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16190834-RR-75 | 362 | ## EXAMINATION:
MRI of the Abdomen
## INDICATION:
year old woman with chronic bronchitis, IDDM, cirrhosis.
// please assess liver for solid liver masses, assess for ascites, assess
spleen size.
## LOWER THORAX:
The lung bases are clear. There is no pericardial pleural
effusion. The heart size is top normal.
## LIVER:
The liver contour is nodular, in keeping with known history of
cirrhosis. The hepatic parenchyma demonstrates normal signal intensity on T1
and T2 weighted sequences. Evaluation for small hepatic masses is limited by
use of non breath hold techniques, however, no focal hepatic mass is detected.
A recanalized paraumbilical vein is again demonstrated (series 8, image 18).
The portal and hepatic veins are patent. Extensive perisplenic varices and
splenorenal shunt are again demonstrated (series 12, image 23).
## BILIARY:
There is no intra or extrahepatic bile duct dilation. The
gallbladder wall is thin. Tiny stones and/or sludge is again demonstrated at
the gallbladder neck (series 7 image 29). No ductal stones are detected.
## PANCREAS:
The pancreas demonstrates normal signal intensity and bulk. There
is no pancreatic duct dilation or focal lesion.
## SPLEEN:
The spleen is moderately enlarged, measuring 18.6 cm.
## ADRENAL GLANDS:
The adrenal glands are normal in size and shape.
## KIDNEYS:
The kidneys are normal in size and enhance symmetrically, without
concerning mass or hydronephrosis. Arising from the upper pole of the right
kidney is a 12 mm cyst (series 6, image 28). Other sub-cm cysts are also
present (series 6, image 40, 42).
## GASTROINTESTINAL TRACT:
The stomach and intra-abdominal loops of small and
large bowel are normal in caliber. There is no focal gastrointestinal lesion.
## LYMPH NODES:
There is no mesenteric or retroperitoneal lymphadenopathy, and no
ascites.
## VASCULATURE:
The abdominal aorta, celiac trunk, SMA, and renal arteries are
patent and normal in caliber.
## OSSEOUS AND SOFT TISSUE STRUCTURES:
There are no osseous lesions concerning
for malignancy or infection.
## IMPRESSION:
1. Hepatic cirrhosis. No concerning lesions detected, within limitations of
non-breath-hold technique.
2. Moderate splenomegaly, splenic varices, recanalized paraumbilical vein, and
a splenorenal shunt.
3. Cholelithiasis.
## RECOMMENDATION(S):
Consider CT for next follow-up, as this patient has had
difficulty with breath holding for two consecutive examinations.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16190834", "visit_id": "N/A", "time": "2169-01-14 13:11:00"} |
18342863-RR-28 | 266 | ## INDICATION:
Right-sided flank pain and history of stones requiring
lithotripsy. Evaluate for stones.
## CT ABDOMEN WITHOUT CONTRAST:
There is a 4-mm nodule in the right middle lobe
(2:2), which has been stable since . A second 5-mm nodule along
the left major fissure is also unchanged (2:2). The visualized portion of the
heart is unremarkable.
Evaluation of the abdominal organs is limited on non-contrast CT. Within this
limitation, the liver, gallbladder, pancreas, spleen, and bilateral adrenal
glands are normal. The kidneys are symmetric in size. There are two tiny 1
mm non-obstructing stone in the right upper pole. There is no evidence of
hydronephrosis. A small exophytic left renal hypodensity (2:26) is
incompletely characterized but likely a cyst and unchanged from .
The non-opacified stomach and intra-abdominal loops of bowel including the
appendix are normal. There is no free air or fluid in the abdomen. There is
no mesenteric or retroperitoneal lymphadenopathy meeting criteria for
pathologic enlargement. The aorta is of normal caliber throughout with
atherosclerotic calcification.
## CT PELVIS WITH IV CONTRAST:
The urinary bladder, distal ureters, seminal
vesicles, sigmoid colon and rectum are normal. There is a fat containing left
inguinal hernia. The prostate measures 5.3 cm and has several small
calcifications. There is no free fluid in the pelvis. No pelvic or inguinal
lymphadenopathy is noted.
## BONE WINDOWS:
No suspicious lytic or sclerotic osseous lesion is identified.
## IMPRESSION:
Two tiny non-obstructing stones in the upper pole of the right
kidney. No evidence of hydronephrosis or hydroureter on this
non-contrast-enhanced CT.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18342863", "visit_id": "N/A", "time": "2134-12-30 21:55:00"} |
18407754-RR-10 | 147 | ## HISTORY:
Cervical spine lesion. Evaluate for evidence of demyelinating
disease.
## FINDINGS:
There are multiple scattered focal and confluent FLAIR
hyperintensities within the periventricular and subcortical white matter
without gradient signal artifact, restricted diffusion, or post-contrast
enhancement. The parenchymal gray-white matter differentiation is maintained.
There is no evidence of territorial infarction, intracranial hemorrhage, mass,
mass effect, or shift of midline structures. The ventricles and sulci are
mildly prominent commensurate with the patient's degree of atrophy. The major
intracranial flow voids are present.
There is minimal mucosal thickening of the frontal and ethmoid air cells. The
bilateral maxillary sinuses also demonstrate mucosal thickening predominantly
in the inferior aspect.
## IMPRESSION:
There are multiple scattered focal and confluent FLAIR
hyperintensities within the periventricular and subcortical white matter which
are nonspecific and may be related to demyelinating disease, although small
vessel ischemic disease also has this appearance.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18407754", "visit_id": "24699561", "time": "2153-06-30 20:01:00"} |
10688510-DS-18 | 2,521 | ## HISTORY OF PRESENT ILLNESS:
is a M w/ Addison's disease on fludrocortisone
and steroids, CAD s/p LAD and circumflex stent ( ), and
ischemic HFrEF (25% admitted with acute on chronic HF
based on RHC measurements. Referred for elective right heart
catheterization for subacute shortness of breath.
Patient initially presented in with progressive dyspnea
for the prior four months along with orthopnea. R/L heart at
demonstrated CTO of RCA, LCx, and LAD, along
with elevated biventricular pressures. Patient sent to for
further management and became hypotensive requiring IABP and
multiple inotropes and pressors. Patient was not revascularized
at that time as he was felt to be too high risk and poor graft
targets. He was weaned from IABP, pressors, and inotropes and
started on afterload reduction with hydralazine/ISDN. EF at the
time was 15%. He was sent home with Lifevest. He was readmitted
in with dizziness and orthostatic hypotension and imdur
and hydral decreased. CMR showed areas of viability and
underwent high risk PCI with impella to LAD and LCx. Unable to
revascularize RCA.
Readmitted in with vomiting, diarrhea, and hypotension
with placement of IABP at OSH. Transferred and found to have
DKA, ARDS 2.2 Burkholderia PNA, C. Diff colitis, and adrenal
crisis. Had arterial thrombosis to R great toe with subsequent
amputation.
Patient with DOE, orthopnea, PND for several months. Patient
recently saw Dr. in clinic and had RHC for evaluation.
RHC demonstrated biventricular elevated filling pressures, low
CI, elevated SVR.
RA 12 RV PA 60/31||41 PCW 33 CO 3.88 CI 1.65
PV 165 SV 1608
Decision made to admit to CCU for swan guided therapy.
In the CCU, patient continues to complain of dyspnea on
exertion. He denies chest pain. States that he feels well
overall.
## REVIEW OF SYSTEMS:
Cardiac ROS per HPI.
On further review of systems, denies fevers or chills. Denies
any prior history of stroke, TIA, deep venous thrombosis,
pulmonary embolism, myalgias, joint pains, cough, hemoptysis,
black stools or red stools. All of the other review of systems
were negative.
## PAST MEDICAL HISTORY:
Addison's disease
Insulin dependent diabetes
HTN
Hyperlipidemia
hypothyroidism
Obesity
OSA
cardiomyopathy
## FAMILY HISTORY:
Patient thinks there may be some family members with heart
problems. unaware of other family hx
## PHYSICAL EXAM:
ADMISSION PHYSICAL EXAM
===========================
## GENERAL:
Well developed, well nourished Caucasian Male in NAD.
## HEENT:
Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI.
Conjunctiva were pink. No pallor or cyanosis of the oral mucosa.
No xanthelasma.
## NECK:
JVP not visible due body habitus and R PA catheter
## CARDIAC:
PMI nonpalpable. Regular rate and rhythm. Normal S1,
S2. No murmurs, rubs, or gallops.
## LUNGS:
Respiration is unlabored with no accessory muscle use.
Intermittent small crackles in b/l lower bases, No wheezes or
rhonchi.
## EXTREMITIES:
Warm, well perfused. No clubbing, cyanosis, or
peripheral edema. RLE great toe amputation w/ dry scaling
skin of toes. Dopplerable DP pulses b/l. Radial pulses 2+ b/l
## SKIN:
No significant skin lesions or rashes.
DISCHARGE PHYSICAL EXAM
===========================
## VS:
T 97.8 BP 115-128/59-68 HR RR 20 O2 sat 96 RA
## GENERAL:
WDWN male in NAD. Oriented x3. Mood, affect
appropriate. Sitting at edge of bed.
## HEENT:
NCAT. Sclera anicteric. Pupils reactive, R 2mm L 3mm.
EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral
mucosa. No xanthelasma.
## NECK:
Difficult to assess for JVP. Former RIJ site bandage c/d/i
## CARDIAC:
PMI located in intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g.
## LUNGS:
No chest wall deformities. Resp were unlabored, no
accessory muscle use. bilateral basilar crackes. No wheezes or
rhonchi.
## ABDOMEN:
Soft, NTND. protuberant abdomen.
## SKIN:
WWP. L knee lesion with clean base.
## IMPRESSIONS:
1. Elevated biventricular filling pressures.
2. Postcapillary pulmonary hypertension with pulmonary vascular
resistance of 2.0 .
3. Preserved systemic blood pressure with elevated systemic
vascular resistance.
4. Low cardiac output.
Recommendations
1. Admit to the CCU for Swan-guided therapy with plan for IV
vasodilator therapy and IV diuresis.
2. Further management per the Heart Failure team.
## ECHO :
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity is
moderately dilated. There is severe global left ventricular
hypokinesis (LVEF = 25 %) with akinesis of the inferior wall. No
masses or thrombi are seen in the left ventricle. Right
ventricular chamber size is normal with borderline normal free
wall function. The aortic root is mildly dilated at the sinus
level. The ascending aorta is mildly dilated. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. There are filamentous strands on the aortic leaflets
consistent with Lambl's excresences (normal variant). At least
Moderate (2+) aortic regurgitation is seen. The aortic
regurgitation jet is eccentric, directed toward the anterior
mitral leaflet. The mitral valve leaflets are mildly thickened.
Mild (1+) mitral regurgitation is seen. The pulmonary artery
systolic pressure could not be determined. There is no
pericardial effusion.
Compared with the prior study (images reviewed) of
there has not been a major change. If clinically indicated the
severity of the aortic regurgitation could be better quantified
with cardiac MRI.
STRESS
## INTERPRETATION:
yo man with HL, HTN and DM, systolic and
diastolic CHF with LVEF of 25% s/p PCI to LAD and LCX in
with
occluded RCA (no intervention) was referred for evaluation. The
patient
completed 7 minutes and 34 seconds of a ramping cycle ergometry
protocol. The exercise test was stopped due to fatigue. No
chest, back,
neck or arm discomforts were reported. At peak exercise, there
was 2-3
mm ST segment elevation in the inferior leads with additional
downsloping STD in the lateral leads. These changes resolved
after 10
minutes in recovery. The rhythm was sinus with occasional
isolated
VPBs and rare ventricular couplets. The blood pressure response
to
exercise was flat with a drop in systolic blood pressure noted
at peak
exercise. The heart rate response to exercise was blunted.
## CARDIOPULMONARY DATA:
VO2peak was 8.9 ml/kg/min representing 39%
of the
patient's age-predicted VO2peak of 23.3 ml/kg/min. RER at peak
exercise
was 1.19. Ventilatory threshold was calculated at 5.7 ml/kg/min
representing 64% of the patient's actual VO2peak and 25% of the
patient's age-predicted VO2peak. VE/VCO2 slope was 31.3. PET CO2
at
rest, ventilatory threshold and peak exercise was 35 mmHg, 37
mmHg and
36 mmHg, respectively. O2 pulse was 9 ml/beat; predicted 16
ml/beat.
OUES was 1.18. VO2/WR was low at 7 ml/min/Watt. EOV was not
noted during
the procedure.
## IMPRESSION:
Very poor exercise tolerance as indicated by the low
VO2peak (Weber Class D; < 10 ml/kg/min) and low ventilatory
threshold; <
11 ml/kg/min and < 50% of predicted VO2peak. Mildly elevated
VE/VCO2
slope (Ventilatory Class II). Abnormally low O2 pulse and OUES.
Abnormally low VO2/WR. No anginal symptoms. Ischemic ECG changes
with
inferior ST elevation. Blunted systolic blood pressure response
to
exercise with drop in systolic blood pressure noted at peak
exercise.
## IMPRESSION:
Severe fixed inferior, inferolateral, and apical
perfusion defects with severe wall motion abnormalities in areas
of fixed defects. Severe LV enlargement with EF of 20% with
stress.
## ART EXT :
On the right side, triphasic Doppler waveforms are seen in the
right femoral, popliteal, posterior tibial and dorsalis pedis
arteries.
The right ABI was not obtained due to noncompressible vessels.
On the left side, triphasic Doppler waveforms are seen at the
left femoral and popliteal. There are monophasic waveforms in
the posterior tibial and dorsalis pedis arteries. The left ABI
was not obtained due to noncompressible vessels.
Pulse volume recordings showed symmetric amplitudes bilaterally,
at all
levels.
DISCHARGE LABS
===================
06:50AM BLOOD WBC-12.4* RBC-4.91 Hgb-14.1 Hct-41.6
MCV-85 MCH-28.7 MCHC-33.9 RDW-14.3 RDWSD-43.9 Plt
06:50AM BLOOD Glucose-60* UreaN-70* Creat-1.7* Na-132*
K-4.5 Cl-90* HCO3-27 AnGap-20
06:45AM BLOOD ALT-11 AST-12 LD(LDH)-298* AlkPhos-130
TotBili-0.9
06:50AM BLOOD Calcium-9.6 Phos-3.9 Mg-2.3
07:16AM BLOOD %HbA1c-6.9* eAG-151*
02:18AM BLOOD TSH-5.6*
02:18AM BLOOD T4-7.5
## BRIEF HOSPITAL COURSE:
Information for Outpatient Providers:Mr. is a with
ICMP (LVEF 35%) s/p DES to LAD and LCX ( ), DM, HTN, HLD,
and Addison's disease admitted with acute on chronic heart
failure exacerbation for swan-guided therapy who improved with
diuresis.
# Acute on chronic HFrEF (EF 30%): RHC on demonstrated
biventricular high filling pressures and low CI with an elevated
SVR. He was admitted to the CCU for swan guided therapy. In the
CCU, his BB was held, and he was diuresed and did not require
any inotropes. Trial of low dose captopril 6.25 led to severe
hypotension requiring neo which resolved. He was also started on
digoxin contractility. Echo repeated with stable EF of 25%.
pMIBI showed severe fixed inferior, inferolateral, and apical
perfusion defects with severe wall motion abnormalities in areas
of fixed defects. Severe LV enlargement with EF of 20% with
stress. CPET showed very poor exercise tolerance as indicated by
the low VO2peak (Weber Class D; < 10 ml/kg/min) and low
ventilatory threshold; < 11 ml/kg/min and < 50% of predicted
VO2peak. Mildly elevated VE/VCO2 slope (Ventilatory Class II).
Abnormally low O2 pulse and OUES. Abnormally low VO2/WR. EP was
consulted who thought he would benefit from ICD but recommended
against implanting an ICD until after a decision is reached as
to the overall strategy for his advanced heart failure. He will
undergo outpatient evaluation for transplant and we will
consider VAD placement depending on how he is doing as an
outpatient. If he has severely reduced quality of life from
exertional intolerance, then it would be reasonable to consider
either inotropes or LVAD placement.
## PRELOAD:
switched from torsemide 20 mg PO daily to Lasix 40mg as
needed for weight gain over baseline 111.2 kg
## NHBK:
Not restarted on home BB. Tolerated spironolactone.
## AFTERLOAD:
unable to tolerate afterload reduction w/ captopril
due to hypotension
## #CAD:
Patient with history of significant CAD with PCI CTO of
LAD (2.5x38mm, 3.0x12mm) and LCX (2.5x28 mPROMUS). Unsuccesful
PCI of RCA. pMIBI and CPET as above. Cont ASA 81 qd, Plavix 75mg
qd, ezetimibe 10mg qd. Patient does not tolerate statin
secondary to muscle cramps.
## #CKD:
Patient with history of CKD, however Cr improved in
to 0.8-1.2. Elevated during hospital course with diuresis.
Improved with holding torsemide.
## #ADDISON'S DISEASE:
Outpatient endocrinologist at . No
evidence of adrenal crisis during hospitalization. Endocrine
consulted for steroid recommendations as they would increase
afterload. Recommended to hold prednisone 7.5mg qd,
fludrocortisone 0.011mg qd and use only glucocorticoid
(dexamethasone) while in the CCU setting. Prednisone 7.5mg qd,
fludrocortisone 0.011mg qd were both restarted prior to
discharge. Of note, endocrinology recommends stress dosing prior
to any invasive procedures in the future. Patient instructed to
follow-up with outpatient endocrinologist.
## #HYPOTHYROIDISM:
TSH 5.6. Free T4 7.5. Cont levothyroxine 250mcg
qd. Endocrinology followed during course and recommend repeat
TFTs in weeks.
## #IDDM:
A1c 6.9. Endocrinology consulted with close following.
Cont Lantus 30U (reduced from home 46U) + HISS. On discharge,
lantus 36 qAM and HISS:
Insulin sliding scale TID with meals
blood glucose humalog
71-100 mg/dL 0 Units
101-150 mg/dL 14 Units
151-200 mg/dL 16 Units
201-250 mg/dL 18 Units
251-300 mg/dL 20 Units
301-350 mg/dL 22 Units
351-400 mg/dL 23 Units
QHS SSI
-----
71-100 mg/dL 0 Units
101-150 mg/dL 0 Units
151-200 mg/dL 2 Units
201-250 mg/dL 3 Units
251-300 mg/dL 4 Units
301-350 mg/dL 5 Units
351-400 mg/dL 6 Units
## TRANSITIONAL ISSUES
=====================
#NEW MEDICATIONS:
digoxin 0.125 daily
#CHANGED MEDICATIONS: furosemide 40 mg as needed for weight gain
## #STOPPED MEDICATIONS:
metoprolol
[] Recommended endocrinology follow-up for further management of
Addison's, hypothyroidism, pt will make appointment
[] Timing of ICD in the setting of possible LVAD
[] Please repeat TFTs in weeks
[] Please keep in mind that patient will need stress dose of 50
IV methylpred before and after invasive interventions including
ICD placement for adrenal insufficiency
[] Consider statin re-challenge
# Discharge weight: 111.2 kg
# Discharge Cr: 1.7
# CODE: Full Code
# CONTACT/HCP: (wife)
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Fludrocortisone Acetate 0.1 mg PO DAILY
2. PredniSONE 7.5 mg PO DAILY
3. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild
4. Metoprolol Succinate XL 25 mg PO DAILY
5. Ezetimibe 10 mg PO DAILY
6. Ranitidine 150 mg PO BID
7. Glargine 47 Units Breakfast
Insulin SC Sliding Scale using HUM Insulin
8. Spironolactone 12.5 mg PO DAILY
9. Clopidogrel 75 mg PO DAILY
10. Aspirin 81 mg PO DAILY
11. Levothyroxine Sodium 250 mcg PO DAILY
12. Torsemide 20 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Digoxin 0.125 mg PO DAILY
RX *digoxin 125 mcg 1 tablet(s) by mouth once a day Disp #*30
## TABLET REFILLS:
*0
2. Furosemide 40 mg PO DAILY:PRN if weight is >3 lbs over your
dry weight
if weight gain over your dry weight of 111.2 kg
RX *furosemide 40 mg 1 tablet(s) by mouth once a day Disp #*30
## TABLET REFILLS:
*0
3. Glargine 36 Units Breakfast
Insulin SC Sliding Scale using HUM Insulin
4. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild
5. Aspirin 81 mg PO DAILY
6. Clopidogrel 75 mg PO DAILY
7. Ezetimibe 10 mg PO DAILY
8. Fludrocortisone Acetate 0.1 mg PO DAILY
9. Levothyroxine Sodium 250 mcg PO DAILY
10. PredniSONE 7.5 mg PO DAILY
11. Ranitidine 150 mg PO BID
12. Spironolactone 12.5 mg PO DAILY
13. HELD- Metoprolol Succinate XL 25 mg PO DAILY This
medication was held. Do not restart Metoprolol Succinate XL
until your cardiologist tells you
## DISCHARGE DIAGNOSIS:
PRIMARY DIAGNOSIS
==================
Acute on chronic systolic heart failure
SECONDARY DIAGNOSIS
===================
Coronary artery disease
Chronic kidney disease
Addison's disease
Hypothyroidism
Insulin dependent diabetes mellitus
Gastroesophageal reflux disease
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
Why was I in the hospital?
- You came to the hospital because you were experiencing
worsening shortness of breath.
What happened while I was in the hospital?
- You were treated by removing extra fluid with IV medicines and
fluid pills and felt better.
- You had imaging of your heart which showed it is not pumping
well
What should I do now that I am leaving the hospital?
- Please continue to take your medicines as directed.
- Please follow-up with your heart doctor to determine the next
steps for treating your heart.
- You weighed 245 lbs on the last day of your hospitalization.
Weigh yourself every morning, call MD if weight goes up more
than 3 lbs.
Appointments have been made for you.
It was a pleasure taking care of you,
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10688510", "visit_id": "25338406", "time": "2163-11-25 00:00:00"} |
15994772-DS-22 | 895 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Exploratory laparotomy, right colectomy, ileal
colostomy
## HISTORY OF PRESENT ILLNESS:
The patient is a year old male who is status post renal
transplant for polycystic kidney disease. He originall presented
with iron deficiency anemia and therefore underwent routine
upper and lower endoscopy. Lower endoscopy was positive for a
cecal mass which was biopsied and was positive for high-grade
dysplasia with a concern for cancer that was quite large and
nearly obstructing.
## PAST MEDICAL HISTORY:
1. polycystic kidney disease, s/p R-sided transplant in
2. HTN
3. Anemia- prior to kidney transplant
4. gout
5. previous MI year ago, bare metal stents with 12mo on plavix
## FAMILY HISTORY:
There is no family history of premature coronary artery disease
or sudden death. His mother died from brain cancer, and his
father died from cirrhosis.
## PHYSICAL EXAMINATION:
BP 120/70 HR 72 Resp rate 16 weight 220
## GENERAL:
Appears comfortable and in no respiratory distress;
## HEENT:
No neck mass or thyromegaly; No jaundice or cyanosis.
## HEART:
JVP not elevated; Regular rhythm; PMI normal position;
No
parasternal lift; Normal S1 and S2; S4; No murmur.
## ABDOMEN:
No fluid; Liver not enlarged.
## EXTREMITIES:
No edema; DP pulses normal and symmetric.
Neurologic; Speech intact; Alert; Affect appropriate; No gross
motor abnormalities.
## RIGHT (ASCENDING) COLON.
TUMOR CONFIGURATION:
Exophytic (polypoid).
Tumor Size
Greatest dimension: 8.5 cm. Additional : 5.5 cm
x 3.5 cm.
MICROSCOPIC
## HISTOLOGIC TYPE:
Mucinous adenocarcinoma (greater than 50%
mucinous).
## HISTOLOGIC GRADE:
Not applicable.
EXTENT OF INVASION
## PT3:
Tumor invades through the muscularis
propria into the subserosa or the nonperitonealized pericolic or
perirectal soft tissues.
## PN0:
No regional lymph node metastasis.
Lymph Nodes
Number examined: 15.
Number involved: 0.
Distant metastasis: pMX: Cannot be assessed.
Margins
Proximal margin:
Uninvolved by invasive carcinoma: Distance of tumor
from closest margin: 125 mm.
Distal margin:
Uninvolved by invasive carcinoma: Distance of tumor
from closest margin: 240 mm.
Circumferential margin:
Uninvolved by invasive carcinoma: Distance of tumor
from closest margin: 80 mm.
## ABSENT.
VENOUS (LARGE VESSEL) INVASION:
Absent.
Perineural invasion: Absent.
Tumor border configuration: Infiltrating.
## :
pt was admitted to the floor postop, stable. Renal
transplant was consulted as the patient is staus post kidney
transplant; pt was continued on immunosuppression medications
throughout the entirety of his stay
## :
Epidural dc'd, foley out at 12 am, clears.
## :
failed trial of void, replaced foley
## :
Second voiding trial at the request of renal transplant,
again failed with placement of a leg bag at discharge. pt to
follow up as directed in discharge plan.
pt followed post operative colectomy pathway without significant
deviation except that detailed above
## DISCHARGE MEDICATIONS:
1. Mycophenolate Mofetil 500 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
2. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Cyclosporine Modified 100 mg Capsule
## SIG:
One (1) Capsule PO
Q12H (every 12 hours).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(s)* Refills:*0*
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
## SIG:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
7. Flomax 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO once a day.
Disp:*20 Capsule, Sust. Release 24 hr(s)* Refills:*0*
8. Hydromorphone 2 mg Tablet Sig: Tablets PO Q4H (every 4
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
## INCISION CARE:
Keep clean and dry.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.
.
Please call your doctor or return to the ER for 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.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* 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.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
* Continue to ambulate several times per day.
* No heavy lbs) until your follow up appointment.
* You are unable to urinate
*Use your leg bag as directed by your nurse. follow up with
urology as directed. If you have any cloudy urine, or anything
else concerning, call your renal doctor.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15994772", "visit_id": "29312274", "time": "2141-10-13 00:00:00"} |
14838068-RR-41 | 102 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
with unwitness fall // eval for injury
## FINDINGS:
There is no intra-axial or extra-axial hemorrhage, mass, midline shift, or
acute major vascular territorial infarct. Gray-white matter differentiation is
preserved. There are scattered periventricular subcortical white matter
hypodensities, likely sequela of chronic small vessel disease. Ventricles and
sulci are unremarkable. Basilar cisterns are patent.
Mucosal thickening seen within the visualized maxillary sinuses with adjacent
sclerosis suggesting chronic inflammation. Minimally opacified right ethmoids
are also noted. Remaining paranasal sinuses are essentially clear. Mastoids
are minimally pneumatized but clear.
## IMPRESSION:
No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14838068", "visit_id": "21677481", "time": "2115-04-12 13:30:00"} |
14899146-DS-10 | 1,106 | ## ALLERGIES:
wheat / Iodinated Contrast Media - IV Dye
## CHIEF COMPLAINT:
post-operative chills, nausea, shortness of breath
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
None this admission.
POD#3 myotomy with partial fundoplication for type II
achalasia
## HISTORY OF PRESENT ILLNESS:
Mr. is a , who presented to the ED for subjective
chills, nausea, and shortness of breath on POD#2 of
myotomy with partial fundoplication. He was discharged from
in stable condition the day prior, with adequate pain
control, independent ambulation, voiding well, and tolerating
regular diet with no nausea or vomiting. His discharge vitals
were within normal limits. He received anticipatory guidance to
return to the hospital if experiencing chills or nausea, and
came to the ED.
## PAST MEDICAL HISTORY:
esophagus
Colonic adenoma
Sleep apnea w/home CPAP
HTN
Dysthymic disorder
Varicose veins
Obesity
Cancer of bladder wall s/p surgery+chemo
## PSH:
Right shoulder surgery
Right axillary vein pseudoaneurysm repair
Umbillical hernia repair
Transurethral bladder tumor excision
## FAMILY HISTORY:
Father - cancer
Mother - breast cancer, HTN, phlebitis
Sister - esophagus
Maternal grandfather - cancer
## GEN:
AAOx3, NAD, appears comfortable
## HEENT:
MMM, no scleral icterus
## RESP:
nl effort, CTABL, no wheezes/rales/rhonchi
## CV:
RRR, nl S1/S2, no S3/S4, no murmurs/rubs/gallops
## ABD:
+BS, soft, obese, ND, appropriately tender to palpation
Port site incisions C/D/I with steristrips
## EXT:
no edema, 2+ DP
## BRIEF HOSPITAL COURSE:
Mr. was admitted to the General Surgical Service on
for evaluation and treatment of post-operative chills,
nausea, and shortness of breath. He is POD#2 of myotomy
with partial fundoplication and was discharge from the hospital
in stable condition on POD#1. Testing in the ED with an UGI and
KUB revealed that he did not have a leak at the myotomy, and
that contrast was passing reasonably well into the small bowel
and proximal colon. He was afebrile, with a WBC wnl. His nausea
and shortness of breath resolved spontaneously, although he had
Zofran and albuterol ordered PRN for symptomatic relief.
Throughout his stay, Mr. remained nutritionally
supported with regular diet without bread. He was able to
tolerate oral pain medication oxycodone. At the time of
discharge his diet included regular diet without bread. The
patient voided without problem. During this hospitalization, the
patient ambulated early and frequently, was adherent with
respiratory toilet and incentive spirometry, and actively
participated in the plan of care. The patient received
subcutaneous heparin during this stay.
At the time of discharge, Mr. was doing well, afebrile
with stable vital signs. He was tolerating diet as above per
oral, ambulating, voiding without assistance, and pain was well
controlled. He was discharged home without services. The
patient received discharge teaching and follow-up instructions
with understanding verbalized and agreement with the discharge
plan.
## MEDICATIONS ON ADMISSION:
Sucralfate 100 mg/mL - 1gm bid
Ranitidine 300 mg qhs
Triamterene-HCTZ 37.5 mg / 25 mg qd
Lisinopril 20 mg qd
pantoprazole 40 mg bid
escitalopram oxalate (LEXAPRO) 20 mg qd
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild
3. Docusate Sodium 100 mg PO BID
4. Escitalopram Oxalate 20 mg PO DAILY
5. Lisinopril 20 mg PO DAILY
6. Nicotine Patch 21 mg TD DAILY
7. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate
8. Pantoprazole 40 mg PO Q24H
9. Ranitidine 300 mg PO QHS
10. Senna 8.6 mg PO BID
11. Sucralfate 1 gm PO DAILY
12. Triamterene-HCTZ (37.5/25) 1 CAP PO DAILY
## DISCHARGE DIAGNOSIS:
Post-operative chills, nausea, shortness of breath
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you here at
. You were admitted to our hospital for
chills, nausea, and shortness of breath after your operation
myotomy with partial fundoplication) 3 days ago. You
were not found to have a leak at the site of the surgery, and it
appears that your bowels are functioning. You have recovered and
are now ready to be discharged to home. Please follow the
recommendations below to ensure a speedy and uneventful
recovery.
## ACTIVITY:
- Do not drive until you have stopped taking pain medicine and
feel you could respond in an emergency.
- You may climb stairs.
- You may go outside, but avoid traveling long distances until
you see your surgeon at your next visit.
- You may start some light exercise when you feel comfortable.
- Heavy exercise may be started after 6 weeks, but use common
sense and go slowly at first.
- You may resume sexual activity unless your doctor has told you
otherwise.
## HOW YOU MAY FEEL:
- You may feel weak or "washed out" for 6 weeks. You might want
to nap often. Simple tasks may exhaust you.
## YOUR BOWELS:
- Constipation is a common side effect of medicine such as
Percocet or codeine. If needed, you may take a stool softener
(such as Colace, one capsule) or gentle laxative (such as milk
of magnesia, 1 tbs) twice a day. You can get both of these
medicines without a prescription.
- If you go 48 hours without a bowel movement, or have pain
moving the bowels, call your surgeon.
- After some operations, diarrhea can occur. If you get
diarrhea, don't take anti-diarrhea medicines. Drink plenty of
fluids and see if it goes away. If it does not go away, or is
severe and you feel ill, please call your surgeon.
## PAIN MANAGEMENT:
- Your pain should get better day by day. If you find the pain
is getting worse instead of better, please contact your surgeon.
If you experience any of the following, please contact your
surgeon:
- sharp pain or any severe pain that lasts several hours
- pain that is getting worse over time
- pain accompanied by fever of more than 101
- a drastic change in nature or quality of your pain
## MEDICATIONS:
- Take all the medicines you were on before the operation just
as you did before, unless you have been told differently.
- If you have any questions about what medicine to take or not
to take, please call your surgeon.
-Note: please use home CPAP as directed
## WOUND CARE:
-You may shower with any bandage strips that may be covering
your wound. Do not scrub and do not soak; pat dry. The strips
will peel off by itself.
-Notify your surgeon if you notice excess or abnormal
(foul-smelling, bloody, pus, etc.)drainage from your incision
site.
## YOUR DIET:
Following your myotomy, you should consume a regular diet
as tolerated, with the following modifications:
-begin with clears to softs, and advance to regular food as long
as you do not feel nauseous or vomit, try bread last
-stay upright for at least two to three hours after eating to
prevent reflux
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14899146", "visit_id": "21687991", "time": "2177-05-09 00:00:00"} |
15574477-RR-19 | 555 | ## EXAMINATION:
CT abdomen and pelvis with contrast
## INDICATION:
year old woman with gastric bypass status post ex-lap at
complicated by fevers and 6x3.5cm fluid collection in mesentery. Evaluate
fluid collections.
## SINGLE PHASE SPLIT BOLUS CONTRAST:
MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP =
6.0 mGy-cm.
2) Spiral Acquisition 5.0 s, 55.4 cm; CTDIvol = 16.9 mGy (Body) DLP = 934.5
mGy-cm.
Total DLP (Body) = 940 mGy-cm.
## LOWER CHEST:
Bibasilar atelectasis. Visualized lung fields are otherwise
within normal limits. There is no evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
Hepatic steatosis. The liver demonstrates homogenous
attenuation throughout. There is no evidence of focal lesions. There is no
evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder
is surgically absent.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
As before, the patient is status post gastric bypass.
Again seen is dilatation of small bowel loops in the duodenal loop up to 4.5
cm ( ). There is also distention of the bypassed portion of the stomach
which has increased compared to . As before, these findings
are concerning for small bowel obstruction. The transition point is similar
to prior, best seen on the coronal reformats (601 B/ 27). No evidence of free
abdominal air.
Near complete resolution of the mesenteric fluid collection adjacent to the
sutures for the jejunal reanastomosis status post anterior abdominal pigtail
catheter placement ( ).
The colon and rectum are within normal limits. The appendix is normal.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is
trace free fluid in the pelvis with a few foci of air, likely secondary to
right posterior flank pigtail catheter placement. The collection measures 2.8
x 1.8 cm ( ).
## REPRODUCTIVE ORGANS:
The uterus and bilateral adnexae are within normal
limits.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
No significant change in a 2.6 x 2.3 cm fluid collection in the
anterior subcutaneous tissues, likely postsurgical.
## IMPRESSION:
1. Compared to , again seen is a small bowel obstruction with
transition point likely in the mid abdomen with interval increase in size of
the bypassed portion of the stomach.
2. Status post anterior abdominal pigtail catheter placement with near
complete resolution of the mesenteric fluid collection adjacent to the jejunal
reanastomosis.
3. Interval decrease in size of a 2.8 x 1.8 cm fluid collection containing a
few foci of air in the pelvis, likely secondary to right posterior flank
pigtail catheter placement.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15574477", "visit_id": "21475933", "time": "2114-03-14 16:35:00"} |
16213706-RR-202 | 177 | ## EXAMINATION:
RIGHT DIGITAL 2D DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD AND
RIGHT BREAST ULTRASOUND
## INDICATION:
female recalled from screening dating
for asymmetry in the lateral posterior right breast
## TISSUE DENSITY:
C- The breast tissue is heterogeneously dense which may
obscure detection of small masses.
There is no dominant mass, architectural distortion or suspicious grouped
microcalcifications. Benign-appearing calcifications of the right slightly
upper-outer right breast at posterior depth are unchanged. The asymmetry seen
on recent screening mammogram does not persist on the spot compression views
obtained today and is most consistent with normal superimposed breast tissue
on 3D imaging.
## BREAST ULTRASOUND:
Ultrasound of the entire right lateral breast was
performed a which was without any discrete suspicious solid or cystic masses.
## IMPRESSION:
No suspicious sonographic or mammographic findings in the outer right breast
are confirmed in the area of concern on recent screening mammogram.
## RECOMMENDATION(S):
Age and risk appropriate screening mammography.
## NOTIFICATION:
Findings and recommendation were reviewed with the patient who
agrees with the plan. She was given information to schedule her follow-up..
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16213706", "visit_id": "N/A", "time": "2209-05-14 14:05:00"} |
12283103-DS-14 | 1,040 | ## ALLERGIES:
Erythromycin Base / Augmentin / Lopid / niacin
## HISTORY OF PRESENT ILLNESS:
Ms. is a F with recently diagnosed pacreatic CA
with lung mets C1D10 FOLFIRINOX who initally presented to
with fever to 101 at home. She also complained of weakness,
nausea, vomiting, and general malaise. At , she was found to
be hypotensive to the , given 4L NS there. Labs showed
neutropenia (WBC 0.5) and elevated LFTs. She was given 2g
cefepime and 750mg levofloxacin and transferred to for
further manegment.
Patient states that for the past two days, she has felt
nauseated and weak. When her husband came home from work on the
day prior to admission, she felt so tired she couldn't even get
up. Then went to bed and woke up with temp of 102. No myalgias
or arthralgias. No respiratory symptoms. No diarrhea/shortness
of breath/chest pressure. No recent sick contacts. Received flu
shot pneumovax.
##
IN ED, INITIAL VITALS WERE:
98.5 93 88/46 16 98%. Labs
were significant for +UA, transaminases in the 100s, ANC 255.
Patient was given 1g vancomycin, 1g calcium gluconate, 2g Mag
sulfate, and 5mg IV morphine. Patient underwent CXR, which was
eng for any acute process. Final vitals prior to transfer were
97.7 94 112/57 18 100%.
Patient denies chest pain, shortness of breath, or change in
vision. Does have a headache. A 12-point review of systems is
negative aside from what is described above.
## :
Presented with two weeks of abdominal pain and
35lbs weight loss over two months. Outside CT showed mass in
head of pancreas on abdominal CT. Underwent EUS, ERCP and biopsy
at which demonstrated ill-definied 3cm mass in the head of
the panreas, biliary stricture and adenocarcinoma on cytology.
Plastic stent placed. CTA at demonstrated a 4 x 3 x 2-cm
pancreatic mass with
resulting atrophy and pancreatic ductal dilatation in the
remainder of the pancreas. Common bile duct stent is in place.
The pancreatic head abuts approximately 25% of the proximal SMV.
No SMA involvement. Also Mildly enlarged portocaval lymph node.
A
gastroduodenal node is visualized, although normal in size.
>3000. Evaluated by Dr. surgery who
determined that she is not an up-front surgical candidate given
imaging findings and high worrisome for systemic disease.
## :
Established care with Dr. . Staging CT chest
showed bilateral sub-4-mm pulmonary nodules. No liver mets on
MRCP. Started FOLFIRINOX (C1D1 .
## PAST MEDICAL HISTORY:
--Hyperlipidemia
--DM2
--Vit D deficency
--Pancreatic mass
--Facial reconstructive surgery s/p MVA)
--Removal of breast cyst
## GENERAL:
Appears nauseated, uncomfortable, no acute distress,
very pleasant
## CHEST:
CTA bilaterally, no wheezes, rales, or rhonchi
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## ABDOMEN:
+BS, tender throughout, no rebounding or guarding
## EXTREMITIES:
moving all extremities well, no cyanosis, clubbing
or edema, no obvious deformities
## PULSES:
2+ DP pulses bilaterally
## SKIN:
Warm and well perfused, no excoriations or lesions, no
rashes
DISCHARGE PHYSICAL EXAM
## GENERAL:
no acute distress, very pleasant
## CHEST:
CTA bilaterally, no wheezes, rales, or rhonchi
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## ABDOMEN:
+BS, no rebounding or guarding
## EXTREMITIES:
moving all extremities well, no cyanosis, clubbing
or edema, no obvious deformities
## PULSES:
2+ DP pulses bilaterally
## SKIN:
Warm and well perfused, no excoriations or lesions, no
rashes
## IMPRESSION:
No acute cardiopulmonary process.
## BRIEF HOSPITAL COURSE:
Ms. is a F with recently diagnosed pacreatic CA
with lung mets C1D11 FOLFIRINOX who initally presented to
with fever to 101 at home, found to be hypotensive with elevated
transaminases, + UA, and ANC 255; now with imporving counts.
#. FEBRILE NEUTROPENIA: Pt initially presented neutropenic and
with a fever, however on day of discharge with normal WBC and
afebrile x 24 hours. Likely source was GI given copious
diarrhea, nausea, and vomiting. C diff neg so most likely noro
or other viral gastroenteritis. UCx negative. Neupogen was
discontinued once counts were recovered. Antibiotics were
stopped as well once C. Diff negative and once counts recovered.
.
# PANCREATIC CANCER: on folfirinox on contribute
to diarrhea. Patient's outpatient oncologist should discuss the
likelihood of folfirinox contributing to diarrhea and consider
using anti-diarrheal in conjunction with therapy if folfirinox
is indicated.
- further management per Dr.
.
# DMII: held oral hypoglycemics while inpatient. Insulin
sliding scale during admission.
.
#. TRANSAMINITIS: initially presented with transaminitis which
improved over the course of admission. She was given vitamin K
x 3 doses for high INR. Appears to be nutritional given normal
Tbili.
## TRANSITIONAL ISSUES:
Patient's outpatient provider should follow up on blood cultures
which are pending
Patient's outpatient provider should follow up on folfirinox
induced diarrhea
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Allegra-D 24 Hour *NF* (fexofenadine-pseudoephedrine) 180-240
mg Oral QD
2. Filgrastim 300 mcg SC Q24H
3. GlyBURIDE 2.5 mg PO BID
4. Lorazepam 0.5 mg PO Q4H:PRN Anxiety or nausea
Please hold for oversedation or RR <10.
5. Ondansetron 8 mg PO Q8H:PRN Nausea
6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN Pain
Please hold for oversedation or RR <10.
7. Oxycodone SR (OxyconTIN) 10 mg PO Q12H
Please hold for oversedation or RR <10.
8. Polyethylene Glycol 17 g PO DAILY:PRN Constipation
9. Prochlorperazine 10 mg PO Q8H:PRN Nausea
## DISCHARGE MEDICATIONS:
1. Allegra-D 24 Hour *NF* (fexofenadine-pseudoephedrine) 180-240
mg Oral QD
2. Lorazepam 0.5 mg PO Q4H:PRN Anxiety or nausea
Please hold for oversedation or RR <10.
3. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN Pain
Please hold for oversedation or RR <10.
4. Oxycodone SR (OxyconTIN) 10 mg PO Q12H
Please hold for oversedation or RR <10.
5. Polyethylene Glycol 17 g PO DAILY:PRN Constipation
6. GlyBURIDE 2.5 mg PO BID
7. Ondansetron 8 mg PO Q8H:PRN Nausea
8. Prochlorperazine 10 mg PO Q8H:PRN Nausea
## DISCHARGE DIAGNOSIS:
Viral Gastroenteritis
Neutropenic Fever
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to for severe diarrhea and fever. While
you were here, you received antibiotics and received IV fluid.
It appears that you did not have any bacteria as a cause for
your diarrhea and fever, so antibiotics were stopped. Please
follow up with your primary care doctor in the next week, as
well as your oncologist.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12283103", "visit_id": "25817261", "time": "2150-01-11 00:00:00"} |
18569640-RR-6 | 98 | ## EXAMINATION:
CHEST (PRE-OP PA AND LAT)
## INDICATION:
year old man with mitral valve prolapse/regurg pre-op
MVRcoming to radiology from cath lab holding area // assess for infiltrates,
consolidation assess for infiltrates, consolidation
## IMPRESSION:
Heart size is normal. Pulmonary arteries are bilaterally low enlarged. There
are also dense opacities projecting over the left hilus and mediastinum most
likely representing calcified granuloma.
Left sided pacemaker defibrillator leads terminate in the expected location of
right atrium and right ventricle.
Mild vascular congestion is present but no overt pulmonary edema or
pneumothorax or consolidations or pleural effusion demonstrated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18569640", "visit_id": "N/A", "time": "2183-07-04 18:21:00"} |
10512170-RR-44 | 152 | ## EXAMINATION:
BILAT HIPS (AP, LAT, AND PELVIS) 5 OR MORE VIEWS
## INDICATION:
year old woman with presumed arthritis of the bilateral hips
with worsened pain on the left// eval for progression
## FINDINGS:
Surgical hardware in the lumbar spine is incompletely imaged but unchanged
were seen when compared to the prior lumbar spine radiographs. The reservoir
for a left gastric band is incompletely imaged on this study. A bony defect
along the left iliac crest presumably reflects a site for bone graft
harvesting and is unchanged compared to the prior study. Mild degenerative
changes in the bilateral hip joints with mild joint space narrowing and
acetabular osteophytes. This appearance is unchanged compared to the prior
study. No fracture or dislocation seen. No destructive lytic or sclerotic
bone lesions. Nonobstructive bowel gas pattern.
## IMPRESSION:
Postoperative changes in the lumbar spine and left iliac crest. Mild
degenerative changes in the bilateral hip joints.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10512170", "visit_id": "N/A", "time": "2208-05-21 12:24:00"} |
19718343-RR-36 | 446 | ## INDICATION:
year old man with rectal cancer// please eval for mets
## ONCOLOGY 2 PHASE:
Multidetector CT of the abdomen was done with IV
contrast. A single bolus of IV contrast was injected and the abdomen and
pelvis was scanned in the portal venous phase, followed by scan of the abdomen
in equilibrium (3-min delay) phase.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.0 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 6.3 s, 0.2 cm; CTDIvol = 103.4 mGy (Body) DLP =
20.7 mGy-cm.
3) Spiral Acquisition 10.5 s, 68.4 cm; CTDIvol = 9.8 mGy (Body) DLP = 666.8
mGy-cm.
4) Spiral Acquisition 4.3 s, 27.9 cm; CTDIvol = 9.5 mGy (Body) DLP = 260.1
mGy-cm.
Total DLP (Body) = 949 mGy-cm.
## LOWER CHEST:
Please refer to separate report of CT chest performed on the same
day for description of the thoracic findings.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
Unchanged few cortical hypodensity less than 5 mm too small to be
characterize. There is no evidence of focal renal lesions or hydronephrosis.
There is no perinephric abnormality.
## GASTROINTESTINAL:
S/p low anterior section with colorectal anastomosis with no
signs of locoregional recurrence. No bowel obstruction. There is also bowel
anastomotic suture in the right lower quadrant with no signs of complication.
Small bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. The colon and rectum are within normal limits. The appendix is
normal.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The visualized reproductive organs are unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
-Status post low anterior resection with no signs of locoregional recurrence
nor metastases in the abdomen and pelvis.
-Please refer to separate chest CT for thoracic findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19718343", "visit_id": "N/A", "time": "2123-07-14 14:02:00"} |
10494497-RR-57 | 411 | ## INDICATION:
male with metastatic colon cancer abdominal
distention and pain.
## CHEST:
Patchy consolidations within the left lower lobe may reflect early
pneumonia. The right lung base is clear. There is no pericardial effusion.
There is no pleural effusion.
## ABDOMEN:
The liver appears homogeneous in attenuation with no focal lesion
identified. There is no intrahepatic biliary ductal dilatation. The portal
vein is patent. There is no radiopaque cholelithiasis. The pancreas is
unremarkable. The spleen is enlarged, measuring 19 cm in coronal dimension.
Multiple stable periphery located wedge-shaped infarct in the spleen are again
identified. Bilateral adrenal glands are unremarkable.
The kidneys present asymmetric nephrograms and excretion of contrast, delayed
on the right. Moderate right-sided hydronephrosis is similar in appearance to
prior examination dated . A large lobulated centrally necrotic
mass is again seen arising from the anastamosis of the prior right
hemicolectomy site. And identified invading the lower pole of the right
kidney similar in appearance to prior study. The mass appears to invade the
second and third duodenal segments. A duodenal stent is present with more
debris within relative to prior examination.
New since prior examination, there is moderate volume ascites. Dilated
fluid-filled loops of small bowel reflect a small bowel obstruction. A
definite transition point is not identified. The distal colon is decompressed.
The abdominal aorta is normal in caliber without aneurysmal dilatation.
Retroperitoneal nodes are not enlarged.
## PELVIS:
The bladder is not well distended and grossly unremarkable. Prostate
gland and seminal vesicles are within normal limits. No inguinal or pelvic
sidewall adenopathy is detected.
## OSSEOUS STRUCTURES:
No suspicious lytic or blastic lesion is identified.
## IMPRESSION:
1. Dilated fluid filled loops of small bowel concerning for small bowel
obstruction. No definite transition point identified; may be at the level of
mass. No evidence of pneumatosis or abdominal free air.
2. Large lobulated mass large lobulated centrally necrotic mass is again seen
arising from the anastamosis of the prior right hemicolectomy site, centrally
necrotic, appears possibly slightly enlarged but otherwise not significantly
changed in appearance when compared to prior study dated . A
duodenal stent is noted as is a gastrostomy. Duodental stent contains
debris/possibly some invasion from the large mass.
3. Persistent splenomegaly with stable peripherally located wedge-shaped
infarcts. No evidence to suggest interval development of new splenic infarcts
or laceration.
4. New since prior examination is moderate volume ascites.
5. Left basilar patchy consolidations may reflect early pneumonia or
alternatively aspiration. Clinical correlation recommended.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10494497", "visit_id": "29581870", "time": "2164-08-02 18:12:00"} |
13575070-RR-69 | 135 | ## INDICATION:
History of osteoporosis and steroid use, now with acute on
chronic lower back and bilateral hip pain, here to evaluate for fracture.
## FINDINGS:
There are five non-rib-bearing lumbar-type vertebral bodies. The
vertebral body heights and alignment are preserved. No fracture or
malalignment is detected. Mild-to-moderate degenerative changes of the lumbar
spine are most pronounced at the L2-3, L4-5 and L5-S1 vertebral level with
loss of intervertebral disc space, endplate sclerosis, facet hypertrophy, and
osteophyte formation. A left hip prosthesis is partially imaged. The imaged
portion of the sacrum appears intact, although bowel gas obscures evaluation.
Surgical clips in the right lower quadrant are noted. Irregularity of the
right posterior eleventh rib may represent prior fracture.
## IMPRESSION:
No evidence of acute fracture or traumatic malalignment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13575070", "visit_id": "26359198", "time": "2204-03-17 09:15:00"} |
14164062-DS-18 | 817 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Exploratory laparotomy; extensive lysis of adhesions (greater
than 2 hours); wedge resection of stomach; small-bowel
resection; reduction of internal hernia.
## PCP:
.
.
Patient is a year old male with history of small bowel
obstruction and adhesions secondary to repair of gastroschisis
as an infant. He presented today to the emergency room with
crampy abdominal pain. Per his family, he had been having nausea
and vomiting for the last two weeks. Overnight and into the
morning of presentation, he was "doubled over" in abdominal
pain, and his roommate called . His work-up in the ED was
notable for an elevated lactate of 3.0 and leukocytosis of 11.1.
A CT scan was concerning for possible internal hernia.
## PAST MEDICAL HISTORY:
gastroschisis s/p repair
prior large bowel obstruction
## FAMILY HISTORY:
The patient is the youngest of four brothers and three sisters.
He himself has no children. His parents died at the age of .
His father died from a stroke and his mother died from breast
and pancreatic cancer.
## BRIEF HOSPITAL COURSE:
OR course:
The patient was taken to the OR and underwent an exploratory
laparotomy; extensive lysis of adhesions (greater than 2 hours);
wedge resection of stomach; small-bowel resection; and reduction
of internal hernia.
.
FICU course:
Patient was initially admitted to the FICU for altered mental
status and inability to extubate. He still had an NGT, as well
as a foley catheter. His mental status improved, and he was
extubated later that day. Elevated bilirubin levels and
creatinine levels were noted at that time.
.
FLOOR course:
The patient was transferred to the floor once he was extubated
the same day of the operation. His foley catheter was removed
on , and the patient voided.
His NGT was removed, but the patient had a postop ileus. He
experienced flatus by , and his diet was advanced from NPO
to sips to clears on and then to regular diet on .
.
His postoperative course was complicated by fever and elevated
bilirubin levels immediately postop. His preoperative abx of
kefzol and flagyl had been continued until . The dosage of
kefzol was increased to 1g q8h. His LFTs were monitored, and
the Tbili rose to a high of 2.5 on . His WBC rose to a high
of 11.6 on . A RUQ U/S on was unrevealing; there were
no GB stones or dilation of the ducts. Cultures were negative.
After , the bilirubin and WBC gradually trended back down to
normal. Simultaneously, the patient's hct trended down from
42.8 to 27.9 postoperatively. The patient was asymptomatic and
had no blood per rectum or hematemasis. Labs showed no evidence
of hemolysis. The team thought that it was possible that he had
bled internally. He was not transfused, and by , his Hct
was back up to 30.6.
.
At the time of discharge, the patient's pain was well-controlled
on PO pain medications, and he was ambulating, voiding to the
toilet, having flatus and bowel movements, and tolerating
regular diet. He had been afebrile for more than 24 hours
without medications.
## 1. OXYCODONE-ACETAMINOPHEN MG TABLET SIG:
Tablets PO
Q4H (every 4 hours) as needed for pain for 2 weeks.
Disp:*30 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day for
2 weeks.
Disp:*28 Capsule(s)* Refills:*1*
## PRIMARY:
Small-bowel obstruction
(strangulating secondary to internal hernia).
## DISCHARGE CONDITION:
Stable
Tolerating a regular diet
Adequate pain control with oral medication
## DISCHARGE INSTRUCTIONS:
Please call your doctor or return to the ER for any of the
following:
* 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.
* Your pain is not improving within hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.
*Avoid driving or operating heavy machinery while taking pain
medications.
* 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.
* Continue to ambulate several times per day.
.
## INCISION CARE:
-Your staples will be removed at your follow-up appointment with
Dr. .
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-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": "14164062", "visit_id": "25665992", "time": "2112-12-22 00:00:00"} |
16680109-RR-29 | 180 | ## EXAM:
MRI of the lumbar spine.
## CLINICAL INFORMATION:
Patient with known L4-5 disc herniation with new left-
sided radiculopathy.
## FINDINGS:
There has been no significant interval change. At T12-L1 and L1-2,
no abnormalities are seen. At L2-3, mild disc bulging and degenerative disc
disease is identified without spinal stenosis.
At L3-4, no abnormalities are seen.
At L4-5, there is annular tear to the left of midline with a small broad-based
central protrusion slightly indenting the thecal sac, unchanged from previous
study.
At L5-S1 level, disc degenerative changes and mild bulging identified without
spinal stenosis. There is a broad-based central protrusion seen which does
not displace the thecal sac or nerve roots.
The distal spinal cord shows normal signal intensities.
## IMPRESSION:
Overall, no significant change since the previous MRI of
. Small disc protrusion and annular tear at L4-5 level and disc
bulging at this level are again noted. Disc bulging and a broad-based
protrusion at L5-S1 level are also again identified. No significant new
abnormalities are seen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16680109", "visit_id": "22956986", "time": "2149-09-17 09:40:00"} |
11307965-DS-6 | 1,611 | ## HISTORY OF PRESENT ILLNESS:
yo M w/ IDDM and HTN, now presenting with a new irregular
rhythm found on routine follow-up by his PCP. The patient was
in his usual state of health when he presented to his PCP today
for his q3month follow-up. At that time, the patient was found
to have a new irregular rhythm with tachycardia. The pt denies
CP/tightness, dyspnea, decrease in exercise tolerance (not
limited on flat surface), orthopnea, PND, illicit drug use,
heat/cold intolerance. He does endorse fatigue of 6 month
duration, and intermittent palpitations (unknown duration). He
has occasional edema in his RLE that is chronic and attributed
to a prior orthopedic procedure in that leg. ROS also notable
for wt loss of 20 lbs over the last year, decreased appetite
with early satiety.
.
In the ED initial vital signs were T 97.7, HR 54, BP 134/107; RR
16, 100% on RA. EKG notable for atrial flutter waves at a rate
of 300, with variable conduction (1:2 to 1:4). He was
transferred to the floor in no distress.
## PAST MEDICAL HISTORY:
#) Type II Diabetes, diagnosed in the 1980s, insulin dependent
for years; last HgA1c 6.1 on
#) Diabetic neuropathy
#) HTN
#) H/o cervical disc surgery years ago due to "neck pain"
#) H/o R tib-fib repair fall, years ago; chronic edema
in that leg
#) B/l cataracts surgery years ago
#) R eye "macula hole" surgery years ago
#) ?BPH (used to be on flomax, currently urinates q1hour)
## FAMILY HISTORY:
Father with gastric cancer. Sister with melanoma. No h/o heart
disease or pulmonary disease.
## GEN:
Well-nourished elderly gentleman, NAD
## HEENT:
NC/AT, sclerae anicteric, no injection; no conjunctival
pallor, no rhinorrhea, MMM, OP clear; good dentition
## NECK:
supple, trachea midline, no carotid or thyroid bruit, no
thyromegaly, no JVD; JVP not appreciated given habitus; no
lymphadenopathy appreciated
## CV:
irregular, nl S1 and S2, no m/r/g
## PULM:
CTAB, no IWOB, speaking in full sentences
## ABD:
rotund; tender hepatomegaly down to the R iliac crest;
spleen tip palpable ~3cm below costal margin; +BS, no rebound or
guarding
## EXT:
No c/c; pitting edema to the ankle; 2+ DP pulses
bilaterally
## SKIN:
No rashes or bruising; no pretibial petechiae
## NEURO:
EOMI, R eye 3->2, L eye 2.5->1.5; V intact to LT, face
symmetric, no dysarthria, tongue midline; moving all
extremities; gait wnl
## GEN:
Well-nourished elderly gentleman, NAD
## HEENT:
NC/AT, sclerae anicteric, no injection; no conjunctival
pallor, no rhinorrhea, MMM, OP clear; good dentition
## NECK:
supple, trachea midline, no JVD
## CV:
irregular, nl S1 and S2, no m/r/g
## PULM:
CTAB, no IWOB, speaking in full sentences
## ABD:
rotund; tender hepatomegaly down to the R iliac crest;
spleen tip palpable ~3cm below costal margin; +BS, no rebound or
guarding
## EXT:
No c/c; pitting edema to the ankle; WWP
## SKIN:
No rashes or bruising; no pretibial petechiae
## NEURO:
EOMI, R eye 3.5->3, L eye 3->2.5, face symmetric, no
dysarthria, tongue midline; moving all extremities;
## CARDS:
Cardiology ECHO:
The left atrium is mildly dilated. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF >55%). There is considerable beat-to-beat
variability of the left ventricular ejection fraction due to an
irregular rhythm/premature beats. Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. Trace
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is no pericardial effusion.
## IMPRESSION:
Normal regional and global biventricular systolic
function. Moderate pulmonary hypertension. Mild mitral/tricuspid
regurgitation.
Compared with the prior study (images reviewed) of ,
the severity of tricuspid regurgitation is reduced. Estimated
pulmonary artery pressures are slightly higher.
## IMPRESSION:
No hepatosplenomegaly. The visualized hepatic vessels are patent
as described. The pancreas could not be visualized, if there is
concern for pancreatic pathology, consider CT or MR to better
evaluate.
## BRIEF HOSPITAL COURSE:
yo M w/ IDDM and HTN, now presenting with a new irregular
rhythm found on routine follow-up by his PCP. Atrial flutter
with variable conduction on ECG.
.
#) Atrial Flutter
The patient's admission EKG was remarkable for atrial flutter
waves with variable conduction. The patient remained
asymptomatic during the entire hospital admission. His
nifedipine was stopped and metoprolol was started for rate
control. Warfarin was added to begin anticoagulation. Heparin
was not begun given the risk/benifit ratio for this patient. A
TTE was conducted on HOD2 which showed normal regional and
global biventricular systolic function, moderate pulmonary
hypertension, and mild mitral/tricuspid regurgitation. At the
time of discharge, the patient was quite nervous during a
detailed discussion of the risks and benefits of warfarin
therapy. At that time, he had a brief reactive increase in HR
up to 110. Otherwise, his rate control was successful, HR
ranging from 60-90s. He was discharged on 50mg metoprolol XL
and 5mg of warfarin daily. Close follow-up was setup for INR
checks and warfarin dose modification.
.
#) Fatigue with wt loss and early satiety
The patient had a brief work-up given the concern for malignancy
and his hepatosplenomegaly on exam. The patient's
transaminases, LDH, albumin, electrolytes, and CBC were
unremarkable. A full abdominal ultrasound was conducted that
also was reassuring against a possible cause of the patient's
organomegaly.
- Recommend continued follow-up as an outpatient in the primary
care setting
.
#) HTN
Well controlled as an inpatient. His home nifedipine was
discontinued and he was started on metoprolol XL. The patient
tolerated the added BB well.
## MEDICATIONS ON ADMISSION:
Lantus 8 units QHS
- Metformin (dose unknown)
- Lasix 20mg daily
- Potassium 20meq daily
- Amitriptyline 25mg QHS
- Nifedipine ER 30mg daily
- Lisinopril 5mg daily
- ASA 81mg daily
- Ocuvite tablet daily
- MVI
## DISCHARGE MEDICATIONS:
1. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*
6. Lantus 100 unit/mL Cartridge Sig: One (1) 8 units
Subcutaneous at bedtime.
7. warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
## 8. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY (Daily).
9. metformin 500 mg Tablet Sig: Two (2) Tablet PO twice a day.
10. Klor-Con 20 mEq Packet Sig: One (1) PO once a day.
11. Outpatient Lab Work
Standing lab order for , PTT, and INR to be forwarded to Dr.
.
## SECONDARY DIAGNOSES:
Diabetes
Diabetic Neuropathy
High Blood Pressure
## DISCHARGE INSTRUCTIONS:
It was a pleasure taking care of you in the hospital. You were
admitted for a cardiac arrhythmia called atrial flutter. Atrial
flutter can cause transient increases in your heart rate called
rapid-ventricular-response (RVR), which can result in
palpitations and low blood pressure. You were started on a drug
called metoprolol to help prevent RVR. Atrial flutter also
predisposes you to the development of strokes. In order to help
reduce your future risk of stroke, you were begun on a blood
thinner called warfarin (also known as Coumadin). Coumadin must
be adjusted frequently based upon the level of anticoagualation
it achieves in you. The level of anticoagulation is termed the
INR, and your INR should be between 2 and 3. The only way to
check INR is with routine blood draws. Initially, you will
require frequent blood draws so that your Coumadin dose can be
adjusted. As your INR becomes stabilized on a fixed dose of
Coumadin, you will be transitioned to monthly lab draws for
chronic management. It is important to have your INR monitored,
and to be in touch with the doctor managing your INR, because an
INR that is too high or low can be dangerous. Also, Coumadin
interacts with many medications, and you should always tell a
prescribing physician that you are on Coumadin. Also, many
over-the-counter medications and supplements may interact with
Coumadin. Please consult with your primary care physican before
starting new over the counter medications, or any new
supplements.
You will get your blood draws to check your INR at the
, and you should have your first INR check on
. the results will be forwarded to your
primary care doctor, ( ). Dr.
will interpret the results of your INR checks, and
will direct you on how to change your Coumadin dose if needed.
He will also determine when and how frequently you will need to
have your INR checked.
While you are on Coumadin, you will have a reduced ability to
clot your blood. Therefore, you are at increased risk for
bleeding. If you strike/hit your head, you should call your
doctor because you may develop bleeding in your head.
Significant changes have been made to your home medications.
Unless otherwise noted, please continue your other home
medications as directed.
1) Metoprolol Succinate was ADDED, please take 50mg by mouth
daily
2) Warfarin (Coumadin) was ADDED, please take 5mg (2 x 2.5 mg
pills) by mouth daily; you will need frequent INR checks and
your primary care doctor adjust this dose based upon the
INR
3) Your nifedipine was STOPPED
4) You should STOP taking ocuvite now that you are on warfarin
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11307965", "visit_id": "29713713", "time": "2133-03-12 00:00:00"} |
19965625-RR-59 | 142 | ## INDICATION:
year old woman post bronch// post bronch
## FINDINGS:
An endotracheal tube terminates 2.6 cm above the level of the carina. A
nasogastric tube courses into the stomach and out of view of the radiograph.
Left subclavian central venous catheter terminates within the mid SVC.
There is persistent complete whiteout of the left hemithorax with apparent
mild rightward mediastinal shift, which appears similar to the prior
examination allowing for differences in patient rotation and positioning. A
moderate right pleural effusion with adjacent airspace opacities appear to
have increased from the prior examination. The right upper lung is grossly
clear.
## IMPRESSION:
1. Complete left hemithorax opacification likely due to lung collapse.
2. Increasing, moderate to large right pleural effusion with adjacent right
lower lobe airspace opacities which appear increased from the prior
examination and may represent worsening atelectasis versus consolidation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19965625", "visit_id": "26179795", "time": "2185-11-17 14:46:00"} |
13746897-RR-52 | 104 | ## EXAMINATION:
ANKLE (AP, MORTISE AND LAT) RIGHT
## INDICATION:
with R posterior ankle pain, erythema, and edema. Evaluate
for fracture dislocation.
## FINDINGS:
No fracture or dislocation of the right ankle is detected. Mild degenerative
changes are noted. The mortise is congruent on this non stress view.
Periosteal reaction is noted in the distal tibia and fibula. The tibial talar
joint space is preserved and no talar dome osteochondral lesion is identified.
No radiopaque foreign body. Soft tissue swelling overlying the medial
malleolus is noted.
## IMPRESSION:
1. No evidence of right ankle fracture or dislocation.
2. Soft tissue swelling overlying the right medial malleolus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13746897", "visit_id": "26802431", "time": "2168-06-29 16:55:00"} |
12496926-RR-26 | 166 | FOUR VIEWS OF LEFT HAND
## FINDINGS:
Comminuted fracture of the left thumb distal phalanx is evident with interval
removal of hardware and near anatomic alignment of fragments. The fracture
line has become more obscured compatible with healing.
There has been amputation at the level of the PIP joint at the index and long
fingers. There is evidence of transversely orientated fracture at the middle
phalanx of the left ring finger. There is evidence of a transversely oriented
fracture through the distal phalanx of the left ring finger. These fracture
lines remain evident. There is persistent mild dorsal displacement of the
distal component of the distal phalangeal fracture of the left long finger.
There has been interval removal of hardware from the left long finger.
No carpal bone injury is seen. Old healed fracture of the left fourth
metacarpal shaft is evident.
## IMPRESSION:
Multiple fractures and amputations as described above. Interval
removal of hardware from left long finger and thumb. No change in alignment
of fractures.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12496926", "visit_id": "N/A", "time": "2153-10-23 08:56:00"} |
13768004-RR-49 | 518 | ## HISTORY:
Crohn's flare of previous microperforation with intestinal fluid
collections status post abdominal drain insertion. Please assess positioning
of drain and size of fluid collections. Drain flushes appropriately but is no
longer draining fluid.
## ABDOMEN:
The appearances have improved since the previous CT. There is now no
definable collection identified at the tip of the pigtail catheter within the
anterior abdomen to the left of the umbilicus (2:56). There is residual soft
tissue thickening at the tip of the catheter which extends within the small
bowel mesentery at the site of the previous collection - this likely
representing residual inflammatory change but without definable fluid
collection now present. There is no evidence of extravasation of oral
contrast outside of the small bowel lumen. The collection that was previously
identified within the left flank has also almost completely resolved with only
a tiny sliver of fluid now identified - this measures 4.6 x 0.9 cm (2:54;
previously 4.7 x 1.1 cm). The collection that was previously identified
within the subcutaneous tissues to the right of the umbilicus has resolved.
No new collections are identified. No free air.
Similar to the previous CT and MRI, the distal ileum appears abnormal and
thickened within the right iliac fossa, consistent with Crohn's disease.
There is a ventral abdominal wall hernia that contains loops of matted small
bowel without evidence of obstruction or strangulation. The patient is status
post ileocecectomy. The colon is otherwise unremarkable.
The liver is within normal limits. No focal liver lesions. The portal and
hepatic veins are patent. No intra or extrahepatic duct dilatation. There is
mild gallbladder wall edema, unchanged since previous. The gallbladder is
otherwise unremarkable. The adrenals and pancreas are within normal limits.
The kidneys are unremarkable. No hydronephrosis. There is mild splenomegaly,
unchanged since previous with the spleen measuring 13.5 cm in length.
Multiple mildly enlarged mesenteric lymph nodes are identified with haziness
of the small bowel mesentery - these appearances are unchanged since previous
and are likely reactive in nature. The abdominal aorta is of normal caliber.
There are new small bilateral pleural effusions which have developed since
previous CT. Ground-glass changes identified within both lung bases and is
unchanged since previous. The visualized portion of the heart and pericardium
is unremarkable.
## PELVIS:
The bladder is within normal limits. The uterus and ovaries are unremarkable.
No pelvic adenopathy. No free fluid within the pelvis.
## OSSEOUS STRUCTURES:
There is a focal area of sclerosis within the left femoral neck, consistent
with a bone island. Severe degenerative disc disease is noted at L5-S1. The
osseous structures of the abdomen and pelvis are otherwise unremarkable.
## IMPRESSION:
1. Interval improvement with near-complete resolution of all of the abdominal
and subcutaneous collections. No definable collection is now identified at
the tip of the pigtail catheter within the anterior abdomen.
2. New small bilateral pleural effusions.
3. Persistent wall thickening in the distal ileum, consistent with Crohn's
disease.
4. Ventral abdominal wall hernia containing loops of matted small bowel,
without evidence of strangulation or obstruction.
5. Mild splenomegaly.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13768004", "visit_id": "24749111", "time": "2178-03-10 13:10:00"} |
19594787-RR-50 | 93 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
History: with dyspnea, cough// ? pna ?fluid overload
## FINDINGS:
Patient is status post median sternotomy, CABG, and mitral valve repair. Mild
cardiac enlargement is unchanged. The mediastinal and hilar contours are
similar. Pulmonary vasculature is not engorged. Lungs are hyperinflated
without focal consolidation. Complete or near complete resolution of a left
pleural effusion is noted. No pneumothorax. No acute osseous abnormality.
Osseous structures are diffusely demineralized.
## IMPRESSION:
No evidence for pneumonia or pulmonary edema. Complete or near complete
resolution of a previously noted left pleural effusion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2140-05-09 12:07:00"} |
12074140-RR-103 | 91 | ## INDICATION OF STUDY:
male with hypercoagulable syndrome, status
post gastric resection, now found unresponsive. Study is done to evaluate for
infiltrate, pneumonia or aspiration.
## BONE WINDOWS:
Demonstrate an L4 compression fracture, also seen in prior
examination. There are no suspicious lytic or blastic osseous lesions.
## IMPRESSION:
1. Bilateral pleural effusion with associated atelectasis. No obvious
pneumonia.
2. Thrombosis in the superior mesenteric artery and the right common iliac
artery, unchanged since .
3. Post-surgical changes following small bowel resection
4. Prominent small and large bowel loops consistent with ileus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12074140", "visit_id": "24387001", "time": "2134-07-01 19:47:00"} |
15802661-RR-34 | 193 | ## EXAMINATION:
SECOND OPINION MR NEURO PSO4 MR
## INDICATION:
year old man with back pain, elevated CRP and febrile, r/o
osteomyelitis// second read MRI T spine
## FINDINGS:
Vertebral body heights and sagittal spinal alignment are maintained within the
thoracic spine. No cord T2 signal abnormality.
T8 vertebral body lesion with bright T2, stir signal and mixed decreased and
increased T1 signal, mild enhancement, consistent with benign hemangioma.
A disc bulge is noted at the level of T8-T9, causing mild canal stenosis,
minimal effacement of the ventral cord, and well preserved CSF about cord..
Minimal additional levels of disc bulging are noted, most prominently T9-10
without appreciable canal stenosis or neural foraminal narrowing.
No foraminal narrowing at any level in the thoracic spine.
Probably moderate central canal narrowing at C6-C7 level, suboptimally seen on
this scan.
No epidural mass or fluid collection. There is no evidence for abnormal
intramedullary, leptomeningeal, or epidural enhancement.
The visualized portions of the paraspinal soft tissues are grossly
unremarkable.
## IMPRESSION:
1. No evidence for discitis/osteomyelitis. No abnormal enhancement.
2. Mild degenerative changes thoracic spine.
3. Mild central canal narrowing at T8-T9 level.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15802661", "visit_id": "25717453", "time": "2133-02-22 15:23:00"} |
19895232-RR-53 | 101 | ## INDICATION:
with history of right lower lobeectomy, dyspnea on exertion,
nausea// Eval consolidation
## FINDINGS:
There is persistent opacity at the right lung base which correlates with area
of bronchiectasis and consolidation seen on prior CT scans. Elsewhere, the
lungs are clear. There is no effusion or edema. Cardiomediastinal silhouette
is stable. No acute osseous abnormalities, postop changes seen at the right
humeral head.
## IMPRESSION:
No acute cardiopulmonary process. Persistent consolidation at the right lung
base adjacent to the site of prior wedge resection. This has been seen on
multiple prior CTs and follow-up per prior report is suggested
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19895232", "visit_id": "N/A", "time": "2168-12-11 21:32:00"} |
13743315-DS-4 | 1,137 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HISTORY OF PRESENT ILLNESS:
with COPD, CHF, atrial fibrillation on coumadin with prior
stroke with cough x1 week. Cough has been productive of white to
tan sputum, associated with wheezing. Occasionally pt noted by
her son to have coughing/choking fits. ROS otherwise was
completely neg: no fevers, rhinorrhea, sore throat, CP, SOB, Abd
pain. Pt is a long time smoker, quit ago.
Pt transferred to ED for evaluation. In the ED, initial VS were:
98 80 172/114 20 98. Exam revealed Dry cough, diffusely wheezy,
decreased BS at bases, no crackles. Labs were sig for INR 1.5,
CEs neg x1, otherwise WNL. CXR - Cardiomegally, fluid overload,
right lower lung linear atelectasis, ? infiltrate. Pt was given
heparin bridge without bolus sicne CHADS2=5. EKG - unchanged
from prior. Pt was treated with prednisone, azithro and nebs for
presumed COPD exacerbation.
Review of systems:
(+) Per HPI
(-) Denies fever, night sweats, recent weight loss or gain.
Denies headache, sinus tenderness, rhinorrhea or congestion.
Denied shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.
## PAST MEDICAL HISTORY:
Hypertension
COPD
Atrial Fibrillation
Breast CA, s/p bilateral mastectomy, augmentation
CVA - residual L sided weakness
Diastolic heart failure with an EF of 60%
Status post cholecystectomy
## FAMILY HISTORY:
Father - alcoholism.
Brother - smoking related death
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear
## NECK:
supple, JVP not elevated, no LAD
## LUNGS:
Diffuse wheezing, no crackles
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## NEURO:
A+Ox3, strenght on right , left , LUE with
contractions of hand and wrist. Sensation in tact
## BRIEF HOSPITAL COURSE:
yo F with h/o HTN, COPD, Afib, CVA, CHF, presents with 1 week
of worsening productive cough, likely due to COPD exacerbation.
## ACUTE EXACERBATION OF COPD:
CXR with cardiomegally, volume
overload and Right lower lung atelectasis vs infiltrate. Exam
with wheezing and decreased breath sounds. The patient received
was started on Prednisone taper, standing Nebs and a 5 day
course of Azithromycin presumed COPD exacerbation. Tessulon
perles and Codeine-Guaifenesin for cough suppression prn. The
patient's symptoms improved gradually over the next several
days. She continued to exhibit O2 sats abive 95% on room air
and denied shortness of breath. She was evaluated by physical
therapy who determined that the patient may go home with around
the clock care by her son. She was discharged home with
Albuterol and Ipratropium inhalers, Prednisone taper,
Codeine-Guaifenesin and Tessulon perles for cough suppression,
and Azithromycin to complere a trial fibrillation: The patient was anticoagulated with
Coumadin but INR was subtheraputic at 1.5 (goal 2.0-3.0). Given
prior CVA and CHADS2 score of 5, the patient was given heparin
bridge while inpatient. Given she was started on Azithromycin,
we expected a fast increase in INR, so the patient's Coumadin
dose was increased slightly to 2mg from 1.5mg. Her INR became
therapeutic prior to discharge and Heparin was discontinued.
She will continue to be followed by by clinic
upon discharge. We continued patient's Metoprolol for rate
control.
## BENIGN HYPERTENSION:
we continued Metoprolol, Valsartan,
Amlodipine.
## CHRONIC DIASTOLIC CHF:
We did not feel that the patient was
volume overloaded on clinical exam, so we continued the patient
on her home dose of Lasix.
## MEDICATIONS ON ADMISSION:
AMLODIPINE - 10 mg daily
FUROSEMIDE - 20 mg once a day
HYDROCODONE-ACETAMINOPHEN - 5 mg-500 mg every six (6) hours as
needed
METOPROLOL TARTRATE - 25 mg Tablet twice a day
NORTRIPTYLINE - 25 mg Capsule at bedtime
VALSARTAN - 80 mg daily
WARFARIN - 1.5mg daily
DOCUSATE SODIUM - 100mg twice a day
## DISCHARGE MEDICATIONS:
1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Nortriptyline 25 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Prednisone 5 mg Tablet Sig: as directed Tablet PO once a day
for 6 days: Take 4 pills daily for 2 days, then 2 pills daily
for 2 days, then 1 pill daily for 2 days, then stop.
Disp:*20 Tablet(s)* Refills:*0*
8. Azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 days.
Disp:*2 Tablet(s)* Refills:*0*
9. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
## :
Please continue at 2mg daily until directed otherwise by
your doctor.
Disp:*30 Tablet(s)* Refills:*0*
10. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*0*
11. Codeine-Guaifenesin mg/5 mL Syrup Sig: MLs PO
Q6H (every 6 hours) as needed for cough.
Disp:*150 ML(s)* Refills:*0*
12. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
One (1) INH Inhalation every hours as needed for shortness
of breath or wheezing.
Disp:*1 unhaler* Refills:*0*
13. Atrovent HFA 17 mcg/Actuation HFA Aerosol Inhaler Sig:
INH Inhalation four times a day.
Disp:*1 INHALER* Refills:*0*
## 14. VICODIN MG TABLET SIG:
One (1) Tablet PO every six (6)
hours as needed for pain.
## SECONDARY DIAGNOSES:
Hypertension
Atrial Fibrillation
Breast CA, s/p bilateral mastectomy, augmentation
CVA - residual L sided weakness
Chronic diastolic heart failure (LVEF 60%)
Status post cholecystectomy
## ACTIVITY STATUS:
Out of Bed with assistance to chair or
wheelchair
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital at because you developed
cough with phlegm production. We performed a Chest X-ray which
did not show a Pneumonia. You were likely having a COPD flare,
which was treated with oral Prednisone, Azithromycin and
standing nebulizer treatments.
We made the following changes to your medications:
1. We started you on oral Prednisone. Please take 20mg every
morning for 2 days, then 10mg every morning for 2 days and 5mg
every morning for 2 days, then stop.
2. We started you on Azithromycin. Please take 250 mg in the
morning on and .
3. We prescribed you Atrovent and Albuterol inhalators. Please
use them every 6 hours as needed for shortness of breath and
wheezing.
4. We prescribed you Tessulon perles (benzonatate) three times a
day for cough.
5. We prescribed you Codeine-Guaifenesin for cough. Please take
ml every 6 hours as needed for cough.
You should continue to take your other medications as
prescribed.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13743315", "visit_id": "26175297", "time": "2181-12-22 00:00:00"} |
13154951-RR-10 | 142 | ## INDICATION:
year old woman with recent diagnosis of mucosal melanoma.
Assess for metastatic disease
## FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. Few scattered T2/FLAIR hyperintense lesions within the
subcortical white matter are nonspecific and likely sequelae of chronic small
vessel ischemic disease, chronic migraines, and less likely demyelinating
process. The ventricles and sulci are normal in caliber and configuration.
There is no abnormal enhancement after contrast administration. Major
intracranial vascular flow voids and dural sinuses are patent. There is mild
mucosal thickening of the ethmoid air cells. The orbits are unremarkable. No
fluid signal is seen in the mastoid air cells.
## IMPRESSION:
1. No evidence of metastatic disease at this time.
2. Few scattered nonspecific T2/FLAIR hyperintensities within the white matter
are likely sequelae of chronic small vessel ischemic disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13154951", "visit_id": "N/A", "time": "2147-12-15 19:39:00"} |
18326492-RR-10 | 161 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
History: with confusion// please eval for mass, bleeding
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.1 cm; CTDIvol = 49.9 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 2.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
## FINDINGS:
There is no evidence of large territorial infarction,hemorrhage,edema,or
mass-effect. There is prominence of the ventricles and sulci suggestive of
involutional changes. Periventricular white-matter hypodensities are
nonspecific, but likely represent sequela of severe chronic small vessel
ischemic disease. Suggestion of 0.4 cm partially calcified meningioma right
vertex.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
## IMPRESSION:
No acute intracranial abnormality.
Severe chronic small vessel ischemic changes.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18326492", "visit_id": "22511280", "time": "2113-08-02 03:51:00"} |
14094453-RR-12 | 182 | ## HISTORY:
Known AAA, evaluate for for interval change.
## FINDINGS:
The proximal aorta measures 2.5cm in diameter. The mid abdominal aorta at the
level of the left renal vein measures 1.5cm. In the distal aorta is saccular
aneurysmal with mural thrombus and measures 4.0cm, previously measured 4.4 cm,
not significantly changed in size. There are moderate calcified
atherosclerotic plaques seen along the aorta extending into the common iliacs.
The right common iliac artery measures 1.1 cm and the left common iliac artery
measures 0.9 cm. Wall to wall color flow is seen within aorta with
appropriate arterial waveforms.
Limited views of the kidneys are unremarkable without hydronephrosis. The
right kidney measures 11.0 cm. The left kidney measures 10.2 cm. A 2.0 x 2.9
x 2.2 cm parapelvic cyst is noted in the interpolar region of the left kidney.
## IMPRESSION:
1. Infrarenal saccular abdominal aortic aneurysm measuring 4.0 cm, not
significantly changed in size since .
2. 2.9 cm parapelvic cyst seen in the interpolar region of the left kidney.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14094453", "visit_id": "N/A", "time": "2183-07-13 08:58:00"} |
17220099-RR-46 | 101 | ## EXAMINATION:
UNILAT UP EXT VEINS US LEFT
## INDICATION:
year old woman with thalamic glioblastoma who presented with
worsening dysphagia and now has left arm swelling where PICC line is// DVT?
## FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The left internal jugular, axillary, and brachial veins are patent, show
normal color flow, spectral doppler, and compressibility. PICC is seen within
the left basilic vein. The left basilic veins are otherwise patent,
compressible and show normal color flow.
## IMPRESSION:
PICC within left basilic vein. No evidence of deep vein thrombosis in the
left upper extremity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17220099", "visit_id": "26997707", "time": "2148-01-09 16:40:00"} |
19721801-RR-39 | 314 | ## INDICATION:
woman status post right colectomy and acute kidney
injury, needing RRT. Suspected difficult access due to body habitus and
request placement under fluoroscopy. Please place trialysis HD catheter in
left IJ under fluoroscopy guidance.
## RADIOLOGISTS:
Dr. , the attending radiologist, was present and
supervising throughout the procedure, Dr. , radiology
resident.
## PROCEDURE AND FINDINGS:
After explaining the risks, benefits and alternatives
of the procedure, written informed consent was obtained from a healthcare
proxy (brother). The patient was brought to the angiography suite and placed
supine on the imaging table. The left side of the neck was prepped and draped
in standard sterile fashion. Preprocedure timeout and huddle was performed
per protocol.
Using ultrasound guidance, the patent left internal jugular vein was accessed
using a micropuncture needle through which a 0.018 guidewire was advanced into
the SVC under fluoroscopic guidance. Hard copy images of the ultrasound study
were saved to PACS. The needle was exchanged for a micropuncture sheath and
the wire upsized to wire, which after making appropriate measurements,
was advanced into the IVC for stability. Initially, advancement of the
wire was somewhat challenging due to surrounding soft tissues. However, on
second attempt, the wire was advanced with no difficulty. The
micropuncture sheath was removed and the soft tissue tract was dilated using
10 and 12 dilators. A 13 x 20 cm Power-Trialysis catheter was
then advanced over the wire. The tip of the catheter was positioned in
the distal SVC. The guidewire was removed. Three ports were aspirated,
flushed easily and were capped. The catheter was secured to the skin using 0
silk sutures and sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
complications.
## IMPRESSION:
Uncomplicated placement of temporary tri-lumen Power-Trialysis
catheter via internal jugular venous access. Tip of the catheter terminates
in the distal SVC and is ready to use.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19721801", "visit_id": "24016655", "time": "2131-05-15 14:58:00"} |
16981397-RR-31 | 826 | ## INDICATION:
Thrombosed fistula.Multiple percutaneous interventions
## OPERATORS:
Dr. radiology fellow) and Dr.
radiology attending) performed the procedure. The
attending, Dr. was present and supervising throughout the procedure.
## ANESTHESIA:
Moderate sedation was provided by administrating divided doses of
200 mcg of fentanyl and 3 mg of midazolam throughout the total intra-service
time of 2 hr 45 min 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.
## MEDICATIONS:
Versed, fentanyl, lidocaine. 4000 IU heparin. 11mg of intragraft
tPA
## CONTRAST:
171 ml of Optiray contrast.
## PROCEDURE:
1. Right upper extremity AV graft fistulagram.
2. Axillary, subclavian and super vena cava venography.
3. Chemical and mechanical thrombolysis of the thrombosed graft and outflow
vein using the Angiojet device.
4. 7 and 8 mm Balloon angioplasty of the intragraft stenoses.
5. 12 mm balloon angioplasty of the outflow vein and central vein stenoses.
## PROCEDURE DETAILS:
Written informed consent was obtained from the patient outlining the risks,
benefits and alternatives to the procedure. The patient was then brought to
the angiography suite and placed supine on the image table with the right
upper extremity abducted and stabilized.
Clinical examination demonstrated a completely thrombosed graft in the right
extremity. Further evaluation by targeted ultrasound demonstrated a completely
thrombosed graft extending into the outflow vein. The right upper extremity
was prepped and draped in the usual sterile fashion. A preprocedure timeout
and huddle was performed as per protocol.
Using ultrasound and fluoroscopy, the arterial inflow and outflow stent levels
were identified and the skin was marked with a skinmarker.
Following administration of lidocaine antegrade (directed towards the venous
outflow) access into the thrombosed graft/fistula was obtained under
continuous ultrasound guidance using a 21G micropuncture needle. Permanent
ultrasound images were saved. A 018 wire was then advanced easily into the
outflow vein under fluoroscopic guidance. A 4.5F micropuncture sheath was
advanced and used to exchange for an 0.035 Glidewire. The glide wire was
advance to the level of the subclavian vein. A short 6 sheath was
placed over the wire. A Kumpe catheter was then advanced over the wire and
slowly withdrawn while injecting dilute contrast to establish the distal
extent of thrombus into the outflow vein.
Following, an exchange length wire was advanced via the Kumpe into the
IVC for stability.
Retrograde access directed towards the arterial inflow was then obtained in a
similar fashion using continuous ultrasound and intermittent fluoroscopic
guidance. Permanent ultrasound images were saved. Care was taken not to
advance the wire into the inflow brachial artery prior to thrombolysis. At
this point 3000 IU of heparin was administered systemically.
Tissue plasminogen activator was administered along the entire length of the
thrombosed graft and outflow vein using the AngioJet pulsespray device in the
both antegrade and retrograde directions. A total of 11 mg was infused. The
tPA was allowed to dwell for approximately 10 minutes. The AngioJet device was
then switched to thrombectomy mode and mechanical thrombectomy was performed
from the antegrade and retrograde approaches. Balloon plasty of the stenotic
outrflow vein was performed to 8mm . Following these maneuvers alone flow was
restored to the graft.
The antegrade sheath was then connected to a side arm heparinized saline
flush.
Subsequently, angioplasty was performed along the length of the graft and
outflow vein using a 7-mm and then 8 balloon. A fistulagram was performed from
the proximal brachial artery demonstrating residual clot and stenosis
throughout the graft as well as residual stenoses throughout the axillary,
brachiocephalic veins and superior vena cava. The decision was then made to
place a new Viabahn stent extending from the venous outflow and of the graft
across the axillary vein. The outflow directed sheath was upsized to and a
15cm x 9mm Viabahn endograft was deployed overlapping the existing and
traversinf the long segment of venous outflow stenosis. Repeat hand injection
of dilute contrast demonstrated stable thrombus within the graft and residual
stenosis of the brachiocephalic vein and superior vena cava. Repeat balloon
angioplasty with a 12 mm balloon throughout to the superior vena cava, outflow
veins, stent and graft.
A completion fistulagram was performed demonstrating no residual clot and
stenosis throughout the graft, outflow or central veins. There was an
excellent palpable thrill.
The sheaths were removed and hemostasis was achieved with two 0-silk
pursestring sutures. There were no immediate complications.
## FINDINGS:
1. Complete thrombosis of the right upper extremity AV graft just beyond the
level of the outflow vein.
2. Multiple outflow vein stenoses with improvement following angioplasty to 12
mm and stent deployment.
3. Satisfactory appearance of the arterial anastomosis. No in-graft or central
venous stenosis.
4. Well-positioned and patent 9mm x 15cm Viabahn stent in the stenotic outflow
vein.
## IMPRESSION:
Satisfactory restoration of flow following chemical and mechanical
thrombolysis , stent graft placement and balloon plasty with a good
angiographic and clinical result.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16981397", "visit_id": "23612237", "time": "2160-07-11 15:08:00"} |
10354222-RR-12 | 107 | LEFT WRIST RADIOGRAPH PERFORMED ON
## FINDINGS:
Total of four images were provided including AP, lateral, oblique
and dedicated scaphoid views of the left wrist. There is an acute transverse
fracture of the left distal radius with evidence of impaction though no
significant angulation. Regional soft tissue swelling is seen. There is
severe degenerative disease at the first carpometacarpal joint with articular
surface irregularity and evidence of erosive changes. No definite fracture is
seen at the base of the first metacarpal, though evaluation is limited given
the extensive underlying degenerative disease. The scaphoid appears intact.
## IMPRESSION:
Distal radius fracture. Severe degenerative disease at the first
carpometacarpal joint.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10354222", "visit_id": "N/A", "time": "2160-09-28 19:50:00"} |
15587926-RR-27 | 134 | EXAMINATION OF 9:45 A.M.
## CLINICAL HISTORY:
Sepsis. Respiratory failure secondary to ARDS. Evaluate
pneumonia, endotracheal tube placement.
## FINDINGS:
The patient remains intubated, with the tip of the endotracheal
tube approximately 2.8 cm above the carina. Right-sided IJ central venous
catheter seen, with the tip in the right atrium just below the junction of the
RA/SVC. A nasogastric tube is present, terminating within the stomach.
Overall, pulmonary edema, dominant in the lower lobes, appears essentially
unchanged since the prior examination. There is persistence of minimal
retrocardiac opacity as well, likely secondary to atelectasis. No evidence of
pneumothorax. No definite pleural effusions at this point. Osseous
structures appear unremarkable.
## IMPRESSION:
No appreciable interval change of diffuse pulmonary edema. No
new or worsening consolidation is evident allowing for differences in
technique.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15587926", "visit_id": "21685507", "time": "2120-03-18 08:26:00"} |
13801450-DS-22 | 1,259 | ## HISTORY OF PRESENT ILLNESS:
Mr. is an year-old male with a recent diagnosis
of acute myelogenous leukemia (diagnosed , treated with
1C of MUC1/decitabine and C2 D1-5 but since taken off study due
to progressive disease in setting of peripheral blast count 36%
LDH 1830 and uric acid of 9.2. He has since began
treatment with dacogen alone on and completed C1. He now
presents with and noted for rising blast count of 32%
consistent with progressive leukemia.
## ROS:
The patient states he has been more tired over the last two
days at home. lacks appetite, does not eat or drink much because
he has no sensation of thirst or appetite. denies fevers chills
uri sx. no n/v/d. no cp dyspnea cough. no urinary c/o
rashes/lesions. all other ROS negative.
## PAST MEDICAL HISTORY:
thrombocytopenia, and circulating 'others' of 16%. found to be
in renal failure with spontaneous tumor lysis syndrome, received
rasburicase, fluids with improvement. morphology of circulating
cells initially suspicious for Burk 's, however results
revealed acute myeloid leukemia with monocytic differentiation;
cytogenetics show an abnormal karyotype with cells containing
extra copies of chromosome 8, four separate neoplastic
clones, 1 having trisomy 15, and another having tetraploid form
of trisomy 8
- - skin biopsy of rash on chest/abdomen revealed
leukemia cutis
- - enrolled onto trial , C1D1 of treatment with
MUC1-inhibition in combination with decitabine.
- : Per protocol bone marrow biopsy performed. This
reveals a hypocellular bone marrow with markedly erythroid
predominant trilineage hematopoiesis and a minor population of
blasts (2%). Myeloid sequencing reveals mutations in TET2 and
SRSF2. Karyotype shows no evidence of trisomy 8 or tetrasomy 8.
- : C2D1 of treatment with GO-203 (MUC1-inhibitor) and
decitabine.
- : taken off trial and dacogen alone started C1D1
## PAST MEDICAL HISTORY:
- AML, as above
- CAD status post multiple stents in 1980s
- HFrEF ~25% on TTE
- HTN
- HLD
- Back surgery in the distant past, unknown type
- BPH
- Elevated PSA, negative biopsy
## FAMILY HISTORY:
He has no family history of blood disorders. His mother
reportedly died of breast cancer when he was years old.
## GEN:
NAD alert and oriented
1510 Temp: 97.9 PO BP: 154/72 HR: 82 RR: 18 O2 sat:
100%
O2 delivery: RA
## HEENT:
MMM, no OP lesions, no cervical, supraclavicular, or
axillary LAD
## CV:
Regular, normal S1 and S2 no S3, S4, or murmurs
## PULM:
Clear to auscultation bilaterally
## ABD:
BS+, soft, non-tender, non-distended, no masses, no
hepatosplenomegaly
## LIMBS:
No edema, no inguinal adenopathy
## SKIN:
No rashes or skin breakdown
## NEURO:
Grossly nonfocal, alert and oriented
## GEN:
NAD alert and oriented, fatigue appearing chronically ill
appearing
1059 Temp: 99.1 PO BP: 130/54 HR: 78 RR: 20 O2 sat: 94%
O2 delivery: ra
## HEENT:
MMM, no OP lesions, no cervical, supraclavicular, or
axillary LAD
## CV:
Regular, normal S1 and S2 no S3, S4, or murmurs
## PULM:
Clear to auscultation bilaterally
## ABD:
BS+, soft, non-tender, non-distended, no masses, no
hepatosplenomegaly
## LIMBS:
No edema or inguinal adenopathy
## SKIN:
No rashes or skin breakdown
## NEURO:
Grossly non-focal, alert and oriented
## CXR:
Compared to chest radiographs through
.
New right supraclavicular central venous infusion catheter ends
in the low
SVC. No pneumothorax mediastinal or widening or pleural
effusion. Heart size normal. Lungs grossly clear.
## ASSESSMENT AND PLAN:
Mr. is an male
with PMH significant for systolic heart failure (last LVEF 25%),
CAD with stent and HTN s/p 1C of MUC1/decitabine and C2 D1-5 of
MUC1/decitabine taken off trial due to disease progression and
initiated C1 dacogen alone on with unfortunate rising
blast count and consistent with persistent disease. Options
are limited at this point and family appropriately opted for
transitioning goals of care to comfort and setting up home
hospice arrangements.
## #ACUTE MONOCYTIC LEUKEMIA:
Unfortunately, patient with evidence
of progressive disease with high circulating peripheral smear
blasts. Given disease relapse, patient is now off trial
and was initiated on treatment with Decitabine alone for x10D
but has since had rising blast count again, 31% on from
2% on
. No other good treatment options at this point. Family
meeting on with consensus to focus on comfort measures
and transition to hospice care at home. Of note, no transfusions
or lab monitoring needs at this point.
-Initiated hydrea 1000mg daily
-Continues on allopurinol daily, reduced dose to 150mg with
-Continue fluconazole as well as acyclovir prophylaxis
## #PANCYTOPENIA:
#FEBRILE NEUTROPENIA:
noted in setting of recent Dacogen use and
progressive disease.
He was empirically on cefepime and vancomycin without identified
source of infection; therefore, given overall goals of care, as
above, he was transitioned to Levofloxacin for bacterial
infectious at discharge.
## #ACUTE KIDNEY INJURY:
likely pre-renal in this setting vs tumor
lysis syndrome.
-Encourage hydration as able at home.
#Heart failure with reduced ejection fraction: Presumed related
to his prior ischemic injury. Continue metoprolol at discharge.
Continues holding losartan/HCTZ as well as Atorvastatin
## #HYPERURICEMIA
#HYPERCALCEMIA:
suspect due to TLS from underlying relapsing
leukemia.
-Continues on allopurinol daily
===============================
## #COAGULOPATHY:
He has risk factors for DIC given relapsing
disease and age > so requires close monitoring. He received
Cryo and FFP to decrease propensity of bleeding on s vitamin K x 3 days ( ). No further lab
monitoring as above
## #BPH/ELEVATED PSA:
Continue home finasteride and tamsulosin
## #HTN:
Holding home losartan/HCTZ as above
## #HLD:
Holding atorvastatin. He is now off aspirin given TCP and
continues on decreased dose of metoprolol.
#CAD status post stenting x4 in 1980s:
-Holding ASA
-Continue metoprolol as above
==============
## ==============
#ACCESS:
POC placed at
#CODE: DNR/DNI since
#CONTACT: , HCP/son,
#DISPO: Discharged with hospice services
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acyclovir 400 mg PO Q12H
2. Allopurinol mg PO DAILY
3. Vitamin D UNIT PO QMONTH
4. Finasteride 5 mg PO DAILY
5. Fluconazole 400 mg PO Q24H
6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS
7. Levofloxacin 500 mg PO Q48H
8. Metoprolol Succinate XL 50 mg PO DAILY
9. Tamsulosin 0.8 mg PO QHS
10. Timolol Maleate 0.5% 1 DROP BOTH EYES DAILY
11. Aspirin 81 mg PO DAILY
12. Bisacodyl 10 mg PO DAILY:PRN Constipation - First Line
13. Docusate Sodium 100 mg PO BID:PRN constipation
14. Polyethylene Glycol 17 g PO DAILY:PRN constipation
15. Senna 8.6 mg PO BID:PRN Constipation - First Line
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q6H:PRN fever
2. Hydroxyurea 1000 mg PO DAILY
3. Promethazine 12.5 mg PO Q6H:PRN nausea/vomiting
4. Acyclovir 400 mg PO Q12H
5. Allopurinol mg PO DAILY
6. Bisacodyl 10 mg PO DAILY:PRN Constipation - First Line
7. Docusate Sodium 100 mg PO BID:PRN constipation
8. Finasteride 5 mg PO DAILY
9. Fluconazole 400 mg PO Q24H
10. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS
11. Levofloxacin 500 mg PO Q48H
12. Metoprolol Succinate XL 50 mg PO DAILY
13. Polyethylene Glycol 17 g PO DAILY:PRN constipation
14. Senna 8.6 mg PO BID:PRN Constipation - First Line
15. Tamsulosin 0.8 mg PO QHS
16. Timolol Maleate 0.5% 1 DROP BOTH EYES DAILY
17. Vitamin D UNIT PO QMONTH
## PRIMARY DIAGNOSIS:
=================
Progressive acute myeloid leukemia
FN
Hyperuricemia
TLS
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted due to elevated kidney function and found to
have progressive acute leukemia. We had a family meeting and you
opted to concentrate on making you comfortable and spending
valuable time with family. You are welcome to call us with any
questions or concerns. It was a pleasure taking care of you.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13801450", "visit_id": "25474592", "time": "2120-09-02 00:00:00"} |
10642300-RR-25 | 419 | ## EXAMINATION:
BILATERAL DIAGNOSTIC BREAST MRI WITH AND WITHOUT INTRAVENOUS
CONTRAST
## INDICATION:
woman with dense breast tissue and recent diagnosis
of tubular carcinoma left breast presents for the evaluation of additional
sites of disease. Family history of premenopausal breast cancer in maternal
grandmother and maternal aunt.
## RIGHT:
There is a benign intramammary lymph node within the upper outer right
breast posterior depth (series 203, image 150 and series 202, image 200).
There is a 0.9 x 0.7 x 0.6 cm area of patchy non mass enhancement in the upper
inner right breast (series 203, image 11 and series 202, image 175)
demonstrating predominantly below threshold enhancement kinetics and has some
corresponding T2 hyperintense signal. There is no additional suspicious
enhancing mass, non-mass enhancement, unexplained architectural distortion,
nipple retraction or skin thickening. No enlarged or suspicious axillary or
internal mammary lymph nodes are present.
## LEFT:
There is a 0.5 x 0.3 x 0.4 cm irregular mass within the upper inner left
breast posterior depth (series 203, image 194 and series 202, image 61)
demonstrating mixed but predominantly plateau enhancement kinetics
corresponding to biopsy proven malignancy. Susceptibility artifact is seen
along its posterosuperior margin (series 203, image 200 and series 202, image
60) corresponding to the biopsy clip. There is a 2 mm focus of skin
enhancement involving the inner central left breast posterior depth (series
203, image 161 and series 202, image 77). There is no suspicious enhancing
mass, non-mass enhancement, unexplained architectural distortion, nipple
retraction or skin thickening. No enlarged or suspicious axillary or internal
mammary lymph nodes are present.
## NON-BREAST:
No abnormality is identified in the visualized chest and upper
abdomen.
## IMPRESSION:
1. 0.5 cm irregular mass upper inner left breast corresponding to biopsy
proven grade 1 tubular carcinoma.
2. 0.9 cm area of patchy non mass enhancement in the upper inner right breast
demonstrating predominantly below threshold kinetics. Although this most
likely represents physiologic background enhancement, MRI guided biopsy is
recommended for confirmation given patient's known left-sided malignancy.
3. 2 mm focus of skin enhancement inner central left breast posterior depth.
This presumably represents a benign entity however recommend correlation with
physical exam.
## RECOMMENDATION(S):
1. MRI guided biopsy non-mass enhancement upper inner
right breast.
2. Physical exam correlation for skin enhancement left breast.
## NOTIFICATION:
The findings were emailed to , N.P. by
, M.D. by email on at 9:23 am.
## FINAL ASSESSMENT BI-RADS:
4A Suspicious - low suspicion for malignancy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10642300", "visit_id": "N/A", "time": "2185-10-05 16:41:00"} |
14561512-RR-10 | 105 | ## INDICATION:
with s/p intubation// s/p intubation
## FINDINGS:
The endotracheal tube terminates approximately 6.5 cm above the carina. The
enteric tube terminates in the distal esophagus.
The lung volume is small, exaggerating bronchovascular markings. There is
bibasilar atelectasis. Otherwise no focal consolidation. No pulmonary edema.
No pleural effusion or pneumothorax. Heart size is severely enlarged.
Mediastinum appears widened secondary to known type aortic dissection with
aneurysmally dilated descending thoracic aorta.
## IMPRESSION:
1. Endotracheal tube terminates approximately 6.5 cm above the carina. The
enteric tube terminates in the distal esophagus.
2. Small lung volume with bibasilar atelectasis. Otherwise no focal
consolidation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14561512", "visit_id": "23429654", "time": "2120-09-02 17:31:00"} |
11816565-RR-116 | 158 | ## INDICATION:
female presents with postmenopausal bleeding.
.
## FINDINGS:
Transabdominal and transvaginal sonograms were performed, the
latter of which for further assessment of the endometrium and adnexa. The
uterus is anteflexed, measuring 5.7 x 5.1 x 3.9 cm, containing multiple small
fibroids, including a slightly exophytic 1.1 x 1.0 x 0.8 cm left posterior
fibroid in the lower uterine segment, a 1.2 x 0.8 x 0.8 cm intramural fibroid
on the right in the lower uterine segment. The endometrium appears thickened
and heterogeneous, measuring up to 8 mm. The ovaries appear normal in size
and morphology. No significant free fluid in the cul-de-sac.
## IMPRESSION:
1. Thickened and heterogeneous endometrium up to 8 mm in this postmenopausal
patient, requires biopsy, differential diagnosis include endometrial polyp,
hyperplasia or carcinoma.
2. Fibroid uterus.
Findings posted to dashboard at approximately 5 p.m. on for
direct communication with the ordering physician.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11816565", "visit_id": "N/A", "time": "2129-09-24 14:34:00"} |
17874076-RR-20 | 312 | ## INDICATION:
History of abdominal pain, nausea and vomiting. Please evaluate.
## FINDINGS:
Bases of the lungs are clear. Liver enhances homogenously without
evidence of focal lesions or intrahepatic biliary ductal dilatation. Patient
is status post cholecystectomy with surgical clips seen in place. The portal
vein is patent. The adrenal glands are normal. Spleen is homogenous and
normal in size. The pancreas is normal without evidence of focal lesions or
peripancreatic stranding. The right kidney is normal without evidence of
focal solid or cystic lesions. There is no pelvicaliceal dilatation. There
is evidence of left-sided hydronephrosis and hydroureter with a 5 mm
obstructing stone in the proximal ureter. There is also significant
perinephric stranding around the left kidney. There is delayed left sided
excretion of contrast.
No bowel obstruction or bowel wall thickening is seen. The appendix is not
visualized. There is no intra-abdominal free air. Note is made of a small fat
containing umbilical hernia. There is evidence of mesenteric haziness with
prominent but not frankly enlarged lymph nodes. No definite mesenteric
lymphadenopathy is identified. The intra-abdominal vasculature is
unremarkable.
## CT PELVIS:
The bladder and terminal ureters are unremarkable. Uterus has
been surgically removed. There is no pelvic free fluid. No pelvic wall or
inguinal lymphadenopathy is identified.
## OSSEOUS STRUCTURES:
No lytic or blastic lesion concerning for malignancy is
identified. Degenerative changes are seen throughout the thoracolumbar spine,
with minimal anterolisthesis of L4 on L5.
## IMPRESSION:
1. Left-sided hydronephrosis and hydroureter to the level of a 5 mm
obstructing caluclus in the proximal left ureter. Left perinephric
stranding/fluid.
2. Mild mesenteric haziness which could be secondary to mesenteric
panniculitis, however this may be chronic in nature given the similar
appearance of the mesentery on the CT scan from .
These findings were discussed with Dr. by Dr. by telephone at
11am on the day of the exam.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17874076", "visit_id": "28261225", "time": "2150-04-02 08:22:00"} |
14166592-RR-167 | 119 | ## INDICATION:
year old woman with hx left UPJ in horseshoe kidney // r/o
significant changes
## FINDINGS:
A horseshoe kidney is again seen. The right kidney measures 11.3 cm. A 1.1 x
1.2 x 1.6 cm right parapelvic cyst is stable. The left kidney measures 9.2 cm.
There continues to be a markedly thinned left renal cortex, with multiple
fluid-filled structures likely representing distended pelvis and calyces,
slightly improved since . Normal cortical echogenicity and
corticomedullary differentiation is seen within the right kidney.
The bladder is normal in appearance.
## IMPRESSION:
1. Horseshoe kidney.
2. Chronic severe left collecting system appears slightly improved since the
US.
3. Normal appearance of the right collecting system.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14166592", "visit_id": "N/A", "time": "2150-01-01 09:54:00"} |
10517964-RR-9 | 131 | ## HISTORY:
Chest pain. Evaluate for pneumonia.
## FINDINGS:
Frontal and lateral radiographs of the chest demonstrate areas of increased
opacification of the right mid and lower lung, with effacement of the right
heart border, concerning for right middle lobe and lower lobe pneumonia.
However, underlying mass cannot be excluded. There is a probable right-sided
pleural effusion. Increased opacification of the left lung base probably
represents atelectasis, although superimposed infection cannot be excluded.
## IMPRESSION:
Findigns as above raise concern for RML and RLL pneumonia with
associated pleural effusion. However, underlying mass cannot be excluded.
Recommend follow-up imaging to assess for underlying mass once pneumonia has
resolved.
## NOTIFICATION:
These findings and follow-up recommendations were discussed with
Dr. resident) by Dr. telephone at 3:54pm on ,
10 minutes after discovery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10517964", "visit_id": "28459645", "time": "2172-08-21 13:55:00"} |
11394532-RR-18 | 245 | ## INDICATION:
with left hip pain s/p struck by MVC on left hip and fell
onto right hip with pain and decreased ability to bear weight and ambulate,
evaluate for fracture.
## PELVIS:
The partially visualized small and large bowel are unremarkable. The
urinary bladder and distal ureters are unremarkable. There is no free fluid in
the pelvis.
## REPRODUCTIVE ORGANS:
There are calcified uterine fibroids. There is no
worrisome focal uterine or adnexal abnormality.
## LYMPH NODES:
There is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
Minimal atherosclerotic disease is noted.
## BONES:
There is subtle contour or irregularity and suggestion of buckling of
the cortex in the left inferior pubic ramus (3, 79), which could represent a
nondisplaced fracture. No additional fracture is seen. The pelvic bony ring
is otherwise intact. There is mild bilateral femoroacetabular joint
degenerative change. There is no evidence of joint effusion.
## SOFT TISSUES:
There is fascial thickening and mild subcutaneous fat stranding
and edema centered just lateral to the left greater trochanter with trace
fluid likely sequelae of recent trauma possibly a very small hematoma (see
series 2, image 60). Otherwise, there is no focal worrisome subcutaneous or
musculoskeletal soft tissue abnormality.
## IMPRESSION:
1. Subtle cortical buckling of the left inferior pubic ramus could represent a
nondisplaced fracture. Correlate with focal physical exam tenderness at this
location. No additional fracture or dislocation noted.
2. Mild stranding edema just lateral to the left greater trochanter with trace
fluid, likely very small hematoma.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11394532", "visit_id": "N/A", "time": "2137-02-26 21:27:00"} |
19797600-RR-14 | 238 | ## ULTRASOUND-GUIDED WIRE LOCALIZATION LEFT BREAST:
The patient was referred for
a preoperative wire localization of a mass in the left breast at 11:30, 4 cm
from the nipple. The patient notes that she can no longer palpate the mass in
the left breast. For clarification, a phone call was made to
, NP in Dr. . The plan is to localize the largest
of the several lesions at 11:30, 4 cm from the nipple. This is the lesion
that is closest to the pectoralis and measures slightly larger than the others
identified on her ultrasound.
Preprocedure scanning today demonstrates at 11:30, 4 cm from the nipple, an
oval hypoechoic mass measuring 1.57 x 1.16 x 0.39 cm. 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.
Using standard aseptic technique and 1% lidocaine for local anesthesia, needle
and subsequently a wire were advanced into the patient's breast. Orthogonal
views confirmed placement of the needle, then the wire was deployed. The wire
stiffener sits just above the hypoechoic mass. The localization was difficult
due to the density of the breast tissue.
The patient tolerated the procedure well and there were no immediate
complications. The procedure was performed by , NP and
supervised by , M.D.
## IMPRESSION:
Successful wire localization of a nodule in the left breast.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19797600", "visit_id": "N/A", "time": "2141-08-24 10:33:00"} |
17145765-RR-39 | 204 | ## TYPE OF EXAMINATION:
Chest, PA and lateral.
## INDICATION:
female patient with CHF (ejection fraction 30%) with
one week of cold symptoms, fatigue, and shortness of breath. Diffuse wheezing
on examination. Evaluate for infiltrate or pulmonary edema.
## FINDINGS:
PA and lateral chest views were obtained with patient in upright
position. Available for comparison is the next preceding similar chest
examination dated . Borderline heart size as before with
prominence of left ventricular contour. Thoracic aorta is generally widened
and elongated. These findings appear rather stable. On the preceding
examination, a crowded appearance of the pulmonary vasculature was observed on
the right base, raising the possibility of right lower lobe infiltrate versus
atelectasis. These changes on the lung base have cleared up completely and
normalized. Thus, the present finding suggests that the patient at that time,
in early , had undergone an infectious pulmonary process. The
lateral and posterior pleural sinuses remain free from any pleural effusion,
similar as they were before. Previously described degenerative changes in the
thoracic spine are rather unchanged. No evidence of vertebral body
compression.
## IMPRESSION:
Cardiovascular aortic findings consistent with hypertension, but
no evidence of CHF presently. Previously described density most likely
represented right lower lobe pneumonia, which now has cleared.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17145765", "visit_id": "N/A", "time": "2179-10-28 16:37:00"} |
19930271-RR-22 | 100 | ## HISTORY:
with hx of pancreatic cancer and afib on Coumadin
presents with syncope; please r/o bleed, fracture, e/o infection //
with hx of pancreatic cancer and afib on Coumadin presents with syncope;
please r/o bleed, fracture, e/o infection
## FINDINGS:
A right chest port ends in the low SVC. The cardiomediastinal silhouette is
unremarkable. There is no pneumothorax or pleural effusion. Surgical clips
project over the upper abdomen on the lateral view. The lung fields are
clear. There is a mild endplate deformity of a lower thoracic vertebral body,
unchanged from .
## IMPRESSION:
No acute cardiopulmonary abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19930271", "visit_id": "28798580", "time": "2138-12-19 09:22:00"} |
18087550-RR-22 | 163 | ## INDICATION:
man with fall, subdural hematoma, evaluate for spine
fractures.
## FINDINGS:
There is no acute fracture or cervical spine dislocation. The
atlantoaxial, atlanto-occipital, and bilateral facet articulations are
preserved. The pre- and paravertebral soft tissues are unremarkable.
Patient is s/p remote C4 through C 6 wide laminectomy. Multilevel degenerative
changes with marginal osteophyte formation and subarticular cystic changes is
evident. There is mild retrolisthesis of C4 on C5. Neural foramina is patent
bilaterally. There is no significant central canal stenosis. Mild central
canal narrowing is noted at C4-C5 through C6-C7 due to disk endplate
osteophyte complex. Please note limited sensitivity of CT towards evaluation
of intrathecal details.
## IMPRESSION:
1. No acute fracture or alignment abnormality of the cervical spine.
2. s/p C4 - C6 wide laminectomy; however, multilevel degenerative changes
result in moderate canal stenosis and apparent ventral cord flattening at C5-
C6 and C6-C7. Please note limited sensitivity of CT towards evaluation of
intrathecal detail.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18087550", "visit_id": "N/A", "time": "2139-04-23 22:48:00"} |
14226181-RR-22 | 333 | ## HISTORY:
History of abdominal aortic aneurysm
## LUNGS AND HEART:
The lung bases are unremarkable with no pleural effusions,
nodules or opacities seen. The heart and pericardium are unremarkable with no
pericardial effusion seen.
## LIVER:
The liver is homogeneous in attenuation and has no focal lesions. The
liver is normal in size and without intra or extrahepatic biliary dilatation.
The hepatic and portal veins are patent. The gallbladder is unremarkable with
no cholelithiasis.
## PANCREAS:
The pancreas is normal in enhancement with no focal lesions. There
is no peripancreatic abnormality or duct dilatation.
## SPLEEN:
The spleen is normal.
## ADRENALS:
The adrenals are normal in size and morphology.
## KIDNEYS:
There is a hypodensity in the lower pole of the left kidney, which
is too small to characterize.
## BOWEL:
The distal esophagus is unremarkable and the stomach is grossly
normal. The small bowel is normal without wall thickening. The large bowel
is filled with stool and does not have any focal wall thickening, diverticula
or masses. There is a small 6.5 mm calcification seen posterior to the spleen
which most likely represents a calcified epiploic appendage.
## LYMPH NODES:
There are no pathologically enlarged mesenteric or
retroperitoneal lymph nodes by CT size criteria.
## PELVIS:
The bladder is well distended and normal appearing without focal wall
thickening. There is no pathological enlargement of pelvic lymph nodes. The
rectum and sigmoid colon are unremarkable.
## VESSELS:
There is an infrarenal abdominal aortic aneurysm measuring 5.2 cm at
its largest point, which continues down the entire length of the right common
iliac artery. All the major branches of the aorta are patent including the
celiac axis, SMA, and renal arteries. 2.1cm aneurysm of the right common
iliac artery
## OSSEOUS STRUCTURES AND SOFT TISSUES:
There are no hernias seen. The
visualized osseous structures are unremarkable with no lesions identified.
## IMPRESSION:
1. Infrarenal aortic aneurysm measuring 5.2 cm extending to the bifurcation.
Aneurysm of the right common iliac artery along its entire length measuring up
to 2.1cm
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14226181", "visit_id": "N/A", "time": "2144-08-02 12:59:00"} |
17181069-RR-104 | 364 | ## EXAMINATION:
CTU abdomen and pelvis with and without IV contrast.
## INDICATION:
with RLQ/R flank pain
## CTU:
Multidetector CT of the abdomen and pelvis were acquired
prior to and after intravenous contrast administration with the patient in
prone position. The non-contrast scan was done with low radiation dose
technique. The contrast scan was performed with split bolus technique. Oral
contrast was not administered. Coronal and sagittal reformations were
performed and reviewed on PACS.
## PELVIS ULTRASOUND:
Abdominal ultrasound: .
CT abdomen and pelvis: .
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. A
tiny hypodensity in hepatic segment VI is compatible with a small cyst or
biliary hamartoma (04:33). 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.
## 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. Diverticulosis of
the sigmoid colon is noted, without evidence of wall thickening and fat
stranding. The appendix is normal.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
Multiple uterine fibroids are again noted. No adnexal
masses are seen.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Minimal atherosclerotic
disease is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Mild degenerative changes are present in the lumbar spine.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. No acute pathology in the abdomen or pelvis.
2. Fibroid uterus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17181069", "visit_id": "N/A", "time": "2173-03-15 17:31:00"} |
18266495-RR-30 | 121 | ## INDICATION:
year old woman with Right PICC// Right PICC 44cm
Contact name: :
## FINDINGS:
The tip of a right internal jugular central venous catheter projects over the
distal SVC. The tip of the new right PICC line projects over the right lung
apex. Evaluation of the lungs is limited due to underpenetration from
overlying soft tissues. There is mild pulmonary edema as well as probable
layering pleural effusions. No discrete pneumothorax is identified. The size
of the cardiac silhouette and vascular pedicle are enlarged.
## IMPRESSION:
The tip of a new right PICC projects over the right lung apex. This finding
was communicated to and acknowledged by the IV nurse at 16h05 by Dr.
described above consistent with cardiogenic pulmonary edema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18266495", "visit_id": "27357346", "time": "2179-07-04 15:19:00"} |
14675620-RR-28 | 100 | ## EXAMINATION:
EARLY OB US <14WEEKS
## INDICATION:
pregnant with protracted abdominal pain.
## FINDINGS:
An intrauterine gestational sac is seen and a single living embryo is
identified with a crown rump length of 2.3 mm representing a gestational age
of 5 weeks 6 days. This corresponds satisfactorily with the menstrual dates of
5 weeks 3 days. The uterus is normal. The ovaries are normal.
## IMPRESSION:
Single intrauterine pregnancy with size equals dates. No fetal heart rate
seen, but it would not necessarily expected to be seen at this gestational
age. Recommend short interval follow-up ultrasound if clinical concern.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14675620", "visit_id": "N/A", "time": "2185-08-15 14:10:00"} |
17190627-DS-15 | 1,186 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Dr. hip arthroplasty right side
## PAST MEDICAL HISTORY:
Hypothyroidism
Hypertension
Hyperlipidemia
Atrial fibrillation after last spine surgery,
no further episodes, not on anticoagulation)
## RLE:
Dressing clean/dry/intact
Fires
SILT S/S/DP/SP/T
Toes warm and well perfused, 1+
## BRIEF HOSPITAL COURSE:
The patient presented as a same day admission for surgery. The
patient was taken to the operating room on for removal of
hardware and right total hip replacement, 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. The patient's home medications were
continued throughout this hospitalization. The patient worked
with who determined that discharge to home was appropriate.
The hospital course was otherwise unremarkable. Hct
was stable for multiple days prior to discharge.
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 tolerate in the right lower extremity with
anterior hip precautinos, and will be discharged on lovenox 30mg
BID for DVT prophylaxis. The patient will follow up with Dr.
routine. A thorough discussion was had with the
patient regarding the diagnosis and expected post-discharge
course including reasons to call the office or return to the
hospital, and all questions were answered. The patient was also
given written instructions concerning precautionary instructions
and the appropriate follow-up care. The patient expressed
readiness for discharge.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Citalopram 10 mg PO DAILY
2. Gemfibrozil 600 mg PO BID
3. Metoprolol Succinate XL 50 mg PO DAILY
4. Levothyroxine Sodium 88 mcg PO DAILY
5. TraZODone mg PO QHS:PRN insomnia
6. TraMADol 50 mg PO DAILY:PRN Pain - Severe
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO 5 TIMES DAILY WHILE AWAKE
RX *acetaminophen [8 Hour Pain Reliever] 650 mg 1 tablet(s) by
mouth 5 times daily while awake Disp #*60
## TABLET REFILLS:
*0
2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation
RX *bisacodyl 5 mg 2 tablet(s) by mouth once a day Disp #*60
Tablet Refills:*0
3. Enoxaparin Sodium 30 mg SC Q12H
RX *enoxaparin 30 mg/0.3 mL 30 mg subcutaneous every twelve (12)
hours Disp #*46 Syringe Refills:*0
4. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain
RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp
#*25 Tablet Refills:*0
5. Senna 8.6 mg PO BID
RX *sennosides [Senna Lax] 8.6 mg 8.6 mg by mouth twice a day
Disp #*60 Tablet Refills:*0
6. Vitamin D 800 UNIT PO DAILY
RX *ergocalciferol (vitamin D2) 400 unit 2 capsule(s) by mouth
once a day Disp #*60 Tablet Refills:*0
7. Citalopram 10 mg PO DAILY
8. Gemfibrozil 600 mg PO BID
9. Levothyroxine Sodium 88 mcg PO DAILY
10. Metoprolol Succinate XL 50 mg PO DAILY
11. TraZODone mg PO QHS:PRN insomnia
12. HELD- TraMADol 50 mg PO DAILY:PRN Pain - Severe This
medication was held. Do not restart TraMADol until you are no
longer taking opioids
## DISCHARGE DIAGNOSIS:
Right hip removal of hardware, total hip replacement
## 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:
-Weightbearing as tolerated anterior hip precautions right
lower extremity
## MEDICATIONS:
1) Take Tylenol every 6 hours around the clock. This is an
over the counter medication.
2) Add oxycodone as needed for increased pain. Aim to wean off
this medication in 1 week or sooner. This is an example on how
to wean down:
Take 1 tablet every 3 hours as needed x 1 day,
then 1 tablet every 4 hours as needed x 1 day,
then 1 tablet every 6 hours as needed x 1 day,
then 1 tablet every 8 hours as needed x 2 days,
then 1 tablet every 12 hours as needed x 1 day,
then 1 tablet every before bedtime as needed x 1 day.
Then continue with Tylenol for pain.
3) Do not stop the Tylenol until you are off of the narcotic
medication.
4) Per state regulations, we are limited in the amount of
narcotics we can prescribe. If you require more, you must
contact the office to set up an appointment because we cannot
refill this type of pain medication over the phone.
5) Narcotic pain relievers can cause constipation, so you should
drink eight 8oz glasses of water daily and continue following
the bowel regimen as stated on your medication prescription
list. These meds (senna, colace, miralax) are over the counter
and may be obtained at any pharmacy.
6) Do not drink alcohol, drive a motor vehicle, or operate
machinery while taking narcotic pain relievers.
7) Please take all medications as prescribed by your physicians
at discharge.
8) Continue all home medications unless specifically instructed
to stop by your surgeon.
## ANTICOAGULATION:
- Please take Lovenox daily for 4 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.
- Incision may be left open to air unless actively draining. If
draining, you may apply a gauze dressing secured with paper
tape.
- If you have a splint in place, splint must be left on until
follow up appointment unless otherwise instructed. Do NOT get
splint wet.
## DANGER SIGNS:
Please call your PCP or surgeon's office and/or return to the
emergency department if you experience any of the following:
- Increasing pain that is not controlled with pain medications
- Increasing redness, swelling, drainage, or other concerning
changes in your incision
- Persistent or increasing numbness, tingling, or loss of
sensation
- Fever 101.4
- Shaking chills
- Chest pain
- Shortness of breath
- Nausea or vomiting with an inability to keep food, liquid,
medications down
- Any other medical concerns
THIS PATIENT IS EXPECTED TO REQUIRE DAYS OF REHAB
## FOLLOW UP:
Please follow up with your Orthopaedic Surgeon, Dr. .
You will have follow up with , NP in the
Orthopaedic Trauma Clinic 14 days post-operation for evaluation.
Call to schedule appointment upon discharge.
Please follow up with your primary care doctor regarding this
admission within weeks and for any new medications/refills.
## ACTIVITY:
Activity as tolerated
Right lower extremity: Full weight bearing
WBAT RLE with anterior hip precautions.
## COMMENT:
To be changed DAILY by starting POD . RN - please
overwrap any dressing bleedthrough with ABDs and ACE
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17190627", "visit_id": "26553616", "time": "2116-03-03 00:00:00"} |
18334731-RR-55 | 644 | CHOLANGIOGRAM, BALLOON DILATATION AND BILIARY STENT PLACEMENT
## INDICATION:
man with ampullary mass with biliary obstruction,
indwelling biliary internal-external drainage.
## OPERATORS:
Drs. (fellow) and (attending
physician). Dr. was present throughout the procedure.
## CONTRAST:
Sterile 40 mL Omnipaque 350 in the biliary system.
## ANESTHESIA:
General endotracheal anesthesia, in addition to about 8 mL of 1%
lidocaine in skin and subcutaneous tissue at the catheter site.
## OTHER MEDICATION:
iv 1g ceftriaxone just before the procedure.
## PROCEDURE:
Consent was obtained from the patient and family member after
explaining the benefits, risks and alternatives (via an interpreter to the
patient). Patient was placed supine on the imaging table in the
interventional suite. Timeout was performed as per performed.
Initial scout fluoroscopic image demonstrated indwelling right upper abdomen
catheter with retention pigtail loop. Under sterile conditions and
fluoroscopy guidance, a small amount of sterile half-strength contrast
material was injected through the biliary catheter. Digital image was
recorded. It was then cut close to the hub to place a 0.035 wire,
which was advanced into the distal duodenum. Catheter remnant was removed to
place a 5 Kumpe catheter. The wire was replaced for a 180 cm
0.035 wire, which was coiled in the distal duodenum. Kumpe catheter was
then removed to place an 8 23-cm sheath, which was advanced
into the duodenum. After removing the inner cannula, pullback cholangiogram
was performed. Mid-to-central CBD was then dilated over the wire with a 10 x
40 mm balloon, which was inflated to atmospheres. After removing the
balloon a small amount of sterile half-strength contrast material injected to
assess the CBD. A 10 x 80 mm Luminexx stent was then placed in the
mid-to-central CBD, with a small portion of the stent extending into the
duodenum. A small amount of sterile half-strength contrast material was then
injected through the sidearm of the sheath to perform a cholangiogram. While
removing the sheath, we noted serosanguineous/sero-bilious fluid drainage when
the sheath tip was in the peripheral liver/perihepatic space. We drained
about 200 mL of such fluid through the sidearm of the sheath. Subsequently,
the sheath was removed to place an 8 Amplatz Anchor catheter, with its
tip in the peripheral CBD adjacent to its bifurcation. A small amount of
sterile half-strength contrast material was injected through this catheter to
confirm its position. About 8 mL of 1% lidocaine was infiltrated in the skin
and subcutaneous tissues at the catheter insertion site. The catheter was
secured by 0 silk sutures and Flexi-Trak. Site was appropriately dressed.
Catheter was connected to an external drainage bag. No immediate
post-procedure complication was seen.
## FINDINGS:
1. Initial contrast injection through the old biliary drainage catheter
demonstrated moderate right intrahepatic biliary ductal dilatation, with no
passage of contrast through to the bowel or in the lumen of the drain,
indicating occlusion of the mid-to-distal catheter.
2. Pullback cholangiogram demonstrated filling of intrahepatic biliary ducts
and CBD. There was moderate long-segment stenosis/narrowing of the
mid-to-distal CBD.
3. While balloon dilating, the long-segment narrowing was again demonstrated
in the form of waist, which was successfully dilated at approximately 18
atmospheres pressure.
4. Post-stent placement cholangiogram again demonstrated free flow of
contrast into the bowel. The stent extends through the ampulla.
5. anchor external drain ends just below the confluence in upper cbd at
upper end of well-expanded stent.
## IMPRESSION:
1. Pre-existing drain was occluded accounting for rising LFTs
2. Uncomplicated fluoroscopy-guided cholangioplasty and 10 x 80 mm CBD stent
placement. An 8 Anchor catheter left in place and connected to a bag
for overnight external drainage after which it may be capped. The plan is to
have the patient come back for check cholangiogram: if the stent is patent the
anchor catheter may be removed.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18334731", "visit_id": "25292488", "time": "2143-03-02 11:25:00"} |
10379683-DS-20 | 846 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
Mr. is a man with hx of T2D, psoriatic
arthritis on MTX, and HLD who presented with 3 days of
lightheadedness and black tarry stools.
Three to four days ago, Mr. developed black, tarry
stools. Associated with lightheaded and nausea, which he
particularly noticed at night. Three nights ago, he woke up to
urinate, and developed worsening nausea and lightheadedness,
which he believes was because "the room was hot". Thinks he had
to support himself to remain standing. There was no LOC or
headstrike. Both episodes improved with cool air and water. Last
night, he had no symptoms because "the AC was on".
Over this time period, he had decreased PO intake and continued
to have black and tarry stools, but had no change in frequency
of
BMs and no BRBPR. Today, he presented to , had Hgb of 6.9 with
positive hemoccult, and was sent to the ED.
Of note, no hx of GI bleeds. His last colonoscopy was 6 months
ago and reportedly normal. No hx syncope or vasovagal episodes.
No liver disease, alcohol use. He uses ibuprofen as needed for
lower back pain, but has not used this medication for over 1
month. He denies abd pain, vomiting (no bloody emesis), fevers,
or CP. At baseline, he has occasional SOB with excessive
exercise
or effort at his job.
## IN THE ED:
Initial vital signs were notable for: T 96.7 HR 76 BP 113/58 RR
17 O2 sat 100% RA
## EXAM NOTABLE FOR:
no abnormal findings on exam.
Labs were notable for:
- Chem 7 notable for BUN 21, Cr 0.6
- LFTs WNL
- Coags WNL
- CBC notable for H/H 6.1/18.3, platelets 141
## STUDIES PERFORMED INCLUDE:
none
Patient was given:
- IV pantoprazole 40mg
- Zofran 4mg
- NS 1L
- 2u pRBCs
## GI:
likely upper GI bleed, recommend admit to medicine, 2 large
bore PIVs, T and C, transfuse PRN, PPI IV BID, obtain records
about prior Hb
## VITALS ON TRANSFER:
HR 71, BP 103/50, RR 18, O2 sat 98% on RA
Upon arrival to the floor, he feels slightly nauseous but
believes it is due to the fact that he hasn't eaten. He has an
appetite. He is not lightheaded and has had no abdominal pain.
## FAMILY HISTORY:
Sister died of gastric cancer years ago
Other sister died of carcinoma of unknown primary
Mother died of lung cancer
Father died of pneumonia
## GENERAL:
Alert and interactive. In no acute distress.
## HEENT:
NCAT. PERRL, EOMI. Sclera anicteric and without
injection.
MMM.
## NECK:
No cervical lymphadenopathy. No JVD.
## CARDIAC:
Regular rhythm, normal rate. Audible S1 and S2. No
murmurs/rubs/gallops.
## LUNGS:
Clear to auscultation bilaterally. No wheezes, rhonchi or
rales. No increased work of breathing.
## ABDOMEN:
Normal bowels sounds, non distended, non-tender to deep
palpation in all four quadrants. Liver edge palpated beneath the
costal margin. No splenomegaly.
## EXTREMITIES:
No clubbing, cyanosis, or edema. Pulses DP/Radial
2+
bilaterally.
## SKIN:
Warm. Cap refill <2s. No rash.
## NEUROLOGIC:
CN2-12 intact. strength throughout. Normal
sensation. AOx3.
## BRIEF HOSPITAL COURSE:
#Melena
Patient initially presented to urgent care on after several
days of malaise and black tarry stools. At the urgent care he
was found to have a Hgb of 6.9 and a positive hemocult. He was
instructed to go the ED where he eceived 2u pRBCs and was
started on IV pantoprazole and was evaluated by GI. He was
admitted to the medicine service. On , he had an EGD which
demonstrated a duodenal ulcer without evidence of active
bleeding. A biopsy of the ulcer was obtained and a stool sample
was sent for H pylori antigen testing. The patient tolerated the
procedure well and was discharged home the following day. The H
pylori testing was still pending at discharge.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. MetFORMIN (Glucophage) 1000 mg PO BID
3. glimepiride 2 mg oral DAILY
4. FoLIC Acid 1 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. magnesium 500 mg oral DAILY
7. Methotrexate 1 mL IM QWEEKLY
8. Ibuprofen 800 mg PO BID:PRN Pain - Moderate
9. Leucovorin Calcium 20 mg PO 1X/WEEK (FR) 12 hours after
Methotrexate
## DISCHARGE DIAGNOSIS:
Duodenal ulcer
Upper Gastrointestinal Bleed
## DISCHARGE INSTRUCTIONS:
It was a pleasure taking part in your care here at !
WHY WAS I ADMITTED TO THE HOSPITAL?: You were admitted to for blood in your stool.
WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL?:
- You had a procedure done to look at your GI tract where they
found a duodenal ulcer. You were started on a proton pump
inhibitor called pantoprazole. We recommend you stop taking the
baby aspirin until otherwise directed by your primary care
doctor.
WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL?:
- Please follow up with your primary care doctor and other
health care providers (see below)
- Please take all of your medications as prescribed (see below).
We wish you the best!
Sincerely,
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10379683", "visit_id": "25382150", "time": "2141-03-11 00:00:00"} |
19937193-RR-26 | 187 | ## HISTORY:
Recurrent syncope and subdural hematoma from fall now with altered
mental status, lethargy. Please evaluate for new bleeds and existing subdural
hematoma.
## FINDINGS:
As compared to prior head CT from , mild diffuse subarachnoid
hemorrhage along the Sylvian fissures bilaterally persists, but is less
prominent. There still remains a small amount of subarachnoid hemorrhage at
the left frontal lobe (3:27) and right and left parietal lobes. There is no
evidence of hydrocephalus. Ventricles and sulci remain stable. Left parietal
subdural hematoma measures 8 mm, decreased ins size when compared to prior
examination and causing mild mass effect of adjacent sulci. There is no shift
of normally midline structures. Subgaleal hematoma along the left parietal
bone has also decreased in size. No new areas of hemorrhage identified.
No fracture identified. Visualized paranasal sinuses, mastoid air cells and
middle ear cavities are clear.
## IMPRESSION:
1. No new areas of hemorrhage identified. Subarachnoid hemorrhage involving
the Sylvian fissures bilaterally has resolved. Small amount of subarachnoid
hemorrhage remains at the left frontal lobe and parietal lobes bilaterally.
2. Interval decrease of left parietal subdural hematoma and subgaleal
hematoma.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19937193", "visit_id": "29759889", "time": "2135-06-08 13:55:00"} |
16368227-RR-10 | 324 | COMPUTED TOMOGRAPHY OF THE THORAX
## INDICATION:
Renal masses with pulmonary nodule on CT, assessment for
metastasis.
## FINDINGS:
For comparison, abdominal CT from is available. CT
examination comes from an outside hospital.
No incidental thyroid findings. No supraclavicular, infraclavicular, hilar,
or mediastinal lymphadenopathy. Normal appearance of the large mediastinal
vessels. Moderate coronary calcifications. No pericardial effusion, no
pleural effusions.
In the abdomen, there is extensive cancerous transformation of the kidney,
with massive tumor invasion into the renal vein and into the inferior vena
cava. Clots of tumor material reach the left renal artery and are visible up
to the level of the aortic diaphragmatic hiatus.
Moderate degenerative bone disease, but no evidence of osteodestructive
lesions. No evidence of vertebral collapse.
The lung parenchyma shows evidence of mild-to-moderate pulmonary emphysema.
In the region of the lung apices, several millimetric subpleural granulomas
are seen (for example, 5, 40 and 5, 44).
Minimal parenchymal scarring, associated with a calcified subpleural
granuloma, at the medial bases of the right upper lobe (5, 148).
Non-characteristic parenchymal scarring is also seen at the bases of the
middle lobe and of the lingula.
In the middle lobe, at the lateral border of the scarring, a 6-mm subpleural
soft tissue nodule is seen (5, 185). A second soft tissue density nodule is
detected at the bases of the lingula (5, 214). No other lung nodules are
seen.
The airways are patent, no evidence of airway lesions.
No other lung disease.
## IMPRESSION:
Extensive cancerous transformation of the right kidney with
invasion of the right and left renal veins as well as extensive invasion into
the inferior vena cava.
Two lung nodules, one at the right and one at the left lung base, are
associated with areas of parenchymal scarring. This makes an old inflammatory
cause more likely than metastasis. No other evidence of malignant changes in
the thorax.
Moderate upper lobe predominant pulmonary emphysema. No pleural effusions, no
lymphadenopathy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16368227", "visit_id": "N/A", "time": "2137-09-18 15:33:00"} |
16099168-RR-13 | 184 | CT HEAD WITHOUT CONTRAST.
## FINDINGS:
There is no large intracranial hemorrhage or shift of normally
midline structures. The ventricles and sulci are normal in appearance. There
is no evidence of hydrocephalus. There is normal gray-white matter
differentiation. Incidental note is made of tiny hyperdense foci within the
left temporal lobe (2:16 and 2:13), which may represent residual contrast in
blood vessels. However, tiny foci of bleeding cannot be excluded.
There is no evidence of acute fracture. Minimal left maxillary mucosal sinus
disease is noted.
## IMPRESSION:
No definite evidence of large acute intracranial hemorrhage,
cerebral edema or shift of normally midline structures. Tiny hyperdense foci
within the left temporal lobe may represent prior IV contrast within vessels,
although tiny foci of hemorrhage cannot be entirely excluded.
## NOTE ADDED IN ATTENDING REVIEW:
The punctate hyperattenuating foci, mentioned
above, were not present on the initial ) NECT, obtained some
2.5 hrs earlier (15 min prior to the CECT torso), and like represent residual
contrast in cortical veins, or artifact. The presence of contrast does limite
the evaluation for small amounts of subarachnoid blood.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16099168", "visit_id": "24580709", "time": "2164-11-12 03:44:00"} |
19328152-RR-16 | 139 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
year old man s/p right thotacotomy, RU lobectomy // check
interval change check interval change
## IMPRESSION:
Compared to chest radiographs through .
The upper portion of the neo esophagus is air-filled, less distended today
than on . Small right pleural effusion is smaller, largely posterior.
There may be a new small right apical pneumothorax best appreciated just above
the level of the now displaced fracture, the posterolateral aspect right fifth
rib. .
Patient has severe emphysema. Previous and edema or pneumonia in the left
upper lung is cleared. Heart size is now normal.
## NOTIFICATION:
Dr. was paged with the new findings, at 11:30.
The findings were discussed with , by , M.D. on the
telephone on at 11:59 AM, 20 minutes after the initial page placed
immediately upon discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19328152", "visit_id": "N/A", "time": "2162-10-24 10:30:00"} |
13188834-RR-92 | 80 | CT C-SPINE WITHOUT CONTRAST.
## FINDINGS:
There is no evidence of fracture or dislocation. There is no
prevertebral soft tissue swelling identified. The vertebral body heights and
alignment are maintained. Mild degenerative changes throughout the cervical
spine are noted including marginal osteophyte formation and disc space
narrowing. Status post median sternotomy.
Again identified is partial collapse of the right upper lobe and a
brachiocephalic stent as seen on recent CT scan dated .
## IMPRESSION:
No evidence of fracture or sublxation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13188834", "visit_id": "N/A", "time": "2174-09-08 22:22:00"} |
16963581-RR-31 | 59 | ## INDICATION:
Chronic pancreatitis and left portal vein thrombosis.
## IMPRESSION:
1. Atrophic pancreatic body and tail with irregular pancreatic duct dilation,
in keeping with known history of chronic pancreatitis, stable since the
examination.
2. Unchanged 4 mm transient hepatic intensity difference within segment VII.
3. Unchanged chronic left portal vein thrombosis with compensatory left
hepatic lobe arterial hyperenhancement.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16963581", "visit_id": "N/A", "time": "2164-02-11 14:06:00"} |
14251620-RR-138 | 238 | ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
year old woman with recurrent strokes and epigastric pain,
40lb wt loss, rule out acute occult thoracic malignancy // occult malignancy
## MEDIASTINUM:
The imaged thyroid is normal. No pathologically enlarged
supraclavicular, axillary, hilar or mediastinal lymph nodes.
## HEART AND GREAT VESSELS:
The ascending aorta measures 3.9 cm and mildly
ectatic. The main pulmonary artery is not enlarged. The heart is mildly
enlarged. No pericardial effusion. Minimal atherosclerotic calcifications of
the thoracic aorta and no appreciable calcifications of the coronary arteries.
Relative low attenuation of the cardiac blood, can be seen with anemia.
## PLEURA:
There is no pneumothorax. There is no pleural effusion.
## LUNGS AND TRACHEOBRONCHIAL TREE:
The airways are patent. The lungs are
hyperinflated. Linear atelectasis and calcified granuloma in the lingula.
Mild bronchiectasis and linear atelectasis/scarring in the right middle lobe,
and minimal atelectasis in the lower lobes bilaterally. No suspicious
pulmonary nodules or masses. Mild aneurysmal dilatation of the distal most
pulmonary arteries.
## BONES AND CHEST WALL:
There are no destructive focal osseous or chest wall
lesions concerning for malignancy within the imaged thoracic skeleton.
Increase kyphosis of the mid thoracic spine with anterior mild wedging of the
mid thoracic vertebral bodies.
## UPPER ABDOMEN:
Although this study is not designed for the evaluation of subdiaphragmatic
structures, small hiatal hernia. Limited visualization of the upper abdomen
is unremarkable.
## IMPRESSION:
No evidence of active intrathoracic infection or malignancy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14251620", "visit_id": "24092893", "time": "2197-10-26 18:02:00"} |
12998095-DS-2 | 1,006 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
Mr. is a previously healthy male who presents
with palpitations.
Early this morning, started having paroxysmal palpitations like
his heart is beating out of his chest while walking to work.
Sudden in onset and severe. Rested on a bench for a while, but
didn't go away, so he asked bystanders to call EMS. Was not
feeling anxious early in the morning or prior to onset. No
history of anxiety. No associated chest pain, dyspnea, or
diaphoresis. Had a headache earlier in the morning and took
ibuprofen for it. Has had 2 prior similar episodes, but those
occurred in the setting of taking methamphetamine, which he
stopped in due to those alarming episodes, which both
self-resolved. Denies current substance use such as
methamphetamine or cocaine. Had a cup of coffee in the AM but
was
his usual amount.
In the ED, initial vitals were HR 151, BP 201/112. HR improved
to
109, and BP improved to 154/102 slowly. O2 SAT normal. Received
2L NS initially without much improvement in HR.
## ROS:
Pertinent positives and negatives as noted in the HPI. All
other systems were reviewed and are negative.
## PAST MEDICAL HISTORY:
- Borderline hypertension (at times measured to be SBP 140s,
more
recently 120s after making some dietary changes)
## FAMILY HISTORY:
Family history of hypertension. Father has multiple myeloma.
Grandfather had unknown kidney disease in his requiring
transplantation, lived to be in his . Family members with
heart failure in their .
## 2204 TEMP:
99.1 PO BP: 138/89 HR: 103 RR: 18 O2
sat: 98% O2 delivery: RA Dyspnea: 0 RASS: 0 Pain Score:
## GENERAL:
Alert and in no apparent distress.
## EYES:
Anicteric, pupils equally round.
## ENT:
Ears and nose without visible erythema, masses, or trauma.
Oropharynx without visible lesion, erythema or exudate.
## CV:
Heart regular, no murmur, no S3, no S4. No JVD.
## RESP:
Lungs clear to auscultation with good air movement
bilaterally. Breathing is non-labored.
## GI:
Abdomen soft, 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.
## PSYCH:
pleasant, appropriate affect.
.
.
DISCHARGE EXAM
==============
## EYES:
EOMI, anicteric sclera, PERRL (4-5 mm)
## ENT:
MMM, no OP lesions, several fillings
## CV:
RR, no m/r/g, no JVD, 2+ radial and DP pulses, no peripheral
edema
## GI:
S, NT, ND, BS+
## MSK:
no joint swelling/erythema in arms or legs
## SKIN:
no rashes, no ecchymosis
## NEURO:
AOx4, clear speech, normal coordination, no tremor, no
facial droop
## MICRO:
========
03:50PM OTHER BODY FLUID FluAPCR-NEGATIVE
FluBPCR-NEGATIVE
2:34 pm URINE
**FINAL REPORT
## IMPRESSION:
Patchy retrocardiac opacity could reflect
atelectasis, with early infection not excluded in the setting.
.
.
## PENDING LABS AT DISCHARGE:
==========================
12:10AM BLOOD CATECHOLAMINES-PND
12:10AM BLOOD Metanephrines (Plasma)-PND
06:07AM URINE METANEPHRINES, FRACTIONATED, 24HR
URINE-PND
06:07AM URINE CATECHOLAMINES, 24 HOUR URINE-PND
## BRIEF HOSPITAL COURSE:
# Palpitations
# Flushing
# Hypertension
# Sinus tachycardia
- Patient had his usual amount of caffeine on day of
presentation; denied any recent substance use; denied any recent
illness or localizing signs/symptoms on admission
- Admission UTox negative, UCx w/ no growth
- Admission CXR without evidence for PNA and patient without
fever, cough, SOB, pleuritic pain etc.
- Trop negative & EKG without ischemic changes
- D-dimer negative
- TSH wnl
- was monitored on telemetry during entire hospital stay,
appears to have been in sinus rhythm at all times, with periods
of sinus tachycardia that were almost always associated with
exertion, though he did have one period of sinus tachycardia at
rest that was associated with palpitations, flushing, and
hypertension at ~1015 AM on
- all episodes of palpitations, flushing, and/or sinus
tachycardia resolved on their own, without medical intervention
- though his BP was elevated on initial presentation, his BP was
normal for >24 hours prior to discharge
- ambulatory HR was within normal limits for him (HRs up to 110s
with ambulation, recovered to normal with rest); ambulatory pOx
was wnl on room air
- he had mild headache on day of discharge that was thought most
likely related to caffeine-withdrawal, was given Tylenol PRN
- checked plasma spot metanephrine & catecholamine: results
pending (send out)
- 24-hour urine metanephrine collection completed: results
pending (send out)
- if recurrent symptoms, avoid pure beta-blockade pending formal
diagnosis
- advised patient to avoid caffeine for now
- he will follow-up with his PCP in the next weeks, by which
time the results of the pending studies should be available
.
.
.
.
Time in care:
[x] Greater than 30 minutes in discharge-related activities on
the day of discharge.
.
.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. This patient is not taking any preadmission medications
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H:PRN Headache
Do not take more than 4000 mg acetaminophen from all sources in
any 24 hour period.
## DISCHARGE DIAGNOSIS:
# Palpitations
# Flushing
# Sinus tachycardia
# Hypertension: transient
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted to the hospital for further evaluation of
palpitations, tachycardia (high heart rate), flushing, and
hypertension. Initial labs were unrevealing. You underwent a
24-hour urine collection to assess for certain substances in the
urine that could potentially suggest a source of the problem,
but the results of that testing is still pending at this time.
As we discussed, if you develop persistent palpitations or
palpitations associated with chest pain, chest tightness,
shortness of breath, or feeling like you are going to faint (or
do faint), please seek medical attention.
Please plan to follow-up with your primary care physician, .
, in weeks to discuss the results of the pending
tests and determine if additional evaluation and/or treatment is
needed.
It was a pleasure caring for you while you were here at ,
and we wish you all the best.
Sincerely,
Dr. the Medicine Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12998095", "visit_id": "27219305", "time": "2130-12-21 00:00:00"} |
13252012-RR-35 | 88 | ## EXAMINATION:
KNEE (AP, LAT AND OBLIQUE) LEFT
## HISTORY:
with L knee pain, fibular head tenderness s/p MVC//
?fibular head fx or other fx ?fibular head fx or other fx
## FINDINGS:
No fracture or dislocation is seen. Mild spurring of the patellofemoral
compartment is compatible with mild degenerative changes. There are otherwise
no significant degenerative changes. There is no knee joint effusion. There is
normal osseous mineralization. No suspicious lytic or sclerotic lesions are
identified.
## IMPRESSION:
1. No evidence of fracture or dislocation. No joint effusion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13252012", "visit_id": "N/A", "time": "2134-06-15 02:31:00"} |
13959386-DS-5 | 434 | ## HISTORY OF PRESENT ILLNESS:
who fell at home, transferred from OSH for displaced
mandibular fracture. Last night, she had taken some vicodin from
chronic pain after drinking a glass of wine after dinner. She
had
gone to her bedroom and felt light headed, thought she was
climbing into bed, but instead fell onto her jaw. She was able
to
get back downstairs, called her husband, and he called EMS. She
denies loss of consciousness and does not complain of any chest
pain, abdominal pain, or spinal pain. She does have a headache
and jaw pain. She was transerred from OSH for evaluation.
## PMH:
polyarticular arthritis, depression, UTI
## PHYSICAL EXAM:
Afebrile, vital signs stable
## HEENT:
EOMI, mmm, tender along L jaw
## CT FACE:
displaced L mandible condyle neck fracture, severe
anterior subluxation of L mandible in the TMJ, nondisplaced R
mandible body fracture, severeal fractured teeth
## BRIEF HOSPITAL COURSE:
The patient was admitted to the acute care surgery service on
after falling at home. She was found to have suffered a
mandibular fracture. She was started on a full liquid diet and
medications for pain. She was also started on chlorahexidine
oral rinses. The patient was attempted to be added on for
surgery on and , but secondary to scheduling
difficulties, this did not happen. Thus, at the request of the
service, she will be discharged from the hospital and
follow-up with them as a scheduled case. She will adhere to a
strict full liquid diet until that time.
At the time of discharge, the patient was ambulating
independently, voiding independently, tolerating PO, and able to
verbalize understanding with the discharge plan/instructions.
## MEDICATIONS ON ADMISSION:
methotrexate 5 tabs qweek (wed), diclofenac 1 tab daily,
gabapentin 300', zoloft 100', vicodin prn, tramadol 50' prn,
folate 1'', tumuric
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q6H
2. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID
3. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain
## DISCHARGE INSTRUCTIONS:
Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.
Maintain a strict full liquid diet
Maintain meticulous oral hygiene with brushing your teeth
gentley and rinsing with Peridex tiwce/day
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13959386", "visit_id": "21975414", "time": "2167-06-20 00:00:00"} |
17298515-DS-5 | 1,160 | ## CHIEF COMPLAINT:
L tibial plateau fracture
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
- L tibial plateau ex-fix
- L tibial plateau ORIF
## HISTORY OF PRESENT ILLNESS:
male presents with the above fracture s/p mechanical fall.
He reports that he was carrying items up a step ladder into his
attic when he lost his balance, felt his knee "twist", and then
fell steps to the floor below, landing on his feet and then
hands. He denies pain or noted injury elsewhere. He denies
medical prodromal symptoms prior to the fall
## PHYSICAL EXAM:
No acute distress
Unlabored breathing
Abdomen soft, non-tender, non-distended
Incision clean/dry/intact with no erythema or discharge, minimal
ecchymosis. Closed with staples
brace in place
Neurovascularly intact. Fires GC, TA, , FHL. SILT
s/s/sp/dp/ta.
## L TIB/FIB XRAY :
The available images show steps related to
open reduction internal fixation of a comminuted medial tibial
plateau fracture. On the most delayed images, alignment appears
improved when compared to the preoperative study with placement
of multiple lag screws and a medial fixation plate with proximal
and distal transfixing screws. Please see the operative report
further details.
## CT LLE :
There is a severely comminuted tibial plateau
fracture involving both the medial and lateral tibial plateaus,
extending to the medial metaphysis and tibial eminence.
Multiple small fracture fragments are seen involving the tibial
eminence. There is 3 mm of depression of the articular surface
of the lateral tibial plateau. There is no depression of the
articular surface of the medial tibial plateau. There is a
large lipohemarthrosis. A tiny locule of air seen in the knee
joint (3, 14) which may be related to vaccum phenomenon from
degenerative changes but correlation with any associated
laceration is recommended. There is no fracture of the
visualized distal femur, patella or fibula. There is mild to
moderate subcutaneous edema/hemorrhage about the knee. There is
minimal fatty atrophy of the medial head of the gastrocnemius
muscle. This study is not tailored for evaluation of the
ligaments and tendons about the knee. Mild vascular
calcifications are noted.
## BRIEF HOSPITAL COURSE:
The patient presented to the emergency department and was
evaluated by the orthopedic surgery team. The patient was found
to have L tibial plateau and was admitted to the orthopedic
surgery service. The patient was taken to the operating room on
for L tibial plateau external fixation, and then on
for ORIF L tibial plateau, both of which the patient
tolerated well. For full details of the procedures please see
the separately dictated operative reports. 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. The patient's home
medications were continued throughout this hospitalization. The
patient worked with who determined that discharge to home 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
TDWB in the left lower extremity, and will be discharged on
lovenox for DVT prophylaxis. The patient will follow up with Dr.
routine. A thorough discussion was had with the
patient regarding the diagnosis and expected post-discharge
course including reasons to call the office or return to the
hospital, and all questions were answered. The patient was also
given written instructions concerning precautionary instructions
and the appropriate follow-up care. The patient expressed
readiness for discharge.
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H
2. Citalopram 20 mg PO QHS
3. Diazepam 5 mg PO Q6H:PRN Spasm
RX *diazepam 5 mg 1 tablet by mouth Every 6 hours Disp #*40
## TABLET REFILLS:
*0
4. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth Twice daily
Disp #*60 Capsule Refills:*0
5. Enoxaparin Sodium 40 mg SC QHS
## TODAY - , FIRST DOSE:
Next Routine Administration
Time
RX *enoxaparin 40 mg/0.4 mL 1 syringe subcutaneously Nightly
Disp #*28 Syringe Refills:*0
6. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH DAILY
7. OxycoDONE (Immediate Release) mg PO Q4H:PRN Pain
RX *oxycodone 5 mg tablet(s) by mouth Every 4 hours Disp
#*60 Tablet Refills:*0
8. Pantoprazole 40 mg PO Q24H
9. Senna 8.6 mg PO BID
RX *sennosides [senna] 8.6 mg 1 capsule by mouth Twice daily
Disp #*60 Capsule Refills:*0
## 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:
- TDWB LLE, knee ROMAT
## 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 4 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.
## DANGER SIGNS:
Please call your PCP or surgeon's office and/or return to the
emergency department if you experience any of the following:
- Increasing pain that is not controlled with pain medications
- Increasing redness, swelling, drainage, or other concerning
changes in your incision
- Persistent or increasing numbness, tingling, or loss of
sensation
- Fever > 101.4
- Shaking chills
- Chest pain
- Shortness of breath
- Nausea or vomiting with an inability to keep food, liquid,
medications down
- Any other medical concerns
## FOLLOW UP:
Please follow up with your surgeon's team (******), with
, NP in the Orthopaedic Trauma Clinic 14 days
post-operation for evaluation. Call to schedule
appointment upon discharge.
Please follow up with your primary care doctor regarding this
admission within weeks and for and any new
medications/refills.
## FOLLOW UP:
FOLLOW UP:
Please follow up with Dr. in the Trauma
Clinic days post-operation for evaluation. Someone from
our office should call you to schedule this, but if you do not
hear from us within a few days after discharge, please call
to schedule appointment.
Please follow up with your primary care doctor regarding this
admission within weeks and for and any new
medications/refills.
## ACTIVITY:
Activity as tolerated
Left lower extremity: Touchdown weight bearing
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17298515", "visit_id": "23964121", "time": "2182-09-15 00:00:00"} |
12835773-RR-30 | 183 | ## EXAMINATION:
KNEE( (SINGLE VIEW) BILAT; 3 FOOT STANDING EXTREMITYBILAT
## INDICATION:
year old woman with left knee pain // left knee pain
## FINDINGS:
A line drawn from the top of the femoral head to the central tibial plafond
measures 86.5 cm on the right and 87 cm on the left. There is slight
medialization of the axis of weight-bearing on the right.
Focused views of the pelvis demonstrates a normal appearance of the bilateral
hip joints. No pelvic tilt seen. A piercing projects over the perineum.
Changes related to a prior ACL repair are seen on the right knee. There are
moderate degenerative changes in the right knee with medial compartment
narrowing. And medial joint line osteophytes. Small patellofemoral
osteophytes also noted. No joint effusion seen.
There is mild medial compartment narrowing in the left knee with small medial
joint line osteophytes. Small patellofemoral osteophytes also seen. No
fracture or dislocation seen. No joint effusion seen.
AP view of the bilateral ankles is within normal limits.
## IMPRESSION:
Moderate degenerative change in the right knee, mild degenerative change in
the left knee.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12835773", "visit_id": "N/A", "time": "2131-05-17 10:55:00"} |
11257115-RR-13 | 103 | ## INDICATION:
year old woman s/p tonic clonic seziure, evaluate for ischemic
event.
## FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, or large territorial
infarction. Prominent ventricles and sulci suggest age related global
atrophy.The basal cisterns appear patent, subtle areas of low density are seen
in the periventricular regions, which are nonspecific and may reflect changes
due to small vessel disease, otherwise, there is preservation of gray-white
matter differentiation.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The globes are unremarkable.
## IMPRESSION:
No evidence of acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11257115", "visit_id": "20425175", "time": "2143-06-07 20:27:00"} |
11839420-RR-39 | 92 | ## INDICATION:
year old man POD 4 CABG x3.// Interval changes
## FINDINGS:
Slightly low lung volume and bibasilar atelectasis consistent with
postoperative state. Increased opacification at the left lung base when
compared to prior, compatible with consolidation, aspiration or atelectasis.
Mild, unchanged cardiomediastinal enlargement. Right IJ has been removed when
compared to prior. There is no pneumothorax. Sternal wires are intact and
aligned. There is no pleural effusion.
## IMPRESSION:
Possible consolidation, aspiration or atelectasis at the left lung base.
Right IJ is removed.
There is no pneumothorax pneumonia or pleural effusion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11839420", "visit_id": "28500137", "time": "2134-01-25 11:07:00"} |
15037716-RR-5 | 98 | ## CLINICAL INFORMATION:
Washout with hardware at outside hospital for septic
knee. Evaluate hardware and soft tissues.
Two views of the left knee are obtained without prior studies available for
comparison. There is methyl methacrylate spacer at the knee joint with
additional methyl methacrylate in the suprapatellar bursa. There is a
moderate joint effusion. Patient is status post osteotomy at the proximal
tibia and distal femur. Status post hardware removal. There is mild lucency
about the methacrylate in the proximal tibia, but this may have been secondary
to prior hardware. Outside radiographs would be helpful for assessment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15037716", "visit_id": "23586046", "time": "2150-09-22 09:52:00"} |
12390691-RR-27 | 98 | ## HISTORY:
male with syncope yesterday and fall.
## FINDINGS:
AP upright and lateral views of the chest were provided. Midline sternotomy
wires and mediastinal clips are again noted. There is a right chest wall
pacer device with lead tips extending to the expected level of the right
atrium and right ventricle. The lungs appear clear bilaterally with no
evidence of focal consolidation, effusion, pneumothorax, or pulmonary edema.
Cardiomediastinal silhouette is normal. Bony structures appear intact.
Degenerative spurring is seen within the thoracic spine. No free air is seen
below the right hemidiaphragm.
## IMPRESSION:
No acute intrathoracic process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12390691", "visit_id": "27225195", "time": "2198-06-22 14:04:00"} |
12490651-DS-41 | 1,267 | ## ALLERGIES:
Ambien / Morphine And Related
## HISTORY OF PRESENT ILLNESS:
yo male with h/o CAD, COPD, HTN, diastolic CHF, anxiety and
depression presents with acute, knife-like chest/abdominal pain
that began last evening. Pt reports he was sleeping at home when
he was awakened with a sharp, non-radiating pain in his right
chest, . Over the next few hours, the pain slowly migrated
across his chest to the left, and then down, so that it is now
localized only in the left upper abdomen. Per his wife he was
initially doubled over in discomfort. Pt reports that he took
breathing meds, Ativan and SL NTG in an attempt to relieve the
discomfort, all without improvement. He reports that he did feel
short of breath at the time but denies any chest pain; this
sense of discomfort is very different from his prior cardiac
pain. He did note some very transient pain in his mid back, but
this has now resolved. Currently, the pain persists but has
improved; now about . The pt is unsure whether this is due
to medical treatment or whether it is getting better on its own.
.
The pt denies any fever or chills. No cough or change in
baseline minimal sputum production. No palpitations. No change
in his stools and no urinary sxs. No change transient changes in
sensory motor function. No MSK complaints.
.
Of note, the pt is now on the final day of a 5 day course of
prednisone for a COPD flair.
## #. CAD:
s/p MI with placement of multiple BMS
- s/p LCx restent stenosis with in
- POBA to LCx in
#. History of PE - on anticoagulation
#. Hyperlipidemia - LDL
#. HTN
#. Diastolic CHF (echo : LVEF>55%, impaired relaxation)
#. COPD:
- PFTS : FEV1 FVC 2.70 FEV1/FVC 40%
- 2L home O2
#. BPH s/p TURP ( )
#. Depression
#. Anxiety
#. Diverticulosis complicated by diverticulitis
#. s/p appendectomy
#. AAA measuring 3.1 cm
## M D87:
Alzheimer's, heart disease
F d56 (MI): Heart disease, asthma
## GEN:
Middle aged male, NAD, comfortable, no use of accessory
muscles to breath
## HEENT:
EOMI, PERRL, O/P clear, MMM
## PULM:
CTA bilaterally, no wheezing
## ABD:
Soft, NT, ND, +BS. Ecchymosis noted over lower abd, most
pronounced in midline. No CVA tenderness.
## EXT:
No edema, clubbing/cyanosis pulses b/l.
## NEURO:
A&O x3, appropriate affect.
## CXR ( ):
Emphysema. No acute process.
.
## ADMISSION EKG:
SR at 82. Normal axis and intervals. Small q
waves in inferior leads. No change from prior.
.
## ABD U/S ( ):
1. No evidence for gallstones or renal stones.
2. Stable 3.4-cm infrarenal aortic aneurysm.
3. Incidental note is made of adenomyomatosis of the
gallbladder.
## BRIEF HOSPITAL COURSE:
yo male presenting with an acute episode of chest/abd pain
that spontaneously improved by the time of admission but did not
fully resolve.
.
# Chest/Abd Pain: Etiology remained somewhat unclear as above.
Main ddx included gall bladder or kidney stones. PE and AMI were
felt to be much less likely. The pt had a negative . An
abdominal ultrasound was negative for pathology that would
explain the pt's sxs. A UA was unremarkable. By the morning of
HD1, the pt's pain had completely resolved. He was discharged
home with close PCP
.
# Prior PE: The pt is anticoagulated for this. His INR was
elevated at the time of admission, thus Coumadin was held. He
will take 2.5 mg daily for the two days after discharge and have
his INR checked by his .
.
# COPD: Pt reported that his breathing was at his baseline. He
was given the final dose of a five day course of prednisone.
Spiriva was continued.
.
# CAD: ASA, Plavix, statin, ezetimibe, Imdur and Lisinopril were
continued. The pt denied any chest sxs beyond what is previously
described.
.
# HTN: Lisinopril, verapamil and Lasix were continued.
.
# CHF: Lasix and lisinopril continued.
.
# Depression/anxiety: Paroxetine continued.
.
# GERD: Ranitidine and Protonix continued.
## MEDICATIONS ON ADMISSION:
ASA 325 mg daily
Atorvastatin 40 mg daily
Clonazepam 0.5 mg three times daily PRN anxiety
Plavix 75 mg dialy
Docusate 100 to 200 mg BID PRN
Senna BID
Ezetimibe 10 mg daily
Ferrous Sulfate 325 mg daily
Advair 2500/50 one inhalation BID
Furosemide 20 mg daily
Isosorbide Mononitrate SR 60 mg daily
Lisinopril 20 mg daily
Lorazepam 2 mg four times daily as needed
Oxycodone 5 mg q6 hours PRN
Pantoprazole 40 mg daily
Paroxetine 20 mg daily
Ranitidine 150 mg BID
Theophylline SR 200 mg BID
Tiotropium 18 mcg once daily
Verapamil 180mg daily
Coumadin 2.5 mg daily
Miralax
Oxycodone 5 mg q6 hours PRN
Verapamil 180 mg daily
## DISCHARGE MEDICATIONS:
1. Xopenex Inhalation
2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Docusate Sodium 100 mg Capsule Sig: Capsules PO BID (2
times a day) as needed for constipation.
6. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) as needed for anxiety.
7. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Furosemide 20 mg Tablet
## SIG:
One (1) Tablet PO DAILY (Daily).
9. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
## SIG:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
10. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
11. Polyethylene Glycol 3350 17 gram (100 %) Powder in Packet
## SIG:
One (1) Powder in Packet PO daily ().
12. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
14. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
16. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation BID (2 times a day).
17. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
18. Lorazepam 1 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours) as needed for anxiety.
19. Theophylline 200 mg Tablet Sustained Release 12 hr Sig: One
(1) Tablet Sustained Release 12 hr PO BID (2 times a day).
20. Verapamil 180 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO Q24H (every 24 hours).
21. Hydromorphone 2 mg Tablet Sig: Tablets PO Q6H (every 6
hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
22. Outpatient Lab Work
Please check on and forward results to Dr.
.
## SECONDARY:
COPD
CAD
h/o PE
anxiety
hypertension
AAA
## DISCHARGE CONDITION:
Improved. Pain resolved, vitals stable, ambulatory.
## DISCHARGE INSTRUCTIONS:
Weigh yourself every morning, call MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
-You were admitted with pain in your chest and abdomen. Testing
has not identified any serious cause for this and your pain has
now improved.
-It is important that you continue to take your medications as
directed. No changes were made to your medications on this
admission. Your INR (Coumadin level) was found to be slightly
elevated and was held for one day. PLEASE TAKE 2.5 MG OF
COUMADIN TODAY ( ) AND TOMORROW ( ). HAVE THE
CHECK YOUR INR ON AND SEND THE RESULTS TO .
.
-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.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12490651", "visit_id": "22115685", "time": "2156-07-18 00:00:00"} |
19644467-RR-264 | 190 | ## INDICATION:
year old woman with planned outpatient para on
switched to inpatient by (has spot per coordinator)// diagnostic and
therapeutic
## FINDINGS:
Limited grayscale ultrasound imaging of the abdomen demonstrated moderate
ascites. A suitable target in the deepest pocket in the left lower quadrant
was selected for paracentesis.
## PROCEDURE:
The procedure, risks, benefits and alternatives were discussed
with the patient and existing annual signed consent was reviewed.
A preprocedure time-out was performed discussing the planned procedure,
confirming the patient's identity with 3 identifiers, and reviewing a
checklist per protocol.
Under ultrasound guidance, an entrance site was selected and the skin was
prepped and draped in the usual sterile fashion. 1% lidocaine was instilled
for local anesthesia.
A 5 catheter was advanced into the largest fluid pocket in the left
lower quadrant and 2.2 L of clear, straw-colored fluid were removed. Fluid
samples were submitted to the laboratory for cell count, differential, and
culture.
The patient tolerated the procedure well without immediate complication.
Estimated blood loss was minimal.
## IMPRESSION:
1. Technically successful ultrasound guided diagnostic and therapeutic
paracentesis.
2. 2.2 L of fluid were removed.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19644467", "visit_id": "24165964", "time": "2203-01-16 07:55:00"} |
15851682-RR-19 | 150 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
year old woman s/p fall w/ decreased RUE/RLE movement //
?hemorrhage
## FINDINGS:
Well-defined area of low density in the right occipital lobe in the territory
of the right PCA is now more evolved, consistent with an area of ischemia
without mass effect or hemorrhagic transformation. There is no evidence of
hemorrhage or mass. Prominent ventricles and sulci are likely due to
age-related atrophy. Areas of low density in the subcortical white matter are
nonspecific but probably represent chronic small vessel ischemic disease.
No osseous abnormalities seen. The paranasal sinuses, mastoid air cells, and
middle ear cavities are clear. The orbits are unremarkable. Vascular
atherosclerotic calcifications are seen in the carotid siphons.
## IMPRESSION:
1. Evolving area of ischemia in the right occipital lobe in the territory of
the right PCA, extending to the right parietal lobe.
2. No hemorrhage.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15851682", "visit_id": "24999949", "time": "2167-04-12 16:30:00"} |
12495749-RR-37 | 332 | ## INDICATION:
History of CVA and atrial fibrillation, now with new sinus
tachycardia, shortness of breath and back pain.
## CTA CHEST:
There is no pulmonary embolism. There is no thoracic
aortic dissection. Thoracic aorta is normal in caliber and contour throughout.
There is mild atherosclerotic calcification in the aortic arch. There is
marked three- vessel coronary artery calcification. There is no pericardial
effusion. There is no left pleural effusion. Small right pleural effusion is
new.
Central airways are patent to the subsegmental level. Prominent mediastinal
lymph nodes measure up to 1.5 cm in short axis dimension in the right
paratracheal region (3, 36). There is no abnormal axillary or hilar
lymphadenopathy.
There is ill-defined airspace opacity scattered within the right middle lobe,
with areas of pleural retraction, and 11 x 9 mm nodular subpleural opacity in
the periphery of the right middle lobe (3, 57). Lungs are otherwise clear.
Moderate cardiomegaly is unchanged. Bilateral thyroid nodules are noted.
## CT ABDOMEN:
Single arterial phase limits evaluation of the abdominal
parenchymal organs. Abdominal aorta is normal in caliber and contour
throughout. There is no abdominal aortic dissection. Conventional hepatic
arterial vasculature is widely patent. Celiac axis, SMA, and bilateral renal
arteries are widely patent. The liver is grossly unremarkable. There is no
biliary ductal dilatation or ascites. Multiple calcified gallstones are seen
within the gallbladder lumen. There is no wall thickening or pericholecystic
fluid. Pancreas is unremarkable. There is no pancreatic ductal dilation. The
spleen, adrenal glands, and kidneys are unremarkable. There is no free air,
free fluid, or abnormal intra-abdominal lymphadenopathy.
Visualized osseous structures show stable multilevel degenerative changes.
## IMPRESSION:
1. No pulmonary embolism. No aortic dissection.
2. Small right pleural effusion.
3. Moderate cardiomegaly, and three-vessel coronary artery calcifications.
4. Ill-defined right middle lobe opacity likely represents an area of round
atelectasis, but followup CT evaluation is recommended in three months.
5. Bilateral thyroid nodules. Please correlate clinically, and with thyroid
ultrasound if necessary.
6. Cholelithiasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12495749", "visit_id": "N/A", "time": "2151-05-13 19:53:00"} |
12717830-RR-17 | 147 | ## INDICATION:
Fever, nausea and vomiting. History of unresectable pancreatic
cancer status post ERCP with biliary stenting.
## FINDINGS:
The liver is echogenic, compatible with fatty infiltration. No
focal liver lesions are identified. No intrahepatic biliary dilation is seen.
There is pneumobilia. A stent is noted within the CBD. The portal vein is
patent with hepatopetal flow. The gallbladder contains several stones. Air
is seen within the gall bladder. No free fluid is seen. Known pancreatic
head mass is not well imaged on this examination due to overlying bowel gas.
No free fluid is seen.
## IMPRESSION:
1. Pneumobilia; extensive air within gallbladder likely due to presence of
stent however if suspicion for cholecystitis is high, further evaluation with
CT may be performed.
2. Cholelithiasis.
3. Echogenic liver compatible with fatty deposition. Other forms of liver
disease including significant hepatic cirrhosis/fibrosis cannot be excluded on
this examination.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12717830", "visit_id": "N/A", "time": "2137-03-29 23:08:00"} |
16875122-RR-2 | 407 | ## INDICATION:
female with kidney stones, fevers, and back pain.
Evaluate for hydronephrosis or pyelonephritis.
## FINDINGS:
The imaged lung bases are clear. There are mild coronary artery
calcifications. Otherwise, the heart and pericardium are unremarkable.
## CT ABDOMEN:
There is a moderate right-sided hydronephrosis with hydroureter,
with an impacted stone or cluster of stones in the proximal third of the
ureter measuring approximately 9 x 4 mm (2:46), approximately 5 cm from the
right renal sinus. There is a small nonobstructive stone in the lower pole of
the right kidney (601B:36). Minimal amount of perinephric stranding. The
left kidney is unremarkable. There is no hydroureter bilaterally.
Otherwise, the liver shows decreased attenuation compatible with hepatic
steatosis. A 1.5 cm hypodensity in the right liver lobe (2:27) is incompletely
evaluated but statistically likely a benign lesion such as a cyst. The
non-enhanced appearance of the gallbladder, pancreas and spleen is
unremarkable. The left adrenal gland shows a 1.8 x 1.8 cm nodule with an
average attenuation of -3 Hounsfield units, compatible with an adenoma. The
right adrenal gland is unremarkable. The small and large bowel are within
normal limits. There are scattered colonic diverticula without evidence of
diverticulitis.
## PELVIC CT:
The uterus is unremarkable. In the left adnexa, there is a 2.8 x
2.8 cm cystic structure (2:71 and 601B:41) which is of unclear clinical
significance, but noteworthy in a patient of this age group. The urinary
bladder and terminal ureters are unremarkable. There is no pelvic wall or
inguinal lymphadenopathy. No pelvic free fluid is identified.
## OSSEOUS STRUCTURES:
There are no lytic or blastic lesions concerning for
malignancy. A tiny posterior osteophyte at the level of T9-T10 (602B:50)
causes mild impingement into the spinal canal.
## IMPRESSION:
1. 9 x 4 mm stone or cluster of stones in the right proximal ureter,
approximately 5 cm from the right renal pelvis, resulting in moderate
hydronephrosis, with perinephric stranding. A small nonocclusive stone in the
lower pole of the right kidney is also present. The left kidney is
unremarkable.
2. A 2.8 x 2.8 cm cystic structure in the left adnexa is of unclear clinical
significance and may represent an ovarian cyst. This finding is noteworthy in
a patient of this age group and should be further evaluated with ultrasound.
3. Incidental finding includes hepatic steatosis, left adrenal adenoma and
colonic diverticulosis without diverticulitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16875122", "visit_id": "28260812", "time": "2124-05-06 18:19:00"} |
19984357-RR-13 | 136 | ## INDICATION:
woman found down with multiple pressure ulcers and
altered mental status.
## FINDINGS:
No acute intra-axial or extra-axial hemorrhage. There is no edema,
mass effect, or acute major vascular territorial infarction. Gray-white
matter differentiation is well preserved. The ventricles and sulci are
prominent, consistent with moderate age-related atrophic changes. There is
partial opacification of the left mastoid air cells , the left middle ear and
left posterior ethmoid air cells. Soft tissue defect overlying the left
zygomatic arch is evident. The underlying bones appear normal. No evidence
of acute fracture.
## IMPRESSION:
1. No acute intracranial hemorrhage or fracture .
2. Fluid in the left mastoid air cells and middle ear cavity. Recommended
clinical correlation.
3. Subcutaneous soft tissue defect overlying the left zygomatic arch,
correlates with the clinical history of pressure ulcer.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19984357", "visit_id": "20216677", "time": "2169-03-22 12:37:00"} |
16777182-RR-194 | 86 | ## INDICATION:
year old woman with HIV on HAART therapy with renal failure
// evaluate for obstruction/hydronephrosis
## FINDINGS:
The right kidney measures 10.2 cm. The left kidney measures 10.7 cm. There is
minimal fullness of bilateral renal collecting systems. Corticomedullary
differentiation is maintained.
The bladder is moderately well distended and normal in appearance. Bilateral
ureteral jets were seen.
## PREVOID BLADDER VOLUME:
276.8 ml
Postvoid bladder volume: 224.3 ml
## IMPRESSION:
Minimal fullness of the bilateral renal collecting systems. Significant post
void residual.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16777182", "visit_id": "22651254", "time": "2189-10-20 11:19:00"} |
14062834-RR-52 | 108 | CT HEAD WITHOUT CONTRAST.
## HISTORY:
male with neural changes, evaluate for intracranial
hemorrhage.
## FINDINGS:
No evidence of acute hemorrhage or shift of normally midline
structures. There is normal gray-white matter differentiation. There is no
acute major vascular territorial infarction. Small area of hypodensity within
the left parietal lobe (2, 20) is relatively stable when allowing for
differences in technique. Small amount of motion artifact is noted. There is
no evidence of acute fracture. The visualized paranasal sinuses are clear.
## IMPRESSION:
1. No acute intracranial hemorrhage or shift. Please note that MRI is more
sensitive in the detection of acute ischemia.
2. Left parietal lobe hypodensity stable.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14062834", "visit_id": "25333522", "time": "2173-10-24 17:52:00"} |
18731079-RR-50 | 187 | ## INDICATION:
year old woman with Bilateral knee pain// Bilateral knee Pain
## FINDINGS:
RIGHT LOWER EXTREMITY
Mechanical axis of weight-bearing passes through: Sagittal midline
Leg length: 94.1 cm
## KNEE:
Possible minimal medial compartment narrowing. Small marginal spurs.
## LEFT LOWER EXTREMITY:
Mechanical axis of weight-bearing passes through: Slightly medial to midline
Leg length: 93.6 cm
## KNEE:
Mild narrowing medial femorotibial compartment. Small marginal spurs.
## HIPS:
Mild spurring about both hip joints. Right acetabular roof lies very
slightly higher than left. Iliac crests are excluded from the film.
## KNEES:
Tibial plateaus are similar in height. Right patella is higher than
left. Ankles: Within normal limits. Slight medial downsloping noted. Left
tibial plafond lies slightly higher than the right.
* leg length measured from top of femoral head through the mid tibial plafond.
## IMPRESSION:
There is slight medialization of the mechanical axis of weight-bearing in the
left lower extremity.
Minimal right and mild left knee osteoarthritis.
No overall leg length discrepancy, though slight differences are seen in the
heights of the acetabular roofs and tibial plafonds and the right patella lies
higher than the left.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18731079", "visit_id": "N/A", "time": "2163-07-13 10:03:00"} |
10474653-DS-6 | 1,186 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HISTORY OF PRESENT ILLNESS:
year-old female with ESRD on HD, recent admission with
upper GI bleed, who presents with nonfocal weakness for 2 months
since starting HD, but worse this week on and the day of
admission after hemodialysis. Today after HD felt so weak could
not stand. She denies any focal weakness, just general malaise.
Endorses a 55 lb weight loss over last year. Of note, she had an
AV fistula placed in the left upper extremity on .
.
In the ED, vitals: T: 98.1 BP: 123/45 P:79 RR: 16 SpO2 99% RA.
Labs were drawn and showed normal WBC and differential, normal
lytes, Hct slightly above baseline, but elevated troponin to
0.06 (Cr 3.2) from baseline of 0.03. CK was not elevated and ECG
was unchanged from prior. She was ordered ASA but she refused
given recent GI bleed. CXR was negative. Rectal exam showed
guiac negative stool. One set of blood cultures were drawn and
she was admitted for and further work up of her weakness.
Per renal she will need a culture drawn off the HD line.
.
## ROS:
Pt denies fever or chills. + 55 lb weight loss in last
year. Denied headache or congestion, but admits to occasional
rhinorrhea. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Has had LUE swelling since graft
placed in . Denied nausea, vomiting, diarrhea, constipation
or abdominal pain. No melena or BRBPR. Denied arthralgias or
myalgias. No rash.
.
## PAST MEDICAL HISTORY:
1. CKD, Stage V
2. HTN
## 3. CAD:
ECHO from with EF of 65%, mild AR, mild MR, mild
TR. Exercise stress test from that showed no evidence of
redistribution. Pt reports history of cardiac catheterization,
yrs ago, which was reportedly normal.
4. DJD
5. Osteoporosis
6. Iron deficiency anemia
7. Colonic polyps, hemorrhoids on . Shatski ring, hiatal hernia
9. Glaucoma
10. Right kidney cysts, slightly complex, first noted in ,
increased in size on . Seasonal allergies
12. pancreatic tumor resection in
13. s/p appy
14. s/p oopherectomy for cyts
15. s/p cholecystectomy
. s/p bilateral cataract surgery
.
Pt reports regular mammograms, Pap smears without any abnormal
results. Pt reports last colonoscopy was year ago.
## FAMILY HISTORY:
Mother who died from a stroke at yo. Father who died from a
stroke at yo. Sister who is healthy. 2 brothers who passed
fairly young, one from alcohol abuse. brother with prostate
problems. No family h/o kidney disease.
## HEENT:
NC/AT, PERRL, EOMI, sclera anicteric. dry mucous
membranes, OP without lesions
## CARDIAC:
RRR, nl S1/S2, + holosystolic murmur, II/VI
## ABDOMEN:
soft, NT/ND, + BS, no masses or hepatomegaly noted.
## EXT:
trace edema b/t, 2+ DP pulses. LUE with swelling from
upper arm to forearm. + Healed surgical scar over site of graft
## SKIN:
no rashes or lesions noted.
## -MENTAL STATUS:
Alert & Oriented x 3. Able to relate history
without difficulty.
-cranial nerves: II-XII intact
-motor: normal bulk, strength, and tone throughout.
-sensory: No deficits to light touch throughout.
## CXR IMPRESSION:
Stable examination. There is baseline
hyperinflation likely due to underlying obstructive lung disease
but no acute pulmonary process. Please note (not mentioned
above) there is a tiny right pleural effusion noted on lateral
view.
## BRIEF HOSPITAL COURSE:
y.o. female with ESRD on HD, recent AV fistula placement,
presents with weakness and slightly elevated troponin in setting
of chronic renal failure.
.
# Weakness: Pt described profound weakness after HD that seemed
to resolve on non-dialysis days. There were no clear localizing
symptom or exam findings. Infectious workup was negative,
hematocrit essentially stable. Cardiac enzymes were flat for
three sets. TSH was normal & Vit B12 was elevated normal. The
post dialysis weakness was thought most likely due to low BPs
due to aggressive volume removal at HD & pt was kept overnight
to attempt HD for with higher blood pressure parameters. The
Candesartan was discontinued and pt was continued on Amlodipine
and Imdur. Pt tolerated HD on and was discharged in stable
condition with plan for follow up with transplant for her recent
fistula and nephrology for regular HD.
.
# LUE swelling: Pt was noted to have left upper extremity
swelling that was evaluated by transplant & by ultrasound. It
was thought likely to be seroma secondary to the recent AV
fistula surgery. Dopplers showed no evidence of DVT. The nodule
was nontender, nonerythematous and pt was encouraged to discuss
this with her transplant surgeon in follow up on .
.
# ESRD on HD: Pt was recently initiated on HD and presented with
complaint of severe post HD exhaustion. Renal was following in
house and felt the presenting symptoms were likely related to
aggressive volume removal and possible low BP after HD. Pt was
dialyzed with higher BP parameters and tolerated this better.
.
# Secondary hyperparathyroidism CKD: no acute issues, pt was
continued on Zemplar & Calcium replacement.
.
# HTN: Pt was continue on outpatient regimen of amlodipine,
isosorbide mononitrate.
Candesartan was discontinued & discussed with renal.
.
# h/o CAD: Pt has been not been taking ASA since recent GI bleed
and this was held in house. This should be discussed with
primary care physician at next follow up.
## MEDICATIONS ON ADMISSION:
Amlodipine 10 mg PO once a day
Isosorbide Mononitrate 30 mg PO DAILY
Protonix 40mg po BID
Calcium Carbonate 500 mg PO TID
Docusate Sodium 100 mg PO BID
Senna 8.6 mg PO BID
Zemplar 2 mcg/mL at HD Intravenous
Epogen 4,000 unit/mL at HD.
nephrocap daily
Candesartan 16 mg PO daily
Aspirin 81mg po daily ** ON HOLD since GI bleeding in
## DISCHARGE MEDICATIONS:
1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.)
## SIG:
One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
5. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
6. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) Injection
MWF ( ).
7. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
## SIG:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
## PRIMARY:
post-dialysis generalized weakness
chronic kidney disease stage V, on hemodialysis
.
## SECONDARY:
Coronary Artery Disease
Osteoarthritis
Duodenal Bulb Ulcer
Hypertension
## DISCHARGE INSTRUCTIONS:
You were admitted with generalized weakness and we think it may
be related to the dialysis treatments and low blood pressure.
We have not made any changes to your medications. You have a
small swelling on the inside of your left arm that may be a
seroma from your recent AV fistula surgery. The transplant
fellow has looked at this and feel it important for you to keep
the follow up appointment with Dr. surgeon) to
see if this needs any further management.
.
If you develop any chest pain, shortness of breath or any other
general worsening of condition, please call your PCP or go
directly to the emergency room.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10474653", "visit_id": "25940044", "time": "2112-09-11 00:00:00"} |
10930214-RR-94 | 132 | ## EXAMINATION:
Portable semi-erect AP chest radiograph
## INDICATION:
year old man s/p esophagectomy// Please eval for
interval change, 5:00am
## FINDINGS:
Compared to the prior study on , the postoperative mediastinal
appearance status post esophagectomy is unchanged. Although grossly improved
in diameter overall, the diameter of the neoesophagus is unchanged compared to
yesterday. Bibasilar atelectasis appears heterogeneously worse on both size
raising the suspicion for aspiration/pneumonia. Heart size is normal.
Tracheostomy tube remains midline. Feeding tube descends into the stomach and
out of view. Tip of right PICC again terminates in the right atrium.
## IMPRESSION:
Worsening bibasilar atelectasis with heterogeneous appearance suggesting
possible aspiration/pneumonia.
## NOTIFICATION:
The findings were discussed with by
, M.D. on the telephone on at 11:45 am, 10 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10930214", "visit_id": "25761758", "time": "2191-08-06 06:05:00"} |
15632919-RR-37 | 742 | ## EXAMINATION:
CTA HEAD AND NECK WITH PERFUSION PQ149 CT HEADNECK
## INDICATION:
year old woman with history of atrial flutter, last dose of
eliquis 24 hours ago. presenting for elective atrial flutter ablation and
reporting right eye shadowing.// Please obtain head CT/ CTA head neck CT
perfusion for code stroke
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
2) Stationary Acquisition 24.0 s, 8.0 cm; CTDIvol = 194.7 mGy (Head) DLP =
1,557.5 mGy-cm.
3) Spiral Acquisition 2.6 s, 40.6 cm; CTDIvol = 13.0 mGy (Body) DLP = 529.3
mGy-cm.
4) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.7 mGy (Body) DLP = 1.4
mGy-cm.
5) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 24.4 mGy (Body) DLP =
12.2 mGy-cm.
Total DLP (Body) = 543 mGy-cm.
Total DLP (Head) = 2,305 mGy-cm.
## FINDINGS:
Streak artifact limits evaluation pontine brainstem. Additionally, dental
amalgam streak artifact limits study. Within these confines:
## CT HEAD WITHOUT CONTRAST:
Likely artifactual punctate hyperdensity within anterior pons is noted, with
no definite correlate on CTA imaging (see 2:8 and 4:221), with maximum
Hounsfield units measuring up to 50HU, measuring up to 2 mm. There is no
definite evidence of acute large territorial infarction, acute intracranial
hemorrhage,edema,ormass. There is prominence of the ventricles and sulci
suggestive of involutional changes. There are periventricular and subcortical
lucencies, which may represent small vessel ischemic changes.
The visualized portion of the mastoid air cells,and middle ear cavities are
clear. The visualized portion of the orbits are preserved. Bilateral sphenoid
sinus and ethmoid air cell mucosal thickening is present. Left frontal sinus
mucosal thickening is present.
## CTA HEAD:
Nonocclusive atherosclerotic vascular calcifications are noted of bilateral
cavernous portions of internal carotid arteries and the right vertebral artery
V4 segment are noted. The right vertebral artery is dominant. The left
posterior cerebral artery demonstrates a fetal origin. Right-sided posterior
communicating artery is visualized. Otherwise, the vessels of the circle of
and their principal intracranial branches appear preserved without
stenosis, occlusion, or aneurysm formation. The dural venous sinuses are
patent.
## CTA NECK:
Bilateral carotid and vertebral artery origins are patent. Nonocclusive
probable atherosclerotic changes of the aortic arch are noted.
The carotidandvertebral arteries and their major branches appear preserved
with no evidence of stenosis or occlusion.
Left internal carotid artery origin calcified plaque with approximately 15 %
narrowing by NASCET criteria is noted. There is no definite evidence of right
internal carotid stenosis by NASCET criteria.
## CT PERFUSION:
No definite vascular territory delayed T-max or focal decreased relative blood
flow is noted.
## OTHER:
The visualized portion of the lungs demonstrate approximately 3 mm left upper
lobe probable granuloma (4:67). Additional approximately 2 mm left upper lobe
pulmonary nodule is noted (see 4:65).. The visualized portion of the thyroid
gland is within normal limits. Scattered subcentimeter nonspecific lymph nodes
are noted throughout the visualized portion of the neck bilaterally, without
definite enlargement by CT size criteria.
## IMPRESSION:
1. Streak artifact limits evaluation pontine brainstem. Additionally, dental
amalgam streak artifact limits study.
2. Punctate right anterior pontine probable artifact as described. If concern
for blood products, consider repeat noncontrast head CT for further
evaluation.
3. No acute intracranial abnormality, with no definite focal vascular
territory defect noted on CT perfusion imaging. Please note MRI of the brain
is more sensitive for the detection of acute infarct.
4. Paranasal sinus disease , as described.
5. Nonocclusive probable atherosclerotic disease of circle of as
described.
6. Otherwise, grossly patent circle of without definite evidence of
occlusion,or aneurysm.
7. Left internal carotid artery approximately 15% narrowing by NASCET
criteria.
8. Otherwise, grossly patent bilateral cervical carotid and vertebral arteries
without definite evidence of occlusion,or dissection.
9. 2 mm left upper lobe pulmonary nodule. Please see recommendation below.
## RECOMMENDATION(S):
For incidentally detected single solid pulmonary nodule
smaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and
an optional CT in 12 months is recommended in a high-risk patient.
See the Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 10:51 into the Department of Radiology critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15632919", "visit_id": "N/A", "time": "2124-08-10 08:03:00"} |
16608293-RR-75 | 262 | ## EXAMINATION:
CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK
## INDICATION:
year old man with follicular lymphoma. Evaluate for disease
and compare with prior. Restaging after 36 weeks on study treatment.// year
old man with follicular lymphoma. Evaluate for disease and compare with prior.
Restaging after 36 weeks on study treatment.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.1 s, 26.6 cm; CTDIvol = 8.5 mGy (Body) DLP = 220.4
mGy-cm.
2) Spiral Acquisition 2.1 s, 3.2 cm; CTDIvol = 8.4 mGy (Body) DLP = 24.3
mGy-cm.
3) Spiral Acquisition 2.1 s, 3.2 cm; CTDIvol = 8.4 mGy (Body) DLP = 24.3
mGy-cm.
Total DLP (Body) = 269 mGy-cm.
## FINDINGS:
Evaluation of the aerodigestive tract demonstrates no mass and no areas of
focal mass effect. Mild tracheomalacia.
The salivary glands enhance normally and are without mass or adjacent fat
stranding. The thyroid gland appears unremarkable.There is no lymphadenopathy
by CT criteria. The neck vessels are patent, noting bilateral atherosclerotic
calcifications at the carotid bifurcations.
Mild biapical pleuroparenchymal scarring without suspicious pulmonary nodules
of the visualized lungs.There are no osseous lesions. Multilevel cervical
spondylosis resulting in at least mild spinal canal narrowing at C4-C5 through
C5-C6, unchanged from prior exam.
Dependent aerosolized mucous in the bilateral maxillary sinuses, new from
prior examination.
## IMPRESSION:
1. No evidence of neck mass or cervical lymphadenopathy. Waldeyer's ring is
unremarkable.
2. Dependent aerosolized fluid in the bilateral maxillary sinuses. Clinical
correlation for acute sinusitis is recommended.
3. Additional findings as described above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16608293", "visit_id": "N/A", "time": "2130-03-03 12:13:00"} |
10096844-RR-38 | 164 | ## INDICATION:
male status post slip and fall with left elbow
(medial epicondyle) and left knee pain, rule out fracture.
## FINDINGS:
AP, oblique, and lateral views of the left elbow were obtained.
There is no significant elbow joint effusion. No acute fracture or
dislocation is identified. Bony irregularity seen along the olecranon process
of the ulna with a small well-corticated ossific density noted in the soft
tissues posterior to the distal humerus and slightly superior to the olecranon
fossa. This could represent sequelae of prior avulsive injury; however,
similar findings were also seen in the right elbow previously and the
symmetric appearance may suggest a congenital/developmental process. No
concerning osseous lesion is detected.
## IMPRESSION:
1. No evidence of acute fracture or dislocation.
2. Irregularity along the olecranon process of the ulna and a well-corticated
ossific fragment lying in the soft tissues slightly superior to the olecranon
fossa may represent sequelae of old avulsive injury or congenital deformity as
noted above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10096844", "visit_id": "N/A", "time": "2156-06-14 10:30:00"} |
13091743-RR-35 | 132 | ## EXAMINATION:
UNILAT UP EXT VEINS US
## INDICATION:
year old man with cholangioCa new LUE swelling // eval for
DVT
## FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The left internal jugular and axillary veins are patent and compressible with
transducer pressure.
The left brachial and basilic veins are patent, compressible with transducer
pressure and show normal color flow and augmentation. The left cephalic vein
demonstrates wall-to-wall color flow however cannot be compressed, likely
related to surrounding edema. Extensive soft tissue edema in the antecubital
fossa.
## IMPRESSION:
No evidence of deep vein thrombosis in the left upper extremity. Limited
evaluation of the left cephalic vein however without any evidence of DVT.
There is extensive edema in the subcutaneous soft tissues, predominantly in
the antecubital fossa.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13091743", "visit_id": "25333162", "time": "2158-07-28 08:12:00"} |
19874288-DS-12 | 1,189 | ## ALLERGIES:
Zoloft / Keppra / Lamictal / Trileptal / topiramate
## CHIEF COMPLAINT:
bil leg weakness, numbness, urinary retention, worsening back
pain
## HISTORY OF PRESENT ILLNESS:
w/L2-3 laminectomy (2 months ago) and L4- presenting with bilateral leg weakness, numbness and
urinary retention. Reports progressive bilateral leg weakness
and numbness over the last s increasing chronic
back pain. Yesterday she was unable to walk her dog anymore and
so she presented to the emergency department. Denies bowel
incontinence or retention. Denies urinary incontinence. Reports
decreased urination over the last 24hrs but did not have a sense
of incomplete empyting of the bladder. No fever or chills.
In ED foley placed with >500cc out. Pt seen by neurosurg. Found
Right leg strength. Left leg strength. Sensation intact
bilaterally though reports decreased sensation in the saddle
region. Normal rectal tone. No perianal anesthesia. MRI
with/without contrast reviewed and discussed with and
Attending, Dr. . MRI showing no signs of cord compression.
Symptoms are not explained by imaging. Neurosurg recommend that
urology or Uro-gynecology be consulted to evaluate these urinary
issues (overflow vs retention) prior to return home. Pt given
macrobid, gabapentin and IV morphine.
## ROS:
+as above, otherwise reviewed and negative
## PAST MEDICAL HISTORY:
# Seizures
# SVT s/p ablation
# Narrow angle glaucoma
# Depression
# cLBP
- s/p L4-L5 lumbar fusion
- s/p L3 full, partial L4 laminectomy ( )
# OA
# s/p R THR, L THR, L shoulder replacement
# s/p appy
# s/p TAH
# s/p CCY
## ABDOMEN:
bowel sounds present, soft, mildly tender suprapubic
## NEURO:
alert, follows commands, RLE strength LLE
## PERTINENT RESULTS:
02:10PM GLUCOSE-91 UREA N-15 CREAT-0.8 SODIUM-142
POTASSIUM-3.9 CHLORIDE-104 TOTAL CO2-28 ANION GAP-14
02:10PM WBC-11.3* RBC-4.96 HGB-13.4 HCT-42.0 MCV-85
MCH-27.0 MCHC-31.9* RDW-13.8 RDWSD-42.6
02:10PM NEUTS-71.6* MONOS-5.7 EOS-1.6
BASOS-0.4 IM AbsNeut-8.11* AbsLymp-2.30 AbsMono-0.64
AbsEos-0.18 AbsBaso-0.04
02:10PM PLT COUNT-187
02:10PM PTT-33.1
06:23PM URINE COLOR-Straw APPEAR-Clear SP
06:23PM URINE BLOOD-SM NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-LG
06:23PM URINE RBC-6* WBC-30* BACTERIA-NONE YEAST-NONE
EPI-0
# MRI L Spine ( ): The patient is status post posterior
laminectomy of the L3 and L4 with posterior fusion of L4-L5.
Alignment is unchanged from prior CT from , and
no significant canal stenosis is seen.
Postsurgical changes are noted in the paraspinal soft tissues
including granulation tissue, and there is a thin fluid
collection overlying the L3-L4 laminectomy site measuring 3.3 x
1.1 x 0.9 cm. There is subtle peripheral enhancement of this
fluid collection, and infection cannot be excluded.
# L-spine x-ray (Flex/ext) ( ): In comparison with the study
of , there is little change in the appearance of
the posterior fusion at L4-L5 with laminectomy with no evidence
of hardware-related complication. Mild anterolisthesis at L4-L5
is again seen. The remainder of the vertebra and intervertebral
disc spaces are within normal limits, though there is apparent
osteopenia. Bilateral total hip prostheses are in place.
## ASSESSMENT & PLAN:
yoF h/o Seizures, SVT s/p ablation,
Depression, cLBP s/p L4-L5 lumbar fusion ( ), L3 full/partial
L4 laminectomy ( ) admitted with bil leg weakness,
numbness, urinary retention, worsening back pain,
## # NEURO:
Ms. has a long history of back pains - s/p L4-5
lumbar fusion, L3-4 laminectomies . She presented with
lower extremity weakness and urinary overlow/retention. She was
evaluated by the neurosurgery team within the ED, and exam
revealed motor strength throughout, L anterior thigh
numbness, no clonus, and normal sphincter control. A L-spine
MRI obtained in the ED showed postoperative changes but no
anatomical findings to account for her symptoms - notably, there
was no focal spinal compression. The findings were unchanged
compared to past CT scan of the lumbar spine.
She was continued with her home regimen of acetaminophen and
oxycodone with good effect. To ensure that there was no dynamic
instability of the spine, L-spine x-ray under ext/flexion
conditions were obtained. This showed no signs of instability.
She was evaluated by and deemed safe for discharge. She can
f/u with Dr. as previously scheduled
## # URINARY RETENTION:
When Ms. was admitted, she clearly
had evidence of urinary retention. She had a foley placed and
>400 cc of urine was removed with the foley in place. Urology
was contacted and the decision was to have her discharged home
with a foley catheter and to follow up with urology (per her
preference - at the Urological Associates) to perform
urodynamic studies. Other than the oxycodone (which she does
not take frequently), there was no identifiable medication to
cause urinary retention. Given her past vaginal deliveries, she
may have structural etiologies for her retention.
She was found during this hospitalization to have a dirty
## U/A:
large, Nit neg, RBC 6 WBC 30. Urine culture grew
>100,000 ampicillin enterococcus. She was initially treated
with ceftriaxone - and then switched to ampicillin IV and later
PO augmenin (once the enterococcus was identified). She will
complete a 7 day course for complicated UTI. Foley care
training was provided to the patient.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Duloxetine 60 mg PO DAILY
2. Gabapentin 900 mg PO QHS
3. Gabapentin 600 mg PO QAM
4. Gabapentin 300 mg PO Q AFTERNOON
5. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
6. TraZODone 100 mg PO QHS
## DISCHARGE MEDICATIONS:
1. Duloxetine 60 mg PO DAILY
2. Gabapentin 900 mg PO QHS
3. Gabapentin 600 mg PO QAM
4. Gabapentin 300 mg PO Q AFTERNOON
5. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
6. TraZODone 100 mg PO QHS
7. Amoxicillin-Clavulanic Acid mg PO Q12H Duration: 7 Days
RX *amoxicillin-pot clavulanate [Augmentin] 875 mg-125 mg 1
tablet(s) by mouth every twelve (12) hours Disp #*12 Tablet
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
It was a pleasure looking after you, Ms. . As you know,
you were admitted with lower extremity weakness, back pain, and
urinary retention. You had extensive workup for your symptoms -
including MRI L-spine and Lumbar x-ray in extension/flexion
positions. These results did not show any anatomical or
distinct cause for your symptoms. There was no impingement of
the spinal cord. As a result, the neurosurgery team (Dr.
did not recommend a surgical intervention.
You were noted to have a distended bladder from a urinary
retention. A foley catheter was placed with significant output
of urine. You will be discharged with the foley, and we
recommend that you follow with the urologist at to do a
urodynamic testing to assess the cause of the urinary retention.
You also had a urinary tract infection (Enterococcus). For
this, you were placed on ampicillin (IV) and then subsequently
an oral antibiotic - Augmentin. This should be completed for an
additional 6 days.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19874288", "visit_id": "23162562", "time": "2147-06-19 00:00:00"} |
11281568-RR-92 | 193 | ## INDICATION:
History of right lower extremity pain. Please evaluate for
fracture.
## PELVIS AND RIGHT HIP:
Bilateral proximal femoral gamma nail fixation.
Bilateral subchondral sclerosis at the femoral head compatible with avascular
necrosis. There is impression of slight articular cortical collapse of the
superolateral femoral head. There is mild bilateral hip joint degenerative
change.
## RIGHT KNEE:
Joint spaces are preserved. There is an area of sclerosis at the
right medial femoral condyle which may reflect an area of avascular necrosis
given findings at the hips. There is some ill-defined sclerosis in the
proximal tibial metaphysis. This is nonspecific although a nondisplaced
insufficiency fracture have this appearance.
## IMPRESSION:
1. Bilateral femoral head avascular necrosis. There is impression of slight
articular cortical collapse of the superior aspect of the right femoral head.
2. Possible osteonecrosis of the medial femoral condyle on the right, with
additional faint sclerosis in the proximal tibial metaphysis raising
possibility of insufficiency fracture. Suggest further assessment with MRI
given history of pain.
## NOTIFICATION:
The impression above was entered by Dr. on
at 08:46 into the Department of Radiology critical communications
system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11281568", "visit_id": "21696619", "time": "2124-04-20 01:04:00"} |
16329034-RR-32 | 101 | ## EXAMINATION:
VENOUS DUP EXT UNI (MAP/DVT) RIGHT
## INDICATION:
year old man with extensive DVT. S/p RLE thrombolysis and
stenting of bilateral common iliac veins
## FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the peroneal vein.
The patient has duplicate right posterior tibial veins with partially
occlusive, likely chronic thrombus in both.
## IMPRESSION:
Patency of the recently recanalized right common femoral vein, femoral vein,
popliteal vein and peroneal veins.
Partially occlusive, likely chronic thrombus in the duplicate right posterior
tibial veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16329034", "visit_id": "29098621", "time": "2123-06-18 12:06:00"} |
15322967-RR-9 | 156 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST
## HISTORY:
with mechanical fall with sternal pain and midline C
spine tenderness// NCHCT- eval for fracture or ICH Neck CT- eval for fracture
## FINDINGS:
There is no acute fracture or traumatic malalignment.Multilevel degenerative
changes are seen, most extensive at C4 through C6 and notable posterior
osteophyte formation and uncovertebral hypertrophy which results in moderate
right neural foraminal narrowing at C4-C5 and C5-C6, as well as mild canal
narrowing at C5-C6. There is no significant canal narrowing there is no
prevertebral edema.
The thyroid is prominent with no discrete nodules identified. The included
lung apices are unremarkable.
## IMPRESSION:
1. No acute fracture or traumatic malalignment.
2. Multilevel degenerative changes most pronounced at C5 through C6 which
results in mild canal narrowing at C5-C6.
3. Diffuse prominence of the thyroid gland with no discrete nodule identified,
which could be correlated with thyroid function tests.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15322967", "visit_id": "N/A", "time": "2156-06-22 15:53:00"} |
10740864-RR-40 | 295 | ## INDICATION:
woman with hydrocephalus status post right VPS, left
VPS extention today. Please evaluate for hydrocephalus or acute hemorrhage.
## FINDINGS:
Patient is status post placement of a second ventriculoperitoneal shunt via
left frontal approach, lateral to the preexisting catheter. The new shunt
enters the left frontal horn, curves inferiorly in the region of the foramen
of , and terminates in the suprasellar cistern. The preexisting left
frontal parasagittal approach VP shunt catheter is in stable position,
entering the ventricles near the septum pellucidum, coursing through the
region of the right foramen of , and terminating to the right of the
third ventricle. There is interval decompression of all components of the left
lateral ventricle. Bilateral frontal horns are now slitlike. Posterior
components of the right lateral ventricle have not significantly changed in
size. The third ventricle is stable to 1 mm smaller. Marked dilatation of
the ventricle has not changed, and extensive surrounding hypodensity,
indicating transependymal migration of CSF, persists. Diffuse enlargement and
hyperdensity of the choroid plexus in the lateral ventricle, of
, fourth ventricle and foramen of Magendie persists, the underlying cause
of the hydrocephalus. There is no evidence of acute hemorrhage. Gray-white
matter differentiation is preserved. There is trace postprocedural
pneumocephalus.
There are aerosolized secretion in a left anterior ethmoid air cell. The
mastoid air cells and middle ear cavities are clear.
## IMPRESSION:
The new left frontal approach ventriculoperitoneal shunt courses through the
region of and terminates in the suprasellar cistern. The
preexisting left frontal approach ventriculoperitoneal shunt catheter is in
stable position. There is interval decrease in the size of the left lateral
ventricle and the right frontal horn, but no significant change in the
dilatation of the posterior right lateral ventricle, and ventricles,
caused by the underlying choroid plexus abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10740864", "visit_id": "20361905", "time": "2157-10-30 18:17:00"} |
11459120-RR-160 | 101 | ## INDICATION:
Status post fall x2 with head strike, on Coumadin. Please
evaluate for intracranial hemorrhage.
## FINDINGS:
There is no evidence of hemorrhage, edema, mass effect, or acute
vascular territorial infarction. Prominent ventricles and sulci are
relatively unchanged and most likely reflect age-related atrophy. Confluent
periventricular white matter hypodensities are nonspecific but likely reflect
sequelae of chronic small vessel ischemic disease, relatively unchanged.
Basal cisterns are patent, and there is preservation of gray-white matter
differentiation. No fracture is identified. Paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. Orbits are unremarkable.
## IMPRESSION:
No acute intracranial abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11459120", "visit_id": "20891858", "time": "2140-10-14 12:09:00"} |
11638384-RR-27 | 421 | ## INDICATION:
woman with AML febrile neutropenia and VRE
bacteremia. Please assess for source of infection.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.3 mGy (Body) DLP = 1.9
mGy-cm.
2) Stationary Acquisition 2.5 s, 0.2 cm; CTDIvol = 42.7 mGy (Body) DLP =
8.5 mGy-cm.
3) Spiral Acquisition 9.8 s, 63.4 cm; CTDIvol = 10.7 mGy (Body) DLP = 673.5
mGy-cm.
Total DLP (Body) = 684 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS WITH CONTRAST)
## FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL:
Right lobe of thyroid lesion
appears similar compared to prior CT. Right central line in situ with the tip
in the right atrium. Left prepectoral dual lead pacemaker in situ with the
lead tips in the right atrium and right ventricle. No supraclavicular or
axillary adenopathy. Nonspecific soft tissue nodules again noted in the
medial aspect of the left breast (4, 33).
## UPPER ABDOMEN:
Will be reported separately.
## MEDIASTINUM:
Borderline enlarged mediastinal lymph nodes (right lower
paratracheal measuring 11 mm) show decrease in size compared to prior imaging.
## HILA:
Subcentimeter hilar lymph nodes show interval decrease in size.
## HEART AND PERICARDIUM:
Normal cardiac configuration. No pericardial effusion.
Moderate aortic valve and coronary artery calcifications. Moderate mitral
annular calcification.
## -PARENCHYMA:
The previously noted diffuse ground-glass opacification of the
central lung zones shows interval improvement, with mild residual ground-glass
opacification (this most likely represents pulmonary edema).
Extensive peribronchial airspace nodules in the posterior aspect of the left
upper lobe and bilateral lower lobes with coalescing airspace consolidation in
the posterior lung bases suggesting multifocal pneumonia. Minimal atelectasis
seen in the lung bases. Subpleural cystic change seen in the right lung apex.
Nonspecific nodule seen in the anterior aspect of the right upper lobe (5,
149).
-AIRWAYS: Patent to the subsegmental level.
-VESSELS: The pulmonary arteries not enlarged. No filling defects on this
nondedicated study.
## CHEST CAGE:
Spondylotic change of the thoracic spine. No lytic/destructive
bony lesions.
## IMPRESSION:
Findings suggestive of multifocal pneumonia.
Aspiration should be considered in the differential diagnosis.
Indeterminate 5 mm nodule seen in the anterior aspect of the right upper lobe.
Please see abdominal CT report for abdominal findings.
## RECOMMENDATION(S):
12 month follow-up advised for the indeterminate 5 mm
nodule in the right upper lobe.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 5:38 , 10 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11638384", "visit_id": "26345932", "time": "2115-10-10 14:24:00"} |
16627639-RR-60 | 218 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
year old man with cirrhosis and TIPS and a GIST// eval for
hepatoma and use Doppler to assess TIPS shunt
## LIVER:
The hepatic parenchyma is again noted to be diffusely coarse. The
contour of the liver is nodular. There is no suspicious solid liver mass
identified. A small cyst measuring 8 mm is noted in segment V of the liver..
There is no ascites.
## BILE DUCTS:
There is no intrahepatic biliary dilation. The CHD measures 2 mm.
## GALLBLADDER:
A stone measuring 1.5 cm is noted in the neck of the gallbladder.
## PANCREAS:
The pancreas is obscured from view by overlying bowel gas.
## SPLEEN:
Normal echogenicity, measuring 10.0 cm.
## DOPPLER EXAMINATION:
The main portal vein is patent with hepatopetal flow at a
velocity of 28 cm/sec. Flow within the left and right portal veins is toward
the TIPS.
The TIPS is patent with wall to wall flow and velocities of 105, 142 and 139
cm/sec. (Previous TIPS velocities measured 152, 125 an 86 cm/sec in the
proximal mid and distal portions respectively).
## IMPRESSION:
1. Patent TIPS with stable velocities.
2. Coarsened nodular hepatic architecture. A small cyst is seen in the right
hepatic lobe however no concerning solid liver lesion is identified.
3. Cholelithiasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16627639", "visit_id": "N/A", "time": "2190-04-25 07:22:00"} |
17217213-RR-129 | 99 | ## HISTORY:
Assessment of a left ankle fracture.
## FINDINGS:
Three views of the left ankle show a side plate with syndesmotic
screws along the left fibula. An unchanged medial malleolar fracture
involving the posterior tibial tubercle has extensive surrounding callus
formation. The fibular fracture line remains visible and little changed since
. No hardware associated complications are identified. There has
been progressive anterior migration of the distal tibia with respect to the
talus. There is minimal surrounding soft tissue swelling.
## IMPRESSION:
Progressive anterior migration of the distal tibia with respect
to the talus is identified. No hardware associated complications.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17217213", "visit_id": "N/A", "time": "2174-09-24 15:37:00"} |
16875096-RR-49 | 84 | ## EXAMINATION:
LEFT DIGITAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD
## INDICATION:
woman with a history of right breast cancer, status
post right mastectomy presents for annual surveillance mammogram of the left
breast.
## TISSUE DENSITY:
B - There are scattered areas of fibroglandular density.
There are no new suspicious abnormalities in the left breast. No suspicious
masses, areas of architectural distortion or suspicious grouped
calcifications.
## IMPRESSION:
No specific mammographic evidence of left breast malignancy.
## NOTIFICATION:
Findings reviewed with the patient at the completion of the
study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16875096", "visit_id": "N/A", "time": "2163-05-09 10:50:00"} |
18278366-RR-37 | 119 | ## INDICATION:
Postmenopausal bleeding. Best possible images as the patient is
immobile.
## FINDINGS:
The uterus is anteverted and measures 6.0 x 2.0 x 3.8 cm. The endometrium is
mildly heterogeneous and measures 3 mm. Small amount of fluid is seen within
the endometrial cavity, which suggest cervical stenosis. No definite focal
endometrial lesion is identified.
The right ovary is normal. There is a 1.2 x 2.4 x 1.2 cm simple left adnexal
cyst. There is a trace amount of free fluid.
## IMPRESSION:
1. Mildly heterogeneous endometrium; endometrial biopsy is recommended for
further evaluation.
2. 2.4 cm simple left adnexal cyst.
3. Fluid within the endometrial cavity is suggestive of cervical stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18278366", "visit_id": "N/A", "time": "2169-08-15 13:22:00"} |
15034346-RR-27 | 124 | ## EXAMINATION:
BILAT LOWER EXT VEINS
## INDICATION:
year old man with history of HTN and hypothyroidism and AIDP
Dx who presents with progressive weakness and pedal edema.// Evaluate
for etiology of bilateral pedal edema
## FINDINGS:
There is normal compressibility, color flow, and spectral doppler of the
bilateral common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa ( ) cyst.
There is mild right calf edema.
The feet were not scanned as the patient felt like "electrical shocks" when
the feet are touched.
## IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15034346", "visit_id": "21096253", "time": "2119-09-25 10:14:00"} |
11763591-RR-49 | 301 | ## INDICATION:
male with posterior lumbar fusion in , new-onset
back pain radiating to right leg.
.
## FINDINGS:
Changes of L4-S1 decompression are present. Posterior fusion
screws are present, without periprosthetic lucency or fragmentation to suggest
complications. There is nonfusion of the posterior bony masses.
At T12-L1 and L1-L2, the central canal and neural foramina are widely patent.
At L2-L3, there is a mild diffuse disc bulge. Moderate facet hypertrophy and
ligamentum flavum thickening are also present, resulting in mild central canal
stenosis. There is no significant neural foraminal stenosis.
At L3-L4, there is a moderate diffuse disc bulge. Severe facet hypertrophy
and ligamentum flavum thickening are also present, resulting in moderate
central canal stenosis and mild bilateral neural foraminal stenosis.
At L4-L5, there is a moderate diffuse disc bulge. Severe facet hypertrophy
and ligamentum flavum thickening are present, resulting in moderate central
canal stenosis. However, laminotomy defect allows for partial posterior
decompression. There is mild bilateral neural foraminal stenosis.
At L5-S1, there is continued moderate degenerative change with loss of disc
space, endplate irregularity/sclerosis, and intervertebral vacuum disc
phenomeno. Radiodense interbody spacer is present. Large disc-osteophyte
complex is present, with anterior and posterior components. This results in
compression of the ventral thecal sac and traversing S1 nerve roots, right
greater than left. However, laminectomy defect allows for posterior
decompression, and the dorsal CSF space appears patulous. There is
near-complete obliteration of the bilateral L5 subarticular and foraminal
zones, right greater than left.
Bone harvest site is noted in the right iliac wing. There are no paraspinal
fluid collections or soft tissue abnormalities.
## IMPRESSION:
Stable L4-S1 surgical changes and nonfusion of the posterior bony
masses. Multilevel degenerative changes with near-complete obliteration of
the L5 foramina, right greater than left.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11763591", "visit_id": "N/A", "time": "2156-06-07 07:44:00"} |
17777013-RR-10 | 144 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST
CT OF THE CERVICAL SPINE
## INDICATION:
year old man with C1 burst fracture C2 ondontoid fracture.//
Please Evaluate.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.4 s, 21.3 cm; CTDIvol = 26.0 mGy (Body) DLP = 553.0
mGy-cm.
Total DLP (Body) = 553 mGy-cm.
## FINDINGS:
Fracture of the odontoid process and the anterior arch of C1 again identified.
The distance between the posterior margin of C2 vertebral body and the
superior fragment is unchanged compared to the prior study. There is no
significant spinal canal narrowing seen. The atlanto odontoid spaces
maintain. The fracture margins are slightly less distinct indicative of
healing process. No new abnormalities are seen.
## IMPRESSION:
Unchanged alignment at the fracture site at the craniocervical junction with
slightly decreased sharpness at the fracture margin indicative of on going
healing process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17777013", "visit_id": "N/A", "time": "2147-10-29 14:51:00"} |
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