . No new compression
or any pathologic fractures or destructive bone lesions.
## IMPRESSION:
No new or growing lung lesions concerning for malignancy or warranting further
imaging evaluation.
New inflammatory changes localized to the right middle lobe could be the
result of intervening infection or aspiration. It is very unlikely this is in
indication of a developing pulmonary inflammatory syndrome.
Stable multiple lower thoracic vertebral compression fractures moderate and
severe.
Severe coronary atherosclerosis.
Stable mild fusiform dilatations descending thoracic aorta.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14288592", "visit_id": "N/A", "time": "2209-02-14 08:33:00"} |
18274437-RR-95 | 102 | ## HISTORY:
female with shunt placed in the year for
pseudotumor who presents with headache. A prior shunt series did not include
the entirety of the shunt.
## FINDINGS:
Frontal radiographs of the abdomen centered over the course of the
lumbar peritoneal shunt demonstrate contiguous shunt tubing along its course,
entering the subarachnoid space at the L3-4 level, wrapping around the right
abdomen, with the tip terminating in the mid pelvis. The abdominal bowel gas
pattern is unremarkable. Surgical clips are noted in the right upper
quadrant.
## IMPRESSION:
In conjunction with the study, contiguous
shunt tubing without evidence of shunt complication.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18274437", "visit_id": "23375835", "time": "2175-07-21 09:07:00"} |
19110249-RR-29 | 203 | ## EXAM:
Abdominal ultrasound obtained .
.
## HISTORY:
An female with abdominal distention and discomfort.
## FINDINGS:
There is diffuse increased echogenicity of the liver. This somewhat limits
evaluation for underlying hepatic lesions. Within the left lobe is a 0.8 x
0.9 x 0.8 cm anechoic structure with posterior enhancement, consistent with a
cyst.
Main portal vein is patent.
Common duct measures 3 mm.
There has been a cholecystectomy and the gallbladder fossa is unremarkable in
appearance.
The pancreas is not visualized.
Spleen is nonenlarged, measuring 9.7 cm.
The right kidney measures 10.7 cm, without evidence of hydronephrosis. Within
the lower pole is a 1.1 x 1 x 1.4 cm anechoic structure with posterior
acoustic enhancement, consistent with a simple cyst. Also identified within
the lower pole is a 0.7 x 0.9 x 0.5 cm echogenic focus, consistent with a
non-obstructing calculus.
Left kidney measures 11.2 cm. There is no hydronephrosis.
## IMPRESSION:
1. Diffuse increased echogenicity of the liver is likely related to fatty
infiltration. However, other forms of hepatic disease including hepatic
fibrosis and cirrhosis cannot be excluded. This limits evaluation for
underlying hepatic lesions.
2. Right lower pole nonobstructing renal calculus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19110249", "visit_id": "N/A", "time": "2180-09-21 12:36:00"} |
18742792-RR-13 | 114 | ## EXAMINATION:
BILAT LOWER EXT VEINS
## INDICATION:
year old man s/p AAA repair// eval for thrombosis
## FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
A left soleal vein was noncompressible and demonstrated no flow, consistent
with acute DVT.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa ( ) cyst.
## IMPRESSION:
Acute left soleal deep vein thrombosis.
## NOTIFICATION:
The findings were discussed with , R.N. by
, M.D. on the telephone on at 12:10 pm, 15 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18742792", "visit_id": "24582337", "time": "2135-04-10 10:43:00"} |
17751905-RR-70 | 104 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
year old gentleman with a PMH of bicuspid aortic valve s/p
aortic valve and ascending aorta graft and repair ( ) and mechanical AVR
( ) with Streptococcal bacteremia, now with dyspnea.// Please assess for
evidence of pulmonary edema
## FINDINGS:
Left PICC terminates in the upper SVC. Sternotomy wires appear intact and
appropriately aligned. Status post aortic valve replacement. Elevation of
the right hemidiaphragm, chronic. Lungs are clear without focal
consolidations or pulmonary edema. Unchanged appearance of the
cardiomediastinal silhouette. No pleural effusion. No pneumothorax.
## IMPRESSION:
Unchanged chronic elevation of the right hemidiaphragm. No focal
consolidations or pulmonary edema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17751905", "visit_id": "N/A", "time": "2190-01-13 10:00:00"} |
10803276-RR-24 | 325 | ## INDICATION:
year old woman with lung ca on palliative alimta with
increased shortness of breath, rule out PE.
## FINDINGS:
The pulmonary arteries are well opacified to the subsegmental level. There is
no evidence of filling defect within the main, right, left, lobar, segmental,
or subsegmental pulmonary arteries. The right medial segmental middle lobe
pulmonary artery appears diminutive and hypoenhancing but is unchanged from
prior exam and likely reflects chronic changes. The main and right pulmonary
arteries are normal in caliber, and there is no evidence of right heart
strain.
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. Mild ectasia of the
descending thoracic aorta to maximum 3.1 cm is stable back to .
The dominant mass in the right lower lobe is slightly enlarged compared to the
most recent prior exam, currently 2.6 x 2.4 cm (5:115) from prior 2.1 x 2.4
cm. An additional irregular nodule near the apex of the left upper lobe
(05:23) is unchanged. Interlobular septal thickening and pleural nodularity
suggestive of lymphangitic spread are not appreciably changed. Right hilar
lymph node measuring 0.8 cm in the short axis is also unchanged.
There are no pleural or pericardial effusions. Multifocal plaque-like pleural
thickening within the right hemithorax (such as a nodule posterior to the
right lung base (05:49)) remains stable from previous exams.
The thyroid gland appears unremarkable.
Visualized portions of the upper abdomen demonstrate no abnormality.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
## IMPRESSION:
1. No acute pulmonary embolism.
2. Mild interval growth of the dominant right lower lobe lesion since the
study of with similar findings suspicious for lymphangitic spread
of tumor. No significant change in an irregular nodule in the left upper
lobe.
4. Stable nodular right pleural thickening.
## NOTIFICATION:
The findings were discussed by telephone with Dr.
at 17:00 hours .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10803276", "visit_id": "N/A", "time": "2176-02-12 15:13:00"} |
12906102-RR-95 | 113 | ## HISTORY:
Severe C-spine degenerative disease, prior surgery, with a
pacemaker, cannot get an MRI. Progressive quadriparesis.
## FINDINGS:
There was good contrast opacification within the thecal sac. Flow
was delayed at the level of T8. Secondly, flow was delayed at the mid
cervical level. Spinal canal stenoses were grossly demonstrated at the T8-T9
level as well as multiple cervical levels. Please see CT of the cervical
spine for further details.
## IMPRESSION:
Successful intrathecal injection of contrast for CT imaging.
Moderate delay of contrast at the T8 level and at multiple cervical spine
levels. These likely represent areas of significant stenoses. Please see CT
of the cervical spine for further details.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12906102", "visit_id": "21354373", "time": "2145-04-11 14:16:00"} |
13877891-RR-18 | 172 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old woman with AMS and dementia and UTI// etiology of AMS
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 5.0 s, 18.8 cm; CTDIvol = 50.0 mGy (Head) DLP =
940.0 mGy-cm.
Total DLP (Head) = 940 mGy-cm.
## FINDINGS:
There is no evidence of acute territorial infarction,hemorrhage,edema, or mass
effect. There is prominence of the ventricles and sulci suggestive of
age-related involutional changes. Periventricular and subcortical white
matter hypodensities are nonspecific, but likely represent sequela of chronic
ischemic microvascular disease. Bilateral calcifications of the carotid
siphons are again noted.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. Aside from
bilateral lens replacement surgery, the visualized portion of the orbits are
unremarkable.
## IMPRESSION:
1. No acute intracranial abnormality on noncontrast head CT. Specifically no
large territory infarct or intracranial hemorrhage.
2. Evidence of chronic microvascular ischemic disease.
3. Age-related involutional change.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13877891", "visit_id": "23984523", "time": "2144-07-30 08:13:00"} |
14469264-RR-27 | 100 | ## INDICATION:
year old man with COPD who presented with RLL pneumonia now
with desaturation and increased tachypnea // concern for infection, new
infiltrate concern for infection, new infiltrate
## IMPRESSION:
Compared to chest radiographs and .
Opacification of the base of the right lung has increased due to more
consolidation, and there is new small right pleural effusion. These findings
findings are concerning for at least atelectasis, perhaps pneumonia. Milder
peribronchial opacification at the left base is another indication of possible
pneumonia due to aspiration. The upper lungs are clear. The heart is mildly
enlarged, but there is no pulmonary edema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14469264", "visit_id": "24474827", "time": "2155-01-23 20:26:00"} |
14749081-RR-37 | 544 | ## INDICATION:
year old man with Jak2+ myeloproliferative disorder and portal
HTN to chronic portal vein thrombosis (s/p splenorenal shunt on
complicated by esophageal varices and cholangitis, who presents with abdominal
pain and nausea/vomiting. // Multiphasic CT. Arterial, portal, and delayed
phase. Requested by Dr. .
## MULTIPHASIC LIVER:
Multidetector CT of the abdomen and pelvis was
done with IV contrast.
A single bolus of IV contrast was injected and the abdomen was scanned in the
early arterial phase, followed by a scan of the abdomen and pelvis in the
portal venous phase, followed by a scan of the abdomen in equilibrium phase
(3-min delay).
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
## ABDOMEN:
Multiple new arterially enhancing hepatic lesions in the liver are
noted: 1.5 cm mm lesion in segment V/VI (2a:34), 1.2 cm mm peripheral lesion
in segment VIII (2a:30), 0.8 cm lesion in segment VII (2a:25), 0.5 cm lesion
in segment VI (2a:9).
The largest lesion measures 4.3 x 3.5 cm lesion in segment VIII (2a:14). On
arterial phase, there is a rim of hypodensity with internal hyperattenuation
and a possible central hypoattenuating scar. On equilibrium phase, the lesion
becomes slightly hypoattenuating to the surrounding liver.
There is no intra or extrahepatic biliary duct dilation. The gallbladder
appears normal. The CBD is normal in caliber.
There is non opacification of the portal vein and intrahepatic portal branches
the SMV appears patent. There is cavernous transformation at the porta
hepatis. Large gastric and splenorenal varices are seen in the left upper
quadrant. There may be small esophageal varices is well (2b:90). The spleen
is enlarged to 20.2 cm.
The pancreas appears normal. There are multiple surgical clips about the
posterior aspect of the pancreas. The kidneys excrete contrast symmetrically
without hydronephrosis or mass. The ureters are normal throughout their
visualized course.
The stomach, small and large bowel are normal in caliber without evidence of
obstruction. The appendix appears normal.
The abdominal aorta and iliac arteries are normal in caliber without
atherosclerosis. The celiac trunk and hepatic artery show compensatory
enlargement. The left hepatic vein is markedly distended (2b:135) likely
result of splenorenal shunts.
There is a small amount of nonhemorrhagic ascites. There is no free air.
Scattered prominent mesenteric lymph nodes measure up to 1.2 cm in short axis.
There is no retroperitoneal lymphadenopathy.
## BONES AND SOFT TISSUES:
There are bilateral pars defects at L5-S1 with grade
1 anterolisthesis of L5 on S1.
## IMPRESSION:
1. Numerous new arterially enhancing hepatic lesions.The largest measures 4.3
x 3.5 cm and shows faint washout on delayed imaging concerning for HCC. Liver
MRI is recommended. Subcentimeter enhancing foci are indeterminate, but may
represent perfusion abnormalities.
2. Chronic main portal vein and intrahepatic portal vein thrombosis with
cavernous transformation and sequela including abdominal varices, trace
ascites, and massive splenomegaly. Esophageal varices are small.
3. Nonspecific mildly prominent mesenteric lymph nodes may relate to
underlying liver disease.
4. Bilateral pars defects at L5-S1 with grade 1 anterolisthesis of L5 on S1.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14749081", "visit_id": "20846597", "time": "2115-12-27 18:39:00"} |
10071167-DS-21 | 688 | ## ALLERGIES:
No Drug Allergy Information on File
## HISTORY OF PRESENT ILLNESS:
with dementia s/p CVA, AC for Afib, and chronic renal
insuffiency presented from with initial complain of "sore
throat" to an OSH. Initial labs at the OSH showed an INR>6,
hyperkalemia to 6.6, and acute renal failure. His INR was
partially reversed with FFP and vitamin K, he was gievn 1amp of
D50 and 10 units of insulin and transfered to for
evaluation.
.
In the ED his VS were 97.1 118/86 80 36 100% on 4L. He was noted
to have purulent urine, a WBC of 29.1, and a K of 5.7. He
received ceftriaxone 2g IV x1 and vancomycin 1g x1. His BPs
64/32 so a femoral line was placed and he was started on
levophed. His SBP quickly rose to 104/53. He was given 3L NS and
transfered to the ICU.
.
In the ICU he is A and O x 1 at best. His responses are mostly
non-sensical. By report, his code status was reversed from DNR
DNI in the ED by his son who is his HCP. He is now FULL CODE.
.
## REVIEW OF SYSTEMS:
Not obtainable mental status
## PAST MEDICAL HISTORY:
Not obtainable mental status but appears to include the
following
- CVA
- Afib on warfarin
- Chronic renal insufficiency
- Anemia on Epo and iron
- s/p R BKA
## FAMILY HISTORY:
Not obtainable mental status
## GEN:
Cachectic, ill appearing, elderly gentleman in no distress
## HEENT:
Dry MM, flat JVP, neck is supple, L facial droop
## CV:
Irregular rate, no MRG
## PULM:
Poor effort, crackles at the L base
## ABD:
BS+ mildly tender, no masses or HSM, L CTAT
## LIMBS:
Wasted limbs, R BKA, contracture of the R hand
## SKIN:
Pale and cool, scattered bruises
## NEURO:
A and O x 1, reflexes are 1+, difficult to assess due to
participation
## IMPRESSION:
Mild linear atelectasis in the left lower lobe with
no definite acute cardiopulmonary findings.
.
Renal U/S:
No evidence of hydronephrosis or obstructing renal calculi
bilaterally.
Questionable non-obstructing calculus within the lower pole of
the right
kidney.
## BRIEF HOSPITAL COURSE:
debilitated with dementia, Afib on warfarin, and chronic
renal insufficiency presented with purulent urine, hypotension,
and acute renal failure complicated by hyperkalemia and
supratherapeutic INR.
.
# Sepsis: Based on UA, likely urosepsis, but bacturia could
represent overflow from bacteremia. Patient covered broadly with
vancomycin and cefepime, blood and urine cultured, judicious
fluid resuscitation given renal failure. Blood pressure
supported with levophed and vasopressin to maintain MAP > 65.
Was not sustaining adequate MAPs on levophed alone. Given left
CVA tenderness and purulent urine, ordered stat renal U/S to
evaluate for hydronephrosis and abscess - negative study.
.
# Acute kidney insufficiency: Appears to be exacerbation of
chronic renal insufficiency based on record review. Current
azotemia could be due to post renal obstruction, hypotension
prior to admission, or dehydration.
.
# Coagulopathy: Likely due to failure to excrete warfarin from
renal insufficiency. Received FFP and vitamin K at OSH. Held
warfarin, type and screen up to date, allowed INR to return
towards baseline without further intervention as patient was not
bleeding, neither did he have an unstable hematocrit.
.
# Hyperkalemia: Likely due to renal insufficiency. Patient
monitored on telemetry, given calcium gluconate 2g IV x1 to
stabilize membranes, and dextrose 25g followed by insulin 10
units IV. Held kayexalate given hypotension.
.
# Access: R femoral line
# PPx: Pain control with tylenol, bowel regimen,
supratherapeutic INR
# Comm: With family
# Code: FULL for now, upon admission.
.
Had family meeting with patient's children - decided to make
patient CMO (comfort measures only). As such, pressors pulled
off. Patient on morphine gtt titrated to comfort, anxiolytics
available as needed, scopolamine patch available. Family at
bedside. Chaplain called to bedside. Patient died in the early
morning of , daughter at bedside at time of death.
Patient pronounced dead. Family declined autopsy (son contacted
on . Please see death note (Event note) in Metavision.
## MEDICATIONS ON ADMISSION:
Allopurinol PO daily
Ascorbic acid PO daily
ASA 81mg PO daily
units SQ weekly
Iron PO daily
Lisinopril 5mg PO daily
MVI daily
Ranitidine 150mg PO QHS
Warfarin 2.5mg PO daily
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10071167", "visit_id": "25098957", "time": "2149-12-13 00:00:00"} |
13881056-DS-14 | 1,637 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## CHIEF COMPLAINT:
Abdominal pain due to chronic pancreatitis
## :
1. Peustow procedure with Roux-en-Y formation.
2. Open cholecystectomy.
## HISTORY OF PRESENT ILLNESS:
This man has suffered from abdominal pain and
chronic pancreatitis. His first pain problems happened about
years ago during college and have continued through his adult
life. However, recently there has been a crescendo effect to
this and within the last month in particular, he has been
debilitated by chronic epigastric and left sided back pain.
Imaging of his pancreas showed an obstructed pancreatic duct
with multiple cystic components dominating the pancreatic head.
ERCP was unsuccessful at traversing the pancreatic duct due to
stone impaction. It was feared that there were multiple stones
within this ductal system causing obstruction chronically. Given
his long-term problem with this and the absolute destruction of
his gland, he was now deemed a surgical candidate He was
admitted for surgical drainage of his pancreatic duct.
## PMHX:
chronic pancreatitis, tobacco use.
.
## FAMILY HISTORY:
No history of pancreatitis. Non-contributory.
## GEN:
Well appearing, no acute distress
## SKIN:
Warm to touch, no apparent rashes.
## HEENT:
OP clear, no cervical LAD
## CV:
RRR, normal S1 and S2
## ABD:
Tender in LUQ and epigastric. No peritoneal signs.
## NEURO:
Strength and sensation intact bilaterally.
.
## GEN:
Well appearing male in NAD.
## HEENT:
Sclerae anicteric. O-P clear.
## COR:
RRR; nl S1/S2 w/o m/c/r.
## ABD:
Subcostal incision with steri-strips c/d/i. Prior JP site
(discontinued) intact with scant serosanginous drainage; DSD
cover. BSx4. Appropriately tender to palpation along incision,
otherwise soft/NT/ND.
## ON ADMISSION:
10:37PM POTASSIUM-4.5
06:06PM GLUCOSE-119* UREA N-9 CREAT-1.2 SODIUM-139
POTASSIUM-5.4* CHLORIDE-105 TOTAL CO2-27 ANION GAP-12
06:06PM estGFR-Using this
06:06PM CALCIUM-8.7 PHOSPHATE-4.3 MAGNESIUM-1.6
06:06PM HCT-39.4*
.
Prior to Discharge:
07:10AM BLOOD WBC-15.2*# RBC-4.13* Hgb-12.0* Hct-35.4*
MCV-86 MCH-29.2 MCHC-34.0 RDW-13.0 Plt
07:10AM BLOOD Glucose-106* UreaN-9 Creat-0.8 Na-140
K-4.6 Cl-105 HCO3-29 AnGap-11
07:10AM BLOOD Calcium-8.4 Phos-4.4 Mg-2.1
.
Intra-Operative U/S:
High-resolution linear array scans were performed directly on
the pancreatic surface. The pancreatic duct was identified and
seen to be dilated. More proximally, in the body, the duct
measures 3-4 mm and the more distal body extending toward the
tail is dilated up to 6 mm. Surrounding parenchymal
calcifications were identified in the pancreas, but no discrete
stones were seen in the duct. The depth from surface to the
dilated duct is approximately 13 mm, and the optimal point for
entering the duct from the opened pseudocyst was identified and
using ultrasound guidance, a needle was passed into the dilated
duct and surgical cutdown ultimately expose the duct for
subsequent drainage procedure.
## CONCLUSION:
Dilated duct in a setting of chronic pancreatitis
was localized for surgical drainage.
.
PATHOLOGY:
## GROSS:
The specimen is received fresh in a container labeled with the
patient's name, , the medical record number and
additionally labeled "gallbladder". It consists of a distended
gallbladder that measures 16 cm x 5 cm x 2.5 cm. The cystic duct
is identified and is probe patent. Cystic duct lymph node is not
identified. The gallbladder is opened and contains 100 ml of
bile and no stones. The mucosa is velvety and bile stained. The
gallbladder wall measures up to 0.1 cm in thickness. There are
no discrete lesions or masses noted. Representative sections are
submitted as follows: A=representative section of cystic duct
and mucosa from gallbladder neck, B=representative sections of
gallbladder wall from body and fundus.
## BRIEF HOSPITAL COURSE:
The patient was admitted to the General Surgical Service on
for treatment of chronic pancreatitis and a pseudocyst.
On , the patient underwent Peustow procedure with
Roux-en-Y formation and open cholecystectomy, which went well
without complication (reader referred to the Operative Note for
details). After a brief, uneventful stay in the PACU, the
patient arrived on the floor NPO with an NG tube, on IV fluids,
with a foley catheter and a JP drain in place, and initially a
Dilaudid PCA for pain control. The patient was hemodynamically
stable.
.
Post-operative pain was initially not adequately controlled with
the Dilaudid PCA, even when the dose was increased to usual
maximum. The Pain Service was consulted, and a Ketamine infusion
and Toradol IV were added to the regimen with significantly
improved pain control. The Ketamine infusion and Dilaudid PCA
were discontinued on POD#5, and the patient was started on
Dilaudid PO PRN and IV for breakthrough pain. The pain regimen
was updated with the addition of Tizanadine PO TID and
Ibuprofen 800mg PO TID as well as an increase of the Dilaudid to
PO Q3Hours PRN with improved effect. The NG tube was
discontinued on POD#3, and the foley catheter discontinued at
midnight of POD#5. The patient subsequently voided without
problem. The patient was started on sips of clears on POD#4,
which was progressively advanced as tolerated to a regular diet
by POD#6. JP amylase was sent on POD#5; the JP was discontinued
on POD#6 as the amylase and output were low.
.
During this hospitalization, the patient ambulated early and
frequently, was adherent with respiratory toilet and incentive
spirrometry, and actively participated in the plan of care. The
patient received subcutaneous heparin and venodyne boots were
used during this stay. The patient's blood sugar was monitored
regularly throughout the stay; sliding scale insulin was
administered when indicated. labwork was monitored routinely;
electrolytes were repleted when indicated.
.
At the time of discharge, the patient was doing well, afebrile
with stable vital signs. The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled. Staples were removed, and steri-strips placed. The
patient was discharged home without services. The patient
received discharge teaching and follow-up instructions with
understanding verbalized and agreement with the discharge plan.
## MEDICATIONS ON ADMISSION:
1. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily). Disp:*14 Patch 24 hr(s)* Refills:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day). Disp:*60 Capsule(s)* Refills:*0*
3. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
4. MSIR 15mg 1 tab PO Q3Hours PRN pain
## DISCHARGE MEDICATIONS:
1. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*14 Patch 24 hr(s)* Refills:*1*
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours): If
not formulary, may substitute Omeprazole 20mg 1 Cap PO daily
(#30, 2 RF). .
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation: Over-the-counter.
5. Ibuprofen 800 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
6. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
7. Tizanidine 4 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*0*
8. Hydromorphone 4 mg Tablet Sig: Tablets PO Q3-4HOURS: PRN
as needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
1. Chronic pancreatitis.
2. Pancreatic pseudocyst.
3. Obstructed pancreatic duct.
## 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 is 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.
## INCISION CARE:
*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.
*Avoid swimming and baths until your follow-up appointment.
*You may shower, and wash surgical incisions with a mild soap
and warm water. Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips days after surgery.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13881056", "visit_id": "26988064", "time": "2128-10-11 00:00:00"} |
15938197-RR-39 | 109 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
History: with sob and cp// r/o infiltrate
## FINDINGS:
On lateral view, there is apparent small opacity projecting over the posterior
aspect of L1, not seen on prior study. This is difficult to confirm on the
frontal view.
The cardio-mediastinal silhouette is unremarkable.
No significant pleural effusion or pneumothorax. Probable calcific
tendinopathy right shoulder.
## IMPRESSION:
On lateral view, possible small retrocardiac opacity projecting over L1, which
could reflect a small infiltrate in the appropriate clinical setting.
Correlate with symptoms of pneumonia. Suggest radiographic follow-up in
weeks to assess for clearance.
## NOTIFICATION:
Message conveyed to Dr. on at
15:30
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15938197", "visit_id": "N/A", "time": "2136-09-04 14:12:00"} |
17038950-RR-62 | 431 | ## CLINICAL HISTORY:
woman with abdominal pain on dialysis and
anuria.
## CT ABDOMEN:
The visualized lung bases demonstrate dependent bibasilar
atelectasis. More nodular opacity in the lingula is unchanged (2:7). There
are dense coronary artery calcifications, mitral annular calcifications and
aortic annular calcifications. A dialysis catheter ends in the inferior
cavoatrial junction.
The liver is shrunken and nodular in contour, similar to prior studies,
compatible with cirrhosis. The gallbladder is not dilated. Splenomegaly to
14 cm is unchanged. A 1.5-cm cystic lesion in the pancreatic tail is
unchanged and likely represents an IPMN. The right adrenal gland is normal.
The left adrenal gland is thickened, unchanged from . The kidneys
are small, without hydronephrosis. The small and large bowel are normal in
course and caliber without obstruction. The aorta is of normal caliber with
dense atherosclerotic calcifications. Diffuse vascular calcifications are
noted in the mesenteric and renal vessels. Large nonhemorrhagic
intra-abdominal ascites is unchanged from prior studies. A filling defect in
the SMV extending for 4.9cm craniocaudally with vascular expansion is
compatible with thrombus, which was not well seen due to lack of IV contrast
on prior studies, but the expansion is similar to (2:37, 601b:19).
The main portal vein and splenic vein are patent. No pathologically enlarged
mesenteric or retroperitoneal lymph nodes are identified.
## CT PELVIS:
Evaluation of the pelvis is limited by streak artifact from
bilateral osseous hardware. The rectum and sigmoid colon are normal.
Calcifications in the uterus are likely due to fibroids. Intrapelvic ascites
is tracking from the abdomen. There is no pelvic or inguinal lymphadenopathy
identified. A right femoral access catheter is seen. The left adductor
hematoma is less well visualized on this study, although there is some
asymmetry in the adductor muscles, left minimally larger than right.
## BONE WINDOWS:
No bone findings suspicious for infection or malignancy are
seen. The patient is status post right total hip arthroplasty and left femoral
fixation. An old left inferior pubic ramus fracture is again identified.
Multilevel degenerative change in the thoracolumbar spine is unchanged.
Healing right rib fractures are again noted.
## IMPRESSION:
1. Cirrhotic liver with moderate-to-large non-hemorrhagic ascites and
splenomegaly.
2. SMV thrombus, not clearly seen on prior studies due to lack of IV
contrast, but was probably present since when SMV expansion was
similar to the current study.
3. The left adductor hematoma is less well visualized on this study.
4. A 1.5 cm hypodensity in the pancreatic tail most likely represents an
IPMN. In the patient's age group, no further followup is needed.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17038950", "visit_id": "28051402", "time": "2119-02-09 02:14:00"} |
16402793-DS-14 | 939 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HISTORY OF PRESENT ILLNESS:
This is a yo female with no significant PMH who was admitted
for severe RUQ pain. She reports that her pain began on ,
increased in severity on and . She started
developing fevers on as well. She called her PMD's
office on who instructed her to come into the office if
the pain persisted. Her PMD saw her on and told her
that she should go to the emergency room. During this time, she
also had chills, anorexia, nausea, but no vomiting. No recent
travel, no changes in her diet, diarrhea, or consipation. No
BRBPR, but ?dark stools. She did not believe her pain was
related to food, although has had poor PO intake. No dizziness,
lightheadedness. In the ED, had a temp of 98.4, HR 90, BP
106/68 and O2 sat 100% RA. She was given morphine and
subsequently found to have low SBP to the , which resolved
with fluid resuscitation. She had an US there which was
negative for cholecystitis, no pericholecystic fluid and
negative sonographic sign. Also had an abdominal CT
with findings concerning for bilateral pyelonephritis.
On the floor, she was found to be febrile to 103.2 and
tachycardic. She was in pain in her RUQ, no nausea. ROS
otherwise negative as indicated above.
## GEN:
sleeping, tearful because of pain
## HEENT:
PERRLA, sclera anicteric, OP clear
## CV:
+s1s2, rrr, +holosystolic murmur heard throughout the
precordium, JVP difficult to see, but arterial pulsation at the
earlobe.
## ABD:
soft, tender to palpation over RUQ, negative sign,
no rebound or guarding
## NEURO:
cn intact, strength in all extremities.
## LFTS:
44 > 0.5/161 < 161
LDH 234
Lipase 17
lactate
UA negative for bacteria, WBC, RBC
## IMPRESSION:
Striated nephrogram bilaterally with minimal
perinephric
stranding, suggesting pyelonephritis bilaterally; however this
finding can
be also seen in vasculitis, embolic phenomena, or less likely
lymphoma.
## FINDINGS:
The hepatic echotexture is normal, without a focal
lesion. The
portal vein is patent with hepatopetal flow. The gallbladder is
normal,
without gallstones. There is no gallbladder wall thickening,
pericholecystic fluid, or sonographic sign. There is no
intra- or extra-hepatic biliary ductal dilatation with the CBD
measuring 4 mm. Visualized pancreatic neck appears unremarkable,
with the remainder of the pancreas not well visualized due to
overlying bowel gas.
The right kidney measures 12.1 cm. There is an area of increased
echogenicity involving the mid and upper poles of the right
kidney, which is more conspicuous compared to .
## CXR :
No acute cardiopulmonary process.
## BRIEF HOSPITAL COURSE:
This is a yo female admitted with 5 days of abdominal pain,
fevers, chills and nausea.
* Abdominal pain - The patient presented with fever, CVA
tenderness, and a CT abdomen consistent with pyelonephritis.
Surprisingly, UA was not consistent with infection. A urine
culture grew out less than 10,000 organisms with speciation and
sensitivities pending at discharge (to be followed-up by primary
care doctor). Other diagnoses considered on the differential
included cholecystitis, GYN pathology, abscess. In ED, had
pelvic exam without adnexal tenderness or CMT, so less likely
GYN pathology. US and CT without evidence of gallstones or
cholecystitis. No RBC or casts in the urine to suggest
vasculitis or glomerulonephritis. Because the CT scan was also
questionable for an embolic event to the kidneys, and the
patient was noted to have a sytolic heart murmur and fever,
blood cultures were obtained as well as a TTE. The TTE was a
normal study with no valvular vegetations. Coags were negative
for hypercoagulable state. The blood cultures were pending at
discharge and should be followed by her primary care physician.
Thus, the patient was treated with IV ceftriaxone for
presumptive pyelonephritis and transitioned to po ciprofloxacin
for discharge. The patient was given IV dilaudid for pain
control and transitioned to po oxycodone upon discharge.
* Transaminitis - Slightly elevated, but nl T bili. Likely
related to hypotensive episode in the ED, but also consider
toxin and viral etiologies. She had been taking Tylenol prior
to admission, so a tylenol level was obtained and found to be
within normal limits. Hep serologies were pending at discharge
and should be followed-up by primary care physician.
* Systolic murmur - C onsistent with benign flow murmur in the
setting of infection, but in the setting of findings above TTE
was pursued and negative for valvular pathology. The murmur was
not present at the time of discharge.
* Code - Full code
## DISCHARGE MEDICATIONS:
1. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days: to be started on day after discharge ( ).
Disp:*10 Tablet(s)* Refills:*0*
2. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital for abdominal pain and fevers.
You underwent a CT scan which showed evidence of a kidney
infection. You were started on an antibiotic, ceftriaxone, to
treat this infection with improvement in your pain and fevers.
You will need to continue on the antibiotic, ciprofloxacin,
twice a dy for seven days starting the day after discharge
The following changes were made to your medications:
You were started on ciprofloxacin 500 mg twice a day for 7 days
to start the day after discharge.
You were give oxycodoe 5 mg to take every 6 hours as needed for
pain.
If you experience any of the following symptoms you should
contact your doctor or go directly to the emergency room:
fevers, chills, chest pain, shortness of breath, abdominal pain,
back pain, inability to tolerate eating, vomiting, severe
nausea.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16402793", "visit_id": "28253300", "time": "2121-06-22 00:00:00"} |
13050109-RR-17 | 117 | ## EXAMINATION:
US NECK, SOFT TISSUE
## INDICATION:
year old woman with left sided lymphadenopathy // left sided
lymphadenopathy
## FINDINGS:
Dominant nodule in the right midpole measures 17 x 21 x 22 mm and is similar
to prior. Several smaller right thyroid nodules are again seen. Small, 5 x 3
x 4 mm right retro thyroid nodule could be compatible with a parathyroid
adenoma as previously reported, and is stable.
Several nodules in the left thyroid, some with coarse calcifications, appear
similar to previous exam.
Views of the neck bilaterally at levels 3, 4, and 6 show no identifiable large
nodes.
## IMPRESSION:
Views of the left neck at levels 3, 4, and 6 show no identifiable large nodes.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13050109", "visit_id": "N/A", "time": "2172-12-19 11:50:00"} |
10847780-RR-15 | 244 | ## CLINICAL INDICATION:
man with prostate cancer.
## FINDINGS:
The prostate measures 3.7 x 4.3 x 3.1 cm (transverse x CC x AP),
yielding a calculated volume of 25.6 cc. At the right base (sequence 7, image
23), there is a region of confluent, abnormal low T2 signal in the right
posterolateral peripheral zone with corresponding moderate enhancement. In
the left peripheral zone, at the apex and mid gland, there is confluent low T2
signal with moderate enhancement (sequence 7, image 32 and sequence 7, image
28). In addition, in the left base, there is a small focus of more low T2
signal and moderate enhancement laterally (sequence 7, image 25). There is no
significant wash-out enhancement kinetics seen on 3TP images. Neurovascular
bundles are unremarkable. Seminal vesicles demonstrate normal morphology and
signal intensity.
No significant lymphadenopathy. Urinary bladder is unremarkable. Visualized
gastrointestinal tract shows no abnormalities. No abnormal marrow signal is
evident.
Multiplanar 2D and 3D reformations provided multiple perspectives for the
dynamic series with kinetic information. CAD analysis facilitated the DCE
interpretation.
## IMPRESSION:
Bilateral gland-confined abnormalities in the left peripheral gland from apex
to base as well as a focus in the right peripheral gland base are not
completely classic for prostate carcinoma without washout characteristics,
however their low signal on T2-weighted images and early enhancement make them
suspicious for carcinoma and concordant with the biopsy results showing lower
grade prostate cancer.
MRI grade T2c.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10847780", "visit_id": "N/A", "time": "2169-03-04 10:45:00"} |
18622600-RR-131 | 102 | ## INDICATION:
year old woman with new onset fever // ?PNA ?PNA
## IMPRESSION:
Consolidation in the right upper and lower lobes and moderate right pleural
effusion are new consistent with multifocal pneumonia. Left lung clear. If
there is any consolidation at the left lung base it is mild. Heart size
normal. No pneumothorax.
Nasogastric tube ends in nondistended stomach. Left subclavian dialysis
catheters end in the SVC. Right-sided central venous catheter ends in the
right brachiocephalic vein.
## NOTIFICATION:
Dr. reported the findings to (In Hospital,
On Page), by telephone on at 10:34 AM, 1 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18622600", "visit_id": "20433528", "time": "2189-06-10 01:26:00"} |
14257008-RR-20 | 212 | ## INDICATION:
year old man with recent distal right ureteral/bladder cancer
resection with urine leak on CT. Nephrostogram showed no leak but
sluggish flow at UVJ, PCNU placed // Assess Bladder Leakage
## FINDINGS:
There is no free fluid in the pelvis. Following cystography, there is no
contrast extravasation from the bladder to suggest bladder leak. No contrast
reflux into ureters. Mild smooth thickening of the right posterolateral
bladder wall near the UVJ, as well as mild thickening of the right distal
ureter itself near the anastomosis, may be postoperative. No new discrete
polypoid or masslike lesion is identified. Normal right ureteral jet is noted
as admixture of unopacified urine in the cystography phase. Foley catheter in
appropriate position with accompanying intravesical air.
Prostate hypertrophy with punctate calcifications is noted.
Unremarkable rectum and visualized bowel. No free fluid or fluid collection.
No adenopathy with noncontrast evaluation. Small fat containing umbilical
hernia. No soft tissue mass. No acute fracture.
## IMPRESSION:
1. Cystogram demonstrates no evidence of bladder leak. No free fluid in the
pelvis.
2. Stable right posterolateral bladder wall thickening and thickening of
distal portion of right ureter may relate to post treatment change but
noncontrast CT / CT cystography is nonspecific for evaluation of this finding.
3. Enlarged prostate consistent with BPH.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14257008", "visit_id": "N/A", "time": "2142-09-02 07:07:00"} |
12583923-RR-29 | 236 | ## INDICATION:
year old man with and Cr 6.1 from baseline 4.9 with
urinary retention on bladder scan// eval for hydronephrosis or parenchymal
process
## FINDINGS:
The right kidney measures 9.7 cm. The left kidney measures 8.2 cm. There is no
hydronephrosis, stones, or masses bilaterally. There is increased cortical
echogenicity bilaterally as on prior exam. In the upper pole of the right
kidney there is a bilobed simple cyst that measures 3.4 x 1.7 x 1.8 cm, stable
from prior exam. An additional simple cyst in lower pole the right kidney
measures 1.4 x 1.7 x 1.1 cm. A hyperechoic focus in the cortex of the
interpolar region of the left kidney with surrounding parenchymal
heterogeneity is again seen.
The bladder is collapsed around a Foley catheter.
A left pleural effusion is incidentally noted.
d
## IMPRESSION:
1. Increased cortical echogenicity bilaterally suggestive of medical renal
disease.
2. No hydronephrosis.
3. Stable hyperechoic focus in the interpolar region of the left kidney with
surrounding parenchymal heterogeneity may represent a renal lesion with
associated parenchymal calcification. Additional indeterminate lesions of
concern seen on prior exams are not well appreciated on this study and have
reportedly been further evaluated on outside hospital abdominal MRI from which is currently not available for comparison. Correlation with
that study is recommended.
4.
## RECOMMENDATION(S):
Correlation with outside MRI for renal lesions.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12583923", "visit_id": "27937691", "time": "2156-02-01 09:42:00"} |
10658681-RR-85 | 93 | ## INDICATION:
year old woman with PICC // Pt had a L PICC,45cm
Contact name: :
## FINDINGS:
Left PICC terminates in the mid SVC. No pneumothorax. The mediastinal
contours and cardiac borders are normal. Prominent pulmonary arteries
bilaterally suggest pulmonary hypertension. Right lower lung opacity with may
be due to atelectasis given elevated hemidiaphragm or pneumonia in the right
clinical scenario.
## IMPRESSION:
1. Left PICC terminates in the mid SVC. No pneumothorax.
2. Pulmonary hypertension.
3. Right lower lung opacity with may be due to atelectasis or pneumonia in the
right clinical scenario.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10658681", "visit_id": "29281585", "time": "2130-09-26 15:29:00"} |
18750947-RR-14 | 363 | ## HISTORY:
Fell on right leg bent. Question internal derangement.
## RIGHT KNEE MRI WITHOUT CONTRAST:
There is a small-to-moderate joint effusion. There are tricompartmental
osteophytes.
In the medial compartment, the meniscus is intact. There is mild-to-moderate
cartilage irregularity, with marginal osteophytes.
In the lateral compartment, the meniscus is intact. Prominence of the free
edge of the body of the meniscus suggests a subtle forme fruste discoid
meniscus. There is some low signal in lateral compartment tibial hyaline
cartilage, without corresponding calcification - ? area of old injury with
fibrocartilaginous change. No large cartilage defect is identified.
In the patellofemoral compartment, there is a probable flap tear along the
lateral facet, near the median eminence (series 3, image 8).
The cruciate ligaments are intact. The medial collateral ligament is intact,
with surrounding edema, consistent with a grade II sprain. A small amount of
fluid is present in the tibial collateral bursa. It is difficult to follow the
medial retinaculum into the anterior fibers of the medial collateral ligament
(series 3, image 14), raising question of a disreuption between the medial
retinaculum and the MCL. The fibular collateral ligament is intact.
The quadriceps and patellar tendons are intact. There is a small amount of
fluid in the infrapatellar bursa.
There is focal edema along the posterior aspect of the lateral femoral condyle
and the posterolateral tibial plateau (series 5, image 9) and an area of focal
edema in the medial proximal tibia anteriorly (series 5, image 17). No low-
signal line to suggest fracture or no cortical interruption is identified.
There is faint edema in the lateral gastrocnemius muscle.
## IMPRESSION:
1. No meniscal tear detectedd. ACL, PCL, and LCL intact. Form fruste discoid
lateral meniscus noted.
2. Edema surrounding intact MCL is consistent with a grade II sprain. Of
note, however, continuity between the medial retinaculum and MCL cannot be
confirmed.
3. Multifocal bone marrow edema - given the history of trauma, these would be
compatible with bone contusions. No fracture lines are identified.
4. Small joint effusion.
5. Osteoarthritis, with cartilage irregularity and multifocal osteophytes.
6. Loose bodies seen posteriorly in the joint on the radiographs are
not well visualized by MR.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18750947", "visit_id": "N/A", "time": "2180-01-08 15:06:00"} |
18265318-DS-19 | 1,652 | ## ALLERGIES:
allopurinol / gabapentin / Iodinated Contrast Media - IV Dye /
sotalol / duloxetine / atorvastatin
## :
1. Right common femoral artery access.
2. Celiac arteriogram.
3. Common hepatic arteriogram.
## HISTORY OF PRESENT ILLNESS:
year old female with afib on xarelto who is s/p fall at home
on . This fall was unwitnessed and her son found her and
brought her to . She was found to have a
nonoperative left iliac wing fracture and was discharged home
with services after days. She has been working with home
nursing and home . Her son explains that she had been in a
nursing home for a few years in the context of overall decline
in
health and that she insisted that she be able to come live at
home again in the recent months. He does not think she has been
doing well at home and says that she frequently falls and has
fallen between and today.
The son noted that she was weak and not well for the past few
days and that he thought she might have a UTI which she has had
in the past. He was asking her to be seen in the hospital but
she
was resistant. He received a call that the patient was found at
home at 10am today by her home physical therapist. She was
minimally responsive and had vomit nearby per report when she
was
found. She was brought to the ED at and found to have a
hemoglobin of 5.8 and a hematocrit of 18 from 33 on d/c, was
given 2UPRBC, ertapenem for UTI, head CT was negative, and CT
A/P
was significant for bibasilar atelectasis concerning for
aspiration and a large amount of free fluid in the abdomen with
a
high density component in the right lobe of the liver. This may
represent a bleeding and ruptured liver mass/cyst/nonspecific
lesion with parenchymal and extraparenchymal hemorrhage. She was
transferred to for further evaluation.
On arrival her hematocrit was 24, a foley was placed, and coags
were normal. Lactate was also normal. Surgery and were
urgently consulted. History is mostly obtained from son who is
at
bedside. OSH notes conflict with this given history in terms of
what happened earlier today prior to being taken to .
## :
afib on xarelto, frequent falls, frequent UTIs,
CHF, GERD, HL, HTN, MI, depression TIA, polymyalgia rheumatica,
giant cell arteritis, spinal stenosis, CKD, osteoporosis,
rheumatoid arthritis, anemia
## PS:
open cholecystectomy, open appendectomy, bilateral knee
surgeries, hysterectomy, right toe surgery (history limited as
patient was somnolent and son was not completely clear on
surgical history)
## ABDOMEN:
non-distended, tender to palpation, tense abdomen
## GU:
2mm ulceration on right buttock
## NEURO:
AO x2, follows simple commands
## GEN:
AA&O x , NAD, calm, cooperative.
## HEENT:
(-)LAD, mucous membranes moist, trachea midline, EOMI,
PERRL.
## CHEST:
Diminished to auscultation bilaterally, (-) cyanosis.
## ABDOMEN:
soft, non tender to palpation
## EXTREMITIES:
Warm, well perfused, pulses palpable, 1+edema.
Scattered ecchymosis over arms and legs.
================================================
## :
OSH Head CT: no acute intracranial abnormalities
## :
Abd/Pelvic CT: No evidence of active extravasation or
pseudoaneurysm. Large clot within a right hepatic lobe lesion
bordered by the hepatic capsule is suggestive of a prior right
hepatic cystic lesion which has ruptured and contains hematoma
and blood products. Moderate volume of intermediate density
fluid
throughout the abdomen and pelvis likely represents old blood
products or proteinaceous contents. Comminuted left iliac wing
fracture. Subacute to chronic left L1 and L2 transverse process
fractures. Hyper enhancement of the urinary bladder mucosa is
worrisome for acute cystitis.
## :
CXR: Cardiomegaly with mild pulmonary edema. No
significant interval change compared to prior imaging. No basal
consolidation seen.
## CTA A/P:
No evidence of active extravasation. Large clot is seen within
the
right hepatic lobe surrounded by the hepatic capsule suggestive
of a prior right hepatic cyst with prior rupture and
hemorrhage.Moderate volume of intermediate density fluid
throughout the abdomen and pelvis likely represents old blood
products or proteinaceous contents. Comminuted left iliac wing
fracture.
**FINAL REPORT
URINE CULTURE (Final :
ESCHERICHIA COLI. >100,000 CFU/mL. PRESUMPTIVE
IDENTIFICATION.
Cefepime (=<2 MCG/ML).
Cefepime sensitivity testing confirmed by Microscan.
## SENSITIVITIES:
MIC expressed in
MCG/ML
ESCHERICHIA COLI
|
AMPICILLIN
-----
=>32 R
AMPICILLIN/SULBACTAM-- =>32 R
CEFAZOLIN
-----
=>64 R
CEFEPIME
-----
S
CEFTAZIDIME
-----
<=1 S
CEFTRIAXONE
-----
8 R
CIPROFLOXACIN
-----
=>4 R
GENTAMICIN
-----
<=1 S
MEROPENEM
-----
<=0.25 S
NITROFURANTOIN
-----
<=16 S
PIPERACILLIN/TAZO
-----
8 S
TOBRAMYCIN
-----
=>16 R
TRIMETHOPRIM/SULFA
-----
<=1 S
**FINAL REPORT
C. difficile DNA amplification assay (Final :
Negative for toxigenic C. difficile by the Illumigene DNA
amplification assay.
## BRIEF HOSPITAL COURSE:
afib on riveroxaban s/p recent falls and known comminuted
left iliac wing fracture after fall on , now presenting with
lethargy, weakness, hematocrit of 18, and ruptured hemorrhagic
liver cyst in right lobe with hemoperitoneum.
Responded to 2U PRBC with increase in hematocrit to 24 in OSH. A
third unit of
blood was given in the ED upon arrival. Vitals stable but mental
status is diminished. No active extravasation on CTA. Patient
admitted to the ICU and
for close monitoring, holding anticoagulation, and serial
hematocrits. She was treated with ertapenem for a possible UTI.
Head CT was negative. Hematocrit was trended every 4 hours, and
remained stable around 8.5-9.
On HD2 the Foley was removed. The patient was bolused 500cc LR
for low UOP with improvement. The patient went to for
selective common hepatic arteriogram which revealed no active
extravasation or pseudoaneurysm. Chest x-ray was concerning for
pulmonary edema and tachypneic for which the patient received
Lasix with goal of being negative 1 liter.
HD3 the urine culture from was growing E coli ESBL,
resistant to CTX so she was switched to Bactrim. Home
medications were restarted with gradual improvement in mental
status. Hematocrit remained stable. The patient was started on
a regular diet. HD4 the patient remained hemodynamically stable.
She was transferred to the floor for Physical therapy and
Occupational therapy evaluation.
On HD6 the patient was complaining of chest pain. EKG showed
rate controlled atrial fibrillation, and the patient's symptoms
self resolved. Stool sample was sent for loose stool which came
back negative for c. diff.
During this hospitalization, the patient ambulated early and
frequently with assistance, was adherent with respiratory toilet
and incentive spirometry, and actively participated in the plan
of care. The patient received subcutaneous heparin and venodyne
boots were used during this stay. The rivaroxaban remained on
hold with plans to restart on .
At the time of discharge, the patient was doing well, afebrile
with stable vital signs. The patient was tolerating a regular
diet, ambulating with assistance, voiding (incontinent) without
assistance, and pain was well controlled. The patient was
discharged to rehab, to complete a 5 day course of Bactrim for
her UTI. The patient received discharge teaching and follow-up
instructions with understanding verbalized and agreement with
the discharge plan.
*Rehab expected to be less than 30 days*
## MEDS:
Ativan 0.5', Cardizem CD 180', digoxin 0.125 every other
day, folate 1;, Fosamax 70qweek, Lasix 40'', mag ox 400',
melatonin 3', methotrexate 15mg weekly, MTV;, KCl 40 TID,
prednisone 3', requip 1', Toprol XL 50'', tramadol 25'''',
vitamin D , wellbutrin 75', xarelto 15', Bactrim 800/160''
(for UTI
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild
2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing
3. Docusate Sodium 100 mg PO BID
4. Heparin 5000 UNIT SC BID
5. Lidocaine 5% Patch 1 PTCH TD QAM
6. Sulfameth/Trimethoprim DS 1 TAB PO BID
7. TraMADol 50 mg PO Q12H:PRN Pain - Moderate
RX *tramadol 50 mg 1 tablet(s) by mouth every twelve (12) hours
Disp #*20 Tablet Refills:*0
8. Digoxin 0.125 mg PO EVERY OTHER DAY
9. Diltiazem Extended-Release 180 mg PO DAILY
10. Furosemide 40 mg PO BID
11. Metoprolol Tartrate 25 mg PO Q8H
12. Potassium Chloride 40 mEq PO BID
13. PredniSONE 3 mg PO DAILY
14. rOPINIRole 1 mg PO QAM
15. Senna 8.6 mg PO BID:PRN cosntipation
## DISCHARGE DIAGNOSIS:
Large ruptured hepatic cyst with hemoperitoneum
Urinary tract infection
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
You were admitted to after being found down. CT imaging
revealed a liver injury with bleeding and your lab work was
notable for a urinary tract infection and a low hematocrit. You
were taken to for an angiogram without any evidence of a
pseudoaneurysm. You received a blood transfusion and
antibiotics. You have responded well to this, and there has been
no signs of ongoing bleeding. You worked with Physical therapy
and Occupational therapy, and you are now medically cleared for
discharge to rehab. 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
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18265318", "visit_id": "26270986", "time": "2134-06-25 00:00:00"} |
18816740-DS-13 | 864 | ## CHIEF COMPLAINT:
Left flank pain, 4mm stone
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Urethral dilation, cystoscopy, left ureteral stent placement
## HISTORY OF PRESENT ILLNESS:
Patient is a male with no history of stones who presented
to the ED this evening with days of left flank pain and LLQ
pain. He reports occasional chills and subjective fevers. He has
some nausea but no emesis. He has dysuria but no hematuria,
frequency or urgency.
He follows with urologist Dr for BPH s/p TURP in
. In he had a weakened stream and office
cystoscopy was notable for what sounds to be bladder neck
contracture. The plan was for dilation in
unfortunately this was put on hold given other issues that the
patient was dealing with. He still reports a weak stream but
feels that he can empty his bladder
## PAST MEDICAL HISTORY:
HERPES ZOSTER
HYPERTENSION
HYPERLIPIDEMIA
DIABETES TYPE II
CORONARY ARTERY DISEASE
HERNIATED DISC
## PHYSICAL EXAM:
On admission:
T 99 HR 114 BP 169/85 RR 18 96% RA
## HEENT:
Extraocular movements intact, face symmetric
## BACK:
Non-labored breathing, no CVAT bilaterally
## ABD:
Soft, non-tender, non-distended, no guarding or rebound
## EXT:
Moves all extremities well
## BRIEF HOSPITAL COURSE:
The patient presented to the emergency department overnight
where a 4mm left obstructing stone was diagnosed. He was
afebrile but with persistent tachycardia and a leukocytosis. He
was taken that morning to the operating room for cystoscopy and
left ureteral stent placement. His bladder neck contracture was
also dilated at that time. He was then admitted to Dr.
service operatively. He maintained a
foley overnight. The following morning this was discontinued and
he voided without difficulty. He was tolerating a regular diet.
His nausea resolved. He remained afebrile and HR and bp
normalized. His creatinine also normalized. He was given Flomax
to help facilitate passage of his stone and stent toleration. At
discharge, patient's pain well controlled with oral pain
medications, tolerating regular diet, ambulating without
assistance, and voiding without difficulty. He is given explicit
instructions to call Dr. follow-up.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Losartan Potassium 50 mg PO DAILY
2. Diazepam 5 mg PO Q12H:PRN anxiety
3. Metoprolol Tartrate 50 mg PO DAILY
4. MetFORMIN (Glucophage) 1000 mg PO BID
5. Atorvastatin 40 mg PO QPM
6. Pantoprazole 40 mg PO Q12H
7. Tamsulosin 0.4 mg PO QHS
## DISCHARGE MEDICATIONS:
1. Diazepam 5 mg PO Q12H:PRN anxiety
2. Losartan Potassium 50 mg PO DAILY
3. MetFORMIN (Glucophage) 1000 mg PO BID
4. Metoprolol Tartrate 50 mg PO DAILY
5. Pantoprazole 40 mg PO Q12H
6. Tamsulosin 0.4 mg PO QHS
RX *tamsulosin 0.4 mg 1 capsule(s) by mouth before bed Disp #*30
## CAPSULE REFILLS:
*2
7. Ciprofloxacin HCl 500 mg PO Q12H
RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day
Disp #*14 Tablet
## REFILLS:
*0
8. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN moderate to
severe pain
RX *oxycodone 5 mg 1 tablet(s) by mouth q6 hr Disp #*25 Tablet
Refills:*0
9. Atorvastatin 40 mg PO QPM
10. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp
#*30 Tablet Refills:*0
## DISCHARGE INSTRUCTIONS:
-You can expect to see occasional blood in your urine and to
possibly experience some urgency and frequency over the next
month; this is normal and may be related to the passage of
stone fragments or the indwelling ureteral stent (if there is
one). Bleeding will gradually improve.
-The kidney stone was lasered into many small fragments which
are still in the process of passing.
-You may experience some pain associated with spasm of your
ureter. This is normal. Take the narcotic pain medication as
prescribed if additional pain relief is needed.
-Ureteral stents MUST be removed or exchanged and therefore it
is IMPERATIVE that you follow-up as directed.
-Do not lift anything heavier than a phone book (10 pounds)
-Resume all of your pre-admission medications, except HOLD
aspirin until you see your urologist in follow-up
-IBUPROFEN (the ingredient of Advil, Motrin, etc.) may be taken
even though you may also be taking Tylenol/Acetaminophen. You
may alternate these medications for pain control. For pain
control, try TYLENOL FIRST, then ibuprofen, and then take the
narcotic pain medication as prescribed if additional pain relief
is needed.
-Ibuprofen should always be taken with food. Please discontinue
taking and notify your doctor should you develop blood in your
stool (dark, tarry stools)
-You MAY be discharged home with a medication called PYRIDIUM
that will help with the "burning" pain you may experience when
voiding. This medication may turn your urine bright orange.
-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication.
Discontinue if loose stool or diarrhea develops. Colace is a
stool softener, NOT a laxative, and available over the counter.
The generic name is DOCUSATE SODIUM. It is recommended that you
use this medication.
-Do not eat constipating foods for weeks, drink plenty of
fluids to keep hydrated
-No vigorous physical activity or sports for 4 weeks
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18816740", "visit_id": "22335340", "time": "2146-01-13 00:00:00"} |
18675991-RR-38 | 161 | ## INDICATION:
female with history of metastatic uterine
adenosarcoma, evaluate for free fluid and hydronephrosis.
## ABDOMINAL ULTRASOUND:
Liver demonstrates no intra- or extra-hepatic biliary
ductal dilation. The common bile duct is normal in caliber. The gallbladder
is not visualized and the pancreas is also poorly visualized due to overlying
bowel gas.
The right kidney measures 10.5 cm. The left kidney measures 10.5 cm. There
is no hydronephrosis, nephrolithiasis, or renal mass.
There is moderate amount of free fluid in the abdomen. There are multiple
masses identified, both in the right and left upper quadrants, as well as in
the midline. This was better characterized on recent CT of the abdomen and
pelvis.
Normal antegrade flow is identified in the main portal vein.
## IMPRESSION:
1. Multiple intra-abdominal masses, better characterized on recent CT of the
abdomen and pelvis.
2. No hydronephrosis.
3. Small amount of free fluid, increased compared to prior study.
4. No biliary ductal dilation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18675991", "visit_id": "29109280", "time": "2153-09-05 16:56:00"} |
14478167-RR-96 | 132 | ## INDICATION:
year old man with liver/kidney transplants s/p reexploration
of both and washouts // eval interval change - ETT, , pulmonary
## IMPRESSION:
In comparison with the study of , there has been placement of an
endotracheal tube with its tip approximately 5 cm above the carina.
Nasogastric tube extends to the upper stomach, with the side port above the
esophagogastric junction. Dobhoff tube is in place, extending at least to the
upper stomach were crosses the lower margin of the image. Left subclavian
catheter tip is in the lower SVC.
There is increased opacification at the left base with silhouetting
hemidiaphragm, consistent with pleural fluid and volume loss in the left lower
lobe. Minimal atelectatic changes are seen at the right base.
No evidence of appreciable vascular congestion or acute focal pneumonia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14478167", "visit_id": "N/A", "time": "2138-12-11 12:52:00"} |
14068105-RR-22 | 320 | ## EXAMINATION:
MRI of the Abdomen
## YO MAN WITH HCC:
5.4 cm in segment II, 3.0 cm in segment VIII
s/p TACE and ablation// please assess for interval change
## FINDINGS:
This examination is severely limited due to non-breath hold technique. Within
these limitations:
## LOWER THORAX:
Trace right pleural effusion. Otherwise, lung bases are clear.
No left pleural or pericardial effusion.
## LIVER:
The liver is cirrhotic in appearance. No hepatic steatosis. Ablation
cavities within segments II and VIII with intrinsic T1 hyperintensity
representing coagulation necrosis. Surrounding the segment II ablation
cavity, there is a thin rim of enhancement, which likely reflects
posttreatment changes. No other enhancing liver lesions visualized. A few
punctate T2 hyperintense lesions throughout the liver likely represent biliary
hamartomas.
## BILIARY:
No intra or extrahepatic biliary dilatation. Sludge layering
dependently throughout the gallbladder. No evidence of acute cholecystitis.
## PANCREAS:
Pancreas is normal in bulk and signal intensity. No focal
pancreatic lesions. No ductal dilatation. No peripancreatic stranding.
## SPLEEN:
Spleen is not enlarged. No focal splenic lesions.
## ADRENAL GLANDS:
Adrenal glands are normal in size and shape bilaterally.
## KIDNEYS:
Kidneys enhance homogeneously and symmetrically. No focal renal
lesions. No hydronephrosis. No perinephric stranding.
## GASTROINTESTINAL TRACT:
Small hiatal hernia. Otherwise, partially imaged
stomach, small, and large bowel are unremarkable in appearance. No bowel
obstruction.
## LYMPH NODES:
Multiple small upper mesenteric lymph nodes likely reflect
underlying liver disease. No retroperitoneal lymphadenopathy.
## VASCULATURE:
No abdominal aortic aneurysm. Major abdominal branches are
patent.
## OSSEOUS AND SOFT TISSUE STRUCTURES:
No suspicious osseous lesions.
Surrounding soft tissues are unremarkable in appearance.
## IMPRESSION:
1. This examination is severely limited due to non-breath hold technique.
Within these limitations, ablation cavities within segment II and VIII are
without definite evidence of recurrence or metastatic disease. Consider
multiphasic liver CT for future examinations as the patient has difficulty
with breath holding technique.
2. Other incidental findings include gallbladder sludge and a small hiatal
hernia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14068105", "visit_id": "N/A", "time": "2187-10-26 09:41:00"} |
10154376-RR-25 | 53 | ## PROCEDURE:
CT-guided drainage of right lower quadrant abscess.
## INDICATION:
Post-laparoscopic appendicectomy for perforated appendicitis.
Now presents two weeks later with right lower quadrant abscess.
## IMPRESSION:
Technically successful CT-guided drainage of right lower quadrant abscess.
Findings were communicated with Dr. , pager , via telephone
on , at 10:28 a.m.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10154376", "visit_id": "27499017", "time": "2174-08-10 09:24:00"} |
13115577-DS-26 | 2,019 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## CHIEF COMPLAINT:
Gangrene of the right transmetatarsal amputation site
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Right below knee amputation.
## HISTORY OF PRESENT ILLNESS:
This is a male who has a history of right lower
extremity gangrene and severe peripheral artery disease. He has
had a TMA on his right leg which he has walked on and
unfortunately has failed. He has had multiple debridements and
VAC placement; however, due to vascular compromise, these
treatments have failed. Given these findings and the non
salvageable right foot, the patient was
consented for a right below knee amputation.
## 1. CARDIAC RISK FACTORS:
Diabetes, Dyslipidemia, Hypertension,
Smoker
## 2. CARDIAC HISTORY:
-CABG:
. Anatomy unknown.
-PERCUTANEOUS CORONARY INTERVENTIONS: cath with stent to LAD and
LCx on
-PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:
3v CAD (s/p cath with stent to LAD and LCx on s/p 4v CABG
CHF (EF <30%)
CKD with baseline Cr's in the 3' through last admission
PVD
HTN
DM, last A1c 6.6 in
dyslipidemia
tobacco abuse
s/p SFA and DP bypass
left iliac stenting
s/p appendectomy
s/p L toe amputation
## FAMILY HISTORY:
There is no family history of premature coronary artery disease
or sudden death.
## GEN:
Alert and orietnted x 3, NAD, speaking
## AOUNW:
Right LLE stump CDI wtih staples intact
dorsal aspect of BKA site has a 2cm-2cm blister with resolving
ecchymosis
No signs of infection of the wound
## PERTINENT RESULTS:
05:32AM BLOOD Hct-30.2*
05:33AM BLOOD WBC-5.9 RBC-3.30* Hgb-9.4* Hct-29.4*
MCV-89 MCH-28.6 MCHC-32.1 RDW-17.0* Plt
05:33AM BLOOD Plt
05:32AM BLOOD Glucose-51* UreaN-59* Creat-3.3* Na-142
K-3.9 Cl-106 HCO3-25 AnGap-15
05:33AM BLOOD Glucose-129* UreaN-56* Creat-3.1* Na-139
K-3.9 Cl-103 HCO3-24 AnGap-16
05:09AM BLOOD ALT-11 AST-15 AlkPhos-60 TotBili-0.2
06:17PM BLOOD CK(CPK)-47
05:09AM BLOOD cTropnT-0.06*
05:32AM BLOOD Calcium-8.6 Phos-4.7* Mg-2.1
M
Cardiology Report ECG Study Date of 5:32:36
Sinus rhythm with probable sinus arrhythmia. Consider left
atrial abnormality.
Left ventricular hypertrophy with ST-T wave abnormalities. Since
the previous
tracing of sinus bradycardia is absent and prolonged QTc
interval is
shorter.
Read by: .
Intervals Axes
Rate PR QRS QT/QTc P QRS T
71 140 86 388/407 54 61 -144
M
Radiology Report CHEST (PORTABLE AP) Study Date of
10:47
. VICU 10:47
CHEST (PORTABLE AP) Clip #
## REASON:
pre-op for R BKA
## UNDERLYING MEDICAL CONDITION:
year old man pre-op for R BKA
## REASON FOR THIS EXAMINATION:
pre-op for R BKA
Final Report
## TECHNIQUE:
Preop portable AP chest radiograph.
## COMPARISON:
Compared to chest radiograph, .
## FINDINGS:
Right PICC in unchanged position. Interval improvement
in the
previously noted right base focal opacity is seen. There is no
focal lung
consolidation. There is no pleural effusion or pneumothorax.
Cardiac
silhouette appears slightly enlarged. There are midline sternal
wires. There
is calcification at the aortic arch. Left old rib fractures.
## IMPRESSION:
1. No pneumonia.
2. Mildly enlarged cardiac silhouette.
The study and the report were reviewed by the staff radiologist.
## BRIEF HOSPITAL COURSE:
Mr. was admitted from clinic on , started on iv
antibiotics and preoperative evaluation initiated. On he
was taken to the OR where he underwent a right below knee
amputation. He tolerated the procedure well, was extubated and
recovered in the pacu. He was then transfered to the vicu. A pca
was initiated post operatively and transitioned to oral meds
shortly thereafter. Mr. has known long standing
chronic kidney disease and his creatinine was stable during this
admission. The pt worked with physical therapy throughout his
post op course. The post op dressing was removed and the stump
was healing well. There was a small blister noted on the dorsal
aspect of the stump, this was dressed wtih adaptik and an
antibiotic was started for 7 days. Mr. was deemed
stable to discharge back to his rehab facility on . He
will follow up in clinic for wound check and staple removal in 4
weeks.
## MEDICATIONS ON ADMISSION:
Calcitriol 0.25 mcg', Isosorbide Dinitrate 30 qid,Metoprolol
12.5", Simvastatin 10', Ferrous Sulfate 300', Sodium Bicarb 1300
tid, Aspirin 325', Clopidogrel 75', percocet prn, MVI, Glargine
15u, SSI
.
## DISCHARGE MEDICATIONS:
1. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day):
Continue while patient is not
ambulating .
5. Isosorbide Dinitrate 10 mg Tablet Sig: Three (3) Tablet PO
QID (4 times a day).
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
7. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
## 8. OXYCODONE-ACETAMINOPHEN MG TABLET SIG:
Tablets PO
Q4H (every 4 hours) as needed for pain.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Sodium Bicarbonate 650 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
11. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
12. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.
13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
14. Insulin
Lantus 15 units QHS
15. Other
Insulin Sliding Scale.
Breakfast Lunch Dinner Bedtime
Insulin Dose Insulin Dose Insulin Dose Insulin Dose
mg/dL Proceed with hypoglycemia
71-150 mg/dL 0 Units 0 Units 0 Units 0 Units
151-200 mg/dL 2 Units 2 Units 2 Units 2 Units
201-250 mg/dL 4 Units 4 Units 4 Units 4 Units
251-300 mg/dL 6 Units 6 Units 6 Units 6 Units
301-350 mg/dL 8 Units 8 Units 8 Units 8 Units
351-400 mg/dL 10 Units 10 Units 10 Units 10 Units
> 400 mg/dL M.D.
16. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO twice a
day for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
Gangrene of right lower extremity
## PMH:
Coronary artery disease
CHF (EF <30%)
Hypertension
Dyslipidemia
IDDM
## ACTIVITY STATUS:
Ambulatory - Independent.
is primary language
## DISCHARGE INSTRUCTIONS:
DISCHARGE INSTRUCTIONS FOLLOWING BELOW OR ABOVE KNEE AMPUTATION
.
This information is designed as a guideline to assist you in a
speedy recovery from your surgery. Please follow these
guidelines unless your physician has specifically instructed you
otherwise. Please call our office nurse if you have any
questions. Dial 911 if you have any medical emergency.
.
## ACTIVITY:
.
There are restrictions on activity. On the side of your
amputation you are non weight bearing until cleared by your
Surgeon. You should keep this amputation site elevated when ever
possible.
.
You may use the other leg to assist in transferring and pivots.
But try not to exert to much pressure on the amputation site
when transferring and or pivoting. Please keep knee immobilizer
on at all times to help keep the amputation site straight.
.
No driving until cleared by your Surgeon.
.
PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS:
.
Redness in or drainage from your leg wound(s) .
.
Watch for signs and symptoms of infection. These are: a fever
greater than 101 degrees, chills, increased redness, or pus
draining from the incision site. If you experience any of these
or bleeding at the incision site, CALL THE DOCTOR.
.
## EXERCISE:
.
Limit strenuous activity for 6 weeks.
.
Do not drive a car unless cleared by your Surgeon.
.
Try to keep leg elevated when able.
.
## BATHING/SHOWERING:
.
You may shower immediately upon coming home. No bathing. A
dressing may cover youre amputation site and this should be
left in place for three (3) days. Remove it after this time and
wash your incision(s) gently with soap and water. You will have
sutures, which are usually removed in 4 weeks. This will be done
by the Surgeon on your follow-up appointment.
.
## WOUND CARE:
.
Sutures / Staples may be removed before discharge. If they are
not, an appointment will be made for you to return for staple
removal.
.
When the sutures are removed the doctor may or may not place
pieces of tape called steri-strips over the incision. These will
stay on about a week and you may shower with them on. If these
do not fall off after 10 days, you may peel them off with warm
water and soap in the shower.
.
Avoid taking a tub bath, swimming, or soaking in a hot tub for
four weeks after surgery.
.
## MEDICATIONS:
.
Unless told otherwise you should resume taking all of the
medications you were taking before surgery. You will be given a
new prescription for pain medication, which can be taken every
three (3) to four (4) hours only if necessary.
.
Remember that narcotic pain meds can be constipating and you
should increase the fluid and bulk foods in your diet. (Check
with your physician if you have fluid restrictions.) If you feel
that you are constipated, do not strain at the toilet. You may
use over the counter Metamucil or Milk of Magnesia. Appetite
suppression may occur; this will improve with time. Eat small
balanced meals throughout the day.
.
## CAUTIONS:
.
NO SMOKING! We know you've heard this before, but it really is
an important step to your recovery. Smoking causes narrowing of
your blood vessels which in turn decreases circulation. If you
smoke you will need to stop as soon as possible. Ask your nurse
or doctor for information on smoking cessation.
.
Avoid pressure to your amputation site.
.
No strenuous activity for 6 weeks after surgery.
.
## DIET:
.
There are no special restrictions on your diet postoperatively.
Poor appetite is expected for several weeks and small, frequent
meals may be preferred.
.
For people with vascular problems we would recommend a
cholesterol lowering diet: Follow a diet low in total fat and
low in saturated fat and in cholesterol to improve lipid profile
in your blood. Additionally, some people see a reduction in
serum cholesterol by reducing dietary cholesterol. Since a
reduction in dietary cholesterol is not harmful, we suggest that
most people reduce dietary fat, saturated fat and cholesterol to
decrease total cholesterol and LDL (Low Density Lipoprotein-the
bad cholesterol). Exercise will increase your HDL (High Density
Lipoprotein-the good cholesterol) and with your doctor's
permission, is typically recommended. You may be self-referred
or get a referral from your doctor.
.
If you are overweight, you need to think about starting a weight
management program. Your health and its improvement depend on
it. We know that making changes in your lifestyle will not be
easy, and it will require a whole new set of habits and a new
attitude. If interested you can may be self-referred or can get
a referral from your doctor.
.
If you have diabetes and would like additional guidance, you may
request a referral from your doctor.
.
## FOLLOW-UP APPOINTMENT:
.
Be sure to keep your medical appointments. The key to your
improving health will be to keep a tight reign on any of the
chronic medical conditions that you have. Things like high blood
pressure, diabetes, and high cholesterol are major villains to
the blood vessels. Don't let them go untreated!
.
Please call the office on the first working day after your
discharge from the hospital to schedule a follow-up visit. This
should be scheduled on the calendar for seven to fourteen days
after discharge. Normal office hours are
through .
.
PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR
QUESTIONS THAT MIGHT ARISE
Weigh yourself every morning, call MD if weight goes up more
than 3 lbs.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13115577", "visit_id": "22847814", "time": "2167-07-09 00:00:00"} |
14713330-RR-16 | 531 | ## INDICATION:
year old man with obstructive jaundice, s/p perc biliary drain
placement. Oozing from R drain site // please assess for obstruction or other
cause for seeping at drain site
## OPERATORS:
Dr. radiology fellow) and Dr.
radiology attending) performed the procedure. The
attending, Dr. was present and supervising throughout the procedure.
## ANESTHESIA:
MAC anesthesia was administered by the anesthesiology department.
Please refer to anesthesiology notes for details. 1% lidocaine was injected in
the skin and subcutaneous tissues overlying the access site
## CONTRAST:
35 ml of Optiray contrast.
## PROCEDURE:
1. Over-the-wire cholangiogram through existing right percutaneous
transhepatic biliary drainage catheter.
2. Exchange of the existing percutaneous trans-hepatic biliary drainage
catheter with a new 12 PTBD catheter.
## PROCEDURE DETAILS:
Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per
protocol. The right and mid abdomen was prepped and draped in the usual
sterile fashion.
Initial scout images showed biliary drain in the appropriate position. The
right tubes were injected with dilute contrast. The images were stored on
PACS.
Following the subcutaneous injection of 1% lidocaine and instillation of
lidocaine jelly into the skin site, the right catheter was cut and stiff
glidewire was advanced through the catheter into the duodenum. The catheter
was then removed over the wire and a 8 sheath was placed. A Kumpe
catheter was advanced over the wire and the wire was exchanged for a
Lunderquist wire. A pull back cholangiogram was then performed with findings
as outlined below. The sheath was removed over the wire and a 12
percutaneous trans hepatic biliary drainage catheter was advanced into the
duodenum. Additional sideholes were created. Side holes were positioned above
and below the level of obstruction to facilitate internal drainage. The wire
and inner stiffener were removed, the catheter was flushed, the loop was
formed, the catheter was capped and sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications.
## FINDINGS:
1. Existing bilateral 10 percutaneous transhepatic biliary drainage
catheters.
2. Cholangiogram showing an extremely acute angle of the right biliary
drainage catheter as it enters the common hepatic duct. Also noted is a
severe narrowing of the right hepatic duct immediately after the apex of the
right biliary drainage catheter, likely related to the hepatic cellular
carcinoma.
3. Pericatheter leakage noted around the patent 10 biliary drainage
catheter towards the skin entry site.
4. Successful exchange of an existing right 10 percutaneous
transhepatic biliary drainage catheter with new modified 12 catheters
with extra proximal sideholes.
5. The left drainage catheter was not exchanged. Both tubes were capped.
## IMPRESSION:
The existing 10 tube was patent. The leakage around the skin entry site
of the right biliary drainage catheter is likely related to the severely acute
angle of the drainage tube as well as the severe obstruction of the common
hepatic duct. The 12 drain was placed which may result in improved
internal drainage and resolution of pericatheter leakage at the skin entry
site.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14713330", "visit_id": "25293042", "time": "2152-11-16 07:33:00"} |
12561962-RR-18 | 290 | ## INDICATION:
on Plavix with intermittent luq pain yesterday, today with
increasing pain more constant. no n/v/d, no fevers, no chest pain, no dyspnea,
no pleurisy. pain does not feel like last MI. NO PO contrast //
?diverticulitis versus appendicitis
## CHEST:
Bibasilar atelectasis is moderate. There is no pleural effusion or
pericardial effusion. The nodular density at the left lung base (02:18) is
felt atelectatic in etiology.
## ABDOMEN:
The liver appears homogeneous in attenuation without a focal lesion
identified. There is no intrahepatic biliary duct dilation. The portal vein
is patent. There is no radiopaque cholelithiasis. The pancreas, spleen, and
bilateral adrenal glands are normal in appearance.
The kidneys present symmetric nephrograms excretion of contrast. A cortical
hypodensity within each right upper pole posteriorly measures approximately
2.3 x 2.4 cm, most consistent with a simple cyst. There is no perinephric
fluid collection or hydronephrosis.
There is a small hiatal hernia. The stomach, duodenum, and loops of small
bowel are grossly unremarkable. The appendix is imaged, normal in appearance.
Diverticular disease involves predominantly the sigmoid colon. There is no
evidence of acute diverticulitis.
Extensive atherosclerotic calcifications involve the infrarenal abdominal
aorta. There is no aneurysmal dilatation. There is no retroperitoneal or
mesenteric adenopathy. No abdominal free fluid.
## PELVIS:
The bladder is moderately well distended and grossly unremarkable.
Calcified fibroid within the uterus measures approximately 5.6 x 5.9 cm.
There is no adnexal mass. The there is no pelvic free fluid. Inguinal and
pelvic sidewall nodes are not pathologically enlarged.
A no osseous lesion worrisome for malignancy or infection is identified.
Moderate facet arthropathy involves the lower lumbar spine.
## IMPRESSION:
1. No acute intra-abdominal process. Normal appendix.
2. Diverticular disease without evidence of diverticulitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12561962", "visit_id": "N/A", "time": "2172-11-05 18:53:00"} |
17248777-RR-31 | 463 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## NO PO CONTRAST; HISTORY:
with rlq abd pain unwell since sat
NO PO contrast// pain r/o appy
## SINGLE PHASE SPLIT BOLUS CONTRAST:
MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 16.4 mGy (Body) DLP =
8.2 mGy-cm.
2) Spiral Acquisition 6.0 s, 46.3 cm; CTDIvol = 11.2 mGy (Body) DLP = 519.0
mGy-cm.
Total DLP (Body) = 527 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:
1.4 cm right adrenal nodule. Subcentimeter left adrenal nodule
(series 2, image 18).
## 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. The colon and
rectum are within normal limits. The appendix is normal.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. Small amount
of intermediate density free fluid within the pelvis (series 2, image 67).
## REPRODUCTIVE ORGANS:
There is a 2.3 x 1.9 x 4.5 cm hypoense right adnexal
structure, possible ovarian in etiology (series 2, image 60). No left adnexal
abnormalities are visualized. The cervix is unremarkable in appearance. The
uterus is not well visualized, either atrophic or status post hysterectomy.
## 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.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. 4.5 cm hypodense right adnexal structure possibly ovarian in etiology.
Small amount of intermediate density free fluid within the pelvis. The
constellation of these findings may represent a ruptured cyst. However, given
patient age, underlying neoplasm is not excluded and needs to be excluded.
Pelvic ultrasound and close GYN follow-up is recommended.
2. Bilateral adrenal nodules, measuring up to 1.4 cm on the right,
indeterminate, but statistically likely to represent adenomas.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17248777", "visit_id": "N/A", "time": "2160-09-22 18:32:00"} |
16837503-DS-12 | 1,581 | ## CHIEF COMPLAINT:
Shortness of breath due to an acute exacerbation of chronic
systolic heart failure.
## HISTORY OF PRESENT ILLNESS:
M w/hx of CHF, EF 35%, restrictive lung disease, presented
to his PCP with SOB with minimal exertion and lower extremity
edema. He has SOB with taking a few steps over the past
days. Prior to this he was able to walk around his house without
difficulty. He has been eating soup recently as he has lost his
appetite for meals. He also enjoys eating potato chips. He did
not take his medications this morning due to his appointment
with his PCP. Previously he had been taking all of his
medications. He sleeps upright in a chair due to orthopnea which
has been unchanged over the past months. He denies chest
pain, palpitations, diaphoresis, PND, syncope. In his PCP's
office, he had gained 7lbs since . ROS is positive for
abdominal pain and increased shortness of breath due to
abdominal pain. He has had nausea but no vomiting. + for
constipation and bowel movements every days which are hard
and painful. Occasional blood on the toilet paper after bowel
movements. Otherwise ROS is negative.
.
In the ED, initial vitals were 97.9, 179/117, HR101, RR24, 100%
on 4L. He was given a combivent neb, aspirin 325mg, Lasix 40mg
IV X 1 initially and put out 900ccs to this. He was ordered for
home BP meds but it is unclear if he was given these. He was
given a second dose of Lasix 40mg IV around 8pm.
## PAST MEDICAL HISTORY:
1. Congestive Heart Failure
2. Restrictive Lung Disease
3. Obstructive Sleep Apnea
4. Spinal Kyphosis
5. Peripheral Vascular Disease
6. Venous Stasis Ulcers
7. BPH
8. Pseudogout
## GENERAL:
alert, oriented, NAD. Mood, affect appropriate.
## HEENT:
NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
## NECK:
Supple, difficult to visualize JVP due to body habitus.
~8cm
## CARDIAC:
PMI located in intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
## LUNGS:
Kyphotic curvature to spine. Some accessory muscle use
with excessive talking. Bibasilar crackles.
## ABDOMEN:
Soft, obese, non-tender. With palpation of abdomen,
patient has more shortness of breath.
## EXTREMITIES:
No 2+ peripheral edema of the lower extremities
with chronic venous stasis and very dry skin with exfoliation.
No open uclers visualized. No femoral bruits.
## CHEST, AP AND LATERAL:
Lung volumes are low, with increased
interstitial markings bilaterally suggestive of mild
interstitial edema. There is a small right pleural effusion, as
well as likely a small left pleural effusion. The heart is top
normal in size, with an unfolded aorta. No pneumothorax is
identified. There are multilevel degenerative changes of the
thoracic spine.
## IMPRESSION:
Mild interstitial pulmonary edema, with small
bilateral pleural effusions. The study and the report were
reviewed by the staff radiologist.
.
.
## :
FRI 11:44 AM
Cardiology Report ECG Study Date of 7:26:46 AM
Sinus rhythm with ventricular premature beats and premature
atrial contractions and borderline first degree A-V block. Right
bundle-branch block with left anterior fascicular block.
Non-specific ST-T wave changes. Compared to tracing #3
ventricular premature beats and premature atrial contractions
are new.
Cardiology Report ECG Study Date of 6:14:18
Normal sinus rhythm with atrial premature beats. Right
bundle-branch block. Compared to the previous tracing of
no diagnostic interim change.
Read by: .
Intervals Axes
Rate PR QRS QT/QTc P QRS T
89 - - rief Hospital Course by Problems:
# Acute on chronic systolic and diastolic heart failure. By
patient's report has gained 7 lbs. We took off about lbs,
mostly with a Lasix drip, although some of this was fecal matter
- he was markedly constipated. Still feels slightly short of
breath but is essentially baseline. We added metolazone to his
previous regimen to assist diuresis and have counselled him
strongly to reduce fluid and salt intake. He asked everyone on
the ward for extra salt.
.
# Diet. He has been counselled strongly now three times that if
he continues to eat soup and sodium that he will continue to
return to the hospital and that his heart failure will continue
to have exacerbations.
.
# Constipation. Agressive bowel regimen instituted while here.
He was likely impacted given the passing of liquid and very hard
stool. He did not need disimpaction. He was given Colace,
Senna, Mirilax and Bisacodyl.
.
# Coronary artery disease. No evidence of new ischemia based on
ECG. Troponins flat X 3. Has established coronary artery
disease.
- Continued aspirin 325mg PO qday, but changed to EC.
.
# Heart rhythm. Currently NSR with frequent PVCs. Was in an
atrial bigeminy pattern earlier. VT for a run of four beat last
night.
- Continue beta-blocker (used short acting while in hospital but
changed back to succinate on d/c)
.
# Hypertension. Continued Valsartan, Nifedipine, Metoprolol.
Was well controlled during the admission.
.
# Hypothyroidism. Continued Synthroid while in hospital. It
would be avisable to check a thyroid panel as an outpatient.
.
# Hypercholesterolemia. Continue Simvastatin. Did not check
lipids while here, but should be tracked as outpatient.
.
# Venous Stasis. appreciated wound care consult recs (see
Discharge Instructions)
.
# F.E.N. Low salt, cardiac diet, fluid restricted 1500ml.
Potassium repletion was needed in-house to about 40 mEq per day.
This was decreased when Lasix was dicontinued to 10 mEq per
day. Potassium will need to be checked.
.
# Prophylaxis. SC Heparin, bowel regimen with colace, senna,
bisacodyl PRN
.
# Code status. Full confirmed on admission, HCP is nephew
(cell).
.
# Disposition. Going to rehabilitation to assist with mobility,
chest , diet and OT evaluation. We think it is possible that
they will help us get him more care than he is presently
receiving at home. We are concerned that he will simply
continue to return to the hospital given his diet of salt,
potato chips and soup.
## MEDICATIONS ON ADMISSION:
Bumex 4mg PO qday
Colchicine 0.6mg PO qday
B12 1,000mcg qmonth
Synthroid 88mcg qday
Cozaar 50mg PO qday
Metoprolol Succinate 200mg PO qday
Nifedipine ER 30mg PO qday
Omeprazole 20mg PO qday
Simvastatin 20mg PO qday
ASA 325mg PO qday
.
## DISCHARGE MEDICATIONS:
1. Senna 8.6 mg Tablet
## SIG:
One (1) Tablet PO BID (2 times a
day): Hold for loose stool.
Disp:*60 Tablet(s)* Refills:*2*
2. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Bumetanide 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
10. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
11. Ammonium Lactate 12 % Lotion Sig: One (1) Topical BID (2
times a day): Apply to lower extremities twice daily.
Disp:*1 tube* Refills:*2*
12. Metolazone 2.5 mg Tablet Sig: One (1) Tablet PO BID ON
AND ().
Disp:*30 Tablet(s)* Refills:*2*
13. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
PO DAILY (Daily) as needed for constipation: Please use as
needed for constipation and hold for loose stool.
Disp:*30 17g Packets* Refills:*0*
14. Potassium Chloride 10 mEq Tab Sust.Rel. Particle/Crystal
## SIG:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
## DISCHARGE DIAGNOSIS:
Primary diagnosis
Acute exacerbation of chronic systolic heart failure.
Secondary diagnoses
Constipation
Hypertension
Coronary artery disease
Restrictive lung disease secondary to kyphosis
Peripheral vascular disease
Venous stasis ulceration and dermatitis
## DISCHARGE CONDITION:
Hemodynamically stable, afebrile, and with resolution of acute
heart failure exacerbation.
## DISCHARGE INSTRUCTIONS:
You came to the hospital with worsening shortness of breath,
both at rest and particularly on exertion. Based on clinical
examination it was evident that you were fluid overloaded. This
has likely occurred as a result of your diet, given your intake
of salt, including potato chips and many meals of soup, and
given that we excluded other causes. IT IS VERY IMPORTANT THAT
YOU RESTRICT YOUR SALT INTAKE TO LESS THAN TWO GRAMS PER DAY AND
ONLY TAKE FLUIDS TO THIRST. If you continue to take salt and
fluids as previously you will need to return to the hospital.
We recommend that you persevere with such a regimen knowing that
you will find unsalted food more palatable over time. Please do
not take soup as your predominant kind of meal. You were also
constipated when arriving in the hospital. Please take Senna
and Miralax as needed at home to treat this.
Please attend follow-up appointments listed below.
Please take your medications as listed below.
Weigh yourself every morning, call MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
## FLUID RESTRICTION:
To thirst.
If you experience further shortness of breath, increased weight
(as above), increased swelling, chest pain, or any other
concerning symptom, please return to the hospital.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16837503", "visit_id": "29587960", "time": "2181-04-22 00:00:00"} |
14411859-RR-78 | 170 | ## TYPE OF EXAMINATION:
Chest AP portable single view.
## INDICATION:
Patient with hemodialysis catheter, evaluate placement.
## FINDINGS:
AP single view of the chest has been obtained with patient in
supine position. Available for comparison is a preceding similar study
obtained 12 hours earlier during the same date. The sternotomy cannula in
place as before. No pneumothorax has developed. There is a left subclavian
approach central venous line seen to terminate overlying the area of the SVC
from 1-2 cm above the level of the carina. The position of this line is
unchanged in comparison with the study 12 hours earlier. No pneumothorax has
developed. A new HD catheter is not identified in the thoracic area. The
distal portion including tip of a line overlying the inferior vena cava is
noted in the right upper abdominal quadrant, but this finding was already
present on the preceding study. Previously described bilateral pleural
densities obliterating diaphragmatic contours exists as before.
## IMPRESSION:
Stable chest findings in comparison after 12 hours examination
interval.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14411859", "visit_id": "24976204", "time": "2163-02-13 16:28:00"} |
14166603-RR-20 | 332 | ## INDICATION:
man status post cardiac arrest with large right
pneumothorax. Persistent difficulty ventilating despite tube placement.
## FINDINGS:
A previously large pneumothorax, barely visible on chest
radiograph, is tiny. Minimal residual air is seen in the right lung base
(401B:14) adjacent to the right atrium (401B:21). Multifocal consolidations
in the right middle lobe have coalesced to a larger consolidation with air
bronchograms (2:40). The right lower lobe remains completely collapsed. The
left lower lobe is completely collapsed, whereas previously the superior
segment of the left lower lobe remained aerated. Ground-glass opacity in the
posterior right upper lobe (2:36) has coalesced into a small consolidation.
Small amount of pneumomediastinum is similar. Coronary artery calcifications
in the LAD and proximal circumflex are similar. The heart is mildly enlarged.
The great vessels are normal caliber. The aortic arch is free of
calcifications. A left-sided PICC line tip terminates in the low SVC. An
enteric catheter courses into the stomach.
This study was not designed to evaluate sub-diaphragmatic contents. The
hypodense liver is consistent with diffuse steatosis. A 2 cm CC x 4.3 cm TV
hyperdense lesion at the left liver capsular edge (401B:25) was hypodense on
the portal venous phase of prior imaging studies. A smaller 3.2 cm TV x 1.2 cm
CC similarly hyperattenuating lesion is located along the superior liver edge
in segment II (401B:25).
Displaced overriding rib fractures of the anterior right through fifth
ribs are unchanged. There are no lytic or sclerotic bone lesions concering
for malignancy.
## IMPRESSION:
1. Tiny residual right pnuemothorax has improved
2. Progressive bilateral lower lobe collapse
3. Worsening right middle and left upper lobe pneumonia
4. Fatty liver with two large hyperdense lesions in the left lobe which are
more conspicuous on the present study. These lesions are non-specific and
could represent benign or malignent entities. An abdominal MRI is required
for further characterization when the patient's acute issues have stabalized.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14166603", "visit_id": "23520934", "time": "2158-09-03 11:21:00"} |
13821528-RR-19 | 160 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
History: with fall // fall
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
There is no evidence of acute fracture, acute territorial infarction
infarction,hemorrhage,edema,or mass. There is prominence of the ventricles
and sulci suggestive of involutional changes. Periventricular, subcortical,
and deep white matter hypodensities are nonspecific, but likely reflect the
sequela of chronic microvascular infarction. Dense basal ganglia and mild
dentate nuclei calcifications are present.
Minimal partial opacification of the left mastoid air cells suggests mild
ongoing inflammation. The visualized portion of the paranasal sinuses, right
mastoid air cells, and middle ear cavities are clear. Status post lens
replacements. The visualized portion of the orbits are otherwise
unremarkable. Moderate atherosclerotic calcifications of the cavernous
carotid arteries.
## IMPRESSION:
1. No acute intracranial abnormality. No acute fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13821528", "visit_id": "N/A", "time": "2114-03-02 18:25:00"} |
15050135-RR-54 | 208 | ## EXAMINATION:
MR PELVIS WANDW/O CONTRAST
## YEAR OLD WOMAN WITH DIAGNOSIS:
Right hemipelvis
dedifferentiated chondrosarcoma s/p 1. - right hemipelvectomy with
mesh abdominal wall closure / . 2. ,
- multiple I Ds and WV exchanges for wound necrosis 3. - VRAM
flap coverage ( ) // interval evaluation
## FINDINGS:
Post right hemipelvectomy with extensive postsurgical changes including
scarring and edema in the anterior wall extending to the visualized right
thigh. There is ill-defined edema and mild hyperenhancement in the surgical
bed soft tissues without focal area of nodular hyperenhancement to raise
suspicion for local recurrence. Somewhat linear foci of hyperenhancement in
the surgical bed most likely represent residual postsurgical change or vessels
and are stable from (series 8, image 4, 5). The previously seen
postoperative fluid collections in the superior surgical bed have resolved.
Fluid surrounding the right femoral head appears less prominent. No new fluid
collection. Marrow signal in the femur and remaining pelvis is normal with
stable slight sclerosis in the right sacrum immediately adjacent to the
surgical bed. No evidence of acute or suspicious intra-abdominal abnormality.
No lymphadenopathy appreciated.
## IMPRESSION:
No evidence of local recurrence. Extensive postsurgical changes with
resolution of the previously seen postoperative fluid collections. No new
fluid collection. No new suspicious osseous lesions or lymphadenopathy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15050135", "visit_id": "N/A", "time": "2141-12-12 09:57:00"} |
15757279-RR-29 | 158 | ## INDICATION:
CHF exacerbation with worsening LFTs since admission, please
evaluate for hepatic congestion or biliary stones.
## FINDINGS:
Study is significantly limited by body habitus and poor acoustic
window. No definite mass lesion identified within the liver; however,
evaluation is limited. No definite intrahepatic biliary duct dilatation. The
extrahepatic central biliary ducts are not well visualized yet no gross
dilitation demonstrated. The left kidney measures 10.5 cm and is without
hydronephrosis. Right kidney is poorly visulized. The main portal vein is
patent with normal hepatopetal flow. The gallbladder is not well evaluated,
possibly secondary to intraluminal stones. The spleen is enlarged measuring
14.7 cm. No intra- abdominal ascites.
## IMPRESSION:
1. Significantly limited study without definite intrahepatic ductal
dilatation or mass lesion. Gallbladder is not readily identified, possibly
secondary to shadowing intraluminal stones.
2. Splenomegaly with the spleen measuring 14.7 cm.
Given limitations of this study, cross-sectional imaging may be obtained for
further evaluation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15757279", "visit_id": "28340293", "time": "2179-05-02 16:15:00"} |
12907727-RR-39 | 218 | ## INDICATION:
year old woman with syncopal feeling, evaluate for carotid
patency// please complete bilaterally to assess for patency
## RIGHT:
The right carotid vasculature has no atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 77 cm/s.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 60 cm/s, 77 cm/s, and 70 cm/s respectively. The peak end
diastolic velocity in the right internal carotid artery is 36 cm/sec.
The ICA/CCA ratio is 1.0.
The external carotid artery has peak systolic velocity of60 cm/s.
The vertebral artery is patent with antegrade flow.
## LEFT:
The left carotid vasculature has no atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 93 cm/s.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 66 cm/s, 72 cm/s, and 76 cm/s respectively. The peak end
diastolic velocity in the left internal carotid artery is 32 cm/sec.
The ICA/CCA ratio is 0.80.
The external carotid artery has peak systolic velocity of 77 cm/s.
The vertebral artery is patent with antegrade flow.
## IMPRESSION:
No evidence of stenosis or large vessel occlusion of the extracranial carotid
arteries and vertebral arteries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12907727", "visit_id": "28649994", "time": "2127-05-17 15:48:00"} |
14745919-RR-36 | 1,278 | ## INDICATION:
woman with idiopathic cardiomyopathy undergoing
assessment of left ventricular function and coronary anatomy.
## BODY SURFACE AREA (M2):
1.81
Hemodynamic Measurements
Measurement
Systemic Blood Pressure (mmHg) 163/57
Heart Rate (bpm) 66
## RHYTHM:
Sinus
Measurement Female Normal
LV End-Diastolic Dimension (mm) 48 <55
LV End-Diastolic Dimension Index (mm/m2) 27 <33
LV End-Systolic Dimension (mm) 38
LV End-Diastolic Volume (ml) 134 <143
LV End-Diastolic Volume Index (ml/m2) 74 <78
LV End-Systolic Volume (ml) 68
LV Stroke Volume (ml) 66
LV Ejection Fraction (%) *49 >56
LV Anteroseptal Wall Thickness (mm) *10 <10
LV Inferolateral Wall Thickness (mm) 8 <9
LV Mass (g) 99
LV Mass Index (g/m2) 55 <60
RV End-Diastolic Volume (ml) 88
RV End-Diastolic Volume Index (ml/m2) 49 <103
RV End-Systolic Volume (ml) 29
RV Stroke Volume (ml) 59
RV Ejection Fraction (%) 67 >49
QFlow Net Aortic Forward Stroke Volume
(QS net, ml) 61
QFlow Net Pulmonary Artery Forward Stroke Volume
(Qp net, ml) 46
QP/QS 0.8 0.8 - 1.2
QFlow Aortic Cardiac Output (l/min) 4.0
QFlow Aortic Cardiac Index (l/min/m2) 2.2 >2.0
QFlow Aortic Valve Regurgitant Volume (ml) 2
QFlow Aortic Valve Regurgitant Fraction (%) 3 <5
Mitral Valve Regurgitant Volume (ml) 0
Mitral Valve Regurgitant Fraction (%) 0 <5
Effective Forward LVEF (%) *46 >56
Pulmonic Valve Regurgitant Volume (ml) 3
Pulmonic Valve Regurgitant Fraction (%) 6 <5
Tricuspid Valve Regurgitant Volume (ml) 10
Tricuspid Valve Regurgitant Fraction (%) **17 <5
Aortic Valve Area (2-D) (cm2) *2.7 >3.0
Aortic Valve Area Index (cm2/m2) 1.5
Ascending Aorta diameter (mm) 34 <35
Ascending Aorta diameter Index (mm/m2) 19 <21
Transverse Aorta diameter (mm) 25 <31
Descending Aorta diameter (mm) 21 <25
Descending Aorta Index (mm/m2) 12 <15
Main Pulmonary Artery diameter (mm) *28 <27
Main Pulmonary Artery diameter Index (mm/m2) *15 <15
Left Atrium (Parasternal Long Axis) (mm) 32 <40
Left Atrium Length (4-Chamber) (mm) 49 <52
Left Atrium Length (2-Chamber) (mm) 35
Left Atrium Volume (ml) *43 <32
Left Atrium Volume Index (ml/ m2) *24 <22
Right Atrium (4-Chamber) (mm) *52 <50
Pericardial Thickness (mm) 2.5 <4
Coronary Sinus diameter (mm) 8 <15
Length of Visualized Coronary Artery
Left Main (mm) 9
Left Anterior Descending (LAD) (mm) 37
Left Circumflex (LCx) (mm) 38
Right Coronary Artery (RCA) (mm) 94
* = Mildly abnormal, ** =moderately abnormal, *** = severely abnormal
## EGFR:
62ml/min
Total Gd-DTPA (Magnevist ) contrast: 31 ml (0.2mmol/kg)
Injection site: Right antecubital vein
## 1) STRUCTURE:
Axial dual-inversion T1-weighted images of the myocardium were
obtained without spectral fat saturation pre-pulses in 5 mm contiguous slices.
2) Function: Breath-hold cine SSFP images were acquired in the left
ventricular 2-chamber, 4-chamber, horizontal long axis, short axis slices (8
mm slices with 2 mm gaps), sagittal and coronal orientations of the left
ventricular outflow tract, and aortic valve short axis orientations.
3) Flow: Phase-contrast cine images were obtained transverse to the aorta
(axial plane) and main pulmonary artery (oblique plane).
4) Resting Ventricular Perfusion: First-pass TFE-EPI rest perfusion images
were obtained in three short axis 10 mm thick slices (basal, mid, and distal
ventricle) with injection of a total of 0.05 mmol/kg gadopentetate dimeglumine
(8 ml Magnevist solution).
5) Myocardial Viability/Fibrosis: Late gadolinium enhancement (LGE) images
were obtained using a segmented inversion-recovery TFE acquisition with
spectral fat saturation pre-pulses. Short-axis (8 mm slices with 2 mm gaps),
4-chamber and 2-chamber long-axis images were obtained 15 minutes after
injection of a total of 0.2 mmol/kg gadopentetate dimeglumine (31 ml Magnevist
solution). Navigator gated high resolution DE images were also obtained using
a segmented inversion-recovery TFE acquisition with spectral fat saturation
pre-pulses in short-axis (4 mm slices) 20 minutes after injection of a total
of 0.2 mmol/kg gadopentetate dimeglumine (31 ml Magnevist solution).
6) Coronary MRI: After administration of isordil 2.5 mg SL, submillimeter
resolution free-breathing ECG-gated navigator gated/corrected T2 prep 3D turbo
field echo coronary MRI of the aortic root and proximal coronary arteries were
obtained in the transverse (left coronary system) and double oblique (right
coronary artery) imaging planes.
## FINDINGS:
Structure and Function
There was normal epicardial fat distribution. The myocardium appeared to have
homogenous signal intensity. The pericardial thickness was normal. There were
no pericardial or pleural effusions. The origins of the left main and right
coronary arteries were identified in their customary positions. The indexed
diameters of the ascending and descending thoracic aorta were normal. Simple
atherosclerotic plaque was seen in the descending thoracic aorta. The main
pulmonary artery diameter index was mildly increased. The left atrial AP
dimension was normal. The right and left atrial lengths in the 4-chamber view
were mildly increased and normal, respectively. The coronary sinus diameter
was normal.
The left ventricular end-diastolic dimension index was normal. The end-
diastolic volume index was normal. The calculated left ventricular ejection
fraction was mildly reduced at 49% with marked dyssynchrony of the septum
consistent with a left bundle branch block. There were no other significant
regional wall motion abnormalities. The anteroseptal wall thickness was
mildly increased; the inferolateral wall thickness was normal. The left
ventricular mass index was normal. The right ventricular end-diastolic volume
index was normal. The calculated right ventricular ejection fraction was
normal at 67%, with normal free wall motion.
The aortic valve was tri-leaflet with minimally reduced valve area. There was
no fusion of the commissures to suggest significant aortic stenosis.
Quantitative Flow
There was no significant intra-cardiac shunt. Aortic flow demonstrated no
significant aortic regurgitation. The calculated mitral valve regurgitant
fraction was consistent with no mitral regurgitation. The resultant
effective forward LVEF was mildly reduced at 46%. The right ventricular stroke
volume and pulmonic flow demonstrated no significant pulmonic and mild
tricuspid regurgitation.
Myocardial Perfusion and Fibrosis
There was uniform resting perfusion of all visualized segments. There was a
small, non-transmural, focal region of mild hyperenhancement in the basal
inferoseptum at the insertion site of the right ventricular wall.
Coronary MR
Normal origins and orientations of the left main and right coronary arteries.
The overall image quality of the coronary arteries was technically suboptimal,
limiting the interpretation. The left main coronary artery appeared to have
normal signal characteristics and caliber with bifurcation into the LAD and
LCx. The LAD had normal caliber and signal characteristics in the proximal
segment. The ostium of the LCx was not well visualized due to limited
technical image quality, but otherwise showed normal caliber and signal
characteristics in the proximal segment. The RCA showed decreased signal in
the proximal segment, which may be a nonspecific finding due to limited
technical image quality.
## IMPRESSION:
1. Normal left ventricular cavity size with marked dyssynchronous septal
motion consistent with a left bundle branch block. There was no other
regional wall motion abnormality. The LVEF was mildly reduced at 49%. The
effective forward LVEF was mildly reduced at 46%. There was a small area of
focal, nontransmural hyperenhancement at the basal inferoseptum at the
insertion site of the right ventricle.
2. Normal right ventricular cavity size and systolic function. The RVEF was
normal at 67%. Mild tricuspid regurgitation.
3. The indexed diameters of the ascending and descending thoracic aorta were
normal. The main pulmonary artery diameter index was mildly increased.
4. Mild right atrial enlargement.
5. Normal coronary artery origins with no evidence of anomalous coronary
arteries. Limited assessment of proximal coronary arteries due to suboptimal
image quality.
The images were reviewed by Drs. , and .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14745919", "visit_id": "N/A", "time": "2120-05-13 11:25:00"} |
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