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17857424-RR-9 | 219 | ## EXAMINATION:
MRI AND MRA BRAIN AND MRA NECK PT11 MR
## HISTORY:
with sudden onset headache*** WARNING *** Multiple
patients with same last name!// ?stroke, vascular occlusion
## MRI BRAIN:
There is no evidence of hemorrhage,edema,masses, mass effect, midline shift or
infarction. Small foci of periventricular and subcortical white matter
hypodensities are demonstrated bilaterally the T2 FLAIR sequences, which are
suggestive of sequela of chronic microangiopathy. The ventricles and sulci
are normal in caliber and configuration. There is no abnormal enhancement
after contrast administration.
Again noted is thickening of the bilateral ethmoid air cells and right
sphenoid sinus.
## MRA BRAIN:
The intracranial vertebral and internal carotid arteries and their major
branches appear normal without evidence of stenosis,occlusion,or aneurysm
formation. The dural venous sinuses are patent.
## MRA NECK:
The origins of the great vessels, subclavian and vertebral arteries appear
normal bilaterally. The common, internal and external carotid arteries appear
normal. There is no evidence of internal carotid artery stenosis by NASCET
criteria.
## IMPRESSION:
1. No evidence of masses, hemorrhage or infarction.
2. Mild FLAIR hyperintensities within the periventricular and subcortical
white matter are consistent with mild sequela from chronic microangiopathy.
3. Patent circle of without definite evidence of stenosis,occlusion,or
aneurysm.
4. Patent bilateral cervical carotid and vertebral arteries without evidence
of stenosis, occlusion, or dissection.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17857424", "visit_id": "N/A", "time": "2114-05-17 15:17:00"} |
16765623-RR-111 | 125 | ## EXAMINATION:
BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD AND
RIGHT BREAST ULTRASOUND
## INDICATION:
Right lateral breast/ axillary pain
## TISSUE DENSITY:
A - The breast tissue is almost entirely fatty.
There is no dominant mass, architectural distortion or suspicious grouped
microcalcifications. Scattered benign calcifications are noted. Bilateral
benign appearing axillary lymph nodes are identified.
## BREAST ULTRASOUND:
The right axilla was examined in the area of pain. A few
benign appearing lymph nodes are identified. The largest measures 13 mm x 18
mm x 7 mm
## IMPRESSION:
No evidence of malignancy. Benign right axillary lymph node likely accounting
for the patient's pain.
## RECOMMENDATION:
Continued clinical followup is advised. Annual screening
mammography is recommended.
## NOTIFICATION:
Findings reviewed with the patient at the completion of the
study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16765623", "visit_id": "N/A", "time": "2174-09-16 08:38:00"} |
19549491-AR-23 | 668 | This is an addendum being dictated on clip . The previous dictation
was lost prior to transcription and this is a redictation.
## INDICATION:
dissection of the MCA infarct.
## FINDINGS:
Please see the prior CT head on the same day. The large left MCA
territory infarct is better seen on the prior study. No large density is
noted within the suggestion of this hemorrhage.
CT ANGIOGRAM OF THE HEAD AND NECK:
There is status post repair of the type B
aortic dissection with post-surgical changes noted. There is moderate amount
of pleural effusion on both sides, with atelectasis of the adjacent portions
of the lung. There is also fluid noted extending into the mediastinum. The
esophagus was intubated. Part of the fluid is dense may relate to a component
of blood products. However, this is inadequately assessed on the present
study, does not targeted.
Atherosclerotic disease with calcified and noncalcified plaques seen at the
aortic arch origin and in the right subclavian artery as well as the left
subclavian artery. The common carotid arteries on both sides are patent
without focal flow-limiting stenosis. Mild calcified and noncalcified plaques
are noted at the bifurcation causing less than 50% stenosis.
The left cervical internal carotid artery is smaller than the right has also
in the intracranial segments. A few scattered vascular calcifications are
noted in the cavernous carotid segments. There is occlusion of the left
supraclinoid ICA and the termination as well as the left middle cerebral
artery. The A1 segment of the left anterior cerebral artery is diminutive in
size. The collaterals are noted laterally in the left MCA territory.
The right anterior and middle cerebral arteries are patent without focal
flow-limiting stenosis or occlusion.
The vertebral arteries are patent, from the origin throughout their course
without focal flow-limiting stenosis or occlusion. Calcifications are noted
in the left distal vertebral artery in the V4 segment. Slightly prominent
venous tributary is noted in the right side of the posterior fossa (series 2,
image 254).
There is moderate mucosal thickening in the ethmoid air cells, frontal and the
maxillary sinuses as well as in the sphenoid sinus.
The mastoid air cells are clear.
Soft tissue changes with fluid and stranding are noted in the cutaneous soft
tissues of the face extending into the right parietal region and in the left
occipital/parietal region which may relate to the recent procedure and
redistribution of dependent fluid based on patient's position. No suspicious
osseous lesions are noted. Degenerative changes are noted in the cervical
spine. Small disc osteophyte complex and multilevel moderate foraminal
narrowing.
There is comminuted fracture of the posterior aspect of the left first rib
series 2, image 98.
These were incompletely imaged on the present study.
Evaluation of the C-spine for trauma related changes is limited as not
targeted. Dedicated C-spine imaging can be considered if necessary. The
patient is status post left thyroidectomy. A nodule is noted in the right
lobe of the thyroid, few nodules, which can be correlated with dedicated
ultrasound if was not performed earlier.
## IMPRESSION:
1. Large left MCA territory hypodense area better assessed on the prior CT
head.
2. Status post repair of the ascending aortic aneurysm, with post-surgical
changes. Patent major arteries of the neck without focal flow-limiting
stenosis or occlusion.
3. Occlusion of the left ICA termination and supraclinoid segment left MCA
with diminutive A1 segment of the left anterior cerebral artery likely
embolic.
4. Comminuted fracture of the posterior aspect of the left first rib,
incompletely assessed on the present study is not targeted. Similarly,
C-spine is not adequately assessed for any trauma related changes. Dedicated
imaging can be considered and appropriate.
5. Bilateral pleural effusions with atelectasis of the adjacent portions of
the lungs with fluid in the mediastinum part of which is dense and may relate
to a hemorrhagic component.
6. Small amount of mucosal thickening in the right main stem bronchus.
Attention on followup.
7. Other details as above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19549491", "visit_id": "23275605", "time": "2115-08-09 16:32:00"} |
16752626-RR-24 | 163 | ## CLINICAL INDICATION:
Slightly heterogeneous thyroid in a patient with
elevated parathyroid hormone levels.
No prior thyroid scans are available for comparison. The thyroid gland is
normal in size, echogenicity and architecture. The right lobe measures 1.0 x
1.5 x 3.9 cm. The isthmus is 2.8 mm in AP diameter and the left lobe measures
1.2 x 1.5 x 3.9 cm. Echogenicity is normal throughout and no thyroid nodules
or cysts are seen.
In search for enlarged parathyroid glands, a homogeneous hypoechoic nodule is
seen deep to the lower third of the left lobe of the thyroid measuring 0.4 x
0.4 x 0.6 cm. This is solid and homogeneous in appearance with slightly
increased vascularity. No other similar nodules are seen on either side nor
on swallowing maneuvers.
## CONCLUSION:
1. Normal thyroid.
2. Mildly enlarged left parathyroid gland (likely adenoma) deep to the lower
pole of the left lobe of the thyroid.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16752626", "visit_id": "N/A", "time": "2140-09-29 15:06:00"} |
16159386-RR-23 | 383 | ## EXAMINATION:
CT chest with contrast.
## INDICATION:
year old woman with persistent sinus tachycardia, worsening O2
sat// Please evaluate for pulmonary embolism
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 1.9 s, 30.2 cm; CTDIvol = 11.5 mGy (Body) DLP = 347.8
mGy-cm.
2) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 6.9 mGy (Body) DLP = 3.4
mGy-cm.
Total DLP (Body) = 351 mGy-cm.
## FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no
evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present.
There is a central filling defect within the left lower subsegmental pulmonary
artery as well as segmental and subsegmental branches of the right upper and
lower lobes. No saddle embolus or evidence of right heart strain. The main
and right pulmonary arteries are normal in caliber, and there is no evidence
of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
Probable large multinodular goiter with extension into in the anterior
mediastinum measuring 5.5 x 3.9 x 3.5 cm. Further evaluation with ultrasound
is recommended.
There is no evidence of pericardial effusion. There is no pleural effusion.
Mild upper lobe predominant centrilobular emphysema. Bilateral diffuse areas
of ground-glass opacities and interlobular septal thickening may reflect
background pulmonary edema. Small amount of bibasilar atelectasis. Small
amount of dependent secretions in the upper trachea. Otherwise, the airways
are patent to the subsegmental level.
Limited images of the upper abdomen demonstrate an 8 mm hypodensity within
hepatic segment 3, too small to accurately characterize but likely represents
a cyst or biliary hamartoma.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
## IMPRESSION:
1. Segmental and subsegmental nonocclusive pulmonary emboli as described
above in the right upper, right lower and left lower lobes. No evidence of
right heart strain.
2. Bilateral ground-glass opacities and interlobular septal thickening may
reflect a background of pulmonary edema.
3. Probable multinodular goiter measuring up to 5.5 cm. In the absence of
prior studies for comparison, further evaluation with nonemergent ultrasound
is recommended.
## NOTIFICATION:
The findings were discussed with , 5 by
, M.D. on the telephone on at 6:35 pm, 5 minutes
after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16159386", "visit_id": "25128517", "time": "2171-10-03 17:08:00"} |
14358363-AR-10 | 100 | ADDENDUM
1. After completion of 3D reconstruction images, there is moderate stenosis of
the mid to distal left main coronary artery secondary to noncalcified plaque
and moderate stenosis of the proximal left anterior descending artery
secondary to noncalcified plaque. There is mild narrowing of the proximal
right coronary artery due to noncalcified plaque. The left circumflex artery
is grossly unremarkable.
## 2. CALCIUM SCORES:
RCA: 1 LAD: 0 CX: 1 Total 1
Calcium volumes: RCA: 2 LAD: 0 CX: 3 Total 5
The findings were emailed by Dr. Dr. ,
cardiologist whom patient is following up with, at 3:49 pm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14358363", "visit_id": "23111125", "time": "2139-02-05 14:34:00"} |
15548008-RR-25 | 233 | ## HISTORY:
History of fulminant hepatitis-B, here for ultrasound-guided not
targeted liver biopsy.
## PHYSICIANS:
Dr. (resident physician) and Dr.
(attending radiologist).
## PROCEDURE:
Following discussion of the risks, benefits and alternatives to the procedure,
written informed consent was obtained. A preprocedure time out was performed
discussing the planned procedure, confirming the patient's identity with 3
identifiers, and reviewing a pre-procedure checklist per department protocol.
Under ultrasound guidance, an entry site was selected in the right upper
quadrant in the abdomen was marked. The skin was prepped and draped in the
usual sterile fashion. Approximately 10 mL of 1% lidocaine was infiltrated
into the skin and soft tissues for local anesthesia.
A 16 gauge biopsy needle was advanced into the right hepatic lobe under
ultrasound guidance via right lateral intercostal approach and a single core
biopsy was obtained.
Moderate sedation was provided by administering divided doses of 1 mg Versed
and 50 mcg Fentanyl throughout the total intra-service time of 14 min during
which the patient hemodynamics parameters were continuously monitored by
radiology nursing personnel.
The patient tolerated the procedure well and there were no immediate
postprocedural complications. Estimated blood loss was less than 3 mL.
Dr. attending radiologist, was present throughout the entire
procedure. Post procedure instructions were written in the medical
record.
## IMPRESSION:
Technically successful ultrasound-guided non targeted liver biopsy. Pathology
is pending at this time.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15548008", "visit_id": "N/A", "time": "2146-04-14 09:51:00"} |
14450150-RR-48 | 696 | ## INDICATION:
year old with RVH on echo query RV function and shunts
## RHYTHM:
nsr
Measurements
Range
Measurement
LV End-Diastolic Dimension (mm) 45 <55
LV End-Diastolic Dimension Index (mm/m2) 25 <33
LV End-Systolic Dimension (mm) 24
LV End-Diastolic Volume (ml) 80 <143
LV End-Diastolic Volume Index (ml/m2) 44 <78
LV End-Systolic Volume (ml) 30
LV Stroke Volume (ml) 50
LV Ejection Fraction (%) 63 >56
LV Anteroseptal Wall Thickness (mm) 7 <10
LV Inferolateral Wall Thickness (mm) 7 <9
LV Mass (g) 78
LV Mass Index (g/m2) 43 <60
LV Infarct Mass (g) 0
LV Infacrt Percentage (%) 0
RV End-Diastolic Volume (ml) 94
RV End-Diastolic Volume Index (ml/m2) 52 <103
RV End-Systolic Volume (ml) 32
RV Stroke Volume (ml) 62
RV Ejection Fraction (%) 66 >49
QFlow Net Aortic Forward Stroke Volume (QS net, ml) 50
QFlow Net Pulmonary Artery Forward Stroke Volume
(Qp net, ml) 56
QP/QS 1.12 0.8 - 1.2
QFlow Aortic Cardiac Output (l/min) 4.3
QFlow Aortic Cardiac Index (l/min/m2) 2.4 >2.0
QFlow Aortic Valve Regurgitant Volume (ml) 0
QFlow Aortic Valve Regurgitant Fraction (%) 0 <5
Mitral Valve Regurgitant Volume (ml) 0
Mitral Valve Regurgitant Fraction (%) 0 <5
Effective Forward LVEF (%) 63 >56
Pulmonic Valve Regurgitant Volume (ml) 0
Pulmonic Valve Regurgitant Fraction (%) 0 <5
Tricuspid Valve Regurgitant Volume (ml) 6
Tricuspid Valve Regurgitant Fraction (%) 10 <5
Aortic Valve Area (2-D) (cm2) 2.5 >3.0
Aortic Valve Area Index (cm2/m2) 1.4
Ascending Aorta diameter (mm) 25 <35
Ascending Aorta diameter Index (mm/m2) 14 <21
Transverse Aorta diameter (mm) 20 <31
Descending Aorta diameter (mm) 18 <25
Descending Aorta Index (mm/m2) 10 <15
Main Pulmonary Artery diameter (mm) 22 <27
Main Pulmonary Artery diameter Index (mm/m2) 12 <15
Left Atrium (Parasternal Long Axis) (mm) 25 <40
Left Atrium Length (4-Chamber) (mm) 40 <52
Right Atrium (4-Chamber) (mm) 40 <50
Pericardial Thickness (mm) 2 <4
Coronary Sinus diameter (mm) 7 <15
* = Mildly abnormal, ** = moderately abnormal, *** = severely abnormal
## TECHNOLOGISTS:
,
Nursing support: , RN
## EGFR:
100 ml/min1.73m2 based on creatinine 0.8mg/dl on
## 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).
## FINDINGS:
Structure and Function
There was epicardial fat distribution. The pericardial thickness was
. There were no pericardial or pleural effusions. The indexed diameters
of the ascending and descending thoracic aorta were . The main
pulmonary artery diameter index was . The left atrial AP dimension was
. The right and left atrial lengths in the 4-chamber view were .
The coronary sinus diameter was .
The left ventricular end-diastolic dimension index was . The end-
diastolic volume index was . The calculated left ventricular ejection
fraction was at 63% with regional systolic function. The
anteroseptal and inferolateral wall thicknesses were . The left
ventricular mass index was . The right ventricular end-diastolic volume
index was . The calculated right ventricular ejection fraction was
at 66%, with free wall motion.
The aortic valve was tri-leaflet with valve area.
The intra-atrial septum appeared intact.
Quantitative Flow
There was no significant intracardiac shunt. Aortic flow demonstrated no
significant aortic regurgitation. The right ventricular stroke volume and
pulmonic flow demonstrated no significant pulmonic and mild tricuspid
regurgitation.
## IMPRESSION:
1. No significant intracardiac shunting.
2. right ventricular cavity size and systolic function with no evidence
of right ventricular enlargement or hypertrophy. The RVEF was at 66%.
3. left ventricular cavity size with regional left ventricular
systolic function. The LVEF was at 63%..
4. Mild tricuspid regurgitation.
5. The indexed diameters of the ascending and descending thoracic aorta were
. The main pulmonary artery diameter index was .
The images were reviewed by Drs.
, and .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14450150", "visit_id": "N/A", "time": "2145-06-26 12:24:00"} |
15398856-DS-12 | 684 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
PPM placed
Cardioversion to atrial tachycardia
## HISTORY OF PRESENT ILLNESS:
woman with no significant past medical history found
to be in atrial fibrillation on routine annual
physical
ECG screening. Patient with minimal symptoms except dyspnea on
exertion. Sometimes has an awareness of fluttering sensation
when
lying on her left side. Underwent attempt at cardioversion on
after initiating Flecainide 50mg bid the day prior. She
failed CV with 200 Joules. After 360 Joules she developed a long
pause but then no change in her rhythm. Flecainide discontinued.
Patient now being admitted for initiation of Dofetilide tonight,
pacemaker implantation tomorrow followed by cardioversion on
.
## PAST MEDICAL HISTORY:
Atrial fibrillation s/p failed cardioversion in
Currently under workup for possible Lupus
## FAMILY HISTORY:
The patient's mother was diagnosed with lupus
Anticoagulant. She had a history of pulmonary embolism and prior
stroke at the age of . She had a pacemaker put in in her .
? hx of AF as she was on Quinaglute previously. She died at the
age of , possibly related to congestive heart failure. Father
died at the age of of myocardial infarction. Patient's
brothers without cardiac disease.
## GENERAL:
A+Ox3, pleasant. Denies pain
## VASCULAR:
Feet warm, no edema, . 2+radial pulses
bilaterally. Left chest wall pacer site with a dsd. Site soft,
no hematoma, ecchymosis or bleeding.
## GI/GU:
Abdomen soft, non-tender, +bowel sounds. Voiding without
difficulty
## NEURO:
Alert and Oriented x3. Denies pain.
## CV:
NSR, RRR, S1/S2, No murmur, rub, gallop appreciated.
## PULM:
Lung fields CTA throughout.
## GI:
BS +/ Abdomen soft NT/ND.
## GU:
Voiding clear yellow urine.
## VASC:
(B) 2+. No pedal edema. No bleeding,
ecchymosis, hematoma appreciate at left upper chest wall at
pacer
insertion site.
## BRIEF HOSPITAL COURSE:
Mrs. is a year old woman with a history of
atrial fibrillation and failed DCCV and Flecainide trial in
admitted for initiation of dofetilide and is
s/p pacemaker (DDD 60-130) on . She was
subsuquently cardioverted on with 200 joules of biphasic
energy and 70mg of Propofol to atrial tachycardia and remained
on Dofetilide at 500mcg BID until day of discharge. Metoprolol
50mg XL was initiated on for rate control with good result.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Warfarin 7.5 mg PO 4X/WEEK ( )
2. Warfarin 5 mg PO 3X/WEEK (MO,WE,SA)
3. Multivitamins 1 TAB PO DAILY
## DISCHARGE MEDICATIONS:
1. Multivitamins 1 TAB PO DAILY
2. Warfarin 7.5 mg PO 4X/WEEK ( )
3. Warfarin 5 mg PO 3X/WEEK (MO,WE,SA)
4. Metoprolol Succinate XL 50 mg PO DAILY
RX *metoprolol succinate 50 mg 1 tablet extended release 24
hr(s) by mouth daily Disp #*30 Tablet Refills:*2
5. Dofetilide 500 mcg PO Q12H
6. Clindamycin 450 mg PO Q8H Duration: 1 Days
RX *clindamycin HCl 150 mg 3 capsule(s) by mouth three times a
day Disp #*6 Capsule Refills:*0
## DISCHARGE DIAGNOSIS:
Atrial fibrillation
bradycardia
atrial tachycardia
## DISCHARGE CONDITION:
Mrs. is a year old woman with a history of
atrial fibrillation and failed DCCV and Flecainide trial in
who is now here for initiation of dofetilide and
is
s/p pacemaker (DDD 60-130) on . She was
subsuquently cardioverted on with 200 joules of biphasic
energy and 70mg of Propofol to atrial tachycardia.
## DISCHARGE INSTRUCTIONS:
You were admited on for the initiation of Dofetilide and
pacemaker implantation.
On you had a permanent pacemaker placed for a
slow heart rate.
On You had a cardioversion for atrial fibrillation and
then had an atrial tachycardia which resolved with metoprolol.
Continue all your previous medications in addition to:
Dofetilide 500 mg twice a day for prevention of atrial
fibrillation.
Metoprolol 50mg daily to slow the atrial tachycardia.
The Dofetilide will be mailed to you every month from
on in .
You have been given an update medication list.
If you have any questions related to recovery from your
procedure or are experiencing any symptoms that are concerning
to you, please call
the Heartline at to speak with a cardiologist
or cardiac nurse practitioner
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15398856", "visit_id": "23510972", "time": "2165-07-12 00:00:00"} |
19466866-DS-12 | 2,112 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
dyspnea and bloody stools
## HISTORY OF PRESENT ILLNESS:
This is a yo M with a PMHx of metastatic melanoma to the
brain and liver who p/w dyspnea and bloody stools.
.
The patient was recently admitted earlier this month with AMS.
His dose of steriods was increased and he was found to have DKA,
likely to steroids. In addition, the patient was found to
be pan-hypopit and was staretd on replacement therapy. The
patient got an LP during that admission, which was negative for
malignancy cells. A CT of the chest done during that admission
showed cavitary lung lesions, which were thought most likely to
represent metastatic disease. However, as differential included
infectious causes, ID was consulted. Full work-up was not done
at that time, as patient and his family were insistent on going
home. Beta-glucan drawn at that time was positive, galactomannan
was negative.
.
The patient notes that his last dose of ipilimumab was .
His current problems with bloody stools started this past
. The blood appears mostly on the tolilet paper and the
patients stool was solid with blood streaks. The patients stool
frequency was times a day and there has been no change in
frequency from the time it started until now. Denies pain on
defacatition or symptoms of syncope or pre-syncope. The
patients last colonoscopy was yhear ago at and was wnl.
This was for routine screening and the patient does not have a
h/o met's to the colon. The reason the patient presented to
was that the patient developed dyspnea within the last
days. He has no h/o lung disease. The patient reports that at
rest and with walking he describes a difficulty catching breath.
Denies n/v. The patient called Dr. with these
symptoms and he was told to come to the ED.
.
In the ED, the patients VS were stable and the patient got a CTA
which showed no evidence of PE and interval improvement in some
of the infiltrates and new and increased cavitation in a few of
the previously described solid lung lesions. The patient was
started on vanco and cefepime in the ED and sent to the floor.
.
The patient reports his last BM was about 12 hours ago. Denies
any current symptoms.
.
ROS is positive for blurred vision which improved with new
glasses and mild diffuse body weakness. Otherwise ROS is
negative
.
## PAST ONCOLOGIC HISTORY:
from notes
- , Mr. underwent biopsy of a right cheek skin
lesion revealing lentigo maligna.
-He underwent a wide local excision with a focal positive margin
with no further resection at that time.
-In , he underwent abdominal US to evaluate
abdominal pain which revealed small gallstones. There were liver
nodules noted consistent with hemangiomas. He underwent a liver
MRI on , revealing a dominant liver nodule concerning
for possible metastatic disease.
-Torso CT revealed lung nodules
-On , he underwent a brain MRI revealing three brain
lesions.
-On , he underwent a CT-guided liver biopsy confirming
melanoma.
-He was subsequently referred to to Dr.
for a gamma knife evaluation. He underwent gamma
knife treatment to three brain lesions on with brain
MRI one month later revealing stability.
-He began off protocol ipilimumab on . F/U brain MRI in
early showed several new small brain lesions without
associated edema. He had evidence of regression in SQ nodules at
this time so he was observed.
-F/U brain MRI revealed resolution of the largest CNS lesion
with growth in some smaller lesions felt to be ipilimumab
effect. Torso CT revealed continued improvement in systemic
disease. He underwent Gamma knife therapy to 5 lesions on
by Dr. CT was stable.
-He was admitted in twice at for mental status
changes responsive to steroids, presumably due to edema
surrounding known metastatic disease.
## PAST MEDICAL HISTORY:
1. Status post traumatic neck injury in
after falling off a ladder, status post C-spine fusion;
2. history of chronic dysphagia from nutcracker esophagus
syndrome;
3. history of a frozen shoulder status post physical therapy
with
improvement in mobility
4. history of lentigo maligna of the right cheek.
5. Metastatic Melanoma as above
## FAMILY HISTORY:
no history of melanoma
## LUNGS:
mild right basilar crackles
## ABDOMEN:
NTND, active BS X4, no HSM
## EXTREMITIES:
WWP, pulses 2+ and equal
## NEURO:
CN wnl, MS-patient has some short term memory deficits,
strength, BLE strength in ankle dorsiflexion, other muslce
groups are wnl, sensation wnl
## PSYC:
mood and affect wnl
## GU/RECTAL:
patient had no obvious anal fissures, had a skin tabe
that looked normal, no external hemrrhoids, no internal
hemorrhoids and normal tone
Exam on Discharge
VS 98.6, 120/85, 73-92, 19, 100 RA
## LUNGS:
CTAB b/l except some faint wheezing in left lower lung
area
## ABDOMEN:
NT,ND, NABS, no HSM
## EXTREMITIES:
WWP, pulses 2+ and equal
## NEURO:
CN wnl, MS-patient has some short term memory deficits,
strength, BLE strength in ankle dorsiflexion, other muslce
groups are wnl, sensation wnl
## PSYC:
mood and affect wnl
## IMPRESSION:
1. No evidence of pulmonary embolism.
2. Interval resolution of diffusely distributed ground glass
opacities and
interval improvement in right lower lobe consolidation.
Numerous solid
opacities have changed in morphology, some with increased solid
components and
others with new or increased cavitary components. Given that
these findings
are predominantly new since , but changed since
,
an infectious process, possibly fungal, is suspected. New
metastatic disease
is considered unlikely given the time course and rapid change in
morphology.
3. Interval resolution of bilateral pleural effusions.
Bronchoscopy Studies from Bx :
GRAM STAIN (Final :
1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
NO MICROORGANISMS SEEN.
TISSUE (Final :
Reported to and read back by . @
4:10 .
This culture contains mixed bacterial types (>=3) so an
abbreviated
workup is performed. Any growth of P.aeruginosa, S.aureus
and beta
hemolytic streptococci will be reported. IF THESE BACTERIA
ARE NOT
REPORTED BELOW, THEY ARE NOT PRESENT in this culture..
MIXED BACTERIAL FLORA ( >=3 COLONY TYPES) CONSISTENT WITH
OROPHARYNGEAL FLORA.
VIRIDANS STREPTOCOCCI. RARE GROWTH STRAIN 1.
VIRIDANS STREPTOCOCCI. RARE GROWTH STRAIN 2.
GRAM NEGATIVE ROD(S). RARE GROWTH.
NEISSERIA SPECIES. NON-PATHOGENIC SPECIES.
## ANAEROBIC CULTURE (PRELIMINARY):
NO ANAEROBES ISOLATED.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
## FUNGAL CULTURE (PRELIMINARY):
NO FUNGUS ISOLATED.
POTASSIUM HYDROXIDE PREPARATION (Final :
NO FUNGAL ELEMENTS SEEN.
## BRIEF HOSPITAL COURSE:
This is a yo M with a PMHx of metastatic melanoma s/p
multiple gamma knife treatments for brain lesions and s/p
iplimumab treatment who recently was admitted with DKA and AMS
who presented with a one week history of bloody stools and one
day of dyspnea with a stable Hgb and a CTA that is negative for
PE and brochoscopy with BAL labs positive for pneumocystic
jiroveci.
.
# Dyspnea: Etiology in the ED was intially though to be PE, but
CTA was negative and tachycardia resolved. Patient afebrile and
satting well with no increase of work of breathing upon arriving
to the floor. Antibiotics were not continued, given low
suspicion for bacterial pneumonia given lack of fevers, cough,
leukocytosis. Progressive cavitary lesions on chest CT judged to
be possible cause. Imaging suspicious for infection, so ID was
consulted and fungal studies were sent. Patient was placed on
respiratory precautions given possibility (although less likely)
of TB. Patient also on chronic steroids without PCP prophylaxis,
so differential included PCP, although lung findings not
characteristic. Uncompensated anemia also potential cause of
dyspnea, as patient's HCT was 24.1 on . Patient was given a
unit of blood with good response. Multiple attempts at attaining
induced sputum samples were unsuccessful.
* Bronchoscopy on : with Bronchoalveolar lavage which
showed immunoflourescent test POSITIVE FOR PNEUMOCYSTIS
JIROVECII (CARINII). Given this finding pt was started on
Bactrim DS 2 tabs BID for three weeks. After three weeks pt will
need Bactrim DS 1 tab daily indefinitely for secondary
prophylaxis. Pt's vitals remained stable on the floor while
breathing on room air. Given that pt was already on high-dose
dexamethasone for brain mets, ABG was not sent for PaO2.
* Beta glucan was elevated on labs.
# BRBPR, normocytic anemia. Ddx included hemorrohoids vs. anal
fissure vs. ipilimumab effect vs. metastatic dz in colon. No
anal fissue or hemorrhoids detect on physical exam. GI
consulted. Patient had no further bloody stools during
admission, so further workup deferred at this time.
.
# Metastatic melanoma with brain mets: s/p multiple gamma knife
treatments and off-label ipilimumab in . Multiple recent
admissions for mental status changes due to cerebral edema,
maintained on dexamethasone. Followed by Dr. in
Biologics.
.
# Diabetes: remained stable on insulin SS and FSBG qACHS. Pt has
outpt endocrinology appt with for diabetes control on
.
## # HYPOTHYROIDISM:
remained stable on home levothyroxine
Transition issues:
===================
-pt started on Bactrim DS 2 tabs BID for three weeks. After
three weeks pt will need Bactrim DS 1 tab daily indefinitely for
secondary prophylaxis.
-Outpatient labs to be drawn for CHEM 7 on and faxed to ID department. Given pt started on
Bactrim, ID wants to follow up on creatinine.
-f/u fungal studies, galactomannan, urine histoplasmosis
-f/u cytology and infectious studies from bronchoscopy
## MEDICATIONS ON ADMISSION:
Preadmission medications listed are correct and complete.
Information was obtained from PatientFamily/Caregiver.
1. Dexamethasone 4 mg PO Q8H
2. LeVETiracetam 500 mg PO BID
3. Tamsulosin 0.4 mg PO HS
4. Omeprazole 20 mg PO DAILY
5. Testosterone 4 mg Patch 1 PTCH TD DAILY
6. Levothyroxine Sodium 88 mcg PO DAILY
7. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
8. Senna 1 TAB PO BID:PRN constipation
9. Docusate Sodium 100 mg PO BID
## DISCHARGE MEDICATIONS:
1. Dexamethasone 4 mg PO Q8H
2. Docusate Sodium 100 mg PO BID
3. LeVETiracetam 500 mg PO BID
RX *levetiracetam 500 mg 1 (One) tablet(s) by mouth twice daily
Disp #*60 Tablet
## REFILLS:
*0
4. Levothyroxine Sodium 88 mcg PO DAILY
RX *levothyroxine 88 mcg 1 (One) tablet(s) by mouth daily Disp
#*30 Tablet Refills:*0
5. Omeprazole 20 mg PO DAILY
6. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
RX *oxycodone 5 mg 1 (One) tablet(s) by mouth every four hours
Disp #*180 Tablet Refills:*0
7. Senna 1 TAB PO BID:PRN constipation
8. Tamsulosin 0.4 mg PO HS
RX *tamsulosin 0.4 mg 1 (One) capsule(s) by mouth at bedtime
Disp #*30 Capsule Refills:*0
9. Testosterone 4 mg Patch 1 PTCH TD DAILY
10. Glargine 30 Units Breakfast
Glargine 10 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
RX *insulin glargine [Lantus] 100 unit/mL 30 Units before BKFT;
10 Units before BED; Twice daily Disp #*400 Unit Refills:*0
RX *insulin lispro [Humalog] 100 unit/mL Continue following
insulin sliding scale from last discharge four times a day Disp
#*350 Unit Refills:*0
RX *insulin syringe-needle U-100 [Advocate Syringes] 31 gauge X
One syringe per insulin administration per insulin
instructions Disp #*200 Syringe Refills:*0
11. Sulfameth/Trimethoprim DS 2 TAB PO Q8H Duration: 3 Weeks
RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 2
(Two) tablet(s) by mouth Every 8 hours Disp #*126 Tablet
Refills:*0
12. Outpatient Lab Work
Please draw blood for CHEM 7 on and fax
results to . at fax:
## SECONDARY DIAGNOSIS:
Melanoma with Metastasis
Anemia
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted to the hospital with shortness of breath and
bloody stools. A CT of your chest was done, which did not show
any evidence of pulmonary emboli, but did show progressive
cavitary lesions. These were thought to be possibly due to an
infection (possibly fungal) versus metastatic disease. The
infectious disease team was consulted and fungal studies were
sent. You had a bronchoscopy on and samples of the lesions
were taken. These samples came back positive for Pneumocystis
and you were started on an antibiotic (Bactrim)to treat
Pneumocystis pneumonia. You will take this antibiotic at a
treatment dose for the next 3 weeks, and then afterwards the
dose will be adjusted for prophylaxis.
On admission, you were found to be anemic and were given a unit
of blood. You had no bloody stools during your admission, so at
the advice of the GI doctors, imaging of your GI tract was not
done at this time.
You will need close follow up, including outpatient blood work
to be drawn on the same day as your endocrinology appointment on
. Please fax the results of the lab work to
. office at . Please see below
for details regarding your follow up visits with endocrinolgy,
infectious disease, and oncology.
It was a pleasure taking care of you during your hospitalization
and we wish you the best going forward.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19466866", "visit_id": "29872670", "time": "2139-10-27 00:00:00"} |
11390421-RR-37 | 90 | ## HISTORY:
with abd pain recent biliary stenting, abd pain,
reported pneumonia and hypoxia // cx:pna?ct abd: perf, biliary complication
or obstruction?
## FINDINGS:
New since the prior study, there is a moderate left pleural effusion, which
may be partially loculated. Underlying atelectasis is likely present,
underlying consolidation not excluded. No focal consolidation or pleural
effusion is seen on the right. Cardiac silhouette size is top-normal.
Mediastinum is not grossly widened.
## IMPRESSION:
Moderate left pleural effusion which may be partially loculated, new since . Underlying pneumonia is not excluded.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11390421", "visit_id": "N/A", "time": "2138-03-16 22:30:00"} |
11563027-DS-19 | 927 | ## CHIEF COMPLAINT:
Left hip and leg pain
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
ORIF left acetabuler fracture
## HISTORY OF PRESENT ILLNESS:
The patient is a yo female presenting with left hip pain
after falling down approximately 8 stairs in her house and
landing on her left hip and shoulder. She immediately noted pain
and inability to bear weight. She was initially taken to
where a full trauma workup was conducted, and while
other injuries to her head, neck and spine were ruled out, she
was noted to have a left acetabular fracture. She was then
transferred to for management. At baseline, she
ambulates independently without assistance and works full-time
as a , spending a great deal of time on her feet. She
notes some bumps and bruises from the fall around her left
shoulder and back, but no other serious injuries.
## GEN:
alert and oriented, no acute distress
## ABD:
mildly distended, mildy tender to palpation in all 4
quadrants, no rebound or gaurding
## LLE:
Incisions closed with staples, C/D/I, no erythema,
swelling, or drainage, foot and toes WWP with good cap refill,
SILT sp/dp/tibial/sural/saphenous distributions, fires
## ABD SUPINE/ERECT:
Dilated small bowel consistent with
ileus
## 9:30 PM STOOL CONSISTENCY:
LOOSE Source:
Stool.
**FINAL REPORT
C. difficile DNA amplification assay (Final :
Negative for toxigenic C. difficile by the Illumigene DNA
amplification assay.
(Reference Range-Negative).
## BRIEF HOSPITAL COURSE:
The patient presented to the emergency department and was
evaluated by the orthopedic surgery team. She was found to have
left acetabular fracture and was admitted to the orthopedic
surgery service. She was taken to the operating room on
for ORIF left acetabuler fracture, and again on for exam
under anesthesia and anterior column percutaneous screw, which
she tolerated well (for full details please see the separately
dictated operative reports). She was initially given IV fluids
and IV pain medications, and although her diet was advanced to
regular, she was made NPO again after failing to have a bowel
movement for 5 days and developing significant distention and
ileus. ACS was consulted, and they ultimately recommended bowel
decompression with neostigmine in the TSICU, which the patient
tolerated well. After successful bowel decompression, the
patient was transferred back to the floor, NG tube was
discontinued, and her diet was once again advanced to regular.
She passed flatus and had watery bowel movements. Her distention
improved with Reglan. She was also encouraged to ambulate, which
improved her abdominal distention as well. She was given
perioperative antibiotics and anticoagulation per routine. The
patient's home medications were continued throughout this
hospitalization. She worked with who determined that
discharge to rehab was appropriate. Her hospital course was
otherwise unremarkable.
At the time of discharge the patient was afebrile with stable
vital signs that were within normal limits, pain was well
controlled with oral medications, incisions were
clean/dry/intact, and she was voiding/moving bowels
spontaneously. She is touchdown weight bearing in the left lower
extremity, and will be discharged on lovenox for DVT
prophylaxis. The patient will follow up in 7 days. A thorough
discussion was had with the patient regarding the diagnosis and
expected post-discharge course, and all questions were answered
prior to discharge.
## MEDICATIONS ON ADMISSION:
atorvastatin, diltiazem HCl, fenofibric acid, levothyroxine,
raloxifene, celecoxib, cholecalciferol, (vitamin D3)
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q6H
2. Atorvastatin 40 mg PO DAILY
3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
4. Diltiazem Extended-Release 180 mg PO DAILY
5. Docusate Sodium 100 mg PO BID
6. Enoxaparin Sodium 40 mg SC QPM
RX *enoxaparin 40 mg/0.4 mL 40 mg/0.4mL SC QPM Disp #*14 Syringe
## REFILLS:
*0
7. Famotidine 20 mg PO BID
8. Levothyroxine Sodium 150 mcg PO DAILY
9. Milk of Magnesia 30 mL PO Q6H:PRN Constipation
10. Ondansetron 4 mg PO Q8H:PRN nausea
11. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
RX *oxycodone 5 mg 1 to 2 tablet(s) by mouth every four (4)
hours Disp #*60 Tablet Refills:*0
12. PNEUMOcoccal 23-valent polysaccharide vaccine 0.5 ml IM NOW
X1
13. Polyethylene Glycol 17 g PO DAILY:PRN constipation
14. Senna 17.2 mg PO BID
15. Simethicone 40-80 mg PO QID:PRN gas pain
16. Calcium Carbonate 500 mg PO TID
17. Vitamin D 400 UNIT PO DAILY
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## MEDICATIONS:
- Please take all medications as prescribed by your physicians
at discharge.
- Continue all home medications unless specifically instructed
to stop by your surgeon.
- Do not drink alcohol, drive a motor vehicle, or operate
machinery while taking narcotic pain relievers.
- Narcotic pain relievers can cause constipation, so you should
drink eight 8oz glasses of water daily and take a stool softener
(colace) to prevent this side effect.
## ANTICOAGULATION:
- Please take lovenox 40mg daily
## WOUND CARE:
- No baths or swimming for at least 4 weeks.
- Any stitches or staples that need to be removed will be taken
out at your 2-week follow up appointment.
- No dressing is needed if wound continues to be non-draining.
## ACTIVITY AND WEIGHT BEARING:
- Activity as tolerated
- Left lower extremity: touchdown weight bearing
## PHYSICAL THERAPY:
- Activity as tolerated
- Left lower extremity: touchdown weight bearing
## SITE:
L hip, L groin
## DESCRIPTION:
Dry gauze and elastoplast tape dressing
## CARE:
Change dressing every other day or as needed to keep clean
and dry. If incision remains non-draining, OK to leave open to
air.
## FOLLOW-UP:
Pt is to follow-up in 7 days for removal of staples.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11563027", "visit_id": "21598679", "time": "2135-05-12 00:00:00"} |
15937283-RR-141 | 378 | ## EXAMINATION:
CT abdomen and pelvis without contrast
## INDICATION:
History of type 1 diabetes status post renal and pancreas
transplant in on immunosuppression with recurrent UTIs presenting with
acute kidney injury, recent falls, auditory and visual hallucinations with a
recurrent fevers despite treatment, nausea and vomiting and left-sided
abdominal tenderness.
## NON-CONTRAST SCAN:
Multidetector CT images of the chest, abdomen
and pelvis were acquired without intravenous contrast. Non-contrast scan has
several limitations in detecting vascular and parenchymal organ abnormalities,
including tumor detection. Chest images were separated to be evaluated by the
thoracic imaging service.
Coronal and sagittal reformations were performed and reviewed on PACS.
Oral contrast was administered.
## DOSE:
DLP: 483.57 mGy-cm (chest, abdomen and pelvis).
## CT ABDOMEN WITHOUT CONTRAST:
Liver, decompressed bladder, spleen and adrenal
glands are normal in the context of a noncontrast examination. Native pancreas
is severely atrophied. Native kidneys are severely atrophied.
Small hiatal hernia. Stomach, duodenum and remainder of the small bowel loops
are normal caliber without evidence of obstruction. The large bowel is
thin-walled and unremarkable without evidence of obstruction.
The abdominal aorta is normal caliber. Prominent diffuse vascular
calcifications. No ascites or pneumoperitoneum. Small fat containing umbilical
hernia. No frank ventral abdominal hernia.
Mesenteric and retroperitoneal lymph nodes are not pathologically enlarged.
## CT PELVIS WITHOUT CONTRAST:
Bladder is prominently distended but otherwise
unremarkable. Uterus, adnexae and rectum are unremarkable. No free pelvic
fluid or air. Inguinal and pelvic sidewall lymph nodes are not pathologically
enlarged.
Left lower quadrant renal transplant demonstrates an 11 mm interpolar simple
cyst. Transplant kidney is otherwise grossly unremarkable without obvious
mass, stone or hydronephrosis. Right lower quadrant transplant pancreas is
grossly unremarkable though not well assessed.
## BONES AND SOFT TISSUES:
The bones are diffusely demineralized. No suspicious
focal bone lesion. Injection granulomas and focus of gas in the anterior
superficial abdominal soft tissues.
## IMPRESSION:
1. No acute CT findings on this noncontrast examination to account for
left-sided abdominal pain, nausea and vomiting.
2. Prominent distention of the bladder suggests neurogenic bladder in this
patient with a history of type 1 diabetes.
3. Grossly unremarkable transplant kidney and pancreas though evaluation is
limited on this noncontrast study.
4. Small hiatal hernia.
5. Prominent vascular calcifications in this patient with diabetes.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15937283", "visit_id": "27946261", "time": "2189-07-28 22:09:00"} |
11965254-RR-105 | 102 | ## INDICATION:
year old woman with SBO Crohn's // eval for bowel gas
pattern
## FINDINGS:
There is been interval placement of an enteric tube with the tip and side port
terminating in the left upper quadrant, likely within the stomach. There is
interval decrease in previously seen prominently dilated air-filled loops of
bowel with multiple air-fluid levels from the prior study. There is a paucity
of gas in the abdomen. There is rotational scoliosis of the lumbar spine.
## IMPRESSION:
Interval decrease in multiple dilated air-filled loops of small bowel from now with paucity of gas in the abdomen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11965254", "visit_id": "25366791", "time": "2148-09-29 12:50:00"} |
12496782-RR-13 | 183 | ## INDICATION:
man, on Coumadin, status post fall with VF arrest,
now GCS 4. Evaluate for intracranial bleed.
## FINDINGS:
There is no acute intracranial hemorrhage, large mass or mass
effect. There may be a subtle loss of gray-white matter differentiation,
although the ventricles and sulci are normal in size and configuration given
the patient's age. There is extensive periventricular white matter
hypodensity, likely representing sequelae of chronic small vessel ischemic
disease; however, given patient's history, infarct cannot be excluded. There
is extensive atherosclerotic mural calcification involving the cavernous and
supraclinoid carotid arteries, bilaterally.
The paranasal sinuses and mastoid air cells are clear. No fracture is
identified.
## IMPRESSION:
No acute intracranial hemorrhage. Extensive periventricular white
matter hypodensities which may represent sequelae of chronic small vessel
ischemic disease; however, given patient's history, infarct cannot be
excluded.
## NOTE ADDED IN ATTENDING REVIEW:
As above, there is no intracranial hemorrhage.
Allowing for the evidence of severe sequelae of chronic microvascular
infarction, there is no finding to suggest acute vascular territorial
infarction. There is disproportionate and lateral ventriculomegaly, which
may represent central atrophy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12496782", "visit_id": "25315429", "time": "2119-09-15 17:38:00"} |
17895191-DS-16 | 1,857 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
chest tightness, shortness of breath
## HISTORY OF PRESENT ILLNESS:
Mr is a year old male with no cardiac history who
presented with two days of chest tightness.
He reports that chest discomfort began two days ago when he was
doing some free throws (basketball). He reports that he
normally plays basketball at least once a week and has never had
these symptoms before. He describes the chest discomfort as
feeling as though there are "bubbles in his chest" and he felt
very weak and short of breath. He also reported some posterior
neck soreness associated with the chest pain.
Yesterday, he was doing housework and he felt progressively
weaker. He drank diet coke and coffee thinking he had low
blood pressure, but he continued to feel uncomfortable. In the
evening, he was driving when he felt even more fatigued so he
immediately went home. He thought he had low blood sugar so he
ate 2 cookies with no improvement. He felt that he had no
strength to laugh or even talk.
This morning, he was still very short of breath and weak, so
with encouragement of his wife, he presented to the ED around
noon.
In the ED, initial vitals were T 98.1 | 86 | 122/79 | 16 | 97%.
He had serial EKGs and found to have STEMI V1-V4
Labs/studies notable for: troponin 2.32, proBNP 1573
A CXR ( ) showed no acute cardiopulmonary process.
Patient was given:
- aspirin 324mg PO
- nitroglycerine IV gtt
- heparin bolus and gtt
In the ED, his pain escalated and so he was transferred to the
cath lab for ST elevation MI.
## IN CATH LAB:
1. Anterior STEMI succesfully treated with DES to
the LAD ( 3 x DES total, 2 to LAD and 1 to distal). Final
angiography revealed normal flow, no dissection and 0% residual
stenosis in the stents and mild plaquing with 30% stenoses in
the
remainder of the LAD. His BP was in the , so he was given
700cc of fluids.
## VITALS ON TRANSFER:
T 36.7 BP 95/61 HR 78 RR 17 O2 95%
On arrival to the CCU: He reports no chest pain since cath
procedure. Denies shortness of breath and reports good appetite.
He is concerned about bilateral visual changes (dull white
spots, no changes in vision, no pain with extraocular movement)
that have presented after his cath, and he has never had those
symptoms before. He denies any fatigue.
Of note, he reports that he does not like to take medications
due to fear of side effects and unnecessary medications. He
would like to minimize the number of medications he is on.
## PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS
- Prediabetes
- No history of HTN or hyperlipidemia
2. CARDIAC HISTORY
- No known history
3. OTHER PAST MEDICAL HISTORY
- Chronic hepatitis B
## FAMILY HISTORY:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death. Total of 5 siblings.
Has history of diabetes in multiple siblings.
## PHYSICAL EXAM:
Admission physical exam:
T 36.7 BP 95/61 HR 78 RR 17 O2 95%
## GENERAL:
Well developed, well nourished in NAD. Oriented x3.
Mood, affect appropriate.
## HEENT:
Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI.
Conjunctiva were pink. No pallor or cyanosis of the oral mucosa.
No xanthelasma.
## NECK:
Supple. JVD at 3cm above sternal angle when sitting up at
60 degrees.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. Regular rate and rhythm. Normal S1, S2. No murmurs, rubs,
or gallops.
## LUNGS:
No chest wall deformities or tenderness. Respiration is
unlabored with no accessory muscle use. No crackles, wheezes or
rhonchi.
## ABDOMEN:
Soft, non-tender, non-distended. No hepatomegaly. No
splenomegaly.
## EXTREMITIES:
Warm, well perfused. No clubbing, cyanosis, or
peripheral edema.
## SKIN:
No significant skin lesions or rashes. Dry skin on feet.
## PULSES:
Distal pulses palpable and symmetric.
## GENERAL:
Well developed, well nourished in NAD. Oriented x3.
Mood, affect appropriate. Sitting comfortably in bed.
## HEENT:
Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI.
Conjunctiva were pink.
## NECK:
Supple. JVD at 9cm
## CARDIAC:
Regular rate and rhythm. Normal S1, S2. No murmurs,
rubs,or gallops.
## LUNGS:
No chest wall deformities or tenderness. Respiration is
unlabored with no accessory muscle use. No crackles, wheezes or
rhonchi.
## ABDOMEN:
Soft, non-tender, non-distended. No hepatomegaly. No
splenomegaly.
## EXTREMITIES:
Warm, well perfused. No clubbing, cyanosis, or
peripheral edema.
## SKIN:
No significant skin lesions or rashes. Dry skin on feet.
## PULSES:
Distal pulses palpable and symmetric.
## :
EKG on Admission:
Normal sinus rhythm, ST elevation in V1-V3
## DOMINANCE:
Right
The RCA had mild luminal irregularities. The LMCA had no
angiographically apparent CAD. The
proximal LAD was totally occluded with no collaterals. The Cx
had mild luminal irregularities.
CXR:
No acute cardiopulmonary process.
Echo:
The left atrium is normal in size. There is mild
(non-obstructive) focal hypertrophy of the basal septum. The
left ventricular cavity size is normal. There is moderate
regional left ventricular systolic dysfunction with severe
hypokinesis/akinesis of the mid to distal septum, anterior wall
and apex. The remaining segments contract normally (Quantitative
(biplane) LVEF = 35 %, visually . No masses or thrombi
are seen in the left ventricle. Right ventricular chamber size
and free wall motion are normal. The diameters of aorta at the
sinus, ascending and arch levels are normal. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. The pulmonary
artery systolic pressure could not be determined. There is an
anterior space which most likely represents a prominent fat pad.
## IMPRESSION:
Moderate regional left ventricular systolic
dysfunction c/w LAD territory infarction. Normal right
ventricular systolic function. No pathologic valvular flow.
CXR:
In comparison with the study of , there is little change
and no
evidence of acute cardiopulmonary disease. No pneumonia,
vascular congestion, or pleural effusion.
## BRIEF HOSPITAL COURSE:
Mr is a year old male with no cardiac history who
presented with anterior STEMI s/p successful 3 to LAD.
## # CORONARIES:
The RCA had mild luminal irregularities. The LMCA
had no angiographically apparent CAD. The proximal LAD was
totally occluded with no collaterals s/p DES on . The Cx had
mild luminal irregularities
# PUMP: LVEF = 35 % after PCI
# RHYTHM: Normal sinus
==============
## ACTIVE ISSUES:
==============
# STEMI
Patient presented with shortness of breath and some chest
discomfort. EKG showed ST elevation in the anterior leads V1-V3.
He underwent cardiac catheterization on , with successful
3 to the LAD. He had hypotension post-cath, with SBP in
the . ECHO showed LVEF 35%, with moderate regional left
ventricular systolic dysfunction and severe hypokinesis/akinesis
of the mid to distal septum, anterior wall and apex. He was
started on aspirin, ticagrelor, and atorvastatin. He was started
on 6.25mg metoprolol q6h, which was occasionally held due to low
blood pressures, transitioned to 12.5mg metoprolol XL at
discharge. He was not started on ACE inhibitor, given low blood
pressures. He was bridged to warfarin, given the apical akinesis
on ECHO. He was fitted for a LifeVest. He was gently diuresed
and discharged on 20 Lasix PO daily. Discharge weight was 151
lbs. Discharge INR was 3.3.
# Visual changes
Patient reported onset of dull-white spots in eyes after cardiac
cath, which resolved after a few hours, without recurrence.
Normal neurologic exam.
===============
## ===============
# CHRONIC HEPATITIS B:
Last US on showed diffusely
echogenic liver with areas of heterogeneity predominantly within
the right hepatic lobe. Follow-up at MRI at which showed
diffuse steatosis but no focal lesions, last seen by GI on
. Continue to follow as outpatient.
## # CODE:
FULL
# CONTACT/HCP: Wife
## TRANSITIONAL ISSUES:
- Please follow up on blood pressures, which have run SBP in the
high to mid , given that he was started on metoprolol
- Did not start ACE inhibitor given hypotension, please consider
starting as an outpatient if BP allows.
- please consider uptitrating metoprolol as HR and BP allows. We
attempted to uptitrate while inpatient, but patient was
hypotensive and lightheaded with activity.
- Will require regular INR checks, as he was started on
warfarin.
- Discharge INR was 3.3. This may not reflect patient's INR
given that patient maintenance dose of 2.5mg daily was started
less than 2 days prior to discharge.
- Please monitor volume status. Patient was discharged on 20 PO
Lasix daily.
- Discharge weight was 151 lbs.
- Please check LFTs, given that he was started on atorvastatin
- Patient was fitted for a LifeVest, which he went home with.
Please re-assess EF in 1 month and consider ICD if EF does not
recover. EF at time of discharge was .
- Patient enrolled in clinic. Patient provided
with script for outpatient labs. Next INR on results will
be faxed to PCP and cardiology.
## NEW MEDICATIONS:
- Aspirin 81
- Atorvastatin 80
- Metoprolol XL 12.5mg daily
- Ticagrelor 90 BID
- Warfarin 2.5 mg daily
- Lasix PO 20 daily
## CONTACT:
Wife,
on Admission:
No medications
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30
## TABLET REFILLS:
*0
2. Atorvastatin 80 mg PO QPM
RX *atorvastatin 80 mg 1 tablet(s) by mouth at bedtime Disp #*30
## TABLET REFILLS:
*0
3. Furosemide 20 mg PO DAILY
RX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*10
## TABLET REFILLS:
*0
4. Metoprolol Succinate XL 25 mg PO DAILY
Please take a half pill daily (12.5mg).
5. TiCAGRELOR 90 mg PO BID
RX *ticagrelor [Brilinta] 90 mg 1 tablet(s) by mouth twice a day
Disp #*60
## TABLET REFILLS:
*0
6. Warfarin 2.5 mg PO DAILY16
Please take half tablet (2.5mg) daily.
RX *warfarin 5 mg 1 tablet(s) by mouth once a day Disp #*30
Tablet Refills:*0
7.Outpatient Lab Work
## LABS:
INR and
Please fax results to: Dr. , AND Dr.
## DISCHARGE DIAGNOSIS:
PRIMARY DIAGNOSIS
ST elevation myocardial infarction
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was our pleasure to care for you at
.
WHY WERE YOU ADMITTED?
- You were admitted because you had a heart attack
WHAT HAPPENED IN THE HOSPITAL?
- You had a cardiac catheterization, a procedure to take a
better look at the blood vessels in your heart
- One of the vessels in your heart had a blockage
- You had three stents placed in the blocked vessel, to open up
the blood vessel and prevent future blockages
WHAT SHOULD YOU DO AT HOME?
- Please take all your medications as prescribed
- Please go to all your follow up appointments as scheduled
- In particular, it is especially important for you to remember
to take the new medicines aspirin and Plavix everyday, because
they will prevent the stents in your heart from clotting, which
would lead to another heart attack
- You will need to get your blood checked regularly, to monitor
the blood-thinner effect of your new medication warfarin
- Please weigh yourself daily. If you gain more than 3 pounds in
pounds, please call your doctor.
- Do not do any exercise or strenuous activity for the next 4
weeks. Please do not drive for 10 days.
It was a pleasure taking care of you, we wish you the best!
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17895191", "visit_id": "22938533", "time": "2129-02-18 00:00:00"} |
12894920-RR-55 | 356 | ## EXAMINATION:
MRI of the entire spine with and without gadolinium.
## INDICATION:
Metastatic breast cancer to the brain, evaluate for drop
metastases.
MRI of the brain with and without gadolinium.
MRI of the lumbar spine with and without gadolinium.
## FINDINGS:
On the scout sequences, bilateral lung masses are partially visualized, highly
suspicious for metastases. The known enhancing intracranial metastases,
particularly in the right cerebellar hemisphere, are partially evaluated on
some of the sequences as well.
S-shaped scoliotic curvature of the thoracolumbar spine, levoconvex in the mid
thoracic and dextroconvex in the mid lumbar regions, is seen. Sagittal
alignment is near anatomic.
## CERVICAL SPINE:
Subcentimeter thyroid hyperintense lesions are likely
incidental. There is no suspicious osseous lesion or intradural lesion within
the cervical spine to suggest metastasis. Underlying degenerative changes are
seen with multilevel disc osteophyte complexes and ligamentum flavum
thickening causing moderate spinal canal narrowing at C5-6 and C6-7.
## THORACIC SPINE:
There is no suspicious osseous lesion or intradural lesion
within the thoracic spine to suggest metastases. Mild degenerative changes
are seen without evidence of high-grade spinal stenosis.
## LUMBAR SPINE:
In the lumbar spine, there are no focal suspicious osseous or
intradural lesions to suggest metastases. Multilevel degenerative changes are
again demonstrated and include:
At L2-L3, moderate posterior disc osteophyte complex and moderate, left
greater than right facet arthropathy but no high-grade spinal canal narrowing.
At L3-L4, similar changes with less severe facet degeneration.
At L4-L5, small posterior disc osteophyte complex with moderate-to-severe
bilateral facet arthropathy but no high-grade spinal canal narrowing.
At L5-S1, mild posterior disc osteophyte complex and moderate facet
arthropathy but no high-grade narrowing.
## IMPRESSION:
1. No evidence of spinal or vertebral metastases.
2. Bilateral lung masses highly suspicious for metastases. According to a
note by Dr. , a prior thoracic CT from another
institution, not availiable for review at this time, revealed lung masses.
Comparison with that study and/or dedicated follow up thoracic CT would better
evaluate these partially visualized lung masses if clinically necessary.
3. Known cerebellar metastases, partially visualized, better evaluated on the
recent MR brain.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12894920", "visit_id": "N/A", "time": "2158-12-17 13:37:00"} |
15187035-RR-61 | 109 | ## INDICATION:
Status post right thoracotomy, wedge resection in the right lower
lobe and right upper lobe, evaluation for interval change.
## FINDINGS:
As compared to the previous radiograph, there is an increase in
extent of the right soft tissue gas accumulation. Today's image shows a 3-4
mm apical lateral pneumothorax without evidence of tension. The right chest
tube is in unchanged position. Increasing right lateral pleural thickening,
minimal right pleural effusion. The mediastinal aspect of the right
hemithorax is unchanged. On the left, there is minimally increasing extent of
a left hemidiaphragmatic elevation, combined to a small atelectasis. The size
of the cardiac silhouette is constant.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15187035", "visit_id": "25991341", "time": "2170-04-15 10:43:00"} |
18032895-RR-25 | 596 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## INDICATION:
year old woman with metastatic pancreatic cancer to liver with
neutropenic fever and flu-like symptoms. Evaluate for infectious source.
## 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.
## LOWER CHEST:
There is minimal dependent atelectasis in bilateral lower lobes.
There is no pleural pericardial effusion.
## HEPATOBILIARY:
There are multiple irregular lesions the, compatible with
metastatic disease, as described below, all of which are grossly unchanged as
compared to CT abdomen pelvis . The largest of these lesions
measure:
Segment II lesion measuring 3.8 x 4.9 cm (2:23), previously 3.8 x 4.9 cm on
Segment VII lesion measuring 3.1 x 3.0 cm (2:18), previously 3.2 x 3.1 cm
Segment IVB lesion measuring 3.2 x 1.9 cm (2:26), previously 3.4 x 1.7 cm.
Segment V lesion measuring 2.5 x 1.9 cm (2:20), previously 2.0 x 2.5 cm
Caudate lesion measuring 1.2 x 1.8 cm (02:21), previously 1.8 x 1.3 cm.
There is no new lesion. There is no intra- or extrahepatic biliary
dilatation.
## PANCREAS:
Re-demonstrated is a poorly delineated hypoattenuated mass centered
in the pancreatic body measuring 2.4 x 3.3 cm (02:27), grossly unchanged as
compared to . The splenic vein is occluded. This mass abuts
the portal splenic confluence and distal portion of the celiac trunk,
unchanged.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon is
somewhat collapsed, limiting evaluation. However within these limitations,
there is mild wall thickening submucosal edema of the ascending colon and
sigmoid colon, new as compared to . The appendix is not
visualized but there is no secondary sign of acute appendicitis.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
There is a fibroid uterus.
## LYMPH NODES:
There are mesenteric lymph nodes measuring up to 0.8 cm in short
axis (02:37) in the peripancreatic region and 1.4 cm in the periportal region
(02:25) and retroperitoneal lymph nodes measuring up to 0.6 cm in short axis
(02:49), unchanged as compared to . 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. The colon is somewhat collapsed, limiting evaluation. However, there is
mild wall thickening and submucosal edema of the ascending and sigmoid colon,
new as compared to CT abdomen pelvis . These findings are
concerning for colitis, possibly infectious or inflammatory, or treatment
related. Ischemia felt less likely.
2. Pancreatic body mass is unchanged as compared to CT abdomen pelvis .
3. Irregular hypoattenuated lesions in the liver compatible with metastatic
disease are unchanged as compared to .
4. Mesenteric and borderline retroperitoneal lymphadenopathy the is unchanged
as compared to . Attention on follow-up imaging is
recommended.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18032895", "visit_id": "29656884", "time": "2138-03-05 17:51:00"} |
10367068-DS-13 | 1,716 | ## CHIEF COMPLAINT:
jaundice, dark urine, malaise. transferred from with
concern for hemolytic anemia
## HISTORY OF PRESENT ILLNESS:
Mr. is a male with a history of hypertension
and recent GU procedure, transferred in from for
evaluation of unexplained new hyperbilirubinemia.
He is days status post aspiration of hydrocele with reportedly
uncomplicated course. Notes that he was feeling well until
when he began to develop worsening symptoms of
right-sided abdominal pain, nausea, malaise, lack of appetite,
and dark urine for the past 3 days. He denies any distinct
dysuria or hematuria and denies any colicky flank pain,
admitting only to some lower midline back soreness. He denies
substance abuse or any distinct history of fatty food
intolerance, although he admits that he did eat some junk food
including peanut butter cups the day prior to onset of
his symptoms. He denies any vomiting or diarrhea or any blood in
his stool or black stool.
##
COURSE:
Tmax 101.8, BP 140/79, P 78, 100% on RA. Exam
notable for fever, mild jaundice and scleral icterus and RUQ ttp
with positive sign. Labs significant for Tbili 4, Dbili
0.7, Hgb 11, Hct 32, otherwise normal LFTs / lipase / amylase.
BCx x2 drawn, UA/UCx sent. Abdominal US was obtained and showed
hemangioma but no acute findings to explain jaundice, pain and
hyperbilirubinemia. CT A/P with GU protocol and was negative for
nephrolithiasis or acute intra-abdominal process though notable
for mild splenomegaly (15cm). Chest Xray was negative. Patient
was received 1L NS, 500mg IV flagyll, 500mg IV levaquin, 650mg
po Tylenol, 5mg IV Compazine, 0.5mg IV dilaudid. Due to concern
for acute hemolysis and need for Hematology service, patient was
transferred to Emergency Department for further care.
## EXAM:
Notable for scleral icterus, right upper quadrant
tenderness, diffuse low back tenderness
## IMPRESSION:
Patient has had a 3 point hematocrit drop since labs
were performed at . Overall concern at this time is
worsening anemia in an acute onset indirect hyperbilirubinemia,
concerning for hemolytic anemia that is rapidly progressing.
[]Heme/Onc fellow: obtain haptoglobin, direct coombs, admit to
medicine, uric acid, type and screen, if coombs ++, call back,
and discuss steroids
Patient denies personal or family history of blood or liver /
biliary disorders. He denies recent travel or new sexual
partners recently. He states that he is exposed to sewers at
work, and also notes that his boss recently returned from .
He denies smoking or excessive drinking, he further denies h/o
OTC drug use or recreational drug use. On arrival to the floor
he denies pain or discomfort. He further denies SOB,
palpitations, diarrhea, vomiting, or confusion.
## ROS:
Pertinent positives and negatives as noted in the HPI. All
other systems were reviewed and are negative.
## FAMILY HISTORY:
Reviewed and found to be not relevant to this
illness/reason for hospitalization.
-Detailed family history does not reveal any other people in his
family with jaundice or blood disorder
## GENERAL:
Alert and in no apparent distress
## EYES:
mild scleral icterus, 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, non-distended, non-tender to palpation. Bowel
sounds present. No HSM
## GU:
No suprapubic fullness or tenderness to palpation
## MSK:
Neck supple, moves all extremities, strength grossly full
and symmetric bilaterally in all limbs
## SKIN:
No rashes or ulcerations noted
## NEURO:
Alert, oriented, face symmetric, gaze conjugate with
EOMI,
speech fluent, moves all limbs, sensation to light touch grossly
intact throughout
## ON ADMISSION:
6.9 > 9.8 / 29.3 < 175, MCV 89, RDW 48, CRP 111, INR 1.4
26% Monos, 1.6% Immature granulocytes
4% Reticulocyte count, LDH 529, Fibrinogen 456
Direct Coombs test negative, Uric acid pending
AST 40, ALT 38, ALP 94, Tbili 4, Dbili 0.7, lipase 24, amylase
49
Serum tox - negative
INR 1.4, PTT 27
Lactate 0.6
Cr 0.9, k 3.5
Ca 8.2
## MICRO:
BCx x2 ( ) - NGTD
UCx ( ) -NGTD
parasite smear - positive
Labs at were notable for
- urinalysis with large blood, small bilirubin, trace ketones
- Hematocrit 32, WBC 7.9, PLT 195
- Lactate 0.6
- ALT 38 and AST40
- APD 94,
- D bili 0.7, T bili 4.0
- Lipase was 24
- creatinine 0.9
## IMAGING ( ):
- Abdominal ultrasound showed small liver hemangioma. Otherwise
unremarkable abdominal ultrasound exam.
- CT of the abdomen and pelvis GU protocol. No evidence of
urolithiasis or obstructive uropathy on either side. No acute
intra-abdominal pelvic pathology identified. Mild splenomegaly.
Diverticulosis.
- Chest x-ray without focal infiltrate or acute process
On discharge:
06:55AM BLOOD WBC-8.9 RBC-3.21* Hgb-9.6* Hct-27.9*
MCV-87 MCH-29.9 MCHC-34.4 RDW-14.7 RDWSD-46.6* Plt
03:20PM BLOOD Hct-28.3*
06:33AM BLOOD WBC-6.3 RBC-2.99* Hgb-9.1* Hct-26.1*
MCV-87 MCH-30.4 MCHC-34.9 RDW-14.7 RDWSD-46.8* Plt
11:42PM BLOOD WBC-6.9 RBC-3.28*# Hgb-9.8*# Hct-29.3*#
MCV-89 MCH-29.9 MCHC-33.4 RDW-14.8 RDWSD-48.2* Plt
11:42PM BLOOD Hypochr-NORMAL Anisocy-NORMAL
Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL
06:33AM BLOOD PTT-26.1
11:42PM BLOOD
06:55AM BLOOD Parst S-POSITIVE*
11:42PM BLOOD Parst S-POSITIVE*
1.0.1% PARASITEMIA
2.0.4% PARASITEMIA
RARE INTRACELLULAR SOLITARY RING FORMS OF RBC DIAMTER AS
WELL AS PLEOMORPHIC EXTRACELLULAR RING FORMS
CONSISTENT WITH BABESIA SSP
PLEASE CORRELATE WITH CLINICAL AND TRAVEL HISTORY
REVIEWED BY ON
11:42PM BLOOD Ret Aut-4.1* Abs Ret-0.14*
06:55AM BLOOD Glucose-116* UreaN-14 Creat-0.7 Na-141
K-4.1 Cl-105 HCO3-22 AnGap-14
06:55AM BLOOD ALT-48* AST-46* LD(LDH)-642* AlkPhos-98
TotBili-2.0*
06:33AM BLOOD ALT-37 AST-45* LD(LDH)-557* AlkPhos-89
TotBili-4.0*
11:42PM BLOOD ALT-38 AST-43* LD(LDH)-571* CK(CPK)-143
AlkPhos-101 TotBili-4.1* DirBili-0.8* IndBili-3.3
06:55AM BLOOD Hapto-<10*
11:42PM BLOOD Hapto-<10*
11:42PM BLOOD HBsAg-NEG HBsAb-NEG HBcAb-NEG IgM HAV-NEG
06:33AM BLOOD Titer-PND
11:42PM BLOOD CRP-111.5*
06:55AM BLOOD HIV Ab-NEG
06:33AM BLOOD HCV Ab-NEG
11:42PM BLOOD HCV Ab-NEG
06:16PM BLOOD LYME DISEASE ANTIBODY, IMMUNOBLOT-PND
03:40PM BLOOD ANAPLASMA PHAGOCYTOPHILUM (HUMAN
GRANULOCYTIC EHRLICHIA AGENT) IGG/IGM-PND
## BRIEF HOSPITAL COURSE:
Mr. is a male with a
history of hypertension and recent GU procedure, transferred in
from for evaluation of hyperbilirubinemia and
hemolytic anemia.
## ACUTE/ACTIVE PROBLEMS:
#babesiosis
#Jaundice, Indirect hyper-bilirubinemia
#Hemolytic anemia
#abdominal pain
#fever -
Negative direct Coombs test. Elevated retic count, LDH and
fibrinogen. RPI 1.3 (< 2), given Hct 29 with retic count 4%.
Also
with high LDH and bilirubin (Tbili 4 with dbili 0.7). No
suspicion for TTP, HUS. No prior history of jaundice during
times of stress which we would
typically expect in the case of hereditary conditions such as
. No clear culprit from a toxin / drug
or infectious standpoint based on history as denies any
significant exposures. Noted to have mild
splenomegaly on abdominal imaging which can be seen in the
setting of inherited hemolytic anemias, or may be secondary and
representative of splenic sequestration or other acute process.
Pt was evaluated by the hematology service who reviewed his
smears. Initially there was concern for a hematologic cause of
hemolytic anemia and hematology recommended initiation of
prednisone. During this time, thin parasite smears were
negative. However, later in the day, thick review of smears
reveal +parasites likely c/w babesiosos given pt without any
travel outside of the US. Therefore, ID was consulted and pt was
started on atovoquone and azithromycin with doxycycline for
presumed lyme coinfection. The following day, the lab confirmed
babesiosis. Pts symptoms of malaise, poor appetite and fever
improved during this time and his blood count remained stable.
Lyme and anaplasma were sent but PENDING at the time of
discharge. He is being treated for presumed coinfection none the
less. Pt discharged with a 10 day course of atovoquone and
azithromycin and 14 day total course of doxycycline. He was
advised to f/u with his PCP for repeat CBC and LFTs within 1
week of discharge.
## LABS PENDING AT DISCHARGE:
18:16 Lyme Disease Antibody, Immunoblot PND
15:40 Anaplasma phagocytophilum (human
granulocytic Ehrlichia agent) IgG/IgM PND
+, titer PENDING
blood cultures pending, NGTD
## CHRONIC/STABLE PROBLEMS:
#Hypertension - on amlodipine and losartan but doses unknown at
this time. Will need to verify.
-amlodipine 5mg daily for now
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Losartan Potassium 100 mg PO DAILY
2. amLODIPine 10 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Atovaquone Suspension 750 mg PO BID Duration: 9 Days
RX *atovaquone 750 mg/5 mL 5 ml by mouth twice a day Disp #*210
## MILLILITER MILLILITER REFILLS:
*0
2. Azithromycin 250 mg PO Q24H Duration: 9 Days
RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*8
## TABLET REFILLS:
*0
3. Doxycycline Hyclate 100 mg PO Q12H Duration: 13 Days
RX *doxycycline hyclate 100 mg 1 capsule(s) by mouth twice a day
Disp #*18 Capsule
## REFILLS:
*0
4. FoLIC Acid 1 mg PO DAILY
RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
5. amLODIPine 10 mg PO DAILY
your regular dose was not changed
6. Losartan Potassium 100 mg PO DAILY
your regular dose was not changed
## DISCHARGE DIAGNOSIS:
hemolytic anemia due to babesia infection
## DISCHARGE INSTRUCTIONS:
You were admitted for evaluation of a "hemolytic anemia" with
fever. You were found to have an infection with an organism
called "babesia" that is transmitted by ticks. You were started
on antibiotic therapy (atovaquone and azithromycin) for this as
well as doxycycline for presumed lyme coinfection while awaiting
further lab studies. Please continue to take your antibiotics as
directed and follow up with your primary care doctor to have
your blood levels checked in 1 week. Please see below.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10367068", "visit_id": "29462361", "time": "2158-09-18 00:00:00"} |
11146299-RR-25 | 416 | ## INDICATION:
CVA, STEMI in on Coumadin, transferred from with
PE, right hilar mass concerning for malignancy, question metastatic disease.
## CT ABDOMEN:
The patient has had prior median sternotomy. There are persistent ground-
glass opacities at the left base concerning for infection. These are stable
when compared to the prior study. Extensive calcification of the mitral valve
annulus and coronary arteries is noted, although incompletely visualized on
this study. No pleural effusions seen. No pericardial effusion is seen.
No concerning focal liver lesions are identified. The hepatic vein, portal
vein and hepatic arteries are patent. The patient has had a prior
cholecystectomy and there is mild ectasia of the common bile duct, but no
intrahepatic duct dilatation. The spleen is not enlarged measuring 10.8 cm in
maximal diameter. The bilateral adrenal glands are within normal limits. No
solid renal mass is seen. There is asymmetric cortical thinning in the upper
pole of the left kidney. The appearances are most consistent with chronic
ischemia, no hydronephrosis. No mass lesion seen in either kidney. The
pancreas is unremarkable in appearance. There is very extensive vascular
calcification throughout the abdomen and pelvis. No upper abdominal
lymphadenopathy seen. No free fluid seen.
## CT PELVIS:
Extensive vascular calcifications. The sigmoid colon is very redundant;
however, no diverticular disease can be appreciated. No pelvic
lymphadenopathy. No pelvic free fluid. Just below the level of the
umbilicus, there is an anterior abdominal wall defect (3:55) with a fat
containing hernia. This tracks inferiorly and at the inferior most margin of
this peritoneal fat, there is a curvilinear opacity (3:38) with adjacent soft
tissue measuring 2.2 x 1.7 cm. The appearances are consistent with fat
necrosis.
## OSSEOUS STRUCTURES:
No concerning lytic or sclerotic bone lesions are seen. There are moderate
degenerative changes in the lumbar spine with a mild scoliosis convex to the
left. Degenerative disc disease noted at L5-S1. Facet joint degenerative
change at L4-L5 and L5-S1. Mild degenerative changes in the bilateral hip
joints.
## IMPRESSION:
1. No evidence for intra-abdominal metastatic disease.
2. Persistent ground-glass opacity at the left lung base concerning for
infection or inflammation.
3. Asymmetric atrophy of the upper pole of the left kidney likely related to
chronic ischemia.
4. Very extensive vascular calcification involving the aorta, mitral valve
annulus and coronary arteries.
5. Degenerative changes in the lumbar spine and to a lesser extent the
bilateral hips.
6. Probable fat necrosis in an anterior abdominal wall hernia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11146299", "visit_id": "28295295", "time": "2187-07-12 11:53:00"} |
10054690-RR-7 | 362 | ## INDICATION:
Hematuria and flank pain, evaluate for stone.
## FINDINGS:
Evaluation of intra-abdominal soft tissues and organs is somewhat limited
without the administration of IV contrast.
## LOWER CHEST:
The lung bases are clear. The visualized portions of the heart
and pericardium are unremarkable. There is no pleural effusion.
## LIVER:
The liver demonstrates decreased attenuation compatible with fatty
infiltration. No focal liver lesion is seen given the limitations of this
noncontrast enhanced study. The gallbladder is unremarkable. There is no
intrahepatic biliary ductal dilatation.
## PANCREAS:
The pancreas does not demonstrate focal lesions or peripancreatic
stranding or fluid collection.
## SPLEEN:
The spleen is homogeneous and normal in size.
## ADRENALS:
The adrenal glands are unremarkable.
## KIDNEYS:
The kidneys are normal in size and shape. There is mild right
hydroureteronephrosis secondary to a punctate obstructing stone at the right
UVJ measuring 2 mm. Scattered punctate stones are also noted within the
collecting systems bilaterally with the largest measuring up to 3 mm in the
lower pole of the left kidney. There is also suspicion for mild medullary
nephrocalcinosis given scattered punctate hyperdensities within the collecting
systems bilaterally. No hydronephrosis is present in the left kidney. There
is no perinephric abnormality.
## GI TRACT:
The stomach, duodenum, and small bowel are within normal limits,
without evidence of wall thickening or obstruction. The colon is non-dilated
without obstructive lesions. The appendix is visualized and normal.
## VASCULAR:
The aorta is normal in caliber without aneurysmal dilatation. Vessel
patency cannot be assessed on this noncontrast enhanced study.
## RETROPERITONEUM AND ABDOMEN:
There is no retroperitoneal or mesenteric lymph
node enlargement. No ascites, free air, or abdominal wall hernias are noted.
## PELVIC CT:
The urinary bladder and distal ureters are unremarkable. No pelvic
wall or inguinal lymph node enlargement is seen. There is no pelvic free
fluid.
## OSSEOUS STRUCTURES:
No blastic or lytic lesions suspicious for malignancy is
present.
## IMPRESSION:
1. Mild right hydroureteronephrosis secondary to a punctate 2mm obstructing
stone at the right ureterovesical junction. Scattered punctate calcified and
slightly calcified renal calculi are also present with the largest measuring 3
mm in the lower pole of the left kidney with suspicion for mild medullary
nephrocalcinosis.
2. Hepatic steatosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10054690", "visit_id": "N/A", "time": "2156-12-19 20:09:00"} |
19680953-RR-19 | 84 | ## INDICATION:
with normal renal function presenting w/ and cr of 5// ?
hydronephrosis, evidence of ureteralor distal blockage?
## FINDINGS:
There is no hydronephrosis, large stones, or worrisome masses bilaterally.
Normal cortical echogenicity and corticomedullary differentiation are seen
bilaterally. There is a tiny, 7 mm anechoic structure in the lower pole left
kidney, likely a tiny cyst.
## RIGHT KIDNEY:
9.4 cm
Left kidney: 9.4 cm
The bladder is moderately well distended and normal in appearance.
## IMPRESSION:
Essentially normal renal ultrasound. No hydronephrosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19680953", "visit_id": "24193033", "time": "2149-06-25 21:34:00"} |
11248793-DS-32 | 1,054 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HPI:
y/o F with history of DMI, s/p pancreas/kidney
transplant and subsequent kidney retransplant in ,
presenting with fever and diarrhea. Patient reported 2 days of
fever to 102 max with rigors and 5 days non-bloody diarrhea.
Symptoms came on while travelling to , over the
weekend. She reported being able to eat, but poor appetite. She
initially attributed this to bad food, but called PCP after
fevers. Her PCP recommended she call her gastroenterologist who
was concerned for dehydration. Previous febrile episodes have
been related to UTIs.
.
## ROS:
(+) Headache, edema at baseline.
(-) No dysurea, hematuria, SOB, cough, N/V, or sick contacts.
.
In the ER, the patients intial vitals were 101 77 105/49 18 98.
She recieved Vanc/Ceftriaxone. CXR nl. Patient refused cath and
initial urine sample was contaminated with stool. Labs notable
for bands and ARF. Urine culture and c. diff were sent. She was
given 1.5 L IVF. Prior to transfer, VS 63 95/51 97/RA
## PAST MEDICAL HISTORY:
-DM1 c/b retinopathy, nephropathy, neuropathy
-Gastroparesis
-Esophageal dysmotility/spasm
-Chronic diarrhea
-Hypothyroidism
-Colitis
-H/o fungal infection immunosuppression
-Esophageal ulcer/barretts
-pancreatic insufficiency
- : SPK transplant (bladder drainage for pancreas)
- : CCY, was found to have fungus ball eroding into bile duct
and underwent Hepaticojejunostomy
- - bladder leaks ultimately requiring takeback and
enteric drainage of pancreas
- transplant nephrectomy and deceased donor renal
transplant
-Remote h/o toe surgeries, Right AVF creation s/p failure to
mature s/p takedown of fistula, left subclavian stent placement
central stenosis
## FAMILY HISTORY:
Sister with squamous cell anal carcinoma, Mother in with
breast cancer, long family history of stroke on Mother's side.
## GEN:
well appearing female, sitting up, friendly and appropriate
## HEENT:
NC/AT, PERRL, EOMI, OP clear, MMM
## CV:
RRR, nl s1s2, no mrg
## LUNGS:
Clear to auscultation bilaterally, no wheezes or crackles
## ABD:
mild distention, hypoactive bowel sounds. mild tenderness
to deep palpation without rebound or guarding.
## EXT:
+pedal pulses, no edema.
## ASSESSMENT AND PLAN:
y/o F with history of pancrease/kidney
transplant presenting with fever and diarrhea.
.
## FEVERS/DIARRHEA:
History c/w infectious colitis, likely from an
ingestion in NC. With immunosuppression, opportunistic pathogens
were considered including CMV, cryptospyridium, microsporidia.
She was found on stool cultures to have campylobacter jejuni.
She had initially been treated inhouse with ceftriaxone and
flagyll and was transitioned to azithromycin for a five day
course as an outpatient with close outpatient follow up with her
nephrologist.
.
## ACUTE RENAL FAILURE:
Cr peaked at 2.0 from baseline 1.4 in the
setting of diarrhea with urine lytes reflecting a prerenal
etiology. Pt appeared dehydrated and received IVF for
rehydration and her Cr subsequently returned to a baseline of
1.4. Her sirolimus and tacrolimus doses were subsequently
decreased and can be titrated further as an outpatient.
.
## ELEVATED LIVER ENZYMES:
Possibly related to her acute enteritis.
A similar pattern was seen in associated with mild ductal
dilitation and abnormal lesions in the right lobe for which 6
month follow up was recommended. Her liver enzymes trended
downwards during her hospitalization.
## MEDICATIONS ON ADMISSION:
Collagenase Clostridium hist. 250 unit/gram Ointment q2weeks
Esomeprazole Magnesium [Nexium] 20 mg Capsule by mouth twice a
day Estradiol [Estring] 7.5 mcg/24 hour Ring q 3 mo
Levothyroxine 50 mcg by mouth once a day
Lipase-Protease-Amylase [Creon 10] 249 mg (33,200 unit-10,000
unit-37,500 unit) two Capsule(s) by mouth three times a day
Loperamide 2 mg by mouth twice a day
Ondansetron HCl [Zofran] 4 mg by mouth twice a day
Prednisone 5 mg by mouth once a day
Sirolimus [ ] 1 mg x 4 Tablet(s) by mouth once a day
Sulfamethoxazole-Trimethoprim [Bactrim] 400 mg-80 mg Tablet by
mouth daily
Tacrolimus 1 mg 2 Capsule(s) by mouth twice a day
Ascorbic Acid [Vitamin C] 500 mg by mouth once a day
Aspirin 81 mg Tablet by mouth once a day
Calcium Citrate 200 mg (950 mg) by mouth six times a day
Ergocalciferol (Vitamin D2) 400 unit by mouth five times a day
Glucosamine 1,000 mg by mouth once a day
Iron 27 mg (Elemental Iron) by mouth twice a day
Lactobacillus Acidophilus 500 million cell 1 Tablet(s) by mouth
once a day
Multivitamin by mouth once a day (update)
.
## DISCHARGE MEDICATIONS:
1. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Tacrolimus 0.5 mg Capsule Sig: Three (3) Capsule PO Q12H
(every 12 hours).
Disp:*180 Capsule(s)* Refills:*2*
3. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily).
4. Sulfamethoxazole-Trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
5. Azithromycin 250 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 4 days.
Disp:*8 Tablet(s)* Refills:*0*
6. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
## 7. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY (Daily).
8. Lipase-Protease-Amylase 12,000-38,000 -60,000 unit Capsule,
## DELAYED RELEASE(E.C.) SIG:
One (1) Capsule, Delayed
Release(E.C.) PO TID (3 times a day).
9. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Nexium 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
11. Calcium Citrate 200 mg (950 mg) Tablet Sig: One (1) Tablet
PO four times a day.
12. Iron 27 mg (Iron) Tablet Sig: One (1) Tablet PO twice a day.
## PRIMARY:
1. Campylobacter Gastroenteritis
.
Secondary
s/p transplant.
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital because you were having
diarrhea. You were found to have an infection of your
gastrointestinal tract called Campylobacter. You have been
started on an antibiotic called azithromycin to treat this
infection. You will continue this medication for the next 4
days.
.
Your medications have been adjusted during your hospitalization.
Please see below:
Your Tacrolimus has been decreased to 1.5 mg PO Q12H
Your Sirolimus has been decreased to 3 mg PO DAILY
.
You should go to the Renal Transplant Clinic to have your
tacrolimus and sirolimus levels checked and doses adjusted
weekly for the next 3 weeks. The remainder of your medications
have not changed.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11248793", "visit_id": "24732633", "time": "2122-12-26 00:00:00"} |
13883230-DS-11 | 2,119 | ## ALLERGIES:
Lipitor / clopidogrel / lisinopril / Crestor
## HISTORY OF PRESENT ILLNESS:
Mr. is a year old man who has a history of coronary
artery bypass surgery x 2 in (LIMA-OM2; RIMA-LAD),
carotid disease s/p rightcarotid endarterectomy, AAA, HTN, HLD,
COPD, who presented to clinic with increasing shortness
of breath due to moderate-severe aortic stenosis who now
presents for TAVR.
Patient reports for past several months he has noted worsening
shortness of breath with exertion, no SOB at rest. He notes
becoming short of breath with daily tasks such as doing laundry.
He endorses SOB with climbing stairs, 1 flight, occassional PND.
No chest pain, palpitations, lower extremity swelling. Sleeps on
2 pillows which he has done for several years.
Patient was initially evaluated for surgical intervention,
deemed a nonoperative (Extreme Risk) candidate due to his graft
overlying his
sternum. He was then evaluated by Dr. who noted
NYHA Class III symptoms and recommended a second surgical
opinion and repeat echocardiogram, previous mean gradient
24mmHg. Repeat Echo revealed severe aortic stenosis (valve area
= 1.0 cm2). AVI 0.5cm2. Patient saw Dr. second
regarding surgical intervention, due to patient's prior
CABG which included a RIMA-LAD graft crossing under and in close
proximity to the sternum, determined to be extreme risk for redo
sternotomy surgical AVR. Determined to proceed with TAVR.
## REVIEW OF SYSTEMS:
Cardiac review of systems is notable for absence of chest pain,
positive dyspnea on exertion, positive occassional paroxysmal
nocturnal dyspnea, negative orthopnea, negative ankle edema,
negative palpitations, syncope or presyncope.
## PAST MEDICAL HISTORY:
1. Coronary artery disease s/p CABG
2. s/p right thoracotomy for squamus cell lung cancer in
3. s/p left empyema and resection
4. Diabetes mellitus, Type II
5. Prostatitis
6. Abdominal aneurysm 3.7 x 4.1 cm
7. Hypothyroidism
8. GERD
9. Asthma
10. Carotid bruit
11. Colon polys
12. Hyperlipidemia
13. Hypertension
14. COPD
## FAMILY HISTORY:
His family history is significantly for hypertension, diabetes,
heart disease, and stroke. HIs mother died at of an MI; his
father died at of a throat tumor.
## GEN:
Well appearing older gentleman sitting up in bed speaking
in full sentences, comfortable appearing, NAD
## HEENT:
PERRL, no conjunctival pallor or scleral icterus, MMM,
oropharynx with dentures in place, oropharynx without erythema
or exudate
## NECK:
Supple, well healed R carotid endarterectomy scar, No JVD,
no thyromegaly.
## CV:
RRR, S1, S2 with III/VI systolic murmur best appreciated at
RUSB, no rubs or gallops, PMI at intercostal space
## LUNGS:
CTAB B/L anterior and posterior chest, decreased breath
sounds at bases, no wheezes, crackles, or rhonchi
## ABD:
obese, non tender to deep palpation, +BS
## EXT:
warm, well perfused, no lower extremity edema
## PULSES:
2+ DP and bilaterally
## SKIN:
warm, well perfused, no rashes or lesions; well healed
midline sternotomy scar
## NEURO:
axox3, CNII-XII grossly intact, moving all 4 extremities
without deficits
## TELE:
SR, rate 70-105, freq PVC's.
## GEN:
NAd, sitting in chair, making jokes
## CV:
RRR, systolic murmur at RUSB
## ABD:
soft, NT, pos BS
## SKIN:
intact, bilat groin sites with ecchymosis
## URINE CULTURE (PENDING):
12:35 pm Staph aureus Screen Source: Nasal swab.
Staph aureus Screen (Final :
NO STAPHYLOCOCCUS AUREUS ISOLATED.
## 8:57 PM MRSA SCREEN SOURCE:
Nasal swab.
MRSA SCREEN (Final : No MRSA isolated.
## STUDIES:
===================
ECG Study Date of 11:59:04 AM
Artifact is present. Sinus rhythm. Probable non-specific ST-T
wave changes. No previous tracing available for comparison.
TRACING #1
Intervals Axes
Rate PR QRS QT/QTc P QRS T
79 172 96 41
ECG Study Date of 2:42:16
Artifact is present. Sinus rhythm. Probable non-specific ST-T
wave changes. Compared to the previous tracing of the same date,
there is no significant change. TRACING #2
Intervals Axes
Rate PR QRS QT/QTc P QRS T
74 130 94 382/406 63 -9 71
CHEST (PRE-OP PA & LAT) Study Date of 3:50
## IMPRESSION:
Post sternotomy wires are stable. Heart size and mediastinum are
stable. Left basal opacity is unchanged as well as right basal
opacity consistent with prior areas of atelectasis and scarring.
No pleural effusion or pneumothorax is seen.
## IMPRESSIONS:
1. Severe aortic stenosis
2. Successful transcatheter aortic valve replacement
TEE (Complete) Done at 2:03:06 FINAL
***Pre Deployment:
- There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is mildly depressed (LVEF= 45 %). The
remaining left ventricular segments contract normally.
- Right ventricular chamber size and free wall motion are
normal.
- The diameters of aorta at the sinus, ascending and arch levels
are normal. There are simple atheroma in the descending thoracic
aorta.
- The aortic valve leaflets are severely thickened/deformed.
There is severe aortic valve stenosis. There is mild aortic
insufficiency.
- The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen.
- There is no pericardial effusion. Dr. Dr
notified in person of the results in the OR during the
procedure.
***Post Deployment
- The prosthesis is seen in the aortic position. There
is no restriction of anterior mitral leaflet movement. There is
mild perivalvular aortic insufficiency noted. No sign of aortic
injury or dissection. Rest of examination is unchanged.
- Poor transgastric views.
CHEST (PORTABLE AP) Study Date of 3:19
## IMPRESSION:
In comparison with the study of , there is an
endotracheal tube with its tip approximately 6 cm above the
carina. There may be some increasing opacification at the left
base with poor definition of the hemidiaphragm. Although this
could merely reflect atelectasis and effusion, in the
appropriate clinical setting superimposed pneumonia would have
to be considered. No evidence of pulmonary vascular congestion.
Portable TTE (Complete) Done at 2:59:39 FINAL
The left atrium is moderately dilated. The estimated right
atrial pressure is mmHg. There is mild symmetric left
ventricular hypertrophy with normal cavity size and mild
regional left systolic dysfunction (focal hypokinesis of the
basal to mid inferior wall). Right ventricular chamber size and
free wall motion are normal. An aortic prosthesis is
present. The transaortic gradient is normal for this prosthesis.
A small anterior paravalvular aortic valve leak is probably
present. The mitral valve leaflets are mildly thickened. There
is no mitral valve prolapse. Physiologic mitral regurgitation is
seen (within normal limits). There is no pericardial effusion.
## IMPRESSION:
Suboptimal image quality. Left atrial enlargement.
Mild symmetric left ventricular hypertrophy with mild regional
left ventricular systolic dysfunction. is present with
small paravalvular leak. Compared with the prior study (images
reviewed) of is now presen.
ECGStudy Date of 8:23:50 AM
Sinus rhythm. Non-specific ST segment changes. Compared to the
previous
tracing of no change.
IntervalsAxes
## BRIEF HOSPITAL COURSE:
Mr. is a year old man who has a history of coronary
artery bypass surgery x 2 in (LIMA-OM2; RIMA-LAD),
carotid disease s/p rightcarotid endarterectomy, AAA, HTN, HLD,
COPD, now with class III symptoms secondary to severe
aortic stenosis presenting for TAVR.
## # AORTIC STENOSIS, SEVERE:
Patient with class III symptoms,
has been deemed a non operative (Extreme Risk) candidate due to
his graft overlying his sternum. TTE with severe aortic
valve stenosis (valve area = 1.0 cm2), aortic valve area is 0.5
cm2 per m2 BSA. Treated with aspirin 325 mg qd and plavix 75 mg
qd. Home isosorbide dinitrate 30mg PO daily and metoprolol XL
100mg PO daily were continued. TAVR successfully performed on
mean gradient decreased 47.64 -> 8.83 mm Hg. Patient
extubated AM. Postop ECHO on showed left atrial
enlargement, mild symmetric LVH with mild regional LV systolic
dysfunction, and present with small paravalvular leak.
## #CAD, S/P CABG X2:
Patient reports he has allergy to lipitor,
recently developed leg cramps with crestor 10mg PO daily.
Previously on ASA 81mg PO daily, increased to 325 mg qd.
Metoprolol XL continued as above. Because patient needs statin
therapy, was restarted on crestor 5 mg, but at a lower frequency
(3x week).
## #HTN:
continued on home isosorbide dinitrate 30mg PO daily and
metoprolol XL 100mg PO daily, as above. Postop TAVR, patient's
BP reached as high as 326/119 (transient, per Aline), and in the
next SBP sustained in the 150-180 range. Later, BP regimen
was optimized by increasing isosorbide dinitrate to 30 mg TID
and adding amlodipine 2.5 mg qd. Over the 24h before discharge,
the patient's BP was better controlled, ranging from
110-141/50-61.
## #THROMBOCYTOPENIA:
PLT upon admission 207 ( ), but were 119
on day of discharge ( ). Did not meet HIT criteria. No
signs of bleeding. According to NP from 's office,
patient has had this in past (with lowest reading of 125 both on
and off plavix). Patient will need f/u CBC on at 's
office; NP to discuss platelet count with NP on
if PLT continuing to fall.
## CHRONIC MEDICAL ISSUES:
#Hx squamus cell lung cancer in - CT chest with soft
tissue density along right lung resection margin. Will need
repeat CT as outpatient and f/u to rule out malignancy
recurrence.
## # DIABETES MELLITUS, TYPE II:
on metformin 1000mg PO BID as
outpatient, but in-house was treated with low dose humalog ss.
# Hypothyroidism - continued home levothyroxine 25mcg PO daily
# GERD - continued home omeprazole 40mg PO BID.
# COPD - home meds were continued - combivent QID, pulmicort
(swithced to flovent, per forumulary), and albuterol inhaler
prn.
#Bladder spasm- on toviaz (fesoterodine) as outpatient, not on
formulary. Was held while inpatient, as patient not symptomatic.
## # CODE STATUS:
FULL, confirmed with patient
# Contact: Wife, cell
- Soft tissue density along the right lung resection margin, may
be secondary to postoperative changes, however recurrence of
patient's squamous cell carcinoma cannot be excluded on this
study. Please correlate with prior exams. Furthermore, a 3 month
followup with a chest CT is recommended for further evaluation.
- Rousuvastatin was restarted at a lower dose, and lower
frequency (3x/week): PCP to consider if tolerated
well.
- To optimize BP, isosorbide dinitrate was increased from qd to
tid, and low-dose amlodipine was started.
- CBC on to trend platelets
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. Isosorbide Dinitrate 30 mg PO DAILY
3. MetFORMIN (Glucophage) 1000 mg PO BID
4. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain
5. Omeprazole 40 mg PO BID
6. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing
7. Levothyroxine Sodium 25 mcg PO DAILY
8. Levalbuterol Neb 0.63 mg NEB Q8H:PRN sob, wheeze
9. Metoprolol Succinate XL 100 mg PO DAILY
10. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H
11. fesoterodine 4 mg oral daily
12. Pulmicort Flexhaler (budesonide) 180 mcg/actuation
inhalation 2 puffs BID
## DISCHARGE MEDICATIONS:
1. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing
2. Aspirin 81 mg PO DAILY
3. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H
4. Isosorbide Dinitrate 30 mg PO TID
RX *isosorbide dinitrate 30 mg one tablet(s) by mouth three
times a day Disp #*90
## TABLET REFILLS:
*2
5. Levothyroxine Sodium 25 mcg PO DAILY
6. Metoprolol Succinate XL 100 mg PO DAILY
7. Amlodipine 2.5 mg PO DAILY
RX *amlodipine 2.5 mg 2,5 tablet(s) by mouth daily Disp #*15
## TABLET REFILLS:
*2
8. Clopidogrel 75 mg PO DAILY
RX *clopidogrel 75 mg one tablet(s) by mouth daily Disp #*30
Tablet Refills:*2
9. Rosuvastatin Calcium 5 mg PO 3X/WEEK ( )
Call Dr. you develop ankle cramps again
RX *rosuvastatin [Crestor] 5 mg one tablet(s) by mouth three
times a week Disp #*12 Tablet Refills:*2
10. fesoterodine 4 mg oral daily
11. Levalbuterol Neb 0.63 mg NEB Q8H:PRN sob, wheeze
12. MetFORMIN (Glucophage) 1000 mg PO BID
13. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain
14. Omeprazole 40 mg PO BID
15. Pulmicort Flexhaler (budesonide) 180 mcg/actuation
inhalation 2 puffs BID
16. Outpatient Lab Work
Please check CBC on with results to NP
at Phone:
## DISCHARGE DIAGNOSIS:
Aortic stenosis s/p TAVR
Coronary artery disease
thrombocytopenia
Diabetes Type 2
## DISCHARGE INSTRUCTIONS:
It was a pleasure caring for you at .
You were admitted for a transcutaneous aortic valve replacement
(TAVR) to treat your severe aortic stenosis. The procedure went
as expected and an echocardiogram showed that the valve is
funtioning well. Your platelet count is low today and you need
to check this lab on at Dr.
, NP is expecting you on and will let you know the
result.
You will follow up with Dr. in about a month with another
echocardiogram to make sure the valve is functioning well. The
CT scan that was done on showed an abnormality that could
be related to your history of lung cancer. You will need to get
another CT checked within the next month.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13883230", "visit_id": "23033917", "time": "2135-11-06 00:00:00"} |
16440395-RR-30 | 213 | ## INDICATION:
year old man with rise in LFT's post liver txp // Assess
hepatic vessel patency
## FINDINGS:
The patient is status post liver transplant. The liver echotexture is
homogeneous. No focal suspicious liver lesions are identified. There is
moderate ascites. A fluid collection in the right rectus muscle with mass
effect upon the left lobe measuring 3.4 x 1.7 x 4.7 cm is decreased in size
from when it measured 4.9 x 2.4 x 4.1 cm.
The spleen measures 9 cm and has normal echotexture.
## DOPPLER:
The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 85. Appropriate arterial
waveforms are seen in the right hepatic artery and the left hepatic artery
with resistive indices of 0.56, and 0.50, respectively. The main portal vein,
right and left portal veins are patent with hepatopetal flow with normal
waveform. Appropriate flow is seen in the hepatic veins and the IVC.
## IMPRESSION:
Patent hepatic vasculature with appropriate waveforms. Decreased size of
fluid collection in the right rectus muscle. Moderate ascites.
## NOTIFICATION:
These findings were communicated to Dr. telephone at
11:54 AM on by Dr. 15 minutes after discovery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16440395", "visit_id": "N/A", "time": "2158-10-31 09:49:00"} |
18710609-RR-30 | 118 | ## INDICATION:
Status post left ankle ORIF.
## THREE VIEWS, LEFT ANKLE/DISTAL TIBIA:
Compared to .
The tubing overlying the medial aspect of the ankle has been removed, and
several new vascular surgical clips are noted about the medial aspect of the
distal calf. Surgical side plates and screws stabilizing the distal tibia and
fibula are intact and unchanged in position. The overall orientation of the
comminuted fracture involving the distal fibula and tibia is unchanged. The
ankle mortise remains congruent. The talar dome appears minimally sclerotic,
but this is likely due to overlap of osseous structures with relative
osteopenia involving the adjacent bones, as there is no evidence of a talar
neck fracture to suggest avascular necrosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18710609", "visit_id": "N/A", "time": "2113-12-25 12:16:00"} |
18044608-RR-17 | 806 | ## EXAMINATION:
MR CODE CORD COMPRESSION PT27 MR SPINE
## INDICATION:
male with cerebral palsy, prior strokes, multiple
falls, who presents as a transfer from outside hospital with small IPH after a
fall. Please evaluate for evidence of traumatic injuries, infection, or
malignancy causing nerve root or cord compression.
## FINDINGS:
Examination is mildly degraded by motion.
Evaluation of the posterior fossa demonstrates small remote pontine infarcts.
## CERVICAL:
There is minimal retrolisthesis of C3 on C4. There is minimal degenerative
height loss of the C4 to C7 vertebral bodies. There is moderate to severe
intervertebral disc height loss from C2-C3 through C7-T1.
There is focal disruption of the anterior longitudinal ligament at C4-C5
(image 10 of series 6). There is fluid signal extending along the
prevertebral space, posterior to the longus coli muscle, predominantly at the
level C4-C5 and extending superiorly to the level of C2-C3 and inferiorly to
the level of C6. The degree of prevertebral soft tissue thickening appears
increased compared to recent CT cervical spine. Comparison to prior MRI
C-spine exams is markedly limited due to severe motion artifact. However,
there was no evidence of anterior longitudinal ligament disruption on that
prior study.
There are mixed multilevel type 1 and type 2 endplate changes from cyst
C2 through C7. There is no evidence of abnormal enhancement.
There is STIR hyperintense signal abnormality in the paraspinal musculature,
predominant level of C4-C5 on the left. This may reflect muscle strain and/or
subtle ligamentous injury.
The cervical spinal cord demonstrates normal signal intensity without
convincing evidence of edema.
## C2-C3:
Minimal disc protrusion resulting in mild narrowing.
## C3-C4:
There is disc bulge and ligamentum flavum thickening with effacement of
the ventral and dorsal CSF spaces and moderate spinal canal narrowing.
Mild-to-moderate bilateral neural foraminal narrowing.
## C4-C5:
Disc bulge with effacement of the ventral and dorsal CSF spaces and
moderate spinal canal narrowing. There is remodeling of the spinal cord
without evidence of edema. Mild bilateral neural foraminal narrowing.
## C5-C6:
Disc bulge with partial effacement of the ventral and dorsal CSF spaces
and moderate spinal canal narrowing. There is remodeling of the ventral spinal
cord without evidence of edema. Moderate bilateral neural foraminal
narrowing.
## C6-C7:
There is disc bulge with effacement of the ventral CSF space and slight
flattening of the ventral spinal cord without evidence of edema. There is
mild-to-moderate spinal canal narrowing. Mild-to-moderate bilateral neural
foraminal narrowing due to uncovertebral joint osteophytes.
## C7-T1:
There is disc bulge with effacement of the ventral CSF space and mild
spinal canal narrowing. Mild bilateral neural foraminal narrowing.
## THORACIC:
The thoracic vertebral body heights, alignment, and intervertebral disc spaces
are preserved. The spinal cord appears normal in caliber and configuration
without evidence of edema. There is no evidence of spinal canal or neural
foraminal narrowing. There is no evidence of infection or neoplasm. There is
no abnormal enhancement after contrast administration.
## LUMBAR:
The lumbar vertebral body heights and alignment are preserved. There is mild
to moderate intervertebral disc height loss at L5-S1. There are type 2
changes at the L5-S1 endplates. Tiny hemangioma in the L2 vertebral body. No
other focal bone marrow signal abnormalities are identified.
There are minimal disc bulges at L3-L4 and L4-L5 without significant spinal
canal narrowing. There is mild disc bulge with tiny superimposed central disc
protrusion at L5-S1 without significant spinal canal narrowing. There is mild
bilateral neural foraminal narrowing at L4-L5 and mild-to-moderate bilateral
neural foraminal narrowing at L5-S1 with the exiting right L5 nerve root
contacting the disc.
## OTHER:
Endotracheal and nasoenteric tubes are present. There is mucosal thickening
and fluid within the nasopharynx and hypopharynx. Fluid and debris is noted
throughout the course of the esophagus.
Gallstones are present within the gallbladder.
Signal alterations in the right greater than left lungs dependently likely
represent atelectasis. There is more focal consolidation in the dependent
right lower lobe, possibly atelectasis.
T2 hyperintense peripelvic and cortically based cystic lesions in the
visualized kidneys statistically likely represent cysts.
There is fatty infiltration of the lower lumbar paraspinal musculature.
## IMPRESSION:
1. Focal disruption of the anterior longitudinal ligament at C4-C5 with
associated prevertebral fluid.
2. Multilevel multifactorial cervical spondylosis as described above, most
pronounced C3-C4 through C5-C6 with moderate spinal canal narrowing and
multilevel remodeling of the spinal cord without signal abnormalities.
3. No significant spinal canal narrowing in the thoracic and lumbar spine.
4. No evidence of acute fracture, cord signal abnormalities, osteomyelitis, or
discitis.
5. Mild degenerative changes in the lower lumbar spine with mild-to-moderate
bilateral neural foraminal narrowing at L5-S1.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 5:35 pm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18044608", "visit_id": "N/A", "time": "2154-01-15 05:10:00"} |
19661325-RR-32 | 124 | ## FINDINGS:
Decreased lung volumes are noted. The heart size is normal. The aorta is
calcified, and the mediastinal contours are normal.
Persistent right upper lobe volume loss, with >2 cm width of right apical
pleural thickening and reticulonodular parenchymal opacities.
Subtle new right basilar opacity is also demonstrated.
## IMPRESSION:
1. Right apical pleural and parenchymal abnormalities may be the sequelae of
prior granulomatous or other infectious process, but it is difficult to
exclude an active process (reactivation TB or scar carcinoma) without more
remote radiographs for comparison. CT is recommended for further
characterization.
2. Subtle right basilar opacity, which could reflect aspiration, atelectasis
or early pneumonia.
Findings were conveyed by Dr. to Dr. telephone at 11:39am on
, 5 minutes after discovery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19661325", "visit_id": "29884966", "time": "2141-03-08 09:51:00"} |
10279740-RR-3 | 550 | ## EXAMINATION:
CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
## INDICATION:
year old woman with abnormal MRA 6mm t0 7mm aneurysm//
Evaluate for abnormal MRA 6mm t0 7mm aneurysm
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 45.3 mGy (Head) DLP =
684.4 mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 14.6 mGy (Head) DLP = 2.9
mGy-cm.
3) Stationary Acquisition 5.0 s, 0.2 cm; CTDIvol = 132.4 mGy (Head) DLP =
26.5 mGy-cm.
4) Spiral Acquisition 3.5 s, 23.0 cm; CTDIvol = 32.7 mGy (Head) DLP = 730.4
mGy-cm.
Total DLP (Head) = 1,444 mGy-cm.
## CT HEAD WITHOUT CONTRAST:
The ventricles, sulci, and cisterns appear normal. There is no large infarct,
intracranial hemorrhage, or mass effect.
The orbits are unremarkable.
Aerosolized debris within the nasopharynx is noted. The paranasal sinuses are
clear. The middle ear cavities and mastoid air cells are clear.
## CTA HEAD:
There is a 1-2 mm posteriorly directed contour irregularity/outpouching at the
left ICA terminus (series 8, image 82).
There is a 2 mm posteriorly directed aneurysm at the left M1-M2 bifurcation
(series 8, image 88).
There is a superiorly directed multilobulated aneurysm within the right M1
segment 3-4 mm proximal to the right M1-M2 bifurcation. There is a patent M2
branch derived from the anterior surface near the base of the aneurysm, nicely
seen on three-dimensional reconstruction (series 965, image 4). The aneurysm
measures 4 mm at its base and 4 x 6 x 4 mm (AP, TV, SI).
Mild irregularity of the cavernous segments of the bilateral internal carotid
arteries likely reflects atherosclerotic vascular disease, without stenosis.
The anterior middle cerebral arteries are patent, without stenosis. The
anterior communicating artery is patent.
There is a fetal origin of the right posterior cerebral artery. The left
posterior communicating artery is either very small or absent. The posterior
cerebral arteries are otherwise patent without stenosis.
The intracranial vertebral arteries and basilar artery are patent without
stenosis.
There is a 2-3 cm area of opacity within the right upper lobe on the images
use for contrast bolus timing (series 7, image 6; series 6, image 1). This
should be further evaluate with a dedicated chest CT. There may also be a
second smaller area of opacity within the right upper lobe (series 7, image
2).
## IMPRESSION:
1. 6 mm multilobulated right M1 segment aneurysm as detailed above. There is
a patent right M2 branch derived from the aneurysm base.
2. 2 mm aneurysm at the left M1-M2 bifurcation.
3. 1-2 mm contour irregularity/outpouching at the left ICA terminus. This can
be further evaluated on diagnostic cerebral angiogram.
4. Ill-defined 2-3 cm area of opacity within the right upper lobe identified
on the images use for contrast bolus timing. There may also be a second small
area opacity within the right upper lobe. Correlation with dedicated chest CT
is recommended given the incomplete assessment on this exam and inability to
exclude neoplasm.
## RECOMMENDATION(S):
Correlation with dedicated chest CT for the area(s) of
opacification within the right upper lobe. These are incompletely imaged on
this exam to be further evaluated given the inability to exclude neoplasm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10279740", "visit_id": "N/A", "time": "2120-02-15 09:33:00"} |
16166614-RR-100 | 186 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST Q311 CT SPINE
## INDICATION:
year old woman with fall// Eval for acute process. Eval for
acute process
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.0 s, 19.5 cm; CTDIvol = 22.5 mGy (Body) DLP = 439.8
mGy-cm.
Total DLP (Body) = 440 mGy-cm.
## FINDINGS:
The cervical spine alignment appears maintained,no acute cervical spine
fractures are identified. Multilevel degenerative changes are visualized
throughout the cervical spine consistent with disc bulging and posterior
osteophytic bridging at C3/C4, C4/C5 and C5/C6 levels, producing anterior
thecal sac deformity, there is mild intervertebral disc space narrowing at
multiple levels of the cervical spine, most severe at C5-C6 level,there is no
prevertebral soft tissue swelling.There is no evidence of lymphadenopathy.
Vascular arteriosclerotic calcifications are present at the cervical carotid
bifurcations, the airway appears patent, the patient is status post
thyroidectomy, the lung apices are clear.
## IMPRESSION:
1. There is no evidence of acute cervical spine fracture.
2. Multilevel multifactorial degenerative changes throughout the cervical
spine, more significant from C3/C4 through C5/C6 levels.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16166614", "visit_id": "28778168", "time": "2153-04-19 01:40:00"} |
14768077-DS-24 | 1,414 | ## HISTORY OF PRESENT ILLNESS:
This is a year old female with a history of bilateral PEs who
presents with shortness of breath. She was diagnosed with
bilateral PEs during an admission for dyspnea in early . This was followed by a repeat admission for dyspnea later
in , felt to be still related to her known PEs. She had
another brief admission in , where she was felt to have a
small pneumonia, treated with levofloxacin.
.
She notes persistent dyspnea at rest and with minimal exertion
throughout the above time period, although her symptoms acutely
worsened last night. She was unable to sleep and noted new
orthopnea, no PND. She states other have mentioned increasing
leg swelling, but was not aware of this herself. She denies
chest pain or tightness, palpitations, lightheadedness or
presyncope.
.
In the ED, initial VS were: 98.2 78 103/61 42 98. She was placed
on O2 for comfort, but had no O2 requirement. EKG showed Afib at
97bpm. Labs showed INR 1.2 (was given 70mg enoxaparin) and BNP
1491. CXR showed a small pleural effusion, and CTA showed
Occluded pulmonary arterial branches to the lingula and left
lower lobe lateral basal segmental branches. represent
progression and/or coalescing of previously noted emboli or less
likely new emboli. There have developed in the interval new
resulting peripheral pulmonary infarcts.
She was also given 750mg levofloxacin, 20mg IV furosemide, and
milk of Mag. She feels that her breathing is better after the
furosemide.
## PAST MEDICAL HISTORY:
-Pulmonary Embolus dx'ed
-Hypertension
-Type 2 diabetes mellitus complicated by peripheral neuropathy.
HBA1c 10.9 on
-H/o cellulitis, requiring hospital admission
-S/p left SFA and tibial angioplasty on
-H/o breast mass removal many years ago, reportedly benign
-S/p Left Hip ORIF
-Hypothyroidism
-Lumbar Spinal stenosis, s/p laminectomy in
-TAH-BSO
-Rectal and bladder prolapse
-Bilateral total knee replacements in
-Status post cholecystectomy
-Status post appendectomy
-Left rotator cuff injury
## FAMILY HISTORY:
Father died of leukemia in old age. Mother died of sepsis.
Brother, died of leukemia at age . Daughter, died, endometrial
cancer. Two sons, healthy.
## GENERAL:
Alert, oriented, no acute distress, resting tremor in
hands
## LUNGS:
Mild bibasilar crackles, otherwise clear to auscultation
bilaterally, no wheezes.
## CV:
Irregularly irregular, systolic murmur at the apex.
## ABDOMEN:
NABS. Soft, non-tender, mildly distended with tympany
to percussion.
## EXT:
Warm, well perfused, 2+ pitting edema R>L, RLE with some
warmth and tenderness as well.
## HRCT CHEST:
Occluded pulmonary arterial branches to the
lingula and left lower lobe lateral basal segmental branches.
represent progression and/or coalescing of previously noted
emboli or less likely new emboli. There have developed in the
interval new resulting peripheral pulmonary infarcts.
2. Small bilateral pleural effusions with associated compressive
atelectasis.
3. Numerous pulmonary nodules, as above. In absence of risk
factors for
primary or secondary lung malignancy, a follow chest CT should
be obtained in 12 months, otherwise one should be obtained in 6
months.
.
## BRIEF HOSPITAL COURSE:
year old female with a history of bilateral PEs who presents
with shortness of breath found to have coalescing of
previously noted emboli or less likely new emboli and likely
CHF.
.
# Shortness of breath: She was noted to have new small PEs on
CTA, which may be contributing. Of note, her INR was
subtherapeutic on admission. Also, her CXR showed a new right
sided effusion with edema and elevated BNP which would be
consistent with CHF. In the setting of her afib, which is mildly
rapid, she may have some diastolic heart failure. This is
supported by improvement in sx after furosemide. Given that she
is pre-load dependant in the setting of AS she was carefully
diuresed with IV Lasix and then PO Lasix. She was sent home on
Lasix 10 mg PO daily. An outpatient echo is strongly recommended
to evaluate for RV dysfunction. She was continued on enoxaparin
and warfarin while her INR is subtherapeutic. She will follow up
with her primary care provider for titrate of Warfarin and then
the enoxaparin will be discontinued after she is therapeutic on
Warfarin. Rate control for Afib, as below. A was negative
for RLE DVT.
.
# Atrial fibrillation: goal HR ~80 given her dyspnea.
- Cont metoprolol, uptitrate as needed
- Anticoagulate as above
.
#Bilateral pulmonary nodules: The patient has bilateral
pulmonary nodules of unknown etiology-?malignancy. The patient
states that she does not desire any further workup. The nodules
have been stable since . If there is a malignancy
this may be contributing to the hypercoagulable state and
resulting PEs.
.
# Hypothyroidism: She was continued on home levothyroxine.
.
# Hypertension: She was continued on home metoprolol and
nifedipine.
.
# DM2: She was continued on home insulin glargine + sliding
scale, + gabapentin for peripheral neuropathy.
.
# Code: DNR/DNI, confirmed by patient
## MEDICATIONS ON ADMISSION:
FOLIC ACID - 1 mg daily
GABAPENTIN - 600 mg BID
INSULIN GLARGINE - 17 units at bedtime
LEVOTHYROXINE - 125 mcg daily
METOPROLOL SUCCINATE - 100 mg daily
MIRTAZAPINE - 15 mg daily
NIFEDIPINE - 30 mg Sustained Release daily
OMEPRAZOLE - 20 mg daily
TRAMADOL - 50 mg Q6H PRN pain
TRAZODONE - 50 mg QHS
ASCORBIC ACID - mg daily
ASPIRIN - 81 mg daily
CALCIUM CARBONATE - 650 mg (1,625 mg) BID
CHOLECALCIFEROL - 1,000 units daily
INSULIN REGULAR HUMAN - sliding scale
VITAMIN E - dosage uncertain
WARFARIN 0.5mg-1mg daily (doses alternate every other day)
Milk of magnesia QHS
## DISCHARGE MEDICATIONS:
1. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
2. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Gabapentin 300 mg Capsule
## SIG:
Two (2) Capsule PO Q12H (every
12 hours).
5. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale
Injection three times a day.
6. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
## SIG:
One (1) Tablet Sustained Release 24 hr PO once a day.
8. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
9. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) Subcutaneous
Q12H (every 12 hours) for 3 days.
Disp:*6 syringes* Refills:*0*
10. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO once a day.
11. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
12. Tramadol 50 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain.
13. Warfarin 1 mg Tablet Sig: 1.5 Tablets PO Once Daily at 4 .
Disp:*20 Tablet(s)* Refills:*0*
14. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain.
15. Ascorbic Acid mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
17. Calcium Carbonate 500 mg Tablet, Chewable Sig: Three (3)
Tablet, Chewable PO BID (2 times a day).
18. Furosemide 20 mg Tablet Sig: Tablet PO once a day: (10
mg each day).
Disp:*15 Tablet(s)* Refills:*0*
19. Ocean Nasal Mist 0.65 % Aerosol, Spray Sig: One (1) spray in
each nostril Nasal three times a day as needed for nasal
congestion.
Disp:*1 bottle* Refills:*0*
## DISCHARGE DIAGNOSIS:
1) new or enlarging pulmonary embolisms
2) pulmonary edema
## ACTIVITY STATUS:
Out of Bed with assistance to chair or
wheelchair.
## DISCHARGE INSTRUCTIONS:
You were admitted for shortness of breath. You had fluid in your
lungs and new (or enlarging) blood clots in your lungs which
made you short of breath. You were treated with a medication
called lasix to move the fluid off your lungs. You should take
this medication until you see your doctor on . He may
decide to continue it or to discontinue at that time.
You are on a medication called Warfarin to prevent your blood
from clotting. Your INR (the measure of your blood's ability to
clot) was not high enough to prevent clots from forming when you
were admitted. You will need to take Lovenox to keep your blood
from clotting until your INR is . Your doctor help you
decide when to stop taking the Lovenox and will help you
organize to test your INR regularly.
Your heart might be strained from the clots in your lungs
causing the fluid to in your lungs. For this reason your doctor
probably schedule an ultrasound of your heart called an
echocardiogram.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14768077", "visit_id": "25457242", "time": "2159-07-17 00:00:00"} |
10917546-DS-25 | 2,259 | ## HISTORY OF PRESENT ILLNESS:
Ms. is a year old female with history of asthma,
CAD s/p PCI , , and recent otitis media and UTI who
presents with three days of cough, runny nose and wheezing. Her
daughter reports her having several health problems over the
last few weeks. She was found to have otitis media at the her
PCP office and was started on erythromycin. She developed
symptoms of UTI and was switched to Keflex on . During
this time she was found to have acute worsening of her hearing
acuity. Her daughter was unable to get an appointment at her
PCP's office so she went to Mass Eye & Ear on . There
she was started on a ten day course of Augmentin 875 mg bid for
her otitis media. She started this course on after
completing her five day course of Keflex for UTI. Patient
reportedly did well on these medications until about three days
ago when she developed increased cough, wheezing, and runny
nose. Patient's symptoms were initially responsive to cough
syrup and her albuterol inhaler but on the day of presentation
her wheezing and cough were unchanged by these therapies. She
had an episode of lightheadedness with breakfast followed by
emesis. Her daughter was concerned that she may have developed a
pneumonia and brought her to the Emergency Department.
.
In the ED, initial VS were: T 98 BP 108/47 HR 72 RR 20 SpO2 96%
2L.
Patient received solumedrol 125 mg IV and combivent nebulizer
prior to transfer to the medicine floor.
.
On the floor, patient has difficulty communicating due to loss
of hearing. She denies any current questions. She admits to
vomiting this morning and denies any current nausea. She
reports constipation with her last movement yesterday. Her
daughter denies any reports of chest pain, fever, chills,
diarrhea or productive cough.
.
She received her seasonal flu shot in . She did not
receive an H1N1 vaccine. She has no known sick contacts.
.
Review of systems:
(+) Per HPI, lightheadedness this morning, emesis once this
morning, recent dysuria, recent hearing loss in R ear,
nonproductive cough, wheezing
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, shortness of breath
## PAST MEDICAL HISTORY:
Asthma
CAD s/p pci LAD
Hypertension
Hyperlipidemia
Chronic diastolic CHF
Diabetes Mellitus
Osteoarthritis
Hypothyroidism
Breast cancer
Stress incontinence
Recurrent UTIs
Recent Otitis Media with associated hearing loss R>L ear
## FAMILY HISTORY:
Mother died of a stroke in her
Two sisters with MI in their .
## GENERAL:
Alert and oriented, no acute distress, pleasant, talks
softly and able to understand/hear intermittently
## HEENT:
Sclera anicteric, MMM, oropharynx clear, nasopharynx
congested, dentures out, productive cough
## NECK:
soft, supple, no LAD
## LUNGS:
Nonlabored breathing with good inspiratory effort,
course/rhonchorous breath sounds in bilateral upper lobes,
expiratory wheezing L > R, good air movement
## CV:
Regular rate and rhythm, normal S1 + S2, no
murmurs/rubs/gallops
## ABDOMEN:
soft, non-tender/non-distended, bowel sounds present
## EXT:
Warm, well perfused, 2+ pulses, no clubbing/cyanosis/edema
## NEURO:
Poor hearing acuity bilaterally, no other focal deficits
in strength or sensation
## YEAST 10,000-100,000
.
CXR ON ADMISSION:
No acute consolidation, borderline
cardiomegaly.
.
## CXR (PA/LAT) :
Pulmonary vasculature is mildly
congested, but there is no edema. Small left pleural effusion is
new, consistent with borderline cardiac decompensation, even
though heart size is top normal and unchanged since the previous
study.
## BRIEF HOSPITAL COURSE:
year old woman with past medical history of asthma,
hypertension, hypothyroidism and recent hearing loss NOS who
presents with three days of cough, sinus congestion, rhinorrhea,
wheezing and shortness of breath.
.
# Cough/Hypoxia: Patient's symptoms consistent with a upper
respiratory infection with perhaps extension to mild bronchitis
and asthma exacerbation. She remained afebrile and without chest
pain although cough became more productive during
hospitalization. Chest Xray X2 also showed no evidence of
infectious etiology or pulmonary edema. Patient was continued on
Tessalon with good effect for symptomatic management of cough.
Her wheeze resumed on second/third day with rhonchi. Her
steroids were continued at 40mg and then increased to 60mg for a
slower taper than initially planned. Her albuterol and
ipratropium nebulizers were incresed in frequency. Guaifenecin
Dextromethorphan was added and patient was given supplemental
oxygen as needed. Of note, although her pulmonary exam was
increasingly rhonchorous/wheezy for some period of time, her O2
requirement decreased and patient was comfortable on room air
for the latter half of her hospitalization. Patient was able to
ambulate well with no desaturation (O2 sat remained 94% with
active ambulation). Per family's request, patient was discharged
on nebulizers and prescription for a home nebulizer machine.
.
# CKD: Creatinine baseline 1.4-1.5. Was at baseline on admission
(1.3) but bumped overnight and continued to rise to 2.2.
Etiology was unclear but patient has a history of increased
creatinine with Bactrim. Patient's Augmentin was discontinued on
given improved ear exam (no erythema of canal, no bulging
of tympanic membranes). Furosemide was temporarily stopped.
Given FeUrea/Fena suggestive of pre-renal etiology and patient's
continued endorsing of dry mouth, she was encouraged to increase
PO fluids and given ~2.5-3L intravenous fluid gently. By
discharge, patient's creatinine was back to her baseline of 1.5.
She was resumed on her furosemide during her last three days of
hospitalization due to new occurence of urinary retention. Per
her daughter, patient retains urine at baseline perhaps
contributing to her frequent urinary tract infections. Thus,
patient's low-dose furosemide was restarted with resolution of
urinary retension and no bump in her creatinine.
.
# Otitis Media: Patient being followed at Mass Eye and Ear for
recent otitis media causing substantial hearing loss. She has
outpatient follow-up there already scheduled for mid-Janaury,
for possible drainage of inner ear fluid. Ear exam in-house
showed no pain with manipulation of outer ear, no erythema of
ear canal, no bulging tympanic membrane, no discharge. Given
improved ear exam and increased creatinine, Augmentin was
discontinued. Patient was continued on Flonase and Flovent.
.
# HTN: Patient was hypertensive on arrival to the floor (SBP
160s), however she did not receive any of her home medications
in the Emergency Department. Her blood pressures after home
medications were within normal limits (SBP120s). Patient was
continued on home hydralazine, diltiazem extended release,
metoprolol. The medications did not need to be
increased/tailored on her steroids.
.
# Diabetes Mellitus: Recently diagnosed; patient managed on
glyburide at home. Given the intravenous steroids in the ED and
daily Prednisone during this admission, patient's blood sugars
were high this admission. Initially 300-400s and decreased
gradually to <180. Patient was continued on a humalog insulin
sliding scale with regular tightening and was also started on
fixed glargine. Patient has been on insulin during previous
admissions and her family has been to for education on
administering insulin to her. At the end of this admission,
however, given the tapering of her steroids, improving blood
sugars and strong family preference to not have to administer
insulin, patient was discharged home without insulin or sliding
scale. Instead, she was resumed on her home glyburide with close
follow-up in and her primary care doctor's
office.
.
# CAD: Was stable and patient asymptomatic during this
admission. She was continued on home medications of statin, beta
blocker, aspirin, antihypertensives.
.
# Chronic diastolic CHF: Physical exam and chest x-ray showed
no evidence of volume overload as a contributor to her
presenting symptoms. Repeat chest Xray on given increased
wheezing/rhonchi and concern for volume overload was also
negative. Patient's chest xray on was initially concerning
for a new retrocardiac, posterior pneumonia. Patient was briefly
started on Vanc/Cefepime for possible hospital acquired
pneumonia. As soon as final read was mild pleural effusion
without signs of infection, the antibiotics were discontinued.
Patient was continued on home medications for CHF and monitored
closely. Fluid rehydration with intravenous fluids was gentle
(75-100cc/hr) during this admission to minimize risk of
overload/flash.
.
# Hyperlipidemia: Patient was continued on home statin.
.
# Osteoarthritis: Pain was well controlled with home
acetaminophen. Patient did take PRN order of tylenol regularly,
~3 times daily.
.
# Code: FULL (Nightfloat discussed with patient's daughter who
stated she has not discussed it yet with her mother, plans to
discuss and readdress in the future)
## MEDICATIONS ON ADMISSION:
Flovent 2 puffs bid
Albuterol 2 puffs q4h prn
Tylenol mg bid prn
Aspirin 81 mg daily
Stool softener bid prn
Augmentin 875 mg po bid started
Hydralazine 100 mg bid
Furosemide 10 mg daily
Glyburide 1.25 mg daily
Metoprolol 25 mg bid
Tamoxifen 10 mg bid
Diltiazem ER 180 mg bid
Levothyroxine 112 mg daily
Pantoprazole 40 mg daily
Lipitor 10 mg daily
Flonase
.
## DISCHARGE MEDICATIONS:
1. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
## NEBULIZATION SIG:
One (1) neb treatment Inhalation every four
(4) hours as needed for shortness of breath or wheezing.
Disp:*30 vials* Refills:*2*
2. Ipratropium-Albuterol 0.5-2.5 mg/3 mL Solution for
## NEBULIZATION SIG:
One (1) neb treatment Inhalation every six (6)
hours as needed for shortness of breath or wheezing.
Disp:*30 vials* Refills:*2*
3. Nebulizer & Compressor For Neb Device Sig: One (1) set
Miscellaneous every hours as needed for shortness of breath
or wheezing.
Disp:*1 device set* Refills:*0*
4. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain.
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Hydralazine 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
9. Tamoxifen 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO BID (2 times a day).
11. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
13. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
14. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation BID (2 times a day).
15. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
16. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
17. Colace 50 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
18. Prednisone 10 mg Tablet Sig: Tablets PO once a day for 2
weeks: Prednisone 30mg (3 tablets) daily for 3 days: Prednisone 20mg (2 tablets) daily for 3 days: Prednisone 10mg (1 tablet) daily for 3 days:
Prednisone 5mg (half tablet) daily for 3 days:
OFF Prednisone on
.
Disp:*20 Tablet(s)* Refills:*0*
19. Cefpodoxime 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 2 days: Last day: .
Disp:*4 Tablet(s)* Refills:*0*
20. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
21. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
packet PO DAILY (Daily) as needed for constipation.
Disp:*30 packet* Refills:*0*
22. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) as needed for cough.
Disp:*90 Capsule(s)* Refills:*0*
23. Dextromethorphan-Guaifenesin mg/5 mL Syrup Sig: Five
(5) ML PO Q6H (every 6 hours) as needed for cough.
Disp:*1 bottle* Refills:*2*
24. Glyburide 1.25 mg Tablet Sig: One (1) Tablet PO once a day.
## PRIMARY:
Upper respiratory infection with asthma exacerbation,
acute on chronic renal failure, diabetes mellitus type 2
## SECONDARY:
Recent otitis media, coronary artery disease,
hypertension, hyperlipidemia, osteoarthritis, hypothyroidism
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane)
## DISCHARGE INSTRUCTIONS:
-You were admitted with an upper respiratory infection which
exacerbated your asthma. You were given medications to manage
your symptoms (cough, shortness of breath, wheezing), including
nebulizers, supplemental oxygen, steroids, and antibiotics. Your
blood sugars were running high during this admission due to the
steroids for your asthma; this was managed with insulin. We
spoke with your primary doctor who said you do not need to use
insulin going home. Your kidney function also worsened
initially and was felt likely due to dehydration and the
antibiotic for your ear infection. You were given fluids and the
antibiotic Augmentin was stopped with improvement.
.
-It is important that you continue to take your medications as
directed. We made the following changes to your medications
during this admission:
--> START Prednisone. You will taper this medication as follows:
Prednisone 30mg daily for 3 days:
Prednisone 20mg daily for 3 days:
Prednisone 10mg daily for 3 days:
Prednisone 5mg daily for 3 days:
OFF Prednisone on
--> START Cefpodoxime 200mg daily to treat a possible pneumonia,
last day is .
--> START Albuterol nebulizers every 4 hours as needed for
wheezing/shortness of breath
--> START Ipratropium nebulizers every 6 hours as needed for
wheezing/shortness of breath
--> STOP Augmentin 875mg twice daily (antibiotic)
--> RESUME Glyburide 1.25mg daily
.
-Contact your doctor or come to the Emergency Room should your
symptoms return. Also seek medical attention if you develop any
new fever, chills, trouble breathing, chest pain, nausea,
vomiting or unusual stools.
- Weigh yourself every morning, call MD if weight goes up more
than 3 lbs.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10917546", "visit_id": "24350059", "time": "2164-07-03 00:00:00"} |
11148363-RR-21 | 262 | LUMBAR SPINE MRI WITH AND WITHOUT CONTRAST,
## INDICATION:
Acute lower back pain radiating to the legs with associated
paresthesias.
## FINDINGS:
Vertebral body height and alignment are normal. No concerning bone
marrow signal abnormalities are seen. The distal spinal cord appears
unremarkable, with the conus medullaris terminating at the L1-L2 level. No
intrathecal abnormalities are seen.
The L1-2 and L2-3 levels are unremarkable.
At L3-4, there is a minimal disc bulge and a very small left-sided disc
protrusion, which abuts the traversing left L4 nerve root in the subarticular
recess (images 4:11 and 7:4). There is no significant spinal canal or neural
foraminal narrowing.
At L4-5, there is a disc bulge and a small central disc protrusion, as well as
thickening of the ligamentum flavum and facet arthropathy. There is moderate
spinal canal narrowing and impingement of the traversing L5 nerve roots in the
subarticular recesses. There is mild-to-moderate bilateral neural foraminal
narrowing.
At L5-S1, there is moderate bilateral facet arthropathy. The left neural
foramen may be mildly narrowed, but no impingement of the exiting L5 nerve
roots is seen. There is no spinal canal narrowing.
No signal abnormalities are identified in the imaged retroperitoneal soft
tissues.
## IMPRESSION:
1. At L4-5, degenerative disease causes moderate spinal canal narrowing with
impingement of the traversing L5 nerve roots in the subarticular recesses, as
well as mild-to-moderate bilateral neural foraminal narrowing.
2. At L3-4, a small left disc protrusion abuts the traversing left L4 nerve
root in the subarticular recess.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11148363", "visit_id": "N/A", "time": "2161-03-03 14:55:00"} |
12697191-RR-50 | 404 | ## INDICATION:
Bloating, pelvic pain. Ovarian mass.
## FINDINGS:
The left ovary is abnormal. In the posterior and inferomedial aspect of the
left ovary, there is a complex cystic lesion. This is composed of a number of
cystic components, which are high in signal intensity on T2-weighted imaging,
in addition to multiple areas of septation, which are low in signal intensity
on all sequences. There is a component at the inferomedial aspect of this
cystic lesion, which is high in signal intensity on pre-contrast fat
suppressed T1-weighted imaging, compatible with proteinaceous or hemorrhagic
fluid (series 8, image 61). 51). There are small foci of susceptibility
within the lesion raising the possibility of old hemorrhage (series 7B, image
36). Comparison with old CTs demonstrates calcification within the left
ovarian lesion. Following administration of contrast, there is low level
enhancement within the multicystic lesion (series 301, image 52). Overall, the
lesion measures 2.8 cm (transverse) x 2.1 cm (anteroposterior) x 2.4 cm
(craniocaudad) in . Relatively normal enhancing ovarian parenchyma
is seen at the anterior aspect of the left ovary (series 301, image 51).
The right ovary is normal in appearance and enhances normally.
There is evidence of previous cesarean section with a small contour
abnormality at the anterior aspect of the inferior aspect of the uterus. There
is a uterine fibroid measuring 3.2 cm in maximum diameter in the anterior
aspect of the uterine body in intramural location. This fibroid enhances
after the administration of intravenous contrast.
There is no pelvic lymphadenopathy. There is no significant focal bone
lesion. There is no ascites.
Multiplanar 2D and 3D reformations and subtraction images provided multiple
perspectives for the dynamic series.
## IMPRESSION:
1. Complex left ovarian cystic lesion which was calcified on prior CT but
remains stable in size over several years. The appearance is likely due to a
non- aggressive process such as calcification in the region of hemorrhagic
cysts or previous infection. As there is no microscopic fat, it cannot be
characterized as a dermoid. Low-grade neoplasm cannot be completely excluded
given the finding of low level enhancement on the dynamic series. Followup MRI
in months' time is recommended to assess for expected stability.
2. Uterine fibroid.
Dr. was paged at 11:30 a.m. on to communicate these findings.
In the absence of response, the details were entered on the critical dashboard
for communication to the referring physician.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12697191", "visit_id": "N/A", "time": "2195-11-15 17:07:00"} |
10656173-RR-26 | 111 | ## INDICATION:
year old woman with alcoholic cirrhosis here w/ hypoxic
respiratory failure, anemia w/ hemolysis and high residuals on TFs, little
stool output// evaluate for ileus, obstruction, other acute pathology
## FINDINGS:
There are no abnormally dilated loops of large or small bowel.
Assessment for free intraperitoneal air is limited on supine radiographs. If
there is clinical concern for pneumoperitoneum, advise upright or left lateral
decubitus radiograph, or cross-sectional imaging.
Osseous structures are unremarkable.
Enteric tube terminates in the stomach. There are no unexplained soft tissue
calcifications or radiopaque foreign bodies. The lower pelvis is excluded in
this study.
## IMPRESSION:
Nonspecific bowel gas pattern. No radiographic evidence of obstruction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10656173", "visit_id": "25778760", "time": "2177-09-13 10:42:00"} |
11205145-RR-39 | 121 | ## INDICATION:
and failed back surgery, PICC line placement.
## FINDINGS:
As compared to the previous radiograph, the distal course of the
PICC line is not well visible on the radiograph. The right PICC line can be
followed to the level of the subclavian vein, but does not seem more distally.
A repeat radiograph could be performed if the PICC line position is of
importance.
In the interval, the patient has received a right internal jugular vein
catheter. The tip of the catheter projects over the inflow tract of the right
atrium, the line should be pulled back by approximately 1 cm.
No complications, notably no pneumothorax. Plate-like atelectasis at the mid
left lung. Borderline size of the cardiac silhouette.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11205145", "visit_id": "20216027", "time": "2172-10-14 21:23:00"} |
10533034-RR-38 | 179 | ## HISTORY:
female with AML, undergoing chemotherapy, with pain at
right PICC site concerning for thrombus.
## RIGHT UPPER EXTREMITY VENOUS ULTRASOUND:
Grayscale and color and pulse wave
Doppler examinations were performed over the left subclavian vein as well as
the right internal jugular, subclavian, axillary, brachial, and basilic veins.
The patient has a PICC in place via the right basilic venous approach, with
insertion site just above the antecubital region. Assessment over the PICC
site is limited by overlying dressing. However, proximal to the dressing,
examination demonstrates incomplete compression and mildly echogenic
intraluminal material within the basilic vein which extends to the level of
the axillary vein. Color flow is seen around the filling defect, consistent
with incompletely occlusive thrombus. Normal wall-to-wall flow, venous
waveforms, and compressibility are demonstrated in the right internal jugular,
brachial and subclavian veins.
## IMPRESSIONS:
Incompletely occlusive thrombus surrounding PICC extending from
the right basilic vein proximally into the axillary vein (a deep vein). Right
subclavian vein patent.
Findings were discussed over the phone with Dr. at the time of
this dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10533034", "visit_id": "21113761", "time": "2141-05-08 16:34:00"} |
16685903-RR-60 | 487 | ## REASON FOR EXAM:
man with history of hepatitis and cirrhosis and
hepatic cell carcinoma status post RFA and TACE in . Evaluate
for progression of disease.
## CHEST CT WITH CONTRAST:
Imaged thyroid gland is unremarkable. There is no
mediastinal, hilar, or axillary lymphadenopathy by size criteria. Aorta,
pulmonary artery and heart appear unremarkable. There is no pneumothorax or
pleural effusion. Linear atelectatic-chronic fibrotic changes of bilateral
lung bases are noted. There is no evidence of pneumonia or congestive heart
failure. No pulmonary nodules within the limitations of this study, lack of
thin sections, are identified.
ABDOMINAL CT WITHOUT AND WITH CONTRAST:
There is a small hiatal hernia.
Liver is grossly unchanged since prior exam. Esophageal, periesophageal,
perigastric and perisplenic varices as well as dilatation of the portal veins
are compatible with portal hypertension. Mildly nodular contour of the liver
is compatible with cirrhosis. A focus of Ethiodol uptake in the most inferior
aspect of the liver measures 1.7 x 1.6 cm, unchanged. A second tiny focus of
Ethiodol uptake in the right lobe of the liver (2:16) is less conspicuous on
the current study and measures 4 mm, previously 6 mm (2:16). RFA site in
segment V/VI is unchanged in appearance, measuring 2.3 x 1.3 cm (3B:157).
Sub-cm focus of enhancement in segment IV-B follow the blood pool and likely a
vein, unchanged. No new suspicious liver lesions are identified. Numerous
hypodense nonenhancing foci throughout the liver are most consistent with
cysts and are unchanged. There is no biliary ductal dilatation. Nonocclusive
thrombus is again noted in the main portal vein, splenic vein, and superior
mesenteric vein, grossluy unchanged. The gallbladder is unremarkable. The
pancreas is mildly atrophic, otherwise unremarkable. The spleen is severely
enlarged measuring up to 18.5 cm in length. Adrenals are unremarkable. Both
kidneys are in normal anatomic location and demonstrate symmetric enhancement.
Too small to characterize hypodensities in bilateral kidneys are stable. Wall
thickening of the colon extending from the cecum to mid transverse colon with
mucosal enhancement is noted. Abdominal aorta and iliac vessels are grossly
unremarkable. There is no lymphadenopathy. Multiple tiny mesenteric and
retroperitoneal lymph nodes are however identified.
## PELVIC CT WITH CONTRAST:
Rectosigmoid, urinary bladder, prostate, and seminal
vesicles are unremarkable.
## OSSEOUS STRUCTURES:
No bony lesions to suggest malignancy or infection is
identified. Bilateral pars defect at L5 vertebral body is noted.
## IMPRESSION:
1. New moderate wall thickening of the ascending and proximal transverse
colon. The patient is asymptomatic per OMR records. Findings may be secondary
to portal venous congestion. Inflammatory and infectious etiologies are also
possible. Ischemic etiology is unlikely. Please correlate clinically.
2. Grossly stable chronic thrombus in the portal venous system with no
definit acute obstructive thrombus.
3. Stable liver cirrhosis, focus of RFA and chemoembolization.
4. Splenomegaly, Perisplenic, esophageal, paraesophageal and perigastric
varices, and dilated portal venous system compatible with portal hypertension.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16685903", "visit_id": "N/A", "time": "2165-01-07 11:05:00"} |
15726768-RR-43 | 90 | ## INDICATION:
year old woman with Left distal radius
intra-articularfracture. // Assess for healing
## FINDINGS:
Bone and hardware alignment is unchanged. Again seen is a volar plate and
screws transfixing distal left radial fracture, with neutral angulation of
distal radial articular surface. No hardware loosening or failure. Portions
of the fracture line remain visible and other areas are obscured, compatible
with bridging bone.
Ununited ulnar styloid fracture again noted.
Background first CMC and triscaphe joint osteoarthritis again noted.
## IMPRESSION:
Status post ORIF distal left radial fracture, unchanged in alignment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15726768", "visit_id": "N/A", "time": "2139-09-18 09:41:00"} |
15027886-RR-43 | 175 | ## HISTORY:
A male with RF status post chest tube removal x1 on the
right. Please assess for interval changes.
## FINDINGS:
A new skin staple line projects over the left upper quadrant of the
abdomen. A small amount of subdiaphragmatic free air is noted on the superior
medial aspect of the liver. The cardiac and mediastinal contours appear
unchanged from previous study. A left-sided central line is noted with its
tip in the mid-to-lower SVC. There has been interval removal of a right-sided
chest tube (the more inferiorly placed one). There is a small amount of
intrapleural air tracking along the right hemidiaphragm that does not appear
appreciably changed from previous study. The lung fields show no evidence of
focal or lobar consolidation and there is no evidence of pleural effusion.
## IMPRESSION:
1. Small amount of subdiaphragmatic air consistent with recent abdominal
surgery.
2. Status post one chest tube removal with residual intrapleural air,
unchanged from previous study.
3. Left-sided central line tip in the mid-to-lower SVC.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15027886", "visit_id": "26786113", "time": "2188-12-31 12:41:00"} |
12616482-RR-22 | 118 | CT C-SPINE WITHOUT CONTRAST.
## FINDINGS:
There is no evidence of acute fracture or malalignment. The
vertebral body heights are preserved. There is no prevertebral soft tissue
swelling. There are degenerative changes with moderate to severe canal
narrowing at C4-5, C5-6 and C6-7 due to posterior disc bulges. Moderate
multilevel neuroforaminal stenosis is also identified due to bilateral facet
degenerative changes. The visualized lung apices are clear.
## IMPRESSION:
1. No evidence of acute fracture.
2. Degenerative changes including moderate to severe central canal stenosis,
most severe at C4-5, C5-6 and C-7. Please note that extensive degenerative
changes predispose the cord to injury even with minor trauma. Consider MRI if
clinically indicated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12616482", "visit_id": "21930104", "time": "2150-03-03 19:24:00"} |
17264921-DS-18 | 1,186 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## ATTENDING:
Complaint:
Right lower extremity cellulitis/wound dehiscence
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
R leg I&D
Dr.
of Present Illness:
year old female s/p 2 months out from (cerclage wire),
right knee, now presents from rehab facility with wound
dehiscence/right lower extremity cellulitis.
## PMH:
Hypertension, hyperlipidemia, recurrent urinary tract
infections, GERD, hypokalemia, osteoarthritis, vitamin D
deficiency, leukocytosis, CKD, depression and insomnia
## PSH:
R femur ORIF/R TKR ( ), R patellar tendon repair
( ), R patella tendon revision w/allograft ( ),
R knee ( )
## PHYSICAL EXAM:
Well appearing in no acute distress
Afebrile with stable vital signs
Pain well-controlled
## NEUROLOGIC:
Intact with no focal deficits
## MUSCULOSKELETAL LOWER EXTREMITY:
* Incision healing well with staples
* Scant serosanguinous drainage
* Thigh full but soft
* No calf tenderness
* strength
* SILT, NVI distally
* Toes warm
## BRIEF HOSPITAL COURSE:
On the patient was admitted to the orthopedic surgery
service for right lower extremity cellulitis/wound dehiscence.
Her knee was aspirated in clinic, which had cell count of 410
and cultures showed no growth (superficial cultures from rehab
grew MRSA. She was started on IV Ancef every 8 hours, along
with Vancomycin on hospital day #2. Daily dressing changes and
wound checks were performed. On , wet to dry dressing
changes were initiated however the patient continued to have
ongoing drainage from the wound.
On , the patient was taken to the OR for I&D of right knee.
Cultures were taken in the OR and grew out isolated MRSA. IV
antibiotics were resumed post-operatively(Ancef and Vanco).
On POD2, OR culture follow-up demonstrated gram stain
significant for 1+ polys, 3+ GPCs in pairs and clusters
consistent with staph aureus. At that point sensitivities were
pending.
On POD4, Infectious disease was consulted for further antibiotic
management. They recommended continuing on Vancomycin IV 750mg
Q12hr and discontinuing IV Ancef. Recommended treatment course
was for 2 weeks ( ). '
On POD5, the patient lost IV access. She was consented for a
PICC line to be placed. A PICC line was successfully placed as
confirmed by x-ray. She continued to received IV Vancomycin.
On POD7, the patient complained of pruritis around the
site. The nurse was paged to evaluate the site and had no
concern for infection nor adhesive reaction from the dressing.
The patient continued physical therapy during her
hospitalization. Labs were monitored during her
hospitalization.
At the time of discharge the patient was afebrile with stable
vital signs. The operative extremity was neurovascularly intact
and the wound was benign.
The patient's weight-bearing status is weight bearing as
tolerated on the operative extremity. No range of motion
restrictions. Per infectious disease she is to continue
Vancomycin 750mg IV Q12hr for a total of 2 weeks
.
Ms. is discharged to rehab in stable condition.
## MEDICATIONS ON ADMISSION:
1. Citalopram 20 mg PO DAILY
2. Hydrochlorothiazide 25 mg PO DAILY
3. Losartan Potassium 50 mg PO DAILY
4. Omeprazole 20 mg PO DAILY
5. Polyethylene Glycol 17 g PO DAILY
6. Potassium Chloride 10 mEq PO DAILY
7. Tizanidine 1 mg PO BID
8. TraZODone 50 mg PO QHS
9. Aspirin 81 mg PO DAILY
10. Bisacodyl AILY:PRN constipation
11. Vitamin D UNIT PO DAILY
12. Cyanocobalamin 1000 mcg PO DAILY
13. Docusate Sodium 100 mg PO BID
14. Milk of Magnesia 30 mL PO ONCE:PRN constipation
15. Senna 8.6 mg PO BID
16. Fleet Enema AILY:PRN constipation
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Bisacodyl AILY:PRN constipation
3. Citalopram 20 mg PO DAILY
4. Cyanocobalamin 1000 mcg PO DAILY
5. Docusate Sodium 100 mg PO BID
6. Fleet Enema AILY:PRN constipation
7. Hydrochlorothiazide 25 mg PO DAILY
8. Losartan Potassium 50 mg PO DAILY
9. Milk of Magnesia 30 mL PO ONCE:PRN constipation
10. Omeprazole 20 mg PO DAILY
11. Polyethylene Glycol 17 g PO DAILY
12. Potassium Chloride 10 mEq PO DAILY
Hold for K > 5
13. Senna 8.6 mg PO BID
14. Tizanidine 1 mg PO BID
15. TraZODone 50 mg PO QHS
16. Vitamin D UNIT PO DAILY
17. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
18. Acetaminophen 1000 mg PO Q8H
19. Vancomycin 750 mg IV Q 12H
## DISCHARGE DIAGNOSIS:
right lower extremity cellulitis/wound dehiscence
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
1. Please return to the emergency department or notify your
physician if you experience any of the following: severe pain
not relieved by medication, increased swelling, decreased
sensation, difficulty with movement, fevers greater than 101.5,
shaking chills, increasing redness or drainage from the incision
site, chest pain, shortness of breath or any other concerns.
2. Please follow up with your primary physician regarding this
admission and any new medications and refills.
3. Resume your home medications unless otherwise instructed.
4. You have been given medications for pain control. Please do
not drive, operate heavy machinery, or drink alcohol while
taking these medications. As your pain decreases, take fewer
tablets and increase the time between doses. This medication can
cause constipation, so you should drink plenty of water daily
and take a stool softener (such as Colace) as needed to prevent
this side effect. Call your surgeons office 3 days before you
are out of medication so that it can be refilled. These
medications cannot be called into your pharmacy and must be
picked up in the clinic or mailed to your house. Please allow
an extra 2 days if you would like your medication mailed to your
home.
5. You may not drive a car until cleared to do so by your
surgeon.
6. Please call your surgeon's office to schedule or confirm your
follow-up appointment in three (3) weeks.
## 7. SWELLING:
Ice the operative joint 20 minutes at a time,
especially after activity or physical therapy. Do not place ice
directly on the skin. You may wrap the knee with an ace bandage
for added compression. Please DO NOT take any non-steroidal
anti-inflammatory medications (NSAIDs such as Celebrex,
ibuprofen, Advil, Aleve, Motrin, naproxen etc).
## 8. ANTICOAGULATION:
Please continue your Lovenox for four (4)
weeks to help prevent deep vein thrombosis (blood clots). If
you were taking aspirin prior to your surgery, it is OK to
continue at your previous dose while taking this medication.
## 9. WOUND CARE:
Please keep your incision clean and dry. Please
place a dry sterile dressing on the wound each day if there is
drainage, otherwise leave it open to air. Check wound regularly
for signs of infection such as redness or thick yellow drainage.
Staples or sutures will be removed by your doctor at follow-up
appointment approximately 3 weeks after surgery.
## 10. (ONCE AT HOME):
Home , dressing changes as
instructed, and wound checks.
## 11. ACTIVITY:
Weight bearing as tolerated on the operative
extremity. Mobilize with assistive devices ( ) if
needed. Range of motion at the knee as tolerated. No strenuous
exercise or heavy lifting until follow up appointment.
## PHYSICAL THERAPY:
WBAT RLE
No range of motion restrictions
Mobilize frequently
## TREATMENTS FREQUENCY:
daily dressing changes with dry sterile dressing
wound checks daily
elevate operative extremity
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17264921", "visit_id": "28359108", "time": "2142-06-14 00:00:00"} |
12017101-RR-10 | 246 | ## INDICATION:
The patient is a female with low back pain and
radicular symptoms radiating down the left leg. Evaluate for discopathy.
## EXAMINATION:
MR of the lumbar spine without intravenous contrast.
## FINDINGS:
There is preservation of the normal lumbar lordosis. There is no evidence of
malalignment with no evidence of listhesis. There is no vertebral body signal
abnormality. Intervertebral disc heights are maintained with no evidence of
abnormality. The conus terminates normally at T12-L1. There is no cord
signal abnormality demonstrated within the distal spinal cord. There are
multilevel degenerative changes as outlined below:
At the level of L2-L3, there is a minimal circumferential disc bulge. There
is no significant neural foraminal narrowing or central canal stenosis.
At the level of L3-L4, there is a mild circumferential disc bulge. There is
no significant neural foraminal narrowing or central canal stenosis. There is
mild facet arthrosis.
At the level of L4-L5, there is a circumferential disc bulge which just
contacts the exiting left L5 nerve root, and facet arthrosis. There is no
significant neural foraminal narrowing.
At the level of L5-S1, there is a focal disc protrusion. There is no
significant impingement on the exiting nerve roots. There is no significant
neural foraminal narrowing.
There is no paraspinal soft tissue abnormality.
## IMPRESSION:
Mild multilevel degenerative changes as outlined above, most
prominent at the level of L4-L5 where a mild circumferential disc bulge just
contacts the left exiting L5 nerve root.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12017101", "visit_id": "N/A", "time": "2193-02-14 15:26:00"} |
13182868-RR-32 | 198 | ## INDICATION:
woman with new right upper extremity edema and new
chest pain, has PICC.
## RIGHT UPPER EXTREMITY ULTRASOUND:
Grayscale, color, and Doppler ultrasound
was used to evaluate the right basilic, cephalic, brachial, axillary,
subclavian, and internal jugular veins. A PIC catheter is visible extending
from the mid basilic vein, proximally. At this level, there is echogenic
material within the basilic vein, surrounding the catheter, resulting in the
absence of compressibility and decrease of color flow. This is consistent
with acute thrombus. Thrombus extends proximally from the mid basilic vein,
into the axillary and right subclavian veins. Color flow is seen in the right
subclavian vein, but displaced by the nearly occlusive thrombus. A small
amount of thrombus also extends into the right internal jugular vein at its
junction with the subclavian vein.
Thrombus is also present in the right cephalic vein. The brachial veins
demonstrate normal compressibility and flow.
## IMPRESSION:
Acute thrombus along the PICC, extending from the mid basilic
veins proximally into the axillary and subclavian veins. Thrombus is only
partially occlusive in the right subclavian vein. Small amount of thrombus
extends into the right internal jugular vein at its junction with the
subclavian vein.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13182868", "visit_id": "25829230", "time": "2146-02-25 13:51:00"} |
11744705-RR-9 | 127 | ## INDICATION:
year old woman s/p cardiac arrest, intubated. // Evaluate ET
tube placement.
## FINDINGS:
The patient is intubated, the endotracheal tube terminates approximately 2.5
cm above the level of the carina. A gastric tube terminates in stomach.
A right-sided pacemaker is in appropriate position. No pneumothorax seen.
There is a via like opacity at the right lung base likely due to a layering
pleural effusion. There is associated atelectasis, infection cannot be
excluded. Relatively dense material is seen in the stomach, presumably
something the patient ingested. Surgical clips in the upper abdomen
consistent with prior cholecystectomy.
## IMPRESSION:
The endotracheal tube terminates approximately 2.5 cm above the level of the
carina.
Layering pleural effusion with some presumed atelectasis at the right lung
base.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11744705", "visit_id": "21174093", "time": "2168-07-09 16:10:00"} |
13699942-RR-14 | 242 | ## INDICATION:
man with left lower quadrant pain.
## CT ABDOMEN WITHOUT IV CONTRAST:
Lung bases are clear without consolidation or
pleural effusion. There is no pericardial effusion.
In the absence of IV contrast, evaluation of solid abdominal organs is
limited. However, there is no gross abnormality and no interval change in the
liver, gallbladder, pancreas, spleen, adrenal glands, kidneys, stomach and
duodenum. There is no free air in the abdomen.
## CT PELVIS WITHOUT IV CONTRAST:
Oral contrast material has reached the sigmoid
colon. A small amount of oral contrast material remains in the stomach.
However, the proximal small bowel is unopacified at the time of exam. No
abnormalities are noted of the small bowel or colon. The appendix is normal.
There remains a small amount of fluid in the left, dependent pelvis adjacent
to the rectum. Additionally, there is a 7-mm lymph node adjacent to the
rectum, on the right. The rectum itself is well distended with air, without
focal abnormalities. The rectosigmoid junction demonstrates equivocal
inflammatory changes, which could reflect a focal infectious process.
The urinary bladder contains a large amount of excreted contrast. The distal
ureters and prostate gland are unremarkable.
## IMPRESSION:
1. No acute abnormalities of the small bowel or colon following oral contrast
administration. Normal appendix.
2. Small amount of perirectal fluid, 7-mm perirectal lymph node, and
equivocal inflammatory changes at the sigmo-rectal junction and rectum could
reflect a focal infectious or inflammatory process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13699942", "visit_id": "N/A", "time": "2159-05-27 03:17:00"} |
19831176-RR-30 | 318 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old woman with intraventricular hemorrhage getting IT
tpa. Serial exam to assess for interval change .
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
Small right frontal superficial intraparenchymal hemorrhage at the site of
prior right frontal approach ventriculostomy catheter, with a small depressed
bone fragment, are unchanged, with stable mild surrounding edema.
A left frontal ventriculostomy catheter is in unchanged position, terminating
along the lateral margin of the ventricular system near the foramen of .
Trace blood products along the left frontal parenchymal course of the
catheter, image 2:22, stable to slightly decreased since the most recent CT.
The posterior components of the lateral ventricles have slightly decreased in
size since . There is unchanged blood filling and expanding
the third and fourth ventricles, as well as unchanged blood in the occipital
horns of the lateral ventricles.
Hemorrhage centered in a left thalamus appears slightly smaller compared to
several days earlier, with mild associated edema.
The CT demonstrated slightly asymmetric, though likely
artifactual hypodensity projecting over the anterior right temporal lobe. No
asymmetry is seen on the present exam.
There is mild mucosal thickening in the frontoethmoidal recesses and anterior
ethmoid air cells, and partial opacification of bilateral mastoid air cells,
both of which are unchanged since 60 and could be secondary to
prolonged supine positioning in the inpatient setting.
## IMPRESSION:
1. Stable position of left frontal ventriculostomy catheter. Slightly
decreased size of the lateral ventricles. Stable hemorrhage expanding the
third lateral ventricles, and stable hemorrhage layering in the occipital
horns.
2. Parenchymal hemorrhage centered in the left thalamus has slightly decreased
in extent compared to several days earlier.
3. Stable small right frontal superficial parenchymal hemorrhage at the site
of prior right frontal ventriculostomy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19831176", "visit_id": "25589435", "time": "2149-01-30 04:55:00"} |
18995458-DS-14 | 583 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## :
ERCP, sphincterotomy, biliary stent placement
## :
PTC with left PTBD placement
## :
PTC with right anterior PTBD placement
## HISTORY OF PRESENT ILLNESS:
year old man without significant past medical history who was
in his usual state of health until a week prior to admission
when developed diarrhea, dark urine, and jaundice. He presented
to where they performed a CT scan which showed a
hepatic mass. He was discharged to home and then followed up
with his PCP who sent him to . An MRI confirmed
the CT findings of a large right lobe mass, labs with TB 11.9,
AP 641, ALT 125, AST 261; he was seen by gastroenterology, who
referred him to for ERCP.
## PSH:
CCY , Appy , Knee surgery
## FAMILY HISTORY:
Non-significant for malignancy or liver disease
## ABD:
Soft, obese, TTP around drain sites. Bilateral drain sites
c/d/i.
## RECTAL:
non-thrombosed external hemorrhoid in left lateral
position, no fissure or frank blood
## BRIEF HOSPITAL COURSE:
The patient was admitted to the hospitalist service after ERCP
on . Findings revealed malignant appearing stricture at
the hilum and mild intrahepatic dilation. A sphincterotomy and
balloon dilation was successful and a stent was placed into the
right duct. Brushings were obtained and eventually returned as
positive for adenocarcinoma. Tumor markers were checked and
revealed CEA 20, CA , and AFP 4.0. He was placed on
prophylactic ciprofloxacin for cholangitis prophylaxis due to
the high grade stenosis. A triphasic CT scan of the liver that
included the chest and pelvis was obtained on HD 2 and revealed
a 5.8 x 5.9 x 5.2 cm irregularly marginated hypodense mass in
segment VI/VII of the liver abutting the IVC with occlusion of
the right portal vein. There is intrahepatic biliary dilatation
affecting the right system, greater than the left. Borderline
portacaval and porta hepatis lymph nodes as well as 2
non-specific lung nodules up to 7mm. Post-CT scan he was
admitted to the Hepatobiliary service. On HD 3 he went to
interventional radiology where a PTBD was placed into the left
duct. Serial LFTs were checked and with biliary decompression
these improved. He was maintained on IV Unasyn for prophylaxis.
On HD 7 he went back to interventional radiology and a right
PTBD was placed into the right anterior duct and balloon
dilation of the stricture at the proximal CBD was performed and
the ERCP stent was pushed into the duodenum. He was started on
Ursodiol. On HD 8 the bilateral drains were capped and the
antibiotics were changed to PO Ciprofloxacin which he will be
discharged home with. He was complaining of pain over the right
drain as well as rectal pain. Rectal exam revealed a left
lateral external hemorrhoid that was not thrombosed. His pain
regimen was changed to oral dilaudid which better controlled the
pain and he was given Tucks hemorrhoidal cream with improvement.
LFTs on HD 9 trendend down with the drains capped. He continued
to remain afebrile with stable vital signs, he was voiding,
ambulating, and tolerating a regular diet. He was discharged
home with services. He will leave the PTBDs capped and will
follow up with scheduled surgical resection.
## MEDICATIONS ON ADMISSION:
Losartan 50 PO QD
## DISCHARGE INSTRUCTIONS:
Please call Dr. if you have any
fever, chills, nausea, vomiting, jaundice, or increased pain in
abdomen or at drain sites. Please call if capped drain sites
appear red or have drainage.
Continue to change dry gauze dressing daily.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18995458", "visit_id": "23243062", "time": "2176-03-03 00:00:00"} |
15183993-RR-8 | 102 | PREOPERATIVE PA AND LATERAL CHEST, AT 1623 HOURS.
## HISTORY:
Non-Hodgkin's lymphoma, on chronic steroids with new L4 compression
fracture.
## FINDINGS:
Lung volumes are markedly diminished with linear atelectasis seen
in the left lung base. No definite consolidation or effusion is noted. There
is a markedly tortuous aorta. Cardiac silhouette size is difficult to assess,
but is likely top normal for size. No definite effusion or pneumothorax is
evident. The bones are osteopenic; however, no definite compression fractures
are identified within the included regional skeleton.
## IMPRESSION:
Markedly diminished lung volumes with left base atelectasis. No
definite pneumonia or superimposed edema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15183993", "visit_id": "26180217", "time": "2155-02-11 16:13:00"} |
16966974-RR-88 | 245 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
year old woman with symptomatic cholelithiasis// Please
evaluate for cholecystitis
## LIVER:
Again seen is a diffusely echogenic liver parenchyma. The contour of
the liver is smooth. There is a 2.5 x 3.0 x 2.8 cm hyperechoic lesion in the
right lobe of the liver, essentially unchanged compared to prior, consistent
with hemangioma.. The main portal vein is patent with hepatopetal flow. There
is no ascites.
## BILE DUCTS:
There is no intrahepatic biliary dilation.
## GALLBLADDER:
The gallbladder wall is normal in appearance. Again seen is a 6
mm echogenic focus at the gallbladder neck, without posterior shadowing.
Differential for this finding includes cholelithiasis versus gallbladder fold
versus 6 mm gallbladder polyp. Overall, no findings suggestive of acute
cholecystitis.
## PANCREAS:
The head and body of the pancreas are within normal limits. The tail
of the pancreas is not visualized due to the presence of gas.
## KIDNEYS:
Limited views of the kidneys show no hydronephrosis.
Right kidney: 11.6 cm
Left kidney: 12.8 cm
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
1. Gallbladder wall is normal in appearance. Again seen is a 6 mm echogenic
focus at the gallbladder neck, without posterior shadowing. Differential
includes cholelithiasis versus gallbladder fold versus 6 mm gallbladder polyp.
Overall, no findings suggestive of acute cholecystitis.
2. Unchanged hyperechoic lesion in the right lobe of the liver, likely
hemangioma.
3. Unchanged fatty liver.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16966974", "visit_id": "N/A", "time": "2197-02-04 23:14:00"} |
19113885-RR-20 | 788 | ## INDICATION:
year old man with hx of atrial fibrillation// please eval for
possible penetrating aortic ulcer versus dissection
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.0 s, 66.6 cm; CTDIvol = 7.1 mGy (Body) DLP = 474.0
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
mGy-cm.
3) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
mGy-cm.
4) Stationary Acquisition 4.8 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
8.4 mGy-cm.
Total DLP (Body) = 485 mGy-cm.
## HEART AND VASCULATURE:
Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus.
Patient is status post TEVAR with left carotid-subclavian bypass. The bypass
is not included in the study field of view. There is an occlusion device at
the ostium of the native left subclavian artery (2:9). The previously seen
pseudoaneurysm along the aortic arch is excluded and appears smaller since
, now measuring 1.7 x 1.0 cm, previously 2.0 x 1.4 cm (02:28). The
heart is not enlarged. Atherosclerotic calcifications are seen in the aortic
valve. There is no pericardial effusion.
## AXILLA, HILA, AND MEDIASTINUM:
There are a few prominent mediastinal lymph
nodes, likely reactive, measuring up to 1.2 cm (02:41). No axillary or hilar
lymphadenopathy is present. No mediastinal mass.
## PLEURAL SPACES:
No pleural effusion or pneumothorax.
## LUNGS/AIRWAYS:
There are a few scattered cysts throughout the lungs,
unchanged. Clusters of nodular opacities in the right middle lobe
are increased compared to the prior exams dating to (2:65).
Linear atelectasis is noted in the left lower lobe. The airways are patent to
the level of the segmental bronchi bilaterally.
## HEPATOBILIARY:
A few millimetric hypodensities are seen scattered throughout
the liver, likely representing hepatic cysts or biliary hamartomas (2: 85, 93,
94). Otherwise, the liver demonstrates homogenous attenuation throughout.
There is no evidence of concerning 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. Note is made of an accessory spleen.
## 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 are multiple hypodensities in bilateral renal cortices, some of which
are too small to characterize, with the largest measuring 3.1 x 1.3 cm in the
right interpolar kidney, likely simple cyst. Note is made of a 1.0 cm
slightly hyperattenuating lesion in the right upper renal pole, possibly
hemorrhagic cyst (2:104). There is no evidence of hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Colonic
diverticulosis is seen without evidence of acute diverticulitis. Otherwise,
the remaining colon and rectum are within normal limits. The appendix is
normal. There is no free intraperitoneal fluid or free air.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no free
fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The prostate appears unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is ectatic appearance of the infrarenal aorta is without
abdominal aortic aneurysm, measuring up to 2.8 cm (02:32). Moderate
atherosclerotic disease is noted. There is accessory left renal artery.
## BONES:
Patient is status post right hip total arthroplasty. There is no
evidence of worrisome osseous lesions or acute fracture. Degenerative changes
are seen along the visualized spine. Sclerotic foci within the right iliac
bone are unchanged, likely bone islands (02:150).
## IMPRESSION:
1. Post TEVAR. The left carotid-subclavian bypass was not included in the
study. The aortic arch pseudoaneurysm is excluded and appears smaller since
. There is no endoleak.
2. Clusters of nodular pulmonary opacities in the right middle
lobe are increased compared to the prior exams dating to but
appear waxing and waning since at least , suggestive of infection
vs aspiration.
3. Multiple bilateral renal hypodensities, one of which appears
hyperattenuating in the right upper renal pole.
4. Unchanged ectatic infrarenal abdominal aorta, measuring up to 2.8 cm.
## RECOMMENDATION(S):
Nonemergent renal ultrasound is recommended for further
characterization of the right upper pole hyperattenuating lesion.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 17:52 into the Department of Radiology critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19113885", "visit_id": "N/A", "time": "2122-11-20 13:40:00"} |
11633382-RR-91 | 94 | ## INDICATION:
A woman with lymphoma, rule out recurrence.
## OSSEOUS STRUCTURES:
The visible osseous structures show intervertebral disc space narrowing with
endplate sclerosis at L3-L4 and L5-S1. No suspicious lytic or blastic lesions
or fractures are noted.
## IMPRESSION:
1. Interval progression of bilateral opacities with
bronchiectasis, likely related to infectious or inflammatory etiologies. Left
lower lobe 5-mm ground-glass nodule could be related to this process, although
followup scan may be obtained to document resolution.
2. No evidence of lymphoma recurrence.
3. Mild degenerative changes in the lower lumbar spine.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11633382", "visit_id": "N/A", "time": "2153-12-24 10:48:00"} |
18389073-DS-26 | 1,187 | ## ALLERGIES:
Penicillins / Celexa / Ranitidine / Zoloft
## CHIEF COMPLAINT:
Right sided chest pain
## HISTORY OF PRESENT ILLNESS:
year old woman with h/o HTN, PTSD, depression, anxiety, who
presenting with right sided pleuritic chest pain s/p fall one
week ago out of van onto sidewalk where she reportedly hit head
and back. She was seen at and had negative head CT
and pelvis films. She now complains of right sided rib pain
under the right breast which started 3 days ago and she is
having difficulty dressing herself and putting her shoes on.
She presented to her outpatient PCP and her CXR reveals rib fx x
3 , and 8th rib) with displacement of and 8th rib.
She was sent to the ED for trauma surgery evaluation.
.
In the emergency department, initial VS 98.9 75 146/74 16 97.
She received Percocet x 1, Ativan 1mg, Colace, and Atenolol
75mg. UA with sm leuks and few bacteria. She was evaluated by
trauma surgery who recommended pain control and pulmonary
toilet. VS upon transfer 99.1 72 139/50 16 94% RA.
.
On arrival to the floor vital signs were stable. Pt reports
pain with movement. She reports percocet did not help the pain
in the ED. She also reports feeling more depressed since her
fall. Her mood is more down and she has decreased energy. She is
having more trouble sleeping secondary to pain. She denies
trouble concentration, changes in appetite, or SI.
.
## ROS:
+ for ha earlier today now resolved. + for depression. +
for chronic constipation. Neg for chest pain, SOB, cough,
nausea/vomiting/diarrrhea/blood in stool/black stool, abd pain,
weakness/numbness in extremities, edema, dysuria, hematuria.
## PAST MEDICAL HISTORY:
-hypertension
-major depressive d/o
-panic d/o vs. GAD
-PTSD without dissociation
-somatoform pain d/o
-GERD
-chronic tension headaches
-s/p ORIF left hip
## FAMILY HISTORY:
Father committed suicide.
No family history of CAD or SCD.
## GENERAL:
Pleasant, appears in pain with movement
## HEENT:
Normocephalic, atraumatic. No scleral icterus.
PERRL/EOMI. MMM. OP clear. Neck Supple, No LAD.
## CARDIAC:
Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or .
## LUNGS:
CTAB, good air movement biaterally. + pain to palpation
under right breast
## BACK:
brusing over right buttock and over midline, no sinal
tenderness
## ABDOMEN:
+ BS. Soft, NT, ND. No HSM. Guiac negative.
## EXTREMITIES:
No edema or calf pain, 2+ dorsalis pedis
## SKIN:
bruising on back as detailed above
## NEURO:
Appropriate. CN intact. strength throughout.
## CXR:
1) Displaced fractures of the right posterior seventh and eighth
ribs, with a non-displaced fracture of the posterior right sixth
rib.
2) No evidence of pneumothorax.
## ASSESSMENT AND PLAN:
Ms. is an year old woman with
history of hypertension, PTSD, depression, and anxiety who had a
mechanical fall at home one week prior to presentation. She had
gone to an OSH immediately after the fall where a head CT was
negative. She presented to her PCP and was found to have right
sided rib fractures. She was admitted for pain control.
.
#. Rib fractures: Right sided ribs. Displacement in
and 8th rib. There is no evidence of paranchymal injury. She was
evaluated by trauma surgery in ED. They did not feel there were
any acute surgical issues. She was using incentive spirometry.
.
#. Pain control: She was placed on standing acetaminophen 1000
mg TID. Patient also had prn oxycodone. She reported an
improvement in her pain.
.
#. Hypertension: We continued home regimen. Dose of atenolol
confirmed with pharmacy.
.
#. Urinalysis: U/A had WBC, but no bacteria. She was
asymptomatic. We did not treat.
.
#. Psych: History of major depressive, anxiety, and PTSD. We
continued home lorazepam, mirtazepine, paxil, seroquel.
.
#. GERD: Continued home omeprazole.
.
#. Chronic tension headaches: Standing acetaminophen for pain
control.
.
#. Constipation: Continued colace, senna, and lactulose prn. We
gave an enema on the day of discharge.
.
#. FEN: Continued home KCl, multivitamin, and calcium.
.
#. Prophylaxis: She received heparin subcutaneous.
.
#. Physical Therapy: Evaluated by . Safe to go home.
.
#. CODE STATUS: Full code confirmed with patient
.
## MEDICATIONS ON ADMISSION:
-Lidoderm patch 5% once daily
-unclear what eye drops she takes
-calcium 500mg TID
-ATENOLOL 75mg BID
-HYDROCHLOROTHIAZIDE 12.5
-IBUPROFEN - 600 mg Tablet - 1 tab BID PRN
-LACTULOSE - 10 gram/15 mL tsp BID prn
-LISINOPRIL 40MG daily
-LORAZEPAM 0.5 mg BID
-MIRTAZAPINE 45 mg qhs
-OMEPRAZOLE 20 mg daily
-PAROXETINE HCL 40 mg qam
-POTASSIUM CHLORIDE 20 po daily
-QUETIAPINE [SEROQUEL] - 200 mg qhs and 25mg and 2pm
-ACETAMINOPHEN [TYLENOL EXTRA STRENGTH] 500 mg 1 tab q8hrs prn
ha
-ASPIRIN - 325 mg daily
-DOCUSATE SODIUM 100 mg prn
-MULTIVITAMIN daily
-SENNOSIDES 8.6 mg by mouth twice a day
-SODIUM PHOSPHATES [FLEET ENEMA] - 19 gram-7 gram/118 mL Enema
prn
## DISCHARGE MEDICATIONS:
1. Atenolol 50 mg Tablet Sig: 1.5 Tablets PO twice a day.
2. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
3. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Mirtazapine 45 mg Tablet Sig: One (1) Tablet PO once a day.
6. Quetiapine 200 mg Tablet Sig: One (1) Tablet PO once a day.
7. Paroxetine HCl 40 mg Tablet Sig: One (1) Tablet PO once a
day.
8. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO once a day: At
2PM.
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
11. Multivitamin Tablet
## SIG:
One (1) Tablet PO DAILY
(Daily).
12. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
## SIG:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO three
times a day.
14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
15. Lactulose 10 gram/15 mL Syrup Sig: Fifteen (15) ML PO DAILY
(Daily) as needed for constipation.
16. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
17. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day) for 1 weeks: Then take as needed.
18. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours)
as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
Rib fractures
Hypertension
Major depressive disorder
Anxiety
Postraumatic stress disorder
Gastroesophageal reflux
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane)
## DISCHARGE INSTRUCTIONS:
You were found to have rib fractures of your right ribs,
which is giving you pain. You were evaulated by Trauma Surgery
and there is no need for surgery. For now you should take 1000
mg of acetaminophen (Tylenol) three times a day for 1 week.
Then take acetaminophen 1000 mg up to three times a day as
needed. You may also take 2.5 mg of oxycodone every 6 hours as
needed for pain. Oxycodone may make you sleepy. Please do not
take before driving/using heavy machinery.
All your other medications are the same.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18389073", "visit_id": "21654417", "time": "2151-10-30 00:00:00"} |
14288195-RR-52 | 266 | ## INDICATION:
year old man with S/p L Carotid Endarterectomy // I year f/u
s/p Carotid Endarterectomy
## RIGHT:
A stent is again noted in the right CCA/ICA.
The right internal carotid artery has peak systolic velocities of 108 cm/sec
in its proximal portion, 94 cm/sec in its mid portion and 93 cm/sec in its
distal portion.
The right common carotid artery has peak systolic velocities of 123 cm/sec.
The right external carotid artery has peak systolic velocity of 151cm/sec.
Flow in the right vertebral artery is antegrade however note is made that
diastolic flow is absent which is a change from the prior ultrasound of . This appearance could indicate a downstream stenosis.
The right ICA/CCA ratio is 0.88.
## LEFT:
Intimal thickening is seen can be left ICA.
The left internal carotid artery has peak systolic velocities of 90 cm/sec in
its proximal portion, 90 cm/sec in its mid portion and 72 cm/sec in its distal
portion.
The left common carotid artery has peak systolic velocities of 85 cm/sec.
The left external carotid artery has peak systolic velocity of 109cm/sec.
Flow in the left vertebral artery is antegrade.
The left ICA/CCA ratio is 1.06.
## IMPRESSION:
1. ICA/ CCA stent again noted in the right carotid system. No hemodynamically
significant stenosis identified in the right ICA.
2. Abnormal waveform with no antegrade flow in diastole noted in the right
vertebral artery which could indicate a downstream stenosis.
3. Intimal thickening in the left ICA however no hemodynamically significant
stenosis identified.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14288195", "visit_id": "N/A", "time": "2171-11-05 10:25:00"} |
11948187-RR-7 | 96 | ## FINDINGS:
Exam is slightly limited due to difficulty with patient positioning, best
possible views were obtained. The right kidney measures 8.3 cm. The left
kidney measures 9.4 cm. There is a 3.7 x 3.1 x 3.2 cm simple cyst arising
from the upper pole of the left kidney, similar to prior CT. There is no
hydronephrosis, stones, or solid masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
The bladder is only minimally distended and can not be fully assessed on the
current study.
## IMPRESSION:
No hydronephrosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11948187", "visit_id": "29566124", "time": "2116-10-18 16:09:00"} |
19066292-RR-11 | 131 | ## INDICATION:
Painful very indurated lump right anterior chest wall, second rib
for one to two months, x-ray did not show any abnormalities.
## FINDINGS:
Skin markers were placed over the region of the patient's symptoms. This
corresponds to an area of bone marrow and cartilaginous edema, best
appreciated on the axial fluid-sensitive sequences (4:6). There is associated
hyperenhancement in this region (100:15) and the appearances are consistent
with costochondritis at the junction of the second rib with the costal
cartilage. No other areas of abnormal hyperenhancement or bone marrow signal
can be appreciated on this limited study. No large lung masses are detected,
however, MR is poorly sensitive for detection of pulmonary masses. No
mediastinal lymphadenopathy is seen.
## IMPRESSION:
Costochondritis corresponding to the symptomatic region.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19066292", "visit_id": "N/A", "time": "2169-10-12 09:58:00"} |
17144372-RR-65 | 90 | ## INDICATION:
male with headache, on Coumadin. Evaluate for
intracranial hemorrhage.
## FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, or acute
infarction. The gray-white matter differentiation is preserved. The
ventricles and sulci are normal in size and configuration. Note is made of
atherosclerotic calcification in the region of the internal carotid arteries
at the carotid siphons and the left vertebral artery. There is no acute
fracture. The visualized portions of the paranasal sinuses and mastoid air
cells are well aerated.
## IMPRESSION:
No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17144372", "visit_id": "N/A", "time": "2130-11-09 23:03:00"} |
14789632-RR-11 | 122 | ## INDICATION:
male with history of aspiration and recent history
of GI bleed here for evaluation of aspiration.
## DOSE:
Fluoro time: 5 minutes and 6 seconds
## FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There was penetration with swallow of thin and nectar thick
liquid. There was also penetration with swallow of pudding which was cleared
with cough. There was residual liquid posterior to the epiglottis cleared
with cough and chin-tuck maneuver. There was stasis of solid at the esophagus
that eventually cleared. No aspiration.
## IMPRESSION:
Penetration with swallow of pudding, nectar thick, and thin liquid. No
aspiration.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14789632", "visit_id": "24981113", "time": "2168-07-01 09:34:00"} |
19624089-RR-111 | 794 | ## INDICATION:
male with left upper lobe bleeding seen on
bronchoscopy x5. Evaluate for recurrence.
## OPERATORS:
Dr. and Dr.
radiologist performed the procedure. Dr.
supervised the trainee during the key components of the procedure and has
reviewed and agrees with the trainee's findings.
## ANESTHESIA:
Moderate sedation was provided by administrating divided doses of
75mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 95 during which the patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse. 1% lidocaine was injected
in the skin and subcutaneous tissues overlying the access site.
## CONTRAST:
85 ml of Optiray contrast.
## PROCEDURE:
1. Right common femoral artery access
2. Selective arteriogram of common bronchial artery trunk
3. Selective particle embolization (300-500 micron particles) of common
bronchial artery
4. Post-embolization common bronchial trunk arteriogram
5. Selective arteriogram of left internal mammary arteriogram
6. Selective arteriogram of lateral intercostal artery (second order branch of
LIMA)
7. Selective embolization (gelfoam slurry) of lateral intercostal artery
8. Left internal mammary lateral branch is Gel-Foam embolization
9. Post-embolization left internal mammary arteriogram
10. Angioseal closure of right common femoral arteriotomy
## 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 groin was prepped and draped in the usual sterile fashion.
Under palpatory guidance, the right common femoral artery was accessed using a
21 gauge micropuncture Needle. A wire was advanced easily through the
micropuncture sheathinto the aorta. A small skin was made at the skin
entry site. The needle was then exchanged for a 5 sheath which was
attached to a continuous side arm heparinized flush.
Over the , a 5 catheter was advanced up to the level
of the T4 vertebral body and used to cannulate a common bronchial artery
(giving rise to both left and right branches). A small amount of contrast was
injected for confirmation. Subsequently, a Renegade high-flow catheter
was advanced with a 0.016 inch x cm Headliner microwire several cm into
the common bronchial artery. An diagnostic arteriogram was performed in
multiple projections. Following this, a decision was made to perform particle
embolization using 300-500 micron particles. Gentle injection with
intermittent evaluation was performed to acheive reduced flow in the bronchial
arterial bed.
Based on the absence of a sufficient arterial supply to the left upper lobe
from the bronchial artery, a decision was made to also investigate the LIMA
for additional arterial supply. Next, the catheter was removed and
a 5 Vertebral catheter was used to select the left subclavian artery.
Once this was cannulated, a small amount of contrast was injected for
confirmation using careful technique as to not inject air or thrombus. The
Renegade high-flow catheter was subsequently advanced with the Headliner
microwire to select the left internal mammary artery. An arteriogram was
performed. Next, a lateral intercostal artery branch arising from the
proximal portion of the left internal mammary artery was selectively
catheterized. Diagnostic angiography was performed in multiple projections.
Based on this, a decision was made to embolize this branch with Gel-Foam
slurry and post treatment arteriogram was performed.
The catheter was then removed over the wire and the sheath was removed. An
arteriogram of the right common femoral artery was performed, and was deemed
suitable for use of a closure device. Angio-Seal was used to achieve
hemostasis and was successfully deployed. Sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
post-procedure complications. Patient will be monitored in the intensive
care unit and left the interventional radiology suite and stable condition.
## FINDINGS:
1. Diagnostic arteriogram of the common bronchial artery demonstrated variant
anatomy, with a common bronchial trunk arising from the anterior surface of
the aorta supplying both left and right sides. The left branches provided
some small supply to the left upper lobe. No contribution to an anterior
spinal artery was identified on multiple projections (and unlikely to arise
from a common bronchial trunk variant).
2. Selective catheterization and particle embolization of the common
bronchial artery.
3. The left internal mammary artery is of normal course and caliber. A small
branch was seen arising from the proximal portion of the left internal mammary
artery and coursing toward the left apex.
4. Lateral intercostal artery branch arteriogram demonstrated some peripheral
supply to the left upper lobe. Based on this, a decision was made to embolize
this with Gel-foam slurry.
## IMPRESSION:
Successful embolization of the left bronchial artery and lateral intercostal
branch of the left internal mammary artery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19624089", "visit_id": "20969955", "time": "2163-12-24 23:00:00"} |
12762709-DS-5 | 1,237 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## PERTINENT RESULTS:
ADMISSION LABS
===============
10:52AM BLOOD WBC-8.8 RBC-5.43 Hgb-15.9 Hct-48.9 MCV-90
MCH-29.3 MCHC-32.5 RDW-12.9 RDWSD-42.4 Plt
10:52AM BLOOD Neuts-62.6 Monos-8.2 Eos-4.6
Baso-1.0 Im AbsNeut-5.49 AbsLymp-2.04 AbsMono-0.72
AbsEos-0.40 AbsBaso-0.09*
10:52AM BLOOD Glucose-98 UreaN-12 Creat-1.0 Na-139
K-5.5* Cl-106 HCO3-14* AnGap-19*
10:52AM BLOOD Albumin-4.8 Calcium-9.8 Phos-4.1 Mg-2.3
10:52AM BLOOD ALT-16 AST-34 AlkPhos-72 TotBili-0.4
10:52AM BLOOD cTropnT-<0.01 proBNP-17
10:52AM BLOOD TSH-1.3
06:42AM BLOOD Free T4-1.1
10:52AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Tricycl-NEG
12:00PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG oxycodn-NEG mthdone-NEG
DISCHARGE LABS
===============
06:42AM BLOOD WBC-8.6 RBC-5.04 Hgb-14.9 Hct-45.9 MCV-91
MCH-29.6 MCHC-32.5 RDW-13.1 RDWSD-44.3 Plt
06:42AM BLOOD PTT-27.0
06:42AM BLOOD Glucose-97 UreaN-17 Creat-1.1 Na-142
K-4.5 Cl-107 HCO3-23 AnGap-12
06:42AM BLOOD Calcium-9.3 Phos-5.3* Mg-2.3
06:42AM BLOOD ALT-14 AST-13 AlkPhos-67 TotBili-0.2
STUDIES
========
CXR
A 2 cm nodular density in the right perihilar region without
definite
correlate on the lateral view. Given possibility of the
underlying pulmonary nodule, chest CT is suggested to further
characterize.
TTE
The left atrial volume index is normal. There is no evidence for
an atrial septal defect by 2D/color
Doppler. The estimated right atrial pressure is mmHg. The
left ventricle has a normal cavity size.
There is normal regional left ventricular systolic function.
Overall left ventricular systolic function is
low normal. There is beat-to-beat variability in the left
ventricular contractility due to the irregular
rhythm. The visually estimated left ventricular ejection
fraction is 50-55%. Left ventricular cardiac
index is low normal (2.0-2.5 L/min/m2). There is no resting left
ventricular outflow tract gradient. No
ventricular septal defect is seen. Normal right ventricular
cavity size with normal free wall motion. The
aortic sinus diameter is normal for gender with a normal
ascending aorta diameter for gender. There is
no evidence for an aortic arch coarctation. The aortic valve
leaflets (?#) are mildly thickened. There is
no aortic valve stenosis. There is no aortic regurgitation. The
mitral valve leaflets are mildly thickened
with no mitral valve prolapse. There is mild [1+] mitral
regurgitation. The pulmonic valve leaflets are
normal. The tricuspid valve leaflets appear structurally normal.
There is physiologic tricuspid
regurgitation. The estimated pulmonary artery systolic pressure
is normal. There is no pericardial
effusion.
## IMPRESSION:
Frequent ectopy. Low normal left ventricular
systolic function. Mild mitral
regurgitation.No prior study available for comparison.
STRESS EKG
## INTERPRETATION:
This year old man with h/o HTN, HLD and
family
history of pre-mature CAD was referred to the lab for evaluation
of
palpitations. He exercised for 12 minutes on protocol and
stopped
for fatigue. The peak estimated MET capacity is 12.9, which
represents a
good exercise tolerance for his age. No chest, arm, neck, back
discomfort, palpitations or lightheadedness reported. No
significant ST
segment changes noticed. Rhythm was sinus with one isolated APB
and two
isolated VPBs noticed. Appropriate HR and BP response to
exercise and
recovery.
## IMPRESSION:
No malignant arrhythmia, anginal symptoms or
ischemic EKG
changes to the achieved workload. Good functional capacity with
appropriate hemodynamic response to exercise.
## BRIEF HOSPITAL COURSE:
TRANSITIONAL ISSUES
===================
[] Inpatient atrius cardiology consult recommended Zio patch for
outpatient monitoring of arrhythmias given his palpitations. The
patient preferred to leave the hospital and have this placed as
an outpatient.
[] TSH and Lyme testing pending at discharge. These results
should be followed up at his next appointment.
[] Consider chest CT to further characterize a 2 cm nodular
density in the right perihilar region without definite correlate
on the lateral view. Possibility of the underlying pulmonary
nodule.
## ASSESSMENT AND PLAN:
====================
hx HTN, HLD, p/w heart palpitations and lightheadedness,
which he reports were increasing in frequency/duration. EKG
notable for atrial premature beats. He was monitored on
telemetry which was notable for APBs. He was seen by
cardiology while inpatient, who recommended stress test and Zio
patch. Stress EKG was normal w/o worsening of APBs or ischemic
changes. Patient deferred Zio patch to outpatient setting as he
wished to leave the hospital as soon as possible given his
normal stress test. He was instructed to follow up with At
cardiology for an outpatient heart monitor and further
evaluation of his atrial premature beats.
## ACUTE ISSUES:
=============
# palpitations
# presyncope
Pt reported heart palpitations and lightheadedness for past
three weeks. Arrived tachycardic to 100's, received metoprolol
per Atrius cards recs in ED and subsequently became bradycardic
to 40's. EKG notable for atrial premature beats. Echo notable
for frequent ectopy. Etiology of palpitations is unclear. TSH
within normal limits. Patient was counseled regarding excessive
caffeine intake as this may be contributing, but seems unlikely
to be the cause of his APBs. Orthostatic vitals were normal,
thus lightheadedness/presyncope most likely related to
palpitations. He was monitored on telemetry which was notable
for continued APBs. cardiology was consulted, who
recommended stress test and Zio patch. Stress EKG was normal w/o
worsening of APBs or ischemic changes. Patient deferred Zio
patch to outpatient setting as he wished to leave the hospital
as soon as possible given his normal stress test, which we were
in agreement with. He is to follow up with At cardiology on
his own for an outpatient heart monitor.
## CHRONIC ISSUES:
===============
#HTN
Home amlodipine was held in setting of normotension,
lightheadedness. This was resumed on discharge.
HLD
Continued home atorvastatin
#Glaucoma
Continued home eye drops
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. amLODIPine 5 mg PO DAILY
2. Atorvastatin 20 mg PO QPM
3. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS
4. Cetirizine 10 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. amLODIPine 5 mg PO DAILY
2. Atorvastatin 20 mg PO QPM
3. Cetirizine 10 mg PO DAILY
4. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you at the
!
WHY WAS I IN THE HOSPITAL?
==========================
- You were admitted because you felt that your heart was
skipping a beat and we were concerned about your abnormal heart
rhythm
WHAT HAPPENED IN THE HOSPITAL?
==============================
- We monitored you on the heart monitor in the hospital
(telemetry).
- We saw an unusual rhythm on telemetry, so we had the
cardiologist see you, and they were not worried about your heart
rhythm.
- We did a stress test, recommended by the cardiologist who saw
you. This was normal.
- We were unable to get you the heart monitor that the
cardiologist recommended.
WHAT SHOULD I DO WHEN I GO HOME?
================================
- Be sure to take all your medications and attend all of your
appointments listed below.
- Please follow up with a cardiologist ( cardiology phone
number below at to have the heart monitor placed
We wish you the best!
Sincerely,
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12762709", "visit_id": "20759518", "time": "2188-08-29 00:00:00"} |
14858801-RR-20 | 186 | ## INDICATION:
Microcalcifications in the right upper outer deep posterior
breast. Mammographic stereotactic core biopsy was recommended.
## RIGHT:
After a preprocedure timeout with two patient identifiers and the procedure
identified, a written, informed consent was obtained. The risks and benefits
of the procedure were explained to the patient.
The calcifications in the right breast were localized stereotactically with
the patient's arm hole through the table to access the posterior
calcifications. Using standard aseptic technique and 1% lidocaine for local
anesthesia, a small skin incision was made. Pre- and post-fire films were
obtained. Six cores were obtained with a 9 gauge Suros vacuum-assisted biopsy
device.
## SPECIMEN RADIOGRAPH:
A single specimen radiograph shows calcifications in at
least four of the six cores obtained.
## PERCUTANEOUS CLIP PLACEMENT:
A clip was placed at the biopsy site via the 8
gauge coaxial needle.
The patient tolerated the procedure well. There were no immediate
post-procedure complications. The patient was sent home with written and
verbal post-procedure instructions after obtaining a two-view mammogram.
## IMPRESSION:
Technically successful mammographic stereotactic core biopsy with
clip placement. Pathology is pending.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14858801", "visit_id": "N/A", "time": "2185-05-25 10:40:00"} |
19567525-RR-9 | 277 | ## INDICATION:
with pleuritic CP, elevated D-dimer // Eval for PE
## FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no evidence
of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The pulmonary arteries are well opacified to the subsegmental level, with no
evidence of filling defect within the main, right, left, lobar, segmental or
subsegmental pulmonary arteries. The main and right pulmonary arteries are
normal in caliber, and there is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable.
There is no evidence of pericardial effusion. There is no pleural effusion.
There is minimal bibasilar atelectasis. There is no focal consolidation,
effusion or pneumothorax. The airways are patent to the subsegmental level.
Subcentimeter hypodensities throughout the liver left lobe of the liver are
too small to characterize on CT. A 1.3 cm hypodense lesion in the left lobe
is consistent with a hepatic cyst. A 9 mm hypodense lesion in the interpolar
region of the left kidney demonstrates enhancement and is concerning for a
mass.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
## IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality. No pneumonia.
2. 9 mm enhancing lesion in the interpolar region of the left kidney is
concerning for renal cell carcinoma. Further confirmation with MRI is
recommended.
## RECOMMENDATION(S):
MRI of the left kidney recommended due to concern for
renal cell carcinoma
## NOTIFICATION:
Updated impression added to critical results dashboard at 11:06
by Dr. . Email sent to ED QA nurses by Dr. on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19567525", "visit_id": "20545110", "time": "2123-07-27 12:45:00"} |
13154986-RR-22 | 91 | ## HISTORY:
female with new diagnosis of leukemia with elevated
liver function tests that continue to rise despite steroids. Transjugular
liver biopsy requested due to low platelet count.
## RADIOLOGIST:
Procedure was performed by Drs. and
. Dr. attending radiologist was present and
supervised the performance of the entire procedure.
## COMPLICATIONS:
Intravenous piece of broken catheter, 4 x 7 cm, could
not be retrieved. The patient will go to the CT scan suite immediately for
localization, as this fragment is not radiopaque on fluoroscopy.
## IMPRESSION:
Successful transjugular liver biopsy, yielding three fragments.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13154986", "visit_id": "24808389", "time": "2134-07-16 09:56:00"} |
17268943-RR-44 | 105 | ## INDICATION:
year old man with PTX// PTX assessment. **PLEASE DO AT 1400
TODAY PLEASE AND THANK YOU*** PTX assessment. **PLEASE DO AT 1400 TODAY
PLEASE AND THANK YOU***
## IMPRESSION:
Compared to chest radiographs through one.
Small left pneumothorax is larger; lung is at the level of the fourth rib
posteriorly and laterally today, previously at the level of the second
posterior interspace. Extensive subcutaneous emphysema left chest wall is
stable. There is no appreciable left pleural effusion. There is mild
residual edema in the left lung and mild basal atelectasis. Heart size is
normal.
Left pigtail pleural drain has changed slightly in orientation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17268943", "visit_id": "29214645", "time": "2144-11-05 14:14:00"} |
11861978-DS-18 | 1,479 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
shortness of breath, chest pain
## HISTORY OF PRESENT ILLNESS:
s/p VAVD on now with pleuritic chest
pain, shortness of breath/wheezing and "junky" cough, all since
earlier today. The chest pain is substernal and worse with deep
inspiration and began 3 hours ago; the pain does not radiate.
The
cough is new as of this afternoon. She also c/o significant
edema and discomfort. She describes an overall feeling of
malaise
today. She denies fever, nausea, vomiting, diarrhea or
constipation. She does endorse a L-sided dull headache, but
denies RUQ/epigastric pain. She has been urinating a "normal"
amount. She denies sick contacts. Of note, the pt was seen on
in gyn triage for edema and pain and was found to have neg
LENIs.
## OBHX:
- s/p VAVD (nrfht after 2.5 hrs pushing, OP) on of
3475g
male
## GYNHX:
- Remote hx of chlamydia, neg during this pregnancy x 2
## PHYSICAL EXAM:
On admission
VS 98.4 89 138/107, 164/85 18 79RA -> 88RA after deep
inspiration
-> 96 8LNC
NAD, AOx3, sitting upright and conversing easily
RRR
No increased WOB, prominent crackles bilaterally from bases to
apices, expiratory wheezes bilaterally
Abd obese, soft, NT, ND, no r/g, fundus firm 6+cm below
umbilicus
Ext no erythema, 3+ pitting edema BLE, no TTP, WWP
On discharge
AF VSS
NAD
RRR
No increased WOB, CTAB, no crackles
Abd soft, NT, ND, fundus firm 6+cm below umbilicus
Ext no TTP, no edema, WWP
## SENSITIVITIES:
MIC expressed in
MCG/ML
ESCHERICHIA COLI
|
AMPICILLIN
-----
<=2 S
AMPICILLIN/SULBACTAM-- <=2 S
CEFAZOLIN
-----
<=4 S
CEFEPIME
-----
<=1 S
CEFTAZIDIME
-----
<=1 S
CEFTRIAXONE
-----
<=1 S
CIPROFLOXACIN
-----
<=0.25 S
GENTAMICIN
-----
<=1 S
MEROPENEM
-----
<=0.25 S
NITROFURANTOIN
-----
<=16 S
PIPERACILLIN/TAZO
-----
<=4 S
TOBRAMYCIN
-----
<=1 S
TRIMETHOPRIM/SULFA
-----
<=1 S
Respiratory Viral Antigen Screen (Final :
Negative for Respiratory Viral Antigen.
Specimen screened for: Adeno, Parainfluenza 1, 2, 3,
Influenza A, B,
and RSV by immunofluorescence.
Refer to respiratory viral culture for further
information.
Respiratory Viral Culture (Final :
No respiratory viruses isolated.
Culture screened for Adenovirus, Influenza A & B,
Parainfluenza type
1,2 & 3, and Respiratory Syncytial Virus..
Detection of viruses other than those listed above will
only be
performed on specific request. Please call Virology at
within 1 week if additional testing is needed.
Legionella Urinary Antigen (Final :
NEGATIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN.
(Reference Range-Negative).
Performed by Immunochromogenic assay.
A negative result does not rule out infection due to other
L.
pneumophila serogroups or other Legionella species.
Furthermore, in
infected patients the excretion of antigen in urine may
vary.
Imaging
## COMPARISON:
Scout image from a chest CTA of .
## CLINICAL HISTORY:
Recently postpartum with shortness of breath
and chest
pain.
## FINDINGS:
Interval enlargement of the cardiac silhouette,
distention of
azygous vein, and engorgement of pulmonary vessels as compared
to baseline
scout image from . Bilateral asymmetrically
distributed
alveolar opacities are present in the mid and lower lungs, worse
on the right
than the left, and most confluent in the right middle lobe with
resultant
obscuration of the right heart border. Probable bilateral
pleural effusions,
but no visible pneumothorax.
## IMPRESSION:
Bilateral asymmetrical airspace disease, which may
reflect
asymmetrical cardiogenic pulmonary edema from postpartum
cardiomyopathy or
from a pre-existing cardiac condition.
Differential diagnosis for diffuse airspace opacities in the
early post-partum
period also includes amniotic fluid embolism, aspiration
pneumonia, and
widespread infectious pneumonia.
Correlation with cardiac echo may be helpful for initial further
evaluation if
warranted clinically.
## CXR, :
AP CHEST, 5:17 A.M., ON
## HISTORY:
woman with pulmonary edema, now more
tachypneic.
## IMPRESSION:
AP chest compared to :
Moderate-to-severe pulmonary edema has worsened since .
The heart is
only mildly enlarged, so noncardiac causes should be entertained
as well as
cardiac. Pleural effusions are small, unchanged.
I understand the patient is recently postpartum, which raises
the possibility
of amniotic fluid embolus or perinatal cardiomyopathy, or the
effects of
toxemia, all depending upon appropriate clinical circumstances
of course.
## ECHO, :
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. The estimated
pulmonary artery systolic pressure is normal. There is a
trivial/physiologic pericardial effusion.
## IMPRESSION:
Normal regional and global biventricular systolic
function. No pathologic valvular abnormalities. Normal estimated
pulmonary artery systolic pressure.
## FINDINGS:
There is no axillary, hilar, or mediastinal lymphadenopathy.
The heart is
normal in size. The pericardium is intact without evidence of
effusion. The
esophagus is unremarkable.
There are diffuse bilateral ground-glass opacities throughout
the lungs, with
a central predominance. There is also a moderate right-sided
and small
left-sided pleural effusion with adjacent compressive
atelectasis. There is
no evidence of a pneumothorax. The airways are patent to the
subsegmental
levels.
## CTA:
The great vessels and aorta are normal in caliber without
evidence of
dissection or aneurysm. There is no evidence of main, lobar,
segmental,
subsegmental filling defects concerning for pulmonary embolus.
The visualized subdiaphragmatic structures are unremarkable.
## IMPRESSION:
1. No evidence of a pulmonary embolus.
2. Significant, diffuse bilateral ground-glass opacities with a
central
predominance concerning for infection, aspiration, hemorrhage or
edema.
Please correlate clinically.
## BRIEF HOSPITAL COURSE:
Ms. was admitted on after an uncomplicated
vacuum-assisted vaginal delivery on for hypoxemia and
pulmonary edema. She was subsequently found to have a UTI.
#) Pulmonary edema:
On presentation to GYN triage, the patient was hypoxemic with O2
sats in the high on room air, which improved to high
with 8L face mask. ECG was unchanged from prior and did not
demonstrate ACS, acute MI or R-heart strain. Labs revealed BNP
>2500 and troponin I <0.01. Pre-eclampsia labs were drawn given
elevated blood pressures, but the results were difficult to
interpret given concurrent findings of UTI. A portable CXR
demonstrated bilateral pulmonary edema. She received 20mg IV
lasix with improvement in O2 saturations to high on 4L face
mask. Blood pressures improved once an appropriate sized cuff
was used. The patient was then admitted for further evaluation
of her pulmonary edema.
On HD1, a TTE was performed and was within normal limits with a
normal EF (>55%), normal global systolic function and no
elevated pulmonary artery pressures. A repeat CXR demonstrated
worsening pulmonary edema. A cardiology consult was placed, and
consideration of pericarditis was offered, but there was
otherwise low suspicion for peripartum cardiomyopathy given
normal ECHO. On HD2, a CTA was performed and was negative for
pulmonary embolus, but did show ground glass opacities
consistent with pulmonary edema. She was started empirically on
po azithromycin to cover atypical causes of pneumonia, but this
was discontinued prior to discharge given that she remained
without clinical evidence of a pneumonia. Medicine and
pulmonology were both consulted given that the patient continued
to have a persistent O2 requirement on HD2 and 3, and the
etiology for her pulmonary edema remained unclear. She received
a total of 100mg IV lasix with good diuresis, and she was
transitioned to 20mg po lasix BID and then daily with a
successful wean to room air by HD4. She had a net diuresis of
more than 4L. She was given a prescription for 20mg po lasix to
be continued for 2 weeks.
#) UTI:
A UA obtained upon presentation was consistent with UTI, and the
patient was started empirically on IV ceftriaxone which she
continued until HD4. Urine culture returned with E. Coli
species. She required no antibiotics upon discharge.
On , the patient was discharged home in good condition
and maintained O2 saturations on room air. She had outpatient
follow-up scheduled.
## DISCHARGE MEDICATIONS:
1. Docusate Sodium 100 mg PO BID:PRN Constipation
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*30 Capsule Refills:*0
2. Furosemide 20 mg PO DAILY
RX *furosemide [Lasix] 20 mg 1 tablet(s) by mouth once a day
Disp #*14 Tablet Refills:*0
3. Phenazopyridine 100 mg PO TID Duration: 3 Days
RX *phenazopyridine 100 mg 1 tablet(s) by mouth three times a
day Disp #*6 Tablet Refills:*0
## DISCHARGE DIAGNOSIS:
pulmonary edema (water in your lungs)
## DISCHARGE INSTRUCTIONS:
* Take your medications as prescribed (Lasix 20mg by mouth twice
daily)
* Low salt diet
Nothing in the vagina for 6 weeks (No sex, douching, tampons)
Do not drive while taking Percocet
Do not take more than 4000mg acetaminophen (APAP) in 24 hrs
Do not take more than 2400mg ibuprofen in 24 hrs
Please call if you develop shortness of breath, dizziness,
palpitations, fever of 101 or above, abdominal pain, heavy
vaginal bleeding, nausea/vomiting or any other concerns
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11861978", "visit_id": "22142985", "time": "2134-05-17 00:00:00"} |
10381829-RR-15 | 467 | ## EXAMINATION:
CTA HEAD AND NECK WITH PERFUSION PQ149 CT HEADNECK
## INDICATION:
patient status post resection of a left temporal and
insular mass on , hemiparesis. Evaluate for acute infarct.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 16.8 s, 8.0 cm; CTDIvol = 206.2 mGy (Head) DLP =
1,649.7 mGy-cm.
3) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 38.1 mGy (Head) DLP =
19.1 mGy-cm.
4) Spiral Acquisition 5.5 s, 43.2 cm; CTDIvol = 32.0 mGy (Head) DLP =
1,382.2 mGy-cm.
Total DLP (Head) = 3,954 mGy-cm.
## FINDINGS:
Dental amalgam streak artifact limits study.
## CT HEAD WITHOUT CONTRAST:
There are postsurgical changes related to resection of a left temporal and
insular mass with extracranial soft tissue swelling with hemorrhage and fluid,
7 mm left frontal hypodense fluid collection, with sulcal effacement and
surrounding edema with stable 6 mm rightward midline shift. Approximately 8
mm maximum diameter extracranial fluid collection is noted the overlie the
craniotomy site (see 02:19). There is no evidence of new hemorrhage. There
is no discrete CT abnormality to correlate with left lenticulostriate subacute
infarction seen on subsequent head MRI. The paranasal sinuses appear clear.
## CT HEAD PERFUSION:
There is a left lentiform nucleus matched defect between the cerebral blood
volume and mean transit time , 11). In addition, there is a matched
defect within the left temporal lobe corresponding to the surgical resection
site.
## CTA HEAD:
The left superior division M2 segment of the middle cerebral artery
demonstrates attenuation (4: 262). Otherwise, the intracranial vasculature
appears patent without evidence of stenosis, occlusion, or aneurysm.
## CTA NECK:
There is common origin of the brachiocephalic and left common carotid artery.
The bilateral carotid and vertebral arteries appear patent with the internal
carotid artery stenosis by NASCET criteria. There is no evidence of
dissection.
## OTHER:
There is a left thyroid gland heterogeneous lesion measuring 4.2 x 4.1 cm
(4:62) with areas of scattered calcifications. There is right apical pleural
scarring. There is no lymphadenopathy per size criteria.
## IMPRESSION:
1. Dental amalgam streak artifact limits study.
2. Status post resection of a left temporal and insular mass with postsurgical
changes, as described above with stable 6 mm rightward midline shift, and
approximately 8 mm extracranial fluid collection overlying surgical bed.
3. Left lenticulostriate corresponding CT perfusion images demonstrate a
match defect.
4. Matched perfusion defect within the left temporal lobe and insula
correspond to surgical resection cavity.
5. Attenuated left superior division M2 segment of the middle cerebral artery.
Otherwise, patent circle of .
6. No internal carotid artery stenosis by NASCET criteria.
7. Re-demonstration of patient's known left thyroid gland lesion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10381829", "visit_id": "21090381", "time": "2137-03-21 10:02:00"} |
12106911-RR-24 | 329 | ## INDICATION:
with chest pain, hypoxia // PE?
## FINDINGS:
The aorta and its major branch vessels are patent, with no evidence of
stenosis, occlusion, dissection, or aneurysmal formation. There is no evidence
of penetrating atherosclerotic ulcer or aortic arch atheroma present.
The patient is status post right pneumonectomy with an appropriate interval
increase in the air-fluid level. Multiple filling defects are noted within
the left-sided pulmonary arteries, specifically: thrombus is seen in the
distal lobar pulmonary artery and into the segmental branch of the left upper
lobe. Additionally, multiple emboli are seen within the left lower segmental
branches and into the subsegmental branches. The main pulmonary artery is
normal in caliber, and there is no evidence of right heart strain.
There is no evidence of pericardial effusion.
A small bleb is seen in the apex of the left lung. There is no pleural
effusion within the left lung. The airways are patent to the subsegmental
level within the left lung.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
A few scattered subcentimeter prevascular and right paratracheal nodes are
unchanged. Left-sided axillary lymph nodes are subcentimeter but enlarged
since prior. The included thyroid gland appears unremarkable. Right chest wall
port is seen with catheter tip in the right atrium. There is a small hiatal
hernia.
Although this study is not designed for the evaluation of subdiaphragmatic
structures, a re- demonstrated right adrenal nodule appears unchanged.
Diverticulosis is seen within the colon. Multiple simple cysts are seen within
the left kidney.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
Right-sided thoracotomy changes are noted.
## IMPRESSION:
1. Multiple left upper and lower pulmonary emboli with no evidence of right
heart strain.
2. Patient is status post pneumonectomy with expected postop changes.
3. Subcentimeter right axillary lymph nodes have enlarged since prior,
nonspecific, but followup on subsequent exam is suggested.
## NOTIFICATION:
Additional finding of axillary nodes discussed by Dr.
with Dr. at 17:00 on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12106911", "visit_id": "23760023", "time": "2169-04-26 13:13:00"} |
11597448-DS-20 | 726 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Left hip intramedullary nail , Dr.
## HISTORY OF PRESENT ILLNESS:
hx HTN and dementia s/p mechanical fall at nursing,
unwitnessed, ?HH, no LOC. c/o L hip and R hand pain. HD stable
on presentation, pt demented/unable to provide hx at baseline -
denies weakness, numbness, parasthesias to LLE distally.
Ambulates minimally around nursing home to bathroom and dining
room w walker, non community ambulator.
## PAST MEDICAL HISTORY:
HTN
dementia
Hemorrhoids
compression fx spine
anxiety
PAD
hypothyroid
depression
anemia
insomnia
## VITALS:
98.4 101 128/61 22 98% RA
Left lower extremity:
- Skin intact
- No deformity, erythema, edema, induration or ecchymosis
- leg shortened and flexed, held in ext rotation
- equivecal logroll/SLR
- Soft, non-tender thigh and leg
- Full, painless AROM/PROM of knee and ankle
- fire
- SILT SPN/DPN/TN/saphenous/sural distributions
- 1+ pulses, foot warm and well-perfused
## BRIEF HOSPITAL COURSE:
The patient presented to the emergency department and was
evaluated by the orthopedic surgery team. The patient was found
to have left hip fracture and was admitted to the orthopedic
surgery service. She also sustained a R thumb metacarpal base
fracture, which was managed by Plastic Surgery in a thumb spica
splint. The patient was taken to the operating room on
for L hip intramedullary nail, which the patient tolerated well.
For full details of the procedure please see the separately
dictated operative report. The patient was taken from the OR to
the PACU in stable condition and after satisfactory recovery
from anesthesia was transferred to the floor. The patient was
initially given IV fluids and IV pain medications, and
progressed to a regular diet and oral medications by POD#1. The
patient was given antibiotics and anticoagulation
per routine. She received 1u PRBC postoperatively for Hct 23.5.
Her Hct responded appropriately and remained stable. The
patient's home medications were continued throughout this
hospitalization. The patient worked with who determined that
discharge to rehab was appropriate. The hospital
course was otherwise unremarkable.
At the time of discharge the patient's pain was well controlled
with oral medications, incisions were clean/dry/intact, and the
patient was voiding/moving bowels spontaneously. The patient is
weight bearing as tolerated on the left lower extremity, and
will be discharged on Lovenox for DVT prophylaxis. The patient
will follow up with Dr. routine. The patient
should also follow up with Dr. (Hand Surgery). The
patient was given written instructions concerning postoperative
precautions and the appropriate follow-up care. The patient
expressed readiness for discharge.
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H
2. Amlodipine 10 mg PO DAILY
3. Docusate Sodium 100 mg PO BID
4. Levothyroxine Sodium 12.5 mcg PO DAILY
5. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain
RX *oxycodone 5 mg tablet(s) by mouth every four (4) hours
Disp #*60 Tablet Refills:*0
6. Vitamin D 1000 UNIT PO DAILY
7. Enoxaparin Sodium 40 mg SC QPM Duration: 2 Weeks
## TODAY - , FIRST DOSE:
Next Routine Administration
Time
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY:
- You were in the hospital for orthopedic surgery. It is normal
to feel tired or "washed out" after surgery, and this feeling
should improve over the first few days to week. - Resume your
regular activities as tolerated, but please follow your weight
bearing precautions strictly at all times.
## ACTIVITY AND WEIGHT BEARING:
- Weight bearing as tolerated left lower extremity
## MEDICATIONS:
- Please take all medications as prescribed by your physicians
at discharge.
- Continue all home medications unless specifically instructed
to stop by your surgeon.
- Do not drink alcohol, drive a motor vehicle, or operate
machinery while taking narcotic pain relievers.
- Narcotic pain relievers can cause constipation, so you should
drink eight 8oz glasses of water daily and take a stool softener
(colace) to prevent this side effect.
## ANTICOAGULATION:
- Please take lovenox 40mg daily for 2 weeks
## WOUND CARE:
- You may shower. No baths or swimming for at least 4 weeks.
- Any stitches or staples that need to be removed will be taken
out at your 2-week follow up appointment.
- No dressing is needed if wound continues to be non-draining.
## TREATMENTS FREQUENCY:
Dry sterile dressing daily or as needed for staining
Staples to be removed at first follow up appointment
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11597448", "visit_id": "25700496", "time": "2170-03-09 00:00:00"} |
15316825-RR-7 | 119 | ## INDICATION:
Preoperative x-ray. Open fracture dislocation of the ankle.
## FINDINGS:
Lung volumes are low. No focal opacity to suggest pneumonia is
seen. There is likely retrocardiac atelectasis. No significant pleural
effusion is seen. No pneumothorax or pulmonary edema. There are fractures of
the left posterolateral eighth and ninth ribs. The left eighth rib
demonstrates callus formation. The ninth rib fracture is less clearly remote
though appears similar in location to the eighth rib fracture and may be from
the same event.
## IMPRESSION:
No evidence of acute cardiopulmonary process. Two left-sided rib
fractures, one of which is clearly remote, the other of indeterminate age.
Clinical correlation recommended.
Findings discussed with Dr. at 7:00 p.m. .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15316825", "visit_id": "28278639", "time": "2166-01-30 18:16:00"} |
14001731-RR-26 | 138 | MAMMOGRAPHIC WIRE LOCALIZATION OF LEFT BREAST
## INDICATION:
Patient was referred for preoperative mammographic wire
localization of a biopsy-proven left breast carcinoma.
The procedure, risks and benefits were explained to the patient and written
informed consent was obtained. A preprocedure timeout was performed using two
patient identifiers.
A clip within the biopsied mass was localized on two orthogonal projections.
Using standard aseptic technique, a 7.5-cm needle was placed through the
biopsied mass. Needle position was confirmed on two orthogonal projections.
Subsequent to this, a wire was placed with the stiffener against the biopsy
marking clip. Wire position was confirmed on two orthogonal planes of
imaging. The patient tolerated the procedure well without any immediate
complications. Annotated printed images were sent with the patient to the
operating room.
## IMPRESSION:
Successful mammographic wire localization of left breast.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14001731", "visit_id": "28668276", "time": "2175-03-30 09:39:00"} |
19957526-RR-28 | 99 | ## FINDINGS:
As compared to the previous examination, the appearance of the
left-sided ribs is unchanged. There is contour irregularity but no safe
evidence of overt rib fractures.
A minimal left apical pneumothorax is seen on today's examination, there are
no signs of tension.
Unchanged relatively extensive retrocardiac opacity, most likely representing
atelectasis, and better seen on the lateral than on the frontal radiograph.
No interval occurrence of focal parenchymal opacities.
At the time of dictation, on , 9:37 a.m., the referring
physician, was paged for notification. The findings were
discussed over the telephone subsequently.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19957526", "visit_id": "N/A", "time": "2112-08-04 08:20:00"} |
15710798-DS-10 | 2,530 | ## ALLERGIES:
Penicillins / Sulfa (Sulfonamide Antibiotics) / antiemetics /
Influenza Virus Vacc,Specific / Risperdal / droperidol / latex /
ondansetron
## CHIEF COMPLAINT:
L Hip and Low back pain, Urinary incontinence
## HISTORY OF PRESENT ILLNESS:
is a with PNES and possible prior seizures,
depression, anxiety, hypothyroidism, migraines, here with acute
on chronic left hip and low back pain
in setting of physical exertion.
Patient reports that she has had left hip and low back pain
intermittently over the last years. She presented to the ED
several times and received CT scans of her hip that were
unremarkable. She has had previous MRIs in which showed
degenerative disc changes at the L4-L5 junction and foraminal
stenosis at the L5-S1 junction with moderate impingement on the
left L5 nerve root.
Several weeks ago she began to have this pain again especially
at
night, awakening her from sleep when she would roll onto her
left
lateral thigh. In the last 2 days she has had abrupt increase in
her pain to the point where she has pain initially
bilateral inguinal areas and later with a focal area of
tenderness on her lateral thigh. She was seen by her orthopedics
doctor yesterday who referred her to the ER for emergent MRI for
cauda equina syndrome.
At baseline, she does not leave the apartment and cannot walk
secondary to pain. Her husband reportedly does everything for
her, and she has visiting RN who comes daily. She also reports
an acute worsening pain if she was sitting for too long. For
example, if she's in the car for too long she cannot move for
about 10 min pain and weakness.
In the E.D., patient reported some acute worsening of urinary
incontinence.
In the ED:
- Initial vital signs were: Pain 98.0 74 136/86 18 98% RA
- Exam notable for:
TTP in left lateral buttock region; pain with PROM external
rotation worse than internal rotation
## LLE:
strength at hips, knees, ankle with diminished
sensation
distal to knee;
## RLE:
strength at hips, knees, ankle with full sensation
## CODE CORD PHYSICAL EXAM:
in b/l UE and RLE. In L leg, with GW on the left IP and
quad, will not give good effort on hamstring then refuses
testing
of this muscle, TA with GW, gastroc, with
GW.
50% of LT on the left under the knee. PP slightly decreased
below
the knee but returns in the foot. Hyperesthesia over the thigh.
No sensory level over torso and no saddle anesthesia. Reflexes
are brisk, no clonus. Toes down on the right, mute on the left.
- Labs were notable for:
WBC wnl, Abs Eos 200, U/A with 17 epis
Na 134
- Studies performed include:
MR and L-Spine W &W/O Contrast
## - PATIENT WAS GIVEN:
Reglan PRN IV, clonazepam, tizanidine,
morphine IV prn.
## - CONSULTS:
Code cord called for L leg pain, weakness,
intermittent urinary incontinence. MRI unrevealing, neurology
rec'ed admission to medicine for pain control.
- Vitals on transfer:
Pain 2 Tc: 98.8 HR: 84 BP: 127/87 RR: 20 100% RA
Upon arrival to the floor, the patient was lying seemingly
comfortable in bed. When prompted, patient reported pain.
She said she didn't get pain meds since this morning because
there was a shortage of Dilaudid and morphine didn't alleviate
pain.
Pain increases with ambulation, prolonged standing, upright
activity, rising from a chair, climbing stairs, ascending
inclines, and with direct pressure when lying on the painful
side.
She also endorsed urinary incontinence, but reported it was a
chronic issue in which she would be incontinent with a small
amount of urine with coughing, laughing, sneezing and also
periodically at night.
## PAST MEDICAL HISTORY:
- events concerning for seizure
-Migraine
-Depression
- treated with ECT every other
- has R chest port, "I have bad veins"
-Anxiety
-Hypothyroidism
-Insomnia
-Fibromyalgia
-ADD w/o hyperactivity
-Bipolar disorder
## MOTHER:
died of multiple myeloma
## SISTER:
y/o, has seizure disorder that started in her
## SON:
years old, had febrile seizures at 18 months
## HEENT:
NC/AT, EOMI, PERRLA, no scleral icterus noted, moist
mucous membranes
## PULMONARY:
CTAB, No increased work of breathing.
## EXTREMITIES:
+SLR, + Pain with hip flexion, external rotation of
left hip causes point tenderness on lateral thigh; bilateral
internal rotation of hip causes inguinal pain
## BACK:
+Paraspinal tenderness around L4-L5. No spinal deformity.
## GU:
++ Intact perianal sensation.
Rectal tone diminished per ED.
## CN:
II-XII grossly tested and intact
## MOTOR:
upper strength bilaterally. No pronator drift.
Left leg pain with active and passive motion. ++ Cogwheeling
Left lateral thigh with extremely mild focal ?edema fluid
collection?
Right leg strength; normal ROM, no pain with external
rotation, mild pain with internal rotation in inguinal region
## GAIT:
Deferred, Patient declined pain.
Per Neuro exam:
## SENSORY:
50% of LT on the left under the knee. PP slightly decreased
below
the knee but returns in the foot. Hyperesthesia over the thigh.
No sensory level over torso and no saddle anesthesia.
Skin deformation, sensory level L4-L5
For pinprick, sensory level is L4-L5
Vibration intact throughout
## DTRS:
Toes are [x] downgoing R [x] mute L; No clonus
Bi Tri Br Pat Ach
[C5-6] [C6-7] [C5-6] [L3-4] [S1]
L 2 1
R 2 1
## HEENT:
NC/AT, EOMI, PERRLA, no scleral icterus noted, moist
mucous membranes
## PULMONARY:
CTAB, No increased work of breathing.
## EXTREMITIES:
in all muscle groups in L leg, no sensory
deficits to light touch.
## MICRO:
===================
Urine culture negative
## FINDINGS:
The examination is moderate to severely degraded by patient
motion. Within
this confine:
## THORACIC:
The thoracic vertebral body heights are grossly maintained.
Sagittal spinal
alignment is maintained. There is no suspicious bone marrow
signal identified.
There is no evidence for appreciable canal stenosis or neural
foraminal
narrowing within the thoracic spine. Mild epidural lipomatosis.
There are questionable areas of linear T2 hyperintensity within
the central
cord, which may reflect mildly prominent central canal, although
evaluation is
limited by patient motion. For example, at the level of T8-T9
(6: 11).
## LUMBAR:
Moderately degraded exam by motion.
Vertebral body heights are maintained. Vertebral body alignment
is within
normal limits, without evidence for subluxation.
2 benign hemangiomas, larger at L1 vertebral body. Otherwise,
no concerning
bone marrow lesions are identified. The conus medullaris
terminates at the
level of L1.
T12-L1 through L3-L4: There is no spinal canal or neural
foraminal stenosis.
## L4-L5:
Mild posterior disc bulging is seen with leftward
asymmetry flattening
the ventral thecal sac without significant canal narrowing.
However, there is
left greater than right subarticular recess narrowing with mild
left neural
foraminal narrowing at this level.
## L5-S1:
Mild, asymmetric right-sided posterior disc bulging is
noted without
significant canal narrowing, but with mild bilateral
subarticular recess
narrowing, mild right and moderate left neural foraminal
narrowing. The disc
bulge at this level contacts the left greater than right exiting
L5 nerve
roots.
There is no evidence for abnormal intramedullary,
leptomeningeal, or epidural
enhancement. Several T2 hyperintense renal cysts are noted
bilaterally.
Dilated common bile duct, 0.7 cm, correlate with LFTs to exclude
obstruction.
Small bilateral pleural effusions. Suggestion of 1 cm left
thyroid nodule, no
follow-up is indicated. Mild edema posterior left paraspinal
musculature,
and/or fatty atrophy. Distended bladder.
## IMPRESSION:
1. Moderate to severely motion degraded examination.
2. No abnormal enhancement or epidural collection.
3. Multilevel degenerative changes, as above.
4. Several equivocal thoracic cord subtle T2 signal
abnormalities versus
artifact. No evidence for associated enhancement.
5. Mildly prominent common bile duct, correlate with LFTs if
indicated.
6. Mild edema and/or fatty atrophy posterior left paraspinal
musculature.
7. Distended bladder.
## RECOMMENDATION(S):
Check LFTs if indicated.
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.
CHEST (PORTABLE AP) Study Date of 5:48
The tip of the right Port-A-Cath is in the mid SVC. There is no
consolidation. The heart is normal in size. The trachea is
midline. There
is no large pleural effusion.
BILAT HIPS (AP, LAT, & PELVIS) 5 OR MORE VIEWS Study Date of
3:44
Right hip: There is no evidence of fracture or dislocation. No
focal lytic or
sclerotic lesions are seen. No soft tissue calcification or
radiopaque
foreign bodies identified. Mild degenerative changes are seen
with evidence
of joint space sclerosis and narrowing.
Left hip: No evidence of fracture or dislocation. No focal
lytic or sclerotic
lesions are seen. No soft tissue calcification or radiopaque
foreign bodies
identified. Mild degenerative changes are seen, with evidence
of joint space
sclerosis and narrowing.
## IMPRESSION:
No evidence of fracture or dislocation. Mild bilateral
degenerative changes
are seen within the hips, left greater than right.
## DISCHARGE LABS:
06:30AM BLOOD WBC-4.2 RBC-3.55* Hgb-10.5* Hct-32.8*
MCV-92 MCH-29.6 MCHC-32.0 RDW-13.9 RDWSD-46.8* Plt
06:30AM BLOOD Glucose-87 UreaN-17 Creat-0.9 Na-139
K-4.1 Cl-103 HCO3-23 AnGap-13
05:51AM BLOOD ALT-13 AST-15 CK(CPK)-68 AlkPhos-80
TotBili-0.2
06:30AM BLOOD Calcium-8.2* Phos-3.9 Mg-1. with PNES and possible prior seizures, depression, anxiety,
hypothyroidism, migraines, here with acute on chronic left
lateral thigh pain, now s/p code cord without cord compression
on thoracic and lumbar MRIs.
#Greater Trochanteric Pain Syndrome
#Leg Pain and weakness
Abrupt onset of lateral left leg pain, responded well to
lidocaine and steroid injection to bursa. The MRI of thoracic
and lumbar was reassuring for neoplasm, infection, and showed
multilevel degenerative changes. Seen by neurology who felt no
objective weakness and no acute neurologic cause. Was seen by
rheumatology who felt pain was most likely trochanteric bursitis
(which was injected with good effect) and possible component of
hip arthritis. X ray of hip showed mild arthritis. Patient was
advised not to use NSAIDs given risk for . evaluated and
cleared for home with home .
#Urinary retention
PVR 600 on . Subsequent PVR < 200. As above, no indication
of cauda equina or cord compression on MRI. Likely medication
induced, although unclear precipitant.
## # :
presented with mild on HD2, likely poor PO prior
to admission and in ED, resolved with PO. Discharge creatinine
as above.
## FOR BILLING PURPOSES ONLY:
>30 minutes spent on patient care and
coordination on discharge day.
## TRANSITIONAL ISSUES:
[ ] Patient will require at home and rolling walker
[ ] Urinary retention: Patient on multiple medications which
could cause urinary retention, this should continue to be
evaluated by outpatient prescribers.
[ ] Cogwheeling noted on exam during stay. Recommend following
up on exam to see if persistent.
[ ] Thyroid nodule seen on MRI. Patient notified. 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.
[ ] Dilated common bile duct, 0.7 cm seen on MRI, consider
dedicated MRCP for further evaluation. Patient notified.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Benztropine Mesylate 0.5 mg PO QPM
2. Levothyroxine Sodium 112 mcg PO DAILY
3. Omeprazole 20 mg PO DAILY
4. OXcarbazepine 600 mg PO BID
5. rOPINIRole 0.25 mg PO BID
6. Senna 8.6 mg PO BID:PRN constipation
7. Tizanidine 4 mg PO BID:PRN pain
8. Topiramate (Topamax) 200 mg PO BID
9. Zolpidem Tartrate 5 mg PO QHS:PRN sleep
10. CloNIDine 0.2 mg PO QPM
11. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing
12. Calcium 500 + D (calcium carbonate-vitamin D3) 500
mg(1,250mg) -200 unit oral DAILY
13. Promethazine 12.5 mg PO Q4H:PRN headache
14. QUEtiapine extended-release 300 mg PO DAILY
15. ClonazePAM 0.5 mg PO BID
16. Temazepam 15 mg PO QHS
17. Temazepam 15 mg PO QHS:PRN if 1st dose doesn't work
18. Escitalopram Oxalate 20 mg PO DAILY
19. Magnesium Oxide 400 mg PO DAILY
20. Ibuprofen 800 mg PO BID
21. Acetaminophen-Caff-Butalbital 1 TAB PO DAILY
22. Ipratropium Bromide MDI 2 PUFF IH QID:PRN wheezing
23. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH DAILY:PRN
wheezing
24. Melatin (melatonin) 10 mg oral QHS
25. Zolpidem Tartrate 10 mg PO QHS
26. TraMADol 50 mg PO TID:PRN Pain - Moderate
## DISCHARGE MEDICATIONS:
1. Acetaminophen-Caff-Butalbital 1 TAB PO DAILY
Do not exceed 6 tablets/day
2. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing
3. Benztropine Mesylate 0.5 mg PO QPM
4. Calcium 500 + D (calcium carbonate-vitamin D3) 500
mg(1,250mg) -200 unit oral DAILY
5. ClonazePAM 0.5 mg PO BID
6. CloNIDine 0.2 mg PO QPM
7. Escitalopram Oxalate 20 mg PO DAILY
8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH DAILY:PRN
wheezing
9. Ipratropium Bromide MDI 2 PUFF IH QID:PRN wheezing
10. Levothyroxine Sodium 112 mcg PO DAILY
11. Magnesium Oxide 400 mg PO DAILY
12. Melatin (melatonin) 10 mg oral QHS
13. Omeprazole 20 mg PO DAILY
14. OXcarbazepine 600 mg PO BID
15. Promethazine 12.5 mg PO Q4H:PRN headache
16. QUEtiapine extended-release 300 mg PO DAILY
17. rOPINIRole 0.25 mg PO BID
18. Senna 8.6 mg PO BID:PRN constipation
19. Temazepam 15 mg PO QHS
20. Temazepam 15 mg PO QHS:PRN if 1st dose doesn't work
21. Tizanidine 4 mg PO BID:PRN pain
22. Topiramate (Topamax) 200 mg PO BID
23. Zolpidem Tartrate 5 mg PO QHS:PRN sleep
24. Zolpidem Tartrate 10 mg PO QHS
25. HELD- Ibuprofen 800 mg PO BID This medication was held. Do
not restart Ibuprofen until told to by your doctor
26. HELD- TraMADol 50 mg PO TID:PRN Pain - Moderate This
medication was held. Do not restart TraMADol until told to by
your doctor
27.Rolling Walker
## DISCHARGE DIAGNOSIS:
Primary Diagnosis
Greater Trochanter Pain Syndrome
Secondary Diagnosis
Bipolar disorder
Chronic back pain
anxiety
depression
fibromyalgia
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Dear
It was a pleasure taking care of you during your stay at .
WHY WAS I HERE?
- You were having leg pain and trouble urinating
WHAT WAS DONE WHILE I WAS IN THE HOSPITAL?
- You had an MRI of your back that showed your spinal cord was
okay
- You had a steroid injection to help your leg pain
WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL?
- You should go to see your PCP, , and orthopedic
doctor
- Avoid submerging your hip in water for three days (bath
tub/pool etc).
Be well!
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15710798", "visit_id": "28539251", "time": "2171-07-06 00:00:00"} |
12823806-RR-81 | 106 | ## HISTORY:
with complex medical hx p/w chest tightness // r/o
pna, ptx, edema
## FINDINGS:
The cardiomediastinal silhouette is unchanged. A rounded opacity within the
left upper lobe likely reflects residual opacification surrounding the known
left upper lobe pulmonary nodule, which has improved from the most recent
prior study. Mild bibasilar atelectasis. No new focal consolidations. The
bilateral costophrenic angles are excluded from the images, limiting
evaluation. No large pleural effusions. No pneumothorax.
## IMPRESSION:
Interval improvement in a rounded opacity of the left upper lobe, likely
reflecting a combination of residual opacification surrounding the known left
upper lobe pulmonary nodule. No new focal consolidations.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12823806", "visit_id": "21610502", "time": "2181-11-07 00:01:00"} |
15365753-RR-40 | 187 | ## EXAMINATION:
CTA CHEST WANDW/O CANDRECONS, NON-CORONARY
## INDICATION:
with history of aortic dissection presenting with acute chest
pain. Evaluate for progression of dissection.
## CHEST CTA:
A short-segment focal dissection in the mid to distal descending thoracic
aorta (02:46) is unchanged compared to . The aortic arch and
descending thoracic aorta demonstrate next atherosclerotic plaque, without
aneurysmal dilatation. The pulmonary arteries opacified to the subsegmental
level without filling defect.
## CHEST:
The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar lymph
nodes are not pathologically enlarged. The heart and mediastinum are normal.
The pericardium is intact without effusion. Airways are patent to the
subsegmental levels.
The lung parenchyma demonstrates biapical scarring which is mild. There is no
large consolidation or mass. No pleural effusion or pneumothorax.
The distal esophagus and limited views of the upper abdomen are remarkable for
interpolar and upper pole cysts in the left kidney.
## OSSEOUS STRUCTURES:
No focal lytic or sclerotic lesion concerning for
malignancy.
## IMPRESSION:
1. Unchanged appearance of focal dissection in the mid to distal descending
thoracic aorta compared to . No new acute aortic pathology.
2. No pulmonary embolus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15365753", "visit_id": "29351938", "time": "2198-02-25 03:16:00"} |
14778421-RR-82 | 137 | ## HISTORY:
with renal txplt, swelling// transplant eval,
thrombosis
## FINDINGS:
There is redemonstration of moderate hydronephrosis. There is a small amount
of perinephric free fluid.
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal.
The resistive index of intrarenal arteries ranges from 0.6-0.8. The main
renal artery shows a normal waveform, with prompt systolic upstroke and
continuous antegrade diastolic flow, with peak systolic velocity of 95
centimeters/second. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
## IMPRESSION:
1. Redemonstration of moderate renal transplant hydronephrosis. Small amount
of perinephric free fluid.
2. Patent renal transplant vasculature. Resistive indices range from 0.6-0.8.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14778421", "visit_id": "25006393", "time": "2169-05-15 14:07:00"} |
14232310-RR-20 | 104 | ## HISTORY:
CABG, AVR, evaluate for interval change and effusions.
CHEST, SINGLE AP PORTABLE VIEW, LORDOTIC POSITIONING.
Compared with , multiple lines and tubes and Swan-Ganz catheter have
been removed. The patient is status post sternotomy with mediastinal clips.
There is continued prominence of cardiomediastinal silhouette consistent with
recent surgery. There is patchy opacity at the left lung base consistent with
left lower lobe collapse and/or consolidation. This may be slightly worse
compared with but is likely accentuated by low lung volumes. Minimal
atelectasis at the right base is noted. No definite CHF, though the low
inspiratory volumes make this assessment difficult.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14232310", "visit_id": "28547003", "time": "2167-04-25 15:06:00"} |
13577485-RR-33 | 103 | ## INDICATION:
year old man with rule out AAA// AAA eval
## FINDINGS:
The aorta measures 2.7 cm in the proximal portion, 2.2 cm in mid portion and
1.9 cm in the distal abdominal aorta. There is mild calcified atherosclerotic
plaque. Appropriate arterial waveforms are seen on limited Doppler imaging.
The right common iliac artery measures 1.1 cm and the left common iliac artery
measures 1.1 cm.
The right kidney measures 9.7 cm and the left kidney measures 10.3 cm. Limited
views of the kidneys are unremarkable without hydronephrosis.
## IMPRESSION:
No evidence of abdominal aortic aneurysm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13577485", "visit_id": "N/A", "time": "2177-08-24 10:52:00"} |
14932781-RR-76 | 146 | ## HISTORY:
Evaluate nodule.
RIGHT HAND, THREE VIEWS.
No localizing history for the palpable nodule is available.
There is severe osteoarthritis at the first CMC joint, with marked narrowing
of the joint space and associated bony proliferation. Large areas of
ossification (approximately 10-11.5 mm) are seen along both sides of the first
CMC joint and likely reflect bony proliferation due to osteoarthritis and
loose bodies within the first CMC joint.
There is minimal spurring about several DIP joints and narrowing, spurring of
the IP joint,and narrowing of the triscaphe joint, consistent with mild
changes of osteoarthritis.
Otherwise, right hand x-ray examination is within normal limits.
## IMPRESSION:
Osteoarthritis, most severe at the first CMC and to a lesser extent triscaphe
joints. Bony proliferative change and loose bodies in the first CMC joint.
Does this correspond to the site of the palpable nodule?
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14932781", "visit_id": "N/A", "time": "2175-01-28 10:56:00"} |
11375255-RR-19 | 125 | ## INDICATION:
year old man s/p revision posterior/anterior lumbar fusion now
with fluid collection. // anterior abdominal fluid collection
## PROCEDURE:
Ultrasound-guided drainage of a left retroperitoneal collection.
## OPERATORS:
Dr. radiology fellow and Dr.
radiologist, who personally supervised the trainee during the key components
of the procedure and reviewed and agrees with the trainee's findings.
## SEDATION:
100 mcg fentanyl throughout the total intra-service time of 15
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
## FINDINGS:
Left lower quadrant retroperitoneal seroma with removal of 550 cc
serosanguineous fluid. The seroma appeared completely decompressed post
drainage.
## IMPRESSION:
Successful US-guided placement of pigtail catheter into the left
retroperitoneal seroma. Sample was sent for microbiology evaluation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11375255", "visit_id": "22100348", "time": "2118-02-24 14:39:00"} |
12791765-DS-3 | 1,954 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
concern for RRT needs
## MAJOR OR INVASIVE PROCEDURE:
Dialysis line insertion
Paracenteses
Tunneled HD line
Cardiac cath
## HISTORY OF PRESENT ILLNESS:
Mr. is a man with DMII, HTN, HLD, PVD, and
recent diagnosis of EtOH cirrhosis who was discharged 1 week ago
from after treatment of acute decompensated
cirrhosis who is now transferred from after
presenting with renal failure and hypotension.
History and review of systems difficult to obtain due to
patient's mental status, however by report patient had a recent
discharge from after new diagnosis of alcoholic
cirrhosis. He developed progressively worsening weakness and
confusion, and was brought back to emergency department
today. There he was found to have new renal failure with a
creatinine of 11. He was also found to have a suspected
pneumonia
with systolic blood pressure in the which improved with 2 L
IV fluid. He was treated empirically with vancomycin and Zosyn,
and transferred to for ICU level care. In the ED, he
complained of abdominal pain but no other complaints.
In the ED,
## PULM:
CTAB, no rales/rhonchi/wheezing/stridor, no accessory mm.
use
## ABDOMINAL:
Distended, mildly tender diffusely, no
rebound/guarding, no peritonitic signs
## MELD-NA:
39
Paracentesis Fluid collected in ED:
WBC 235 RBC 90 Poly 20% Lymph 18%
## RUQUS:
1. Echogenic liver with mildly nodular contours, suggests
cirrhosis.
2. Splenomegaly up to 16.4 cm.
3. No nephrolithiasis or hydronephrosis bilaterally.
## CXR:
1. Mild central pulmonary vascular congestion.
2. No areas of focal consolidation, pleural effusion or
pneumothorax.
## HEPATOLOGY:
consulted and recommended admission to ET and
evaluation by renal for possible HRS from hypotension
and
infections as noted above.
## INTERVENTIONS:
IV albumin 25% - 87.5g
IV calcium gluconate
PO lactulose 30
IV potassium chloride 10 mEq
On arrival to the ICU, the patient reports that he first
presented to when he began to notice his skin and eyes
turn yellow. He had never been told that he had a liver disease
before. He reported drinking about 3 bottles of beer daily for
many years prior. He has not had a drink in about 8 weeks. He
thinks he was treated for alcoholic cirrhosis, but is unsure if
he took steroids. He was discharged from to home. He
reports feeling weak and dizzy, which led to his presentation.
He
also thinks he may have had a cough. He denies any ingestion of
other intoxicants such as antifreeze.
Currently, he feels well apart from some mild abdominal pain. He
denies chest pain, shortness of breath,
nausea/vomiting/diarrhea.
## PAST MEDICAL HISTORY:
Alcoholic cirrhosis
DMII
HTN
PVD
## FAMILY HISTORY:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
## GEN:
jaundiced, AxOx2-3 with prompting, NAD
## RESP:
CTAB anteriorly (Refused posterior)
## GI:
distended abdomen, mildly tender throughout
## NEURO:
AxOx2-3, CNII-XII grossly intact
## GEN:
jaundiced, laying comfortably in no acute distress
## RESP:
CTAB anteriorly. Unlabored breathing
## GI:
distended abdomen. nontender to palpation, no rebound or
guarding
## NEURO:
no asterixis. AOx3 (self, city, year). Moving all
extremities. Slow to respond. can recite backwards
## CXR:
Compared to chest radiographs . Lungs fully expanded and clear. Heart size
normal. No pleural abnormality. Right jugular line ends in the
low SVC. No mediastinal widening.
## :
CXR:
Interstitial opacities may reflect mild interstitial pulmonary
edema. Please correlate clinically.
## :
ABD US:Cirrhotic hepatic morphology with
splenomegaly, moderate volume ascites. Patent main portal vein
with hepatopetal flow.
CT AP:
. Cirrhotic liver without focal hepatic lesions. Replaced right
hepatic
artery from the SMA. Conventional hepatic veins and IVC. Patent
portal vein.
Splenomegaly, moderate ascites, varices.
2. Enlarged porta hepatis and celiac lymph nodes, likely
reactive in the
setting of cirrhosis.
3. Few punched out subcentimeter osseous lytic lesions in the
pelvis could
represent multiple myeloma or metastasis, less likely focal
osteopenia.
Further evaluation with pelvic MRI recommended.
4. Severe atherosclerosis in the distal aorta with occlusion of
the left
common, external, and internal iliac and right common femoral
arteries with
reconstitution by inferior epigastric collaterals distally.
5. Severe coronary artery calcifications, partially visualized
## IMPRESSION:
No anginal symptoms or ischemic ST segment changes.
Nuclear
report sent separately.
tunneled HD line placement:
Successful placement of a 19 cm tip-to-cuff length tunneled
dialysis line.
The tip of the catheter terminates in the right atrium. The
catheter is ready
for use.
## MRI MSK PELVIS W/O CONTRAST:
1. Scattered lucencies within pelvic bones and in the L5
vertebral body on CT,
correlate with islands of fatty marrow. Allowing for the exam
limitations, no
suspicious bone lesion.
2. Large amount of ascites in the pelvis.
## CTH:
1. No acute intracranial process.
2. Global atrophy and likely sequela of chronic small vessel
ischemic disease.
## MICRO:
======
blood cultures - negative
urine culture - negative
C diff PCR - negative
## DISCHARGE LABS:
===============
05:23AM BLOOD WBC-15.0* RBC-2.39* Hgb-8.4* Hct-26.7*
MCV-112* MCH-35.1* MCHC-31.5* RDW-17.3* RDWSD-72.6* Plt
05:23AM BLOOD PTT-42.5*
05:23AM BLOOD Glucose-129* UreaN-60* Creat-6.0* Na-132*
K-4.6 Cl-91* HCO3-24 AnGap-17
05:23AM BLOOD ALT-60* AST-109* AlkPhos-355*
TotBili-9.8*
05:23AM BLOOD Albumin-2.8* Calcium-7.8* Phos-3.5 Mg-2.3
06:55AM BLOOD calTIBC-88* Ferritn-2764* TRF-68*
06:45PM BLOOD Osmolal-315*
06:55AM BLOOD TSH-4.1
06:55AM BLOOD HBsAg-NEG HBsAb-NEG HBcAb-NEG HAV Ab-POS*
IgM HAV-NEG
05:49AM BLOOD 25VitD-<5*
07:15AM BLOOD PSA-0.5
06:55AM BLOOD CEA-5.5* AFP-4.2
07:15AM BLOOD PEP-M-SPIKE NO FreeKap-275.3*
FreeLam-188.7* Fr K/L-1. man with DMII, HTN, HLD, PVD, and recent diagnosis
of EtOH cirrhosis (child class C, admission MELD ) who
presented with acute renal failure presumed to be due to ATN who
was initiated on HD. During his admission he was worked up for
liver transplant, however was not listed due to his frailty,
insight and need to demonstrate out of hospital sobriety.
# Alcoholic cirrhosis
# Alcoholic Hepatitis
Recent diagnosis for cirrhosis. Workup was notable for negative
viral hepatitis serologies, negative autoimmune hepatitis
serologies (neg , AMA, anti-TTG). Admission MELD-Na 39. RUQ
with doppler without portal vein thrombosis. Held on
prednisolone given lack of response to steroids from last
admission to and concern if it precipitated any infection
although infectious workup negative. EGD showed no
varicies. He was continued on lactulose and rifaximin, and his
volume status was managed with HD. He was evaluated for liver
transplant candidacy with studies including serologies, RHC/LHC,
TTE, stress echo, ABIs. Unfortunately due to his frailty (liver
frailty score 4.98) and poor insight and need to demonstrate out
of hospital sobriety, he was determined to not be an appropriate
candidate for liver transplant at this time. He required
intermittent paracentesis for every week with last
paracentesis on . His liver function continued to improve
during his hospital stay.
# Concerns for aspiration
# Esophageal discomfort, nausea
The patient was noted to be coughing while swallowing pills,
though patient feels this is baseline. A dobhoff was placed and
tube feeds were initiated. His diet was advanced as per SLP
recommendations. The patient reported intermittent nausea and
esophageal discomfort following initiation of tube feeds, which
was managed with PPI, sucralfate, and PRN Zofran. Tube feeds
were continued at time of discharge.
# Acute kidney failure
Elevated Cr to on admission, from a baseline of 0.6.
Etiology likely likely ATN in the setting of hypotension
vs. HRS. He was noted to have AGMA and required CRRT in the ICU.
He was then initiated on HD during this admission, and a
tunneled HD line was placed by . He was not noted to have
signs of renal recovery during this admission and remained
aneuric. He was discharged on HD schedule).
# Delirium
# Deconditioning
The patient was noted to be intermittently delirious, in the
setting of chronic illness and prolonged hospitalization. Liver
frailty index 4.98 on . Delirium precautions were practiced.
His nutrition status was optimized with tube feeds and
supplements, and he worked with .
CHRONIC/STABLE ISSUES
======================
# Osseous lytic pelvic lesions
Noted on CT AP, initially concerning for multiple myeloma
vs metastasis. MRI pelvis obtained; lesions are consistent with
focal fat deposition, no focal suspicious bone marrow lesions.
# Alcohol use disorder
Last alcoholic drink was reportedly 8 weeks prior to admission.
He was continued on folic acid, thiamine, MVI.
# HTN
Home metoprolol was held in the setting of hypotension.
# PVD
Per report he takes cilostazol at home, which was held during
this admission. He was started on ASA 81 and atorvastatin 20 mg
daily prior to discharge. Follows with Dr.
# DMII
Continued on ISS.
## TRANSITIONAL ISSUES:
==================
[] Outpatient providers should consider outpatient
neurocognitive testing.
[] Patient required intermittent paracentesis - further
paracentesis will be coordinated by the .
[] Needs follow up with vascular surgery as an outpatient for
PVD
[] If moving forward with transplant listing will need
appointment with OMFS for teeth removal
[] Could consider transitioning to oral antihyperglycemic as an
outpatient
[] Ensure bowel movements per day, if lower may need
uptitration of lactulose
***Of note, records request from PCP shows previous diagnosis of
ETOH hepatitis***
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Cilostazol 100 mg PO BID
2. FoLIC Acid 1 mg PO DAILY
3. Lactulose 60 mL PO BID
4. Metoprolol Succinate XL 50 mg PO DAILY
5. Pantoprazole 40 mg PO Q24H
6. Thiamine 100 mg PO DAILY
7. prednisoLONE 15 mg/5 mL oral ASDIR
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Atorvastatin 20 mg PO QPM
3. Insulin SC
Sliding Scale
Fingerstick qachs
Insulin SC Sliding Scale using REG Insulin
4. Neomycin-Polymyxin-Bacitracin 1 Appl TP PRN with all
dressing changes
5. Nephrocaps 1 CAP PO DAILY
6. Rifaximin 550 mg PO BID
7. TraZODone 50 mg PO QHS:PRN insomnia
8. Vitamin D UNIT PO 1X/WEEK (FR) Duration: 8 Weeks
Needs 6 more weeks
9. Lactulose 30 mL PO TID
Please titrate to bowel movements per day
10. FoLIC Acid 1 mg PO DAILY
11. Thiamine 100 mg PO DAILY
12. HELD- Cilostazol 100 mg PO BID This medication was held. Do
not restart Cilostazol until you see your vascular surgeon
## DISCHARGE DIAGNOSIS:
Primary diagnosis:
Alcoholic cirrhosis
Acute renal failure
Alcohol use disorder
Hypertension
Peripheral vascular disease
Type 2 diabetes
Protein calorie malnutrition
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure caring for you during your admission to .
Below you will find information regarding your stay.
WHY WAS I ADMITTED TO THE HOSPITAL?
- You were transferred to because your kidneys were
not working appropriately.
WHAT HAPPENED WHILE I WAS IN THE HOSPITAL?
- You were initially admitted to the ICU where you underwent
your first session of dialysis.
- You were transferred to the liver service where you were
continued on dialysis.
- While on the liver service you were worked up for a liver
transplant.
-- This included being seen by the cardiology team who did a
procedure called a cardiac cath which did not show any evidence
of coronary artery disease.
-- You also underwent an EGD which showed no evidence of veins
in your esophagus called varices.
- You were seen by the nutritionist who recommended a feeding
tube be placed to help you get enough nutrition to heal your
liver.
- You worked with physical therapy to get stronger and they
recommended you be discharged to rehab
WHAT SHOULD I DO WHEN I GO HOME?
- Please stick to a low salt diet and monitor your fluid intake
- Take your medications as prescribed
- Keep your follow up appointments with your team of doctors
Thank for letting us be a part of your care!
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12791765", "visit_id": "22862818", "time": "2185-08-18 00:00:00"} |
18992031-RR-79 | 176 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
male with h/o EtOH and stroke, left AMA this AM and
was drinking, now p/w headache, evaluate for intracranial hemorrhage.
## FINDINGS:
The patient is status post right-sided pterional craniotomy, right MCA
aneurysm clipping, and basilar artery embolization, with metallic streak
artifact limiting evaluation of the adjacent structures. Within these
limitations, there is no evidence of acute large territorial
infarction,hemorrhage,edema,or mass. There is stable encephalomalacia in the
right temporal lobe and right frontal lobe. Mild subcortical and
periventricular white matter hypodensities are nonspecific but compatible with
sequelae of chronic small vessel ischemic disease. There is prominence of the
ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are normal.
## IMPRESSION:
1. No acute intracranial process.
2. Stable changes from prior right frontal craniotomy and aneurysm clipping.
3. Encephalomalacia in the right temporal and frontal lobes, unchanged.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18992031", "visit_id": "N/A", "time": "2144-01-09 22:48:00"} |
14143264-RR-121 | 198 | ## INDICATION:
History of pulmonary hypertension, colon cancer, now with
worsened hypoxia.
## FINDINGS:
There is no pulmonary embolus. The lung parenchyma again
demonstrates massive enlargement of the pulmonary arteries indicating
pulmonary artery hypertension. Heart size is normal. There are coarse
coronary calcifications. There are subcarinal and right paratracheal nodes
re-demonstrated. The lung parenchyma demonstrates resolution of the
previously demonstrated patchy ground-glass opacities. Again seen is
architectural distortion with traction bronchiectasis and band-like fibrosis,
consistent with a history of sarcoidosis; however, metastases in some of these
confluent areas cannot be excluded.
In the visualized portion of the abdomen, there are progressively enlarged
retrocrural and retroperitoneal lymph nodes with calcification such as would
be expected in a metastatic mucinous adenocarcinoma. The visualized portion
of the upper abdomen, also demonstrates a cystic lesion in the right lobe of
the liver, with fluid-attenuation.
## IMPRESSION:
1. No PE.
2. Lung parenchymal changes consistent with sarcoidosis with
secondary pulmonary fibrosis; in regions of focal abnormality, metastases
cannot be completely excluded.
3. Increased size of lymph nodes in the visualized portion of the abdomen,
when compared to , concerning for overall progression of
metastatic disease from known Stage IV colon carcinoma.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14143264", "visit_id": "22185019", "time": "2159-12-16 13:24:00"} |
11619706-RR-66 | 243 | CT CHEST WITH CONTRAST DATED
## FINDINGS:
Thyroid gland remains heterogeneously enlarged with left lobe
predominance, associated with slight rightward shift of trachea and mild
coronal narrowing without change. There are no enlarged mediastinal, hilar or
axillary lymph nodes. Heart size is normal, and there is no pericardial or
substantial pleural effusion.
Exam was not tailored to evaluate the subdiaphragmatic region, but a
subcentimeter hypodensity is noted in the upper pole portion of the right
kidney and is not fully characterized by CT. Remaining imaged upper abdomen
is unremarkable on this limited assessment.
Skeletal structures demonstrate no new suspicious lytic or blastic skeletal
lesions.
Assessment of the lungs demonstrates mild upper lobe predominant emphysema
without change as well as nonspecific scarring. Numerous bilateral small
non-calcified pulmonary nodules are again demonstrated with diffuse
distribution but lower lung predominance. Overall size and number of
pulmonary nodules is similar to the prior CT. Surgical clips are present in
the left lower lobe consistent with previous wedge resection procedure with
similar post-operative appearance in this region. The largest nodule in the
left lower lobe measures approximately 1.1 x 1.5 cm, not appreciably changed
from the prior CT (image 239, series 4). Similarly, other widespread
pulmonary nodules are not appreciably changed.
## IMPRESSION:
1. Similar CT appearance of widespread small pulmonary nodules.
2. Heterogeneously enlarged left lobe of the thyroid gland is not fully
characterized by CT but has been previously evaluated by thyroid ultrasound.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11619706", "visit_id": "N/A", "time": "2128-09-09 14:32:00"} |
15165224-RR-15 | 171 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
History: with right upper quadrant abdominal pain
## FINDINGS:
An echogenic lesion without internal vascularity measuring 7 x 6 x 4 mm is
noted in the right lobe of the liver. There is no intra or extra hepatic
ductal dilatation. The common bile duct measures 5 mm. The main portal vein is
patent with hepatopetal flow.
The gallbladder is thick walled, edematous and contains debris. There is a
focal outpouching of the gallbladder wall as well as a collection of fluid
located directly adjacent to the gallbladder, findings concerning for
perforation with abscess. The adjacent liver parenchyma is heterogeneous which
may reflecting changes of inflammation from the gallbladder and/or additional
abscesses.
The right kidney measures 11.8 cm and the left kidney measures 10.3 cm. There
is no hydronephrosis. The spleen measures 12.3 cm.
## IMPRESSION:
1. Findings concerning for perforated cholecystitis with adjacent abscess.
2. Echogenic 7-mm lesion within the right lobe of the liver, likely a
hemangioma.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15165224", "visit_id": "27078373", "time": "2200-11-23 10:58:00"} |
19509298-RR-86 | 358 | ## INDICATION:
man with previous gallbladder surgery with pain and
abdominal distention at the site of surgical incision.
## FINDINGS:
Partially imaged lung bases are notable for a chronic opacity at
the right base containing foci of calcification and overlying atelectasis,
unchanged. There is no pleural effusion.
## CT ABDOMEN:
The liver enhances homogeneously. A subcentimeter hypodensity in
segment is too small to fully characterize. There is no biliary
dilatation. The gallbladder is surgically absent; however, a drain is present
in the gallbladder fossa with no significant adjacent fluid collection. The
spleen contains a tiny hypodensity posteriorly, too small to characterize but
unchanged. The pancreas and adrenal glands are unremarkable. The kidneys
enhance and excrete symmetrically. Previously noted large bilateral renal
stones are no longer present. There is interval development of a subcapsular
hematoma, measuring up to 1.7 cm in maximum thickness, probably related to
recent lithotripsy. Multiple subcentimeter hypodensities in the left kidney
are unchanged, but statistically likely cysts. There is no hydronephrosis.
A percutaneous gastrostomy tube is noted. The stomach is otherwise partially
decompressed. Nondilated loops of small bowel are normal in course and
caliber. There is no wall thickening or signs of obstruction. The colon is
notable for diverticulosis without diverticulitis. The descending and sigmoid
colon are largely collapsed. A large abdominal wall hernia is again noted
containing loops of small and large bowel. There is no mesenteric or
retroperitoneal lymphadenopathy. There is no intra-abdominal free air or
fluid. Abdominal aorta is of normal caliber. Portal vein, splenic vein and
SMV are unremarkable. Surgical staples are noted running obliquely along the
anterior abdomen. Fat stranding and foci of air in the subcutaneous tissues
along the surgical incision likely relate to post surgical changes; however,
no organized fluid collection or rim-enhancing abscess is identified
## CT PELVIS:
A suprapubic catheter ends in the bladder, which is largely
decompressed. There is no pelvic free fluid or lymphadenopathy.
## BONE WINDOW:
Degenerative changes are again noted without concerning osseous
lesion.
## IMPRESSION:
Interval development of a 1.6 cm supcapsular right renal hematoma, likely
related to recent lithotripsy and expected post operative changes. No acute
intra-abdominal process otherwise.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19509298", "visit_id": "N/A", "time": "2194-03-17 21:52:00"} |
16139387-DS-15 | 533 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HISTORY OF PRESENT ILLNESS:
yoF with recent URI comes in with abdominal pain beginnin
24 hours prior in the epigastric area nd localizing to the
suprapubic area more recently. Endorses nausea, vomiting, no
fevers but chills. Normal bowel habits, normal urination. Last
menstrual period 2 weeks ago, and denies chance she could be
pregnant.
## EXAM:
AVSS , Afebrile
AAO x3, NAD
RRR no MRG
CTA b/L no RRW
Soft, tender in suprapubic region, + rebound and rovsings
no CCE
## CT ABD/PELVIS:
Dilated, hyperemic appendix compatible
with acute appendicitis.
No evidence of perforation.
## BRIEF HOSPITAL COURSE:
Ms. was evaluated by the Acute Care service in the
Emergency Room and based on her exam, elevated WBC and CT of the
abdomen she was taken to the Operating Room for a laparoscopic
appendectomy. The appendix appeared acutely inflamed but
non-perforated. She tolerated the procedure well and returned to
the PACU in stable condition. She maintained stable
hemodynamics and her pain was well controlled.
Following transfer to the Surgical floor she continued to make
good progress. Her port sites were dry and she was able to
tolerate a regular diet without difficulty. Her urine output
was adequate and she was up and walking independently. After an
uncomplicated recovery she was discharged to home on and
will follow up in the in weeks.
## DISCHARGE MEDICATIONS:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
2. oxycodone 5 mg Tablet Sig: Tablets PO Q4H (every 4 hours)
as needed for Pain.
Disp:*60 Tablet(s)* Refills:*0*
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
## DISCHARGE INSTRUCTIONS:
You are being discharged on medications to treat the pain from
your operation. These medications will make you drowsy and
impair your ability to drive a motor vehicle or operate
machinery safely. You MUST refrain from such activities while
taking these medications.
Please call your doctor or return to the emergency room if you
have any of the following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in 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 have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
## ACTIVITY:
No heavy lifting of items pounds for 6 weeks. You may
resume moderate
exercise at your discretion, no abdominal exercises.
## WOUND CARE:
You may shower, no tub baths or swimming.
If there is clear drainage from your incisions, cover with
clean, dry gauze.
Your steri-strips will fall off on their own. Please remove any
remaining strips days after surgery.
Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16139387", "visit_id": "21979360", "time": "2184-08-11 00:00:00"} |
13659106-RR-14 | 438 | ## INDICATION:
year old man with renal cell cancer, stage III // recurrence
## DOSE:
DLP: 771.70 mGy-cm (chest, abdomen and pelvis.
## LOWER CHEST:
Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
## HEPATOBILIARY:
There is a 2.5 x 1.7 x 1.6 cm hypo attenuating lesion at the
hepatic dome (series 6, image 36). There is smaller hypo attenuating lesions
in the left hepatic lobe (series 3, image 56). There is a subcentimeter hyper
turning focus in the lateral right hepatic lobe which was present on the
previous exam and may represent a cyst or biliary hamartoma. The detection of
additional lesions is limited due to lack of IV contrast. The gallbladder is
decompressed.
## PANCREAS:
The pancreas is normal in attenuation.
## SPLEEN:
The spleen is normal in size and attenuation..
## ADRENALS:
The right adrenal gland is normal. The left adrenal gland is not
definitively visualized.
## URINARY:
The left kidney is surgically absent. The right kidney has a normal
noncontrast CT appearance. There is no evidence of recurrent or residual
disease in the left renal fossa.
## GASTROINTESTINAL:
Small bowel loops demonstrate normal caliber, wall
thickness and enhancement throughout. Colon and rectum are within normal
limits.
## RETROPERITONEUM:
There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. There is no calcium burden
in the abdominal aorta and great abdominal arteries.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
## BONES AND SOFT TISSUES:
There are no worrisome osseous lesions. There is infraumbilical midline
abdominal stranding.
## IMPRESSION:
1. Hypo attenuating lesions in the liver, the largest in the hepatic dome
measuring up to 2.5 cm in diameter, which has not been appreciated on prior
study. Lack of IV contrast limits evaluation of these lesions and the
detection of additional lesions. Metastatic disease is in the differential and
MRI of the liver is recommended for further characterization.
2. Postsurgical changes related to left nephrectomy. There is no evidence of
recurrent disease in the left renal bed.
3. Infraumbilical midline abdominal stranding, likely postoperative in
etiology. However, due to lack of IV contrast, tumor seeding cannot be
excluded. Recommend continued attention to this area on subsequent followup
examinations.
4. Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings.
## NOTIFICATION:
The impression above was entered by Dr. on
at 17:20 into the Department of Radiology critical communications
system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13659106", "visit_id": "N/A", "time": "2152-01-29 13:33:00"} |
10795237-DS-17 | 576 | ## HISTORY OF PRESENT ILLNESS:
Mrs. is a female who
presents with a right S1 radiculopathy with corresponding
imaging
findings.
She had this for about three to four months and exhausted
physical therapy, activity modification and injection.
We spent about 30 minutes discussing the surgery. We discussed
complications, risks, and benefits including, but not limited to
coma, stroke and death, worsening of current condition, need for
further surgery, worsening or new back pain, paralysis, nerve
injury leading to weakness in her legs, bowel injury, vascular
injury, spinal fluid leak , meningitis and incontinence.
The patient also notes that the symptoms may not improve. We
talked about postoperative recovery period and restrictions.
We discussed about indications, alternatives, complications,
risks and benefits and postoperative recovery period. She would
like to go ahead and we will schedule her for a right L5-S1
microdiscectomy.
## PAST MEDICAL HISTORY:
Infertility s/p Clomid treatment, gestational diabetes,
hypothyroidism/hashimoto's disease
## SURGICAL HISTORY:
C-section , hemorrhoid banding
## PHYSICAL EXAM:
On discharge: A&Ox3, MAE . Incision w dermabond, cd&i.
## BRIEF HOSPITAL COURSE:
On , patient presented to for microdiskectomy L5-S1 for
lumbar stenosis. Her intraoperative course was uneventful,
please refer to the operative note for further details. She was
extubated and transferred to for close observation.
On , the patient remained neurologically and hemodynamically
intact. She expressed readiness to be discharged home. She was
discharged home in stable conditions, all discharge instructions
and follow up were given prior to discharge.
## MEDICATIONS ON ADMISSION:
Levothyroxine 125 mcg daily
## DISCHARGE MEDICATIONS:
1. Acetaminophen 325-650 mg PO Q6H:PRN for fever or pain
Do not exceed more than 4grams in 24hrs.
2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
3. Diazepam 2 mg PO Q8H:PRN muscle spasm
Do not drive while taking this medication
RX *diazepam 2 mg 1 tab by mouth Q 8hrs Disp #*30 Tablet
## REFILLS:
*0
4. Docusate Sodium 100 mg PO BID
5. Levothyroxine Sodium 125 mcg PO DAILY
6. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
please do not drive or operate mechanical machinery while taking
pain meds.
RX *oxycodone 5 mg tablet(s) by mouth Q 4hrs. Disp #*60
## DISCHARGE INSTRUCTIONS:
Surgery
Your incision is closed with dissolvable sutures underneath
the skin and steri strips. You do not need suture removal.
Do not apply any lotions or creams to the site.
Please avoid swimming for two weeks after suture/staple
removal.
Call your surgeon if there are any signs of infection like
redness, fever, or drainage.
Activity
We recommend that you avoid heavy lifting, running, climbing,
or other strenuous exercise until your follow-up appointment.
You may take leisurely walks and slowly increase your activity
at your own pace. try to do too much all at once.
No driving while taking any narcotic or sedating medication.
No contact sports until cleared by your neurosurgeon.
Medications
Please do NOT take any blood thinning medication (Aspirin,
Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon.
You may take Ibuprofen/ Motrin for pain.
You may use Acetaminophen (Tylenol) for minor discomfort if
you are not otherwise restricted from taking this medication.
It is important to increase fluid intake while taking pain
medications. We also recommend a stool softener like Colace.
Pain medications can cause constipation.
When to Call Your Doctor at for:
Severe pain, swelling, redness or drainage from the incision
site.
Fever greater than 101.5 degrees Fahrenheit
New weakness or changes in sensation in your arms or legs.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10795237", "visit_id": "28040571", "time": "2130-06-18 00:00:00"} |
10300976-RR-13 | 156 | ## HISTORY:
male with acute onset of ataxia
## FINDINGS:
There is no hemorrhage, edema, mass, mass effect, large territorial
infarction. The sulci and ventricles are prominent suggesting age related
atrophy. Small lacune in the lentiform nucleus in the right (2:16) as well as
periventricular white matter hypodensities are consistent with chronic small
vessel ischemic disease. There is preservation of gray-white matter
differentiation and the basal cisterns appear patent.
There is no fracture. There is nearly total opacification of the left
sphenoidal sinus with hyperdense material suggestive of fungal colonization
and surrounding bony sclerosis indicative of chronic inflammation. The
remaining paranasal sinuses, mastoid air cells and middle ear cavities are
clear. Atherosclerotic calcification of the carotid siphons and vertebral
arteries is present.
## IMPRESSION:
1. No evidence of acute intracranial process. Chronic changes as described
above.
2. Nearly total opacification of the left sphenoidal sinus with hyperdense
material suggests chronic sinusitis with possible fungal colonization.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10300976", "visit_id": "25845158", "time": "2195-06-25 17:10:00"} |
13042394-RR-110 | 131 | ## FINDINGS:
There is a mild levoconvex upper thoracic scoliosis centered at the T3-T4
level. The pedicles are normal in appearance. There is no radiographic
evidence of a compression fracture within the thoracic spine.
There is decreased intervertebral disc space height at the L5-S1 level with
concomitant facet joint arthropathy within the lower lumbar spine. The
sacroiliac joints are bilaterally symmetric. The arcuate lines are intact.
The imaged portions of the pelvis are intact.
The pulmonary interstitium is diffusely prominent without consoldative
opacities. The thoracic aorta is ectatic.
## IMPRESSION:
1. Unchanged upper thoracic mild levoconvex scoliosis.
2. Degenerative disc disease of the L5-S1 level with concomitant facet joint
arthropathy of the lower lumbar spine.
3. Diffuse prominence of the pulmonary interstitium without focal
consolidation of indeterminant etiology.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13042394", "visit_id": "N/A", "time": "2177-07-07 12:36:00"} |
12969469-RR-57 | 75 | ## INDICATION:
Nodular asymmetry in the left upper breast seen on the screening
mammogram of . Patient here for additional imaging.
GE DIGITAL LEFT DIAGNOSTIC MAMMOGRAM WITH COMPUTER-AIDED DETECTION:
## LEFT BREAST ULTRASOUND:
Targeted ultrasound of the left breast was performed.
The entire left upper breast was scanned and no discrete solid or cystic mass
seen.
## IMPRESSION:
No evidence of malignancy. Patient can continue annual
mammography. Findings discussed with the patient.
BI-RADS 1 - negative.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12969469", "visit_id": "N/A", "time": "2129-08-11 14:36:00"} |
14120700-RR-77 | 170 | ## DOSAGE:
TOTAL DLP reported separatelymGy-cm
## FINDINGS:
Bilateral sub cm axillary, mediastinal, and hilar lymph nodes are similar in
size and number tube chest CT. Heart size is normal, and no
pericardial or pleural effusion is present.
A partially calcified lesion in the medial aspect of the right breast is
unchanged (21, 2) as well as other asymmetrical bilateral breast densities.
Skeletal structures of the thorax demonstrate no new suspicious lytic or
blastic lesions.
Within the lungs, a new medial segment right lower lobe lung nodule has
decreased in size from 6 mm x 4 mm to 5 mm x 2 mm (136, 4). A 3 mm x 2 mm
left upper lobe anterior segment nodule is apparently new (66, 4).
## IMPRESSION:
1. Continued decrease in size of right lower lobe lung nodule.
2. New 3 mm left upper lobe lung nodule is suspicious for a new focus of
metastatic disease.
3. Please see separately dictated CT of the abdomen and pelvis for complete
description of subdiaphragmatic findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14120700", "visit_id": "N/A", "time": "2137-04-07 11:48:00"} |
19642954-RR-73 | 186 | ## EXAMINATION:
CT HEAD WITHOUT CONTRAST
## INDICATION:
with remote history of bilateral TKR admitted with
multi-joint septic arthritis, fever, MSSA bacteremia, and altered mental
status s/p multiple wash-outs and antibiotic, and known intradural abscess
extending to pons now with worsening mental status, unable to move w/ B/l
arm twitching // r/o worsening abscess
## DOSE:
DLP: 1338 mGy-cm; CTDI: 53 mGy
## HEAD CT:
There is no evidence of acute intracranial hemorrhage, edema, mass
effect or shift of normally midline structures. Mild periventricular white
matter hypodensities are compatible with sequela of chronic microvascular
ischemic disease. The gray-white matter interface is otherwise preserved
without evidence of acute major vascular territorial infarct. The ventricles
and sulci are prominent, consistent with age related parenchymal volume loss.
There is no evidence of hydrocephalus. The basal cisterns appear patent. The
orbits and globes are unremarkable. The imaged paranasal sinuses, middle ear
cavities and mastoid air cells are clear bilaterally. The bony calvaria appear
intact. Orthopedic hardware is partially imaged in the posterior upper
cervical spine.
## IMPRESSION:
No evidence of acute hemorrhage or major vascular territorial infarct.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19642954", "visit_id": "29788887", "time": "2166-08-05 08:59:00"} |
14855257-RR-9 | 128 | ## HISTORY:
man with question of a TIA and stroke.
## HEAD CT:
Axial imaging was performed through the brain without IV contrast
administration.
## FINDINGS:
There is no acute hemorrhage, edema, mass effect, or obvious CT
evidence for acute major vascular territorial infarction. There is prominence
of the ventricles and sulci, compatible with age-related parenchymal volume
loss. There is mild periventricular white matter hypodensity, suggestive of
chronic small vessel microvascular infarcts. There is no shift of midline
structures, and gray-white matter differentiation appears well preserved.
The visualized paranasal sinuses and mastoid air cells, are clear.
## IMPRESSION:
No acute intracranial hemorrhage or mass effect. To correlate
clinically and if there is continued concern based on clinical neurologic
examination, follow up with CT as MRI is contra-indicated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14855257", "visit_id": "29568895", "time": "2178-10-09 03:52:00"} |
16036860-RR-23 | 140 | ## INDICATION:
s/p multiple RFAs and EMRs, most recently for T1b esophageal
adenocarcinoma (tumor present at peripheral margin) now s/p MIE. CT
to waterseal// eval for interval change, PTX, effusion. Please do @ 1:30pm
## FINDINGS:
Changes of esophagectomy and gastric pull-trough are again noted. There is
increased lucency in the right hemithorax following the contour of the
neoesophagus, likely due to its increased distension. A superimposed
pneumothorax is difficult to exclude. Right chest tube is noted. Atelectatic
changes in the right lower lobe are again seen. Left lower segmental
atelectasis and small bilateral pleural effusions are slightly worse. Heart
size is stable.
## IMPRESSION:
Increased distention of the neoesophagus, difficulting the evaluation for a
superimposed pneumothorax. Decompression and follow-up chest x-ray in left
lateral position could be obtained.
Worse bilateral lower lobe collapse and effusions.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16036860", "visit_id": "25374924", "time": "2131-12-16 13:21:00"} |
17777109-DS-22 | 1,101 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
ERCP with stone extraction
## HISTORY OF PRESENT ILLNESS:
yo F from a nursing home with A Fib, HTN, diastolic CHF, DM2
and dementia recently admitted with cholecystitis, found to have
choledocholithiasis causing abdominal pain who presents after
ERCP with sphincterotomy and stone extraction.
.
The patient was admitted .11 with abdominal pain,
decreased responsiveness. She was felt to have acute
cholecystitis. Due to her multiple comorbidities, she was felt
to be a poor surgical candidate and was managed conservatively
with IV antibiotics and a percutaneous cholecystostomy tube. On
outpatient follow-up, she was found to have cholelithiasis and
probable choledocholithiasis on percutaneous cholanigiogram.
Non-surgical management was pursued and today she is admitted
after ERCP with sphincterotomy and stone extraction. She has had
no recent symptoms of abdominal pain, nausea or vomiting by the
description of the patient's daughter.
.
Status of 3 chronic conditions:
- A Fib. Stable, controlled on meds.
- HTN. Stable, controlled on meds.
- Diastolic CHF. Chronic and stable, controlled on meds.
.
## ROS:
All other systems were reviewed and are negative.
## PAST MEDICAL HISTORY:
Afib, UTIs, Pyelonephritis, Right ureteral stone s/p stent
placement and removal, RA, Uterine ca, Dementia, Hypothyroidism,
DM T2, HTN, Diastolic CHF, ITP, R retinal detachment
## FAMILY HISTORY:
Mother with cholecystitis, cholecystectomy
## GEN:
NAD, not ill appearing.
## ENT:
Normal appearing ears and nose.
## NECK:
No masses, thyromegaly, asymmetry.
## CV:
RRR. Systolic murmur at the right sternal border. Trace
bilteral lower extremity edema.
## PULM:
CTA bilaterally, some right lung base crackles. Regular
effort.
## ABD:
Soft, nontender, no masses or organomegaly.
## SKIN:
No rashes, ulcers or lesions, normal turgor and temp.
## PSYCH:
A&Ox3 but with poor memory. Appropriate mood and affect.
## PERCUTANEOUS CHOLANGIOGRAM :
Cholecystostomy tube in
appropriate position with a patent cystic duct. Cholelithiases
and common bile duct stones are seen, but contrast is noted to
pass into the duodenum.
.
## ERCP:
3 round stones 4-5mm in size were causing partial
obstruction with CBD of 6mm. Sphinterotomy was performed and 3
stones were successfully extracted.
.
## RENAL ULTRASOUND:
Right kidney normal. Simple-appearing left
renal cyst. No stones, masses, or hydronephrosis.
## BRIEF HOSPITAL COURSE:
yo F from a nursing home with A Fib, HTN, diastolic CHF, DM2
and dementia recently admitted with cholecystitis, found to have
choledocholithiasis causing abdominal pain who presents after
ERCP with sphincterotomy and stone extraction.
.
The patient was admitted .11 with abdominal pain and
decreased responsiveness. She was found to have acute
cholecystitis. Due multiple comorbidities making her a poor
surgical candidate, she was managed conservatively with
antibiotics and a percutaneous cholecystostomy tube. On
outpatient follow-up she underwent percutaneous cholangiogram
and was found to have cholelithiasis and choledocholithiasis.
She was admitted after scheduled ERCP with successful
sphincterotomy and stone extraction x3. She had no recent
symptoms of abdominal pain, nausea or vomiting by the
description of the patient's daughter. The patient was
maintained NPO on IV fluids overnight. With no significant
symptoms, her diet was advanced and she was discharged back to
her nursing home. She must complete 5 total days of augmentin
therapy and she can restart her home coumadin on . She
will follow-up as previously scheduled for further management of
her percutaneous cholecystostomy tube and potential
removal of gallbladder stones.
.
The patient has a history of recurrent UTI's and kidney stones
and was due for a repeat renal ultrasound after recently
completing an antibiotic course for a recent UTI. Renal
ultrasound was done and showed a normal right kidney and simple
cyst in the left kidney with otherwise normal appearance. The
patient will follow-up as an outpatient for further management
of this issue.
.
The remainder of the medical issues including A Fib,
chronic diastolic CHF, hypertension, hypothyroidism, DM2
probably controlled without known complications, rheumatoid
arthritis and dementia were stable and the patient was continued
on her home medications.
.
The patient is DNR. If intubation could provide a temporary
bridge to sustain life then this is acceptable but the patient
would not want prolonged or futile measures.
## MEDICATIONS ON ADMISSION:
Brimonidine tartrate 0.2% 1 drop BID both eyes
CaCarbonate 1300mg daily
Danazol 100mg Daily
Donepezil 10mg QHS
units Q3weeks
Escitalopram 20mg daily
Insulin sliding scale
Latanoprost 1 drop both eyes QHS
Levothyroxine 100mcg daily
Metoprolol Succinate XL 12.5mg QHS
Mirtazapine 15mg QHS
Omeprazole 20mg BID
Prednisone 5mg daily
Timolol maleate 0.25% 1 drop BID both eyes
Tylenol QH PRN
Albuterol neb Q6H
Oxycodone 2.5mg Q4H PRN
## SIG:
One (1) Drop Ophthalmic BID (2
times a day).
2. calcium carbonate 500 mg (1,250 mg) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. danazol 100 mg Capsule Sig: One (1) Capsule PO once a day.
4. donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
5. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1)
Capsule PO q3weeks.
6. escitalopram 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Insulin sliding scale
Continue your pre-admission insulin sliding scale.
8. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
9. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. metoprolol succinate 25 mg Tablet Extended Release 24 hr
## SIG:
0.5 Tablet Extended Release 24 hr PO DAILY (Daily).
11. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
13. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
14. timolol maleate 0.25 % Drops Sig: One (1) Drop Ophthalmic
BID (2 times a day).
15. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for Pain or fever.
16. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
## NEBULIZATION SIG:
One (1) Inhalation Q6H (every 6 hours).
17. Coumadin
Restart your home coumadin on
18. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 4 days.
## DISCHARGE DIAGNOSIS:
Choledocholithiasis
Cholilithiasis
A Fib
Chronic diastolic CHF
Hypothyroidism
DM2
Rheumatoid arthritis
Dementia
## DISCHARGE INSTRUCTIONS:
You were admitted after a procedure to remove stones from your
common bile duct. This procedure was successful. Please
follow-up as previously scheduled for further management of the
gallbladder tube and known gallstones. Please do not restart
your coumadin until . Please take augmentin, an
antibiotic, as prescribed for 5 total days.
You also had a kidney ultrasound for work-up of your recurrent
urinary tract infections. This was normal. Please follow-up as
previously scheduled with your outpatient doctors.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17777109", "visit_id": "26125266", "time": "2159-08-11 00:00:00"} |
10467410-DS-23 | 1,053 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
transfer for fever/abdominal pain
## HISTORY OF PRESENT ILLNESS:
Mr. is a gentleman with pancreatic cancer diagnosed
s/p gastrojejunostomy, XRT, & chemo c/b biliary
obstruction and cholangitis s/p stenting and PBTD, as well as
palliative stenting for residual ductal obstruction who is
transferred due to management of abdominal discomfort.
Most recently, he was admitted to with sepsis
for cholangitis treated with Amp-Sulbactam and transitioned to
Ciprofloxacin/Flagyl which was completed on . He had a
cholangiogram with placement of right and left hepatic stents, a
new left biliary drain and replacement of his right drain. The
drains were removed at an outpatient appointment on and
of note it was found that one of his stents had migrated to the
mid ileum with no evidence of bowel obstruction.
Patient reports that since the time of that appointment he began
feeling body aches and chills, lethargy, as well as worsening of
his upper abdominal pain. No jaundice/icterus and no RUQ pain.
Worsening of his chronic loose stools that progressed to watery
diarrhea. He saw his Oncologist Dr. on and was
found to be febrile to 102 so he was admitted to
.
At the OSH, his LFTs were normal with TBili of 0.23. RUQ U/S
showed a 13mm bile duct, no abscess. He was started on empiric
Pip-Tazo possible cholangitis. He was then found to have C.diff
on and was started on PO Vancomycin. On his labs
showed TBili up to 5.4 so Pip-Tazo was restarted; CT showed
pneumobilia, no abscess, portal vein occlusion new from .
The next day his TBili decreased back to 0.2. He has remained
hemodynamically stable during that admission, with no more
fevers. His Oncologist is in but due to the fact that he has
received most of his care here he was transferred to .
On arrival to , he has no major complaints. He has upper
abdominal pain, but not worse than prior. Last BM was at 5PM
and was watery. Very sleepy from being transferred overnight.
REVIEW OF SYSTEMS
Pertinent for 20 lb weight loss since reports that his
appetite is poor. Has loose bowel movements after eating which
is another reason he does not eat much. Fever/chills as above.
Negative for night sweats, chest pain, palpitations, dyspnea,
constipation, urinary changes, skin/eye color changes, weakness,
numbness/tingling.
## PAST MEDICAL HISTORY:
# Pancreatic Cancer - per prior report, x/p chemotherapy and
xrt. s/p open biopsy, liver biopsy, retroperitoneal LN biopsy,
open CCY and open gastrojejunostomy without vagotomy.
# s/p PTBD
# s/p appendectomy
## FAMILY HISTORY:
There is no family history of pancreatic cancer.
Mother with h/o liver CA, died at .
## HEENT:
PERRL, EOMI, oropharynx clear
## CV:
normal S1 and S2, no murmur
## PULM:
CTA bilaterally, no wheezes/crackles
## ABDOMEN:
Well-healing scars including in upper epigastrium and
right flank; (+)bowel sounds, non-distended, soft, tender to
palpation in epigastrium; no rebound but mild guarding
## EXTREM:
warm, 2+ DP pulses bilaterally; legs are symmetric
## NEURO:
alert and oriented x3, gait normal
## SKIN:
no jaundice, no rash
## BRIEF HOSPITAL COURSE:
Mr. is a gentleman with pancreatic cancer s/p
surgery, chemo, and XRT that has been complicated by biliary
strictures and cholangitis requiring ERCP/stents ir
PBTDs who presented s/p PBTD removal with with fevers, chills,
and worsened abdominal pain & watery diarrhea.
## #. FEVERS/CHILLS, ABDOMINAL PAIN, DIARRHEA:
C. diff colitis.
Risk factors for C.diff include recent hospitalization and Abx
(Amp-Sulbactam, Cipro/Flagyl). He was treated with PO Vanc due
to recent Flagyl exposure. Not considered to be severe CDI by
labs and presentation. He was treated with Zosyn
prophylactically given recent manipulation of and removal of his
PTBD. LFTs were reassuring during admission. He was monitored on
PO vancomycin and the Zosyn was discontinued. He had improvement
in bowel frequency (10->5->3) and as he described it was "formed
and hit the bottom of the bowl."
- Ten day course of PO vancomycin for CDI
## #. PANCREATIC CANCER:
s/p recent PBTD removal, and also has
migrated stent. ERCP was aware of his admission and reviewed
his CT from the OSH. His migrated stent was no longer visible,
and his other two stents were in good position. Given his labs,
clinical improvement on treatment for CDI, and physical exam, no
procedure was warranted.
## #. PORTAL VEIN THROMBOSIS:
new since . After discussion
with , this was present on his prior scan in , but
not present in making this subacute (possibly chronic) and
it was difficult to determine if this was tumor thrombus or
clot.
This was discussed with Mr. , and anticoagulation was
deferred to the outpatient setting. Given the subacute nature,
normal LFTs as well as his prognosis and the risks of systemic
anticoagulation and lack of evidence for anticoagulation with
tumor thrombus the decision between he and I was to defer this
decision to follow-up with his outpatient providers.
## #. GERD:
chronic issue. Continued Omeprazole
Transitional issues:
- Completing ten day treatment for CDI
- Outpatient follow-up and discussion of tumor thrombus, clot
and role for anticoagulation
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain
2. Metoclopramide 5 mg PO TID:PRN nausea
3. Pancrelipase 5000 3 CAP PO TID W/MEALS
4. Omeprazole 40 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Metoclopramide 5 mg PO TID:PRN nausea
2. Omeprazole 40 mg PO DAILY
3. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain
4. Pancrelipase 5000 3 CAP PO TID W/MEALS
5. Vancomycin Oral Liquid mg PO Q6H
Continue for 6 days (through
RX *vancomycin 125 mg 1 capsule(s) by mouth every six (6) hours
Disp #*24 Capsule Refills:*0
## DISCHARGE INSTRUCTIONS:
Mr. -
It was a pleasure taking part in your care. You were admitted to
with an infection in your colon called C. diff. While you
were admitted you were treated with oral vancomycin. Your bowel
movements improved, and you had no fevers.
The radiologists reviewed your CT scan from an outside hospital
and it showed that 2 stents were in good position, and
unchanged. The third stent which had previously migrated, is no
longer visible, and you likely have expelled this through your
bowel movements.
Please continue the vancomycin for 6 more days.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10467410", "visit_id": "27069646", "time": "2155-04-22 00:00:00"} |
17781765-RR-52 | 104 | ## INDICATION:
evaluate massMass in/attached to the interatrial septum
## IMPRESSION:
Please note that this report only pertains to extracardiac findings.
Mild exaggeration of the normal thoracic kyphosis. Otherwise, there are no
extracardiac findings. As noted on the CT abdomen from , again
visualized is an oval homogeneously enhancing mass arising from the posterior
cortex, superior pole of the left kidney measuring 3.5 x 2.7 cm (series ,
image 67) concerning for renal cell carcinoma. From the OMR notes, urology
has been consulted for the same.
The entirety of this Cardiac MRI is reported separately in the Electronic
Medical Record (OMR) - Cardiovascular Reports.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17781765", "visit_id": "N/A", "time": "2176-01-24 15:51:00"} |
11965902-RR-29 | 124 | ## EXAMINATION:
UNILAT UP EXT VEINS US LEFT
## INDICATION:
with left neck pain, left distension of EJ, ct c/f stenosis?
of innominante and subclav. // eval for central thrombus.
## FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins. Additionally, comparison of the right internal jugular vein and left
internal jugular vein demonstrate symmetric waveforms.
The left internal jugular and axillary veins are patent and compressible with
transducer pressure.
The left brachial, basilic, and cephalic veins are patent, compressible with
transducer pressure and show normal color flow and augmentation.
## IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity. Symmetric
respiratory variation within bilateral subclavian veins as well as symmetric
and normal waveforms within bilateral internal jugular veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11965902", "visit_id": "N/A", "time": "2162-09-27 22:27:00"} |
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