id
stringlengths 13
15
| num_tokens
int64 50
8.78k
| text
stringlengths 275
54.6k
| source
stringclasses 1
value | meta
stringlengths 125
138
|
|---|---|---|---|---|
14244969-RR-56 | 287 | ## HISTORY:
male with left frontal glioblastoma, status post biopsy,
radiation, and chemotherapy on Avastin; follow-up for tumor progression.
## FINDINGS:
Post-operative changes are noted with left parietal burr hole and
mild increase in post-surgical dural enhancement, as well as enhancement
within the post space related to the prior burr hole.
The left posterior frontal and parietal mass extending into the temporal lobe
is again demonstrated, with interval increase in extent of enhancement,
anteriorly. There is intrinsic T1-hyperintensity and susceptibility artifact,
compatible with blood products, which are also increased in extent from the
prior exam. Overall extent of the lesion is approximately 4.1 (TRV) by 4.7
(AP) x 3.8 cm (CC). The extent of surrounding FLAIR- hyperintensity appears
overall unchanged.
MR spectroscopy reveals elevated ratios with markedly
reduced NAA peak along the anterior and medial aspects of the lesion,
particularly in voxel 9, anteriorly, and in voxels 25, 26 and 27, posteriorly.
The spectra at these sites are progressively abnormal, with greater elevation
of the choline peaks than on the prior exam. There is increased perfusion
along the anterior margin, on the ASL images. The DSC perfusion sequence
reveals decrease in perfusion in the central portion of the lesion, compatible
with radionecrosis.
An enhancing lesion in the right periorbital region is again seen, stable from
multiple prior examinations, likely a benign finding. There is mild mucosal
thickening in the ethmoid air cells and frontal sinuses.
## IMPRESSION:
Interval increase in the size of a left frontoparietal mass
extending into the temporal lobe, with further elevation of choline peaks and
increased perfusion anterolaterally, as well as abnormal spectroscopy in the
posteromedial portion of the mass, suggestive of progression of the underlying
tumor.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14244969", "visit_id": "N/A", "time": "2186-07-11 08:40:00"} |
17129962-RR-5 | 105 | LIVER AND GALLBLADDER ULTRASOUND
## HISTORY:
man with right upper quadrant pain. Patient has type B
dissection. Evaluate liver and gallbladder for source of pain.
## FINDINGS:
The liver demonstrates normal echotexture throughout without any
focal masses. Note is made of a 2.8 x 2.6 x 0.8 cm hyperechoic mass in the
area of the gallbladder and right lobe. This area is most consistent with
intra-abdominal fat adjacent to the liver. The gallbladder is unremarkable
without any stones. The common bile duct is 0.3 cm. The portal vein is
patent with normal hepatopetal flow.
## IMPRESSION:
Normal liver, gallbladder, and biliary ultrasound.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17129962", "visit_id": "28509682", "time": "2155-02-21 16:23:00"} |
12216000-RR-62 | 287 | EXAMINATION OF THE BRAIN WITHOUT AND WITH CONTRAST DATED, .
## HISTORY:
female with resected grade 1 meningioma; rule out
progression or new lesion.
## FINDINGS:
The study is compared with most recent enhanced MR examination
dated , as well as a series of recent NECTs, the latest on
(performed for "head trauma").
Again demonstrated are the extensive post-surgical changes associated with
suboccipital craniectomy, without evident complication. There is no
suspicious enhancing focus or new signal abnormality at the resection bed,
with persistent mild FLAIR-hyperintensity in the superficial midline
cerebellum, improved since the most recent MR, likely representing
post-surgical gliosis. Otherwise, there is only mild scattered
FLAIR-hyperintensity in bihemispheric periventricular white matter, not much
changed, likely the sequelae of chronic small vessel ischemic disease. Again
demonstrated is the right frontovertex burr hole and subjacent parenchymal
"ghost track" related to previous site of transfrontal ventriculostomy
catheter (demonstrated on the CT). The ventricles and cisterns are
unchanged in overall size and configuration and the midline structures are in
the midline.
There is no acute intra- or extra-axial hemorrhage and no restricted diffusion
to suggest an acute ischemic event. The principal intracranial vascular
flow-voids appear preserved. There is an unusually prominent, lobulated
flow-void at the expected junction of the ACom and left ACA vessels (7:11,
901:39). This is unchanged since the study and the dedicated cranial TOF
MRA of suggests that this may represent a prominent infundibulum at
this site.
## IMPRESSION:
1. Status post extensive suboccipital craniectomy with relatively mild
post-surgical changes but no evidence of recurrent meningioma at this site.
2. No acute intracranial process.
3. Likely infundibulum at the junction of the ACom and left ACA, essentially
unchanged since the MRA.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12216000", "visit_id": "N/A", "time": "2118-02-28 12:36:00"} |
19247702-RR-125 | 227 | ## HISTORY:
with known pancreatic cyst, re-evaluate lesion.
## FINDINGS:
The lung bases are clear. The included heart and pericardium are
unremarkable.
The liver is normal in contour. Incidental note is made of an 8 mm hepatic
cyst in the right lobe of the liver unchanged from (2:6). The
gallbladder is unremarkable without radiopaque gallstones. There is no intra-
or extra-hepatic biliary duct dilation. The adrenal glands and spleen are
unremarkable.
The pancreas is of normal signal on T1- and T2-weighted imaging. Again seen,
is a small 5mm cystic lesion within the body of the pancreas, essentially
unchanged in size or appearance from (2:11). There is no obvious
connection with the main pancreatic duct but this likely represents a side
branch IPMN. There are no other pancreatic lesions visualized. There is no
pancreatic ductal dilation.
A cyst in the lower pole of the left kidney is unchanged (2:20). The kidneys
are otherwise unremarkable. The stomach, small bowel, and large bowel are
unremarkable. There are prominent porta hepatic lymph nodes, likely reactive
in nature. There is no abdominal free fluid.
There are no suspicious osseous lesions or abnormal bone marrow signal.
## IMPRESSION:
1. Stable 5mm indeterminate cystic lesion in the body of the pancreas, which
statistically likely represents a side branch IPMN. A followup scan is
advised in years per departmental protocol.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19247702", "visit_id": "N/A", "time": "2199-04-07 10:35:00"} |
16635191-RR-23 | 270 | ## STUDY:
MRI of the cervical spine.
## CLINICAL INDICATION:
A woman with history of bilateral pain in
upper distal extremities, rule out cervical lesion or compression.
## FINDINGS:
The visualized elements of the posterior fossa and the
craniocervical junction are grossly unremarkable. There is mild straightening
and reversal of the normal cervical lordosis. The signal intensity in the
bone marrow appears grossly normal; however, this is a partially limited study
due to patient motion.
At C2/C3, both neural foramina are patent, there is no evidence of spinal
canal stenosis.
At C3/C4, demonstrates minimal uncovertebral hypertrophy and disc bulging
towards the left with no frank evidence of nerve root compression or spinal
canal stenosis (image 16, series #5).
At C4/C5 level, there is mild posterior disc bulge with no evidence of neural
foraminal narrowing or significant spinal canal stenosis.
At C5/C6 level, there is a left paracentral disc bulge and osteophyte
formation, causing minimal left side neural foraminal narrowing (image #25,
series #5).
At C6/C7 level, there is a posterior disc bulge, causing mild anterior thecal
sac deformity and mild left side neural foraminal narrowing (image 30, series
#5).
C7/T1 level appears unremarkable. The signal intensity throughout the
cervical spinal cord is normal with no evidence of focal or diffuse lesions.
The visualized paravertebral structures are grossly unremarkable.
## IMPRESSION:
1. Mild straightening of the normal cervical lordosis.
2. Mild multilevel disc degenerative changes throughout the cervical spine,
more significant from C3/C4 through C6/C7 levels.
3. The signal intensity throughout the cervical spinal cord is normal with no
evidence of focal or diffuse lesions.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16635191", "visit_id": "N/A", "time": "2197-03-05 11:56:00"} |
17732134-RR-19 | 118 | ## HISTORY:
with no L ovary torsion p/w 3weeks of pelvic
pain// eval for pelvic pathology + torsion
## FINDINGS:
The uterus is anteverted and measures 6.2 cm x 3.0 cm x 2.7 cm. The
endometrium is homogenous and measures 2.3 mm.
The right ovary contains multiple peripheral follicles, mild increased stroma
and is borderline in size with a volume of 13 cc. Normal arterial and venous
waveforms are seen in the right ovary. Patient is post left oophorectomy.
There is no free fluid.
## IMPRESSION:
1. No evidence of right ovarian torsion.
2. Redemonstration of a prominent right ovary with peripheral follicles may be
within normal limits or within the spectrum of polycystic ovaries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17732134", "visit_id": "N/A", "time": "2191-11-11 04:24:00"} |
11320011-RR-16 | 256 | ## INDICATION:
year old woman s/p MI/VF arrest/CPR/EMCO // eval for PNA s/p
bronch
## FINDINGS:
An ET tube is present, tip approximately 5.7 cm above the carina. T day right
IJ catheter is present --the tip has advanced since the prior study
and now overlies the right heart border or, possibly a right lower lobe
vessel. Again seen is a pacing wire from a femoral approach overlying the
inferior cardiac silhouette. The ECMO catheter is again seen, similar in
position.
The cardiomediastinal silhouette is prominent and partially obscured, but
overall similar to prior. There are new or more pronounced small to moderate
layering bilateral pleural effusions with underlying collapse and/or
consolidation. There is vascular plethora and likely interstitial edema,
though the degree and extent of vascular engorgement appears somewhat less
pronounced than on the prior film. No pneumothorax detected .
Clips noted over the right abdomen.
A thin catheter overlies the left chest laterally --question outside the
patient. It does not follow the expected course of the PICC line.
## IMPRESSION:
1. Lines and tubes as described. Of note, the tip of what is thought to
represent a catheter lies relatively distal. Please see comment
above. Clinical correlation is therefore requested.
2. Cardiomegaly, CHF with interstitial edema, bilateral effusions with
underlying collapse and/or consolidation. Overall, this has progressed
compared with the earlier film, though the degree and extent of vascular
engorgement is less pronounced.
3. In this setting, the possibility of an underlying pneumonic infiltrate
would be difficult to exclude.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11320011", "visit_id": "27172472", "time": "2172-10-20 11:53:00"} |
16775289-DS-6 | 1,922 | ## HISTORY OF PRESENT ILLNESS:
In brief, this patient is a woman with h/o lymphocytic
colitis c/b colon perforation during routine colonoscopy,
requiring R hemicolectomy , subsequently readmitted for
septic arthritis of R TKR prosthesis, underwent R TKR washout on
, started 6-week course of Vanc/Erta on , developed
chronic nausea and twice dialy vomiting and switched to full
fluid diet, readmitted for LUE DVT at site of PICC line,
discharged on with new PICC line and Warfarin with
Lovenox bridge, now presenting with fever 103.3 at home and new
pruritic mobiliform rash most prominent on upper and lower
extremities.
In the ED initial vitals were: T 100.4, HR 96, BP 119/53, RR 18,
O2 97% RA. Labs were significant for Na 126, Cl 90. INR 1.3. CBC
w/ baseline anemia (Hg 8.1), lactate 1.1. UA w/ 30 Protein, few
bacteria. CXR w/n/l. Patient was given diphenhydramine, sent to
the floor for further evaluation and treatment. On arrival to
the floor, pt comfortable and VSS: 98.2 127/63 92 18 99%RA.
## REVIEW OF SYSTEMS:
(+) Per HPI. Also endorses sore throat, chills, and poor cold
tolerance, saying "I'm cold all the time." She continues to have
chronic diarrhea s/p hemicolectomy.
(-) Night sweats, HA, vision changes, upper respiratory
congestion, cough, CP, SOB, abdominal pain, BRBPR, melena,
hematochezia, dysuria, hematuria. No recent travel, pets, or
sick contacts
## PAST MEDICAL HISTORY:
HTN
Lymphocytic colitis
GERD
Arthritis
Thrombocytopenia from ASA
Hysterectomy
R knee replacement
Bunionectomy
Right hemi colectomy
## GENERAL:
Comfortable, reclining in bed.
## HEENT:
Anicteric sclera, pink conjunctiva, MMM, OP clear (no
thrush)
## CARDIAC:
RRR, normal S1/S2, no M/R/G
## ABDOMEN:
NTND in all quadrants, no rebound/guarding, laparotomy
scar clean without exudate or induration. 1cm, mobile, painless
nodule felt in subcutaneous tissue in LLQ.
## EXTREMITIES:
Moving all extremities well, no CCE. RT knee is
minimally tender, with slightly increased warmth; no overlying
erythema; incision is clean and without induration.
## PULSES:
2+ DP and radial pulses bilaterally
## NEURO:
CN II-XII intact, moving all extremities independently
and with purpose
## SKIN:
WWP. Rash has resolved
## IMPRESSION:
1. Nearly occlusive thrombus in the right basilic vein with a
PICC in place.
2. Non-occlusive thrombus in the left axillary vein.
EKG
Sinus rhythm with no significant change compared to the previous
tracing
of with persistent ST segment abnormalities.
## BRIEF HOSPITAL COURSE:
============================
REASON FOR ADMISSION
============================
woman with h/o lymphocytic colitis c/b colon perforation
during routine colonoscopy, requiring R hemicolectomy ,
subsequently readmitted for septic arthritis of R TKR
prosthesis, underwent R TKR washout on , started 6-week
course of Vanc/Erta on , developed chronic nausea and twice
dialy vomiting and switched to full fluid diet, readmitted
for LUE DVT at site of PICC line, discharged on with new
PICC line and Warfarin with Lovenox bridge, now presenting with
fever 103.3 at home and new pruritic mobiliform rash most
prominent on upper and lower extremities.
============================
ACUTE ISSUES
============================
#Bilateral acute upper extremity DVTs: Pt admitted on for
LUE DVT at site of PICC line, discharged on Lovenox with PICC
replaced on right side, then readmitted for fever and rash,
found to have a RUC DVT. US confirmed bilateral UE DVTs.
Given current guidelines, additional IVs could not be placed in
either arm, so we continued to use her right PICC line after
clearing with tPA. She was placed on heparin drip and begun on a
warfarin. Over the course of a week, her INR became therapeutic
on Warfarin 7.5mg daily. Hem/Onc was consulted and found no
cause of her hypercoagulability. Her DVTs are thought to be
provoked by PICC line, so she will continue on Warfarin for
months. She will f/u with Hem/Onc as outpt for further screening
(FVL, malignancy) and evaluation.
#Septic right knee: On admission pt was 3 weeks through 6-week
course of Vancomycin and Ertapenem for her septic right total
knee prosthesis, which was likely seeded by Staph and enteric
flora following colon perforation during routine colonoscopy.
Throughout admission she was afebrile and her knee remained
mildly warm and swollen. ID consult recommended switching to PO
antibiotics given difficulties with PICC line, so she was
transitioned to Ciprofloxacin 500mg PO BID and Linezolid
PO BID. She will continue these antibiotics until .
ID felt that afterwards pt does not need to continue on
prophylactic antibiotics. Safety labs will be collected as outpt
for ESR, CRP, CBC, BMP, LFTs. She will f/u with ID in
. She is on OPAT, so can be faxed to .
#Rash: Pt admitted with diffuse, pruritic, erythematous,
mobiliform rash, localized to BLEs, forearms, and cheecks.
Infectious disease consulted and felt this was not infectious,
but rather a drug rash due to Zosyn that she received during her
prior admission. Her symptoms were well-controlled with Benadryl
and Sarna cream. On discharge her rash had completely resolved.
#Oral thrush: On ABX pt developed buccal mucosa oral thrush. Her
infection cleared on Nystatin swish and swallow.
============================
CHRONIC ISSUES
============================
#N/V: Pt had intractable N/V, which is controlled somewhat on
Lorazepam, Odansetron, and Prochlorperazine. Her QTc interval
remained normal, so she can continue on these medications at
home. The differential for her N/V remains broad. She may be
reacting to ABX, although her N/V began 3 weeks prior to
initiation of ABX. EGD on shows hiatal hernia and
duodenal diverticulum. CT on found no intra-abd collection
or abscess. ID has seen her in and out of clinic for last
several weeks and concerned about impact of N/V on her life and
propensity for hyponatremia. EKG shows normal QTc interval, so
she is a candidate for additional N/V medications as needed. We
will continue to manage medically. She can follow-up with her
PCP regarding medication management, and may benefit from GI
consult.
#Anemia: Throughout hospital stay pt had normocytic anemia with
Hct 22.5-24.5. Pt mildly symptomatic with weakness, chills,
fatigue. Iron studies suggested anemia of chronic disease, which
could be explained by her chronic lymphocytic colitis or TKR
infection. B12 and folate were both normal. Stool guaiac
negative x4. On discharge, pt received 2 units of PRBCs. She
will f/u with Hem/Onc as outpt.
#Hyponatremia: Prior records indicate chronic mild hyponatremia
with Na ranging 133-135. During the present admission, her Na
ranged from 128-131. Differential remains broad. She eats a low
solute diet given her propensity for N/V with solid foods.
However, her urine Osm are 116, which is higher than we would
expect if her diet is the cause of her hyponatremia. She also
has diarrhea several times daily in setting of hemicolectomy and
lymphocytic colitis, which could lead to hypovolemic
hyponatremia. Finally, she has evidence of subclinical
hypothyroidism, with TSH 7.1 and associated sx of cold
intolerance, brittle nails, fatigue, which in very rare
circumstances may lead to hyponatremia. Cortisol 16.5 in AM
argues against adrenal insufficiency. She is encouraged to eat
solid foods, soups when possible.
#Diarrhea: Pt has had chronic diarrhea since hemicolectomy, and
in setting of lymphocytic colitis. Pt has diarrhea several times
daily throughout hospitalization, which she reported was normal
for her. Diarrhea controlled with Loperamide and tincture of
opium.
============================
TRANSITIONAL ISSUES
============================
#Primary care provider: needs new PCP for
#F/U Hem/Onc as outpt regarding hypercoagulability and chronic
anemia
#Continue warfarin for next 6 months. Home services to check
warfarin level and collect safety labs in 1 week per ID
#Continue PO ABX until , then f/u with ID at scheduled
appointment
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen mg PO Q6H:PRN Pain
2. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID
3. dexlansoprazole 60 mg oral Every other day
4. LOPERamide 4 mg PO QID
5. Lorazepam 0.5-1 mg PO Q8H:PRN nausea
6. Multivitamins 1 TAB PO DAILY
7. Ondansetron mg PO Q8H:PRN nausea
8. Opium Tincture 10 DROP PO QID:PRN diarrhea
9. OxycoDONE (Immediate Release) mg PO Q4H:PRN pain
10. Sodium Chloride 0.9% Flush mL IV DAILY and PRN, line
flush
11. Tretinoin 0.05% Cream 1 Appl TP QHS
12. Vancomycin 500 mg IV Q 12H
13. ertapenem 1 gram injection daily
14. Warfarin 5 mg PO ONCE
15. Enoxaparin Sodium 70 mg SC Q12H
## START:
, First Dose: Next Routine Administration Time
## DISCHARGE MEDICATIONS:
1. Warfarin 7.5 mg PO DAILY16
RX *warfarin [Coumadin] 2.5 mg 3 tablet(s) by mouth daily Disp
#*90 Tablet
## REFILLS:
*0
2. Ciprofloxacin HCl 500 mg PO Q12H
RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice a
day Disp #*16 Tablet Refills:*0
3. Linezolid mg PO Q12H
RX *linezolid [Zyvox] 600 mg 1 tablet(s) by mouth twice a day
Disp #*16 Tablet Refills:*0
4. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID
5. Acetaminophen mg PO Q6H:PRN Pain
6. LOPERamide 4 mg PO QID
7. Lorazepam 0.5-1 mg PO Q8H:PRN nausea
8. Multivitamins 1 TAB PO DAILY
9. Opium Tincture 10 DROP PO QID:PRN diarrhea
RX *opium tincture 10 mg/mL (morphine) 10 drop by mouth four
times a day Refills:*0
10. Tretinoin 0.05% Cream 1 Appl TP QHS
11. DiphenhydrAMINE 25 mg PO Q6H:PRN itch
12. Nystatin Oral Suspension 5 mL PO QID Oral thrush
RX *nystatin 100,000 unit/mL 5 ml by mouth four times a day
Refills:*0
13. Prochlorperazine 10 mg PO Q6H:PRN Nausea
RX *prochlorperazine maleate [Compazine] 10 mg 1 tablet(s) by
mouth every six (6) hours Disp #*60 Tablet Refills:*0
14. dexlansoprazole 60 mg oral Every other day
15. Ondansetron 4 mg PO Q8H nausea
## FACILITY:
Diagnosis:
Primary diagnosis
-Bilateral UE DVTs
Secondary diagnoses-
-Drug eruption
-Hyponatremia
-Nausea and vomiting
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
It has been our sincere pleasure caring for you during your stay
with us at . You were admitted with a fever and rash and
found to have a blood clot at the site of your new line,
despite using Lovenox for anticoagulation. To help prevent blood
clots, you were asked to stay in the hospital on a Heparin IV
until we could transition you to a therapeutic dose of Warfarin.
On discharge today, your INR is 2.0 and you can continue on
Warfarin 7.5mg daily for the next 6 months. Please be sure
follow-up with your primary care clinic, as
well as with Hematology, on the dates listed below.
Regarding your infected knee, you were transitioned to a regimen
of oral antibiotics, as recommended by our ID team. Taking oral
antibiotics will avoid having to use a PICC line. You can
continue on Ciprofloxacin 500mg twice daily and Linezolid
twice daily through . Your rash was most likely due
to an antibiotic you took for your infection, which we've now
discontinued. Please follow-up with our Infectious Disease
doctors at the detailed below.
## REGARDING YOUR NAUSEA AND VOMITING:
We were able to control your
symptoms with some success using Zofran, Ativan, and Compazine,
which you may continue at home. Along with your nausea, we
noticed you had a chronically low sodium blood level. Most
likely, this is due to your nausea, vomiting, and diarrhea. We
also found that your TSH level was slightly high, suggesting
that you might have mild hypothyroidism, which could explain
your chronic chills and brittle nails. We encourage you to
follow-up with your primary care provider regarding these
issues.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16775289", "visit_id": "22976449", "time": "2161-06-08 00:00:00"} |
17814051-RR-11 | 205 | ## INDICATION:
year old man with critical AS being worked up for AVR.
## RIGHT:
The right carotid vasculature has mild heterogeneous atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 50 cm/sec.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 62, 56, and 60 cm/sec, respectively. The peak end diastolic
velocity in the right internal carotid artery is 20 cm/sec.
The ICA/CCA ratio is 1.2.
The external carotid artery has peak systolic velocity of 66 cm/sec.
The vertebral artery is patent with antegrade flow.
## LEFT:
The left carotid vasculature has mild heterogeneous atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 62 cm/sec.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 58, 88, and 86 cm/sec, respectively. The peak end diastolic
velocity in the left internal carotid artery is 20 cm/sec.
The ICA/CCA ratio is 1.4.
The external carotid artery has peak systolic velocity of 57 cm/sec.
The vertebral artery is patent with antegrade flow.
## IMPRESSION:
Mild heterogeneous atherosclerotic plaque bilaterally resulting in less than
40% stenosis of both ICAs.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17814051", "visit_id": "26857068", "time": "2136-08-25 08:47:00"} |
16563717-RR-21 | 154 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
year old woman with encephalopathy, unable to extubate due to
mental status// Evaluate for bleed
## DOSE:
Total DLP (Body) = 1,368 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS W/O CONTRAST)
## FINDINGS:
Extremely limited examination due to streak and motion artifact. Within these
limitations:
There is no evidence of acute territorial infarction,hemorrhage,edema, or
mass. Periventricular white matter hypodensities are nonspecific, but likely
are represent the sequela of chronic microvascular ischemic disease. The
ventricles and sulci are normal in size and configuration.
ET and OG tubes are partially visualized. 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:
Extremely limited examination due to streak and motion artifact. Within these
limitations, no acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16563717", "visit_id": "21229826", "time": "2164-10-28 15:05:00"} |
11190732-RR-36 | 97 | ## INDICATION:
year old woman with PNA. Daily CXR to evaluate for interval
change.// Daily CXR to evaluate for interval change.
## FINDINGS:
Right greater than left parenchymal opacities are essentially unchanged
compared to 1 day prior, though left parenchymal opacities are improved
compared to 2 days prior. Possible small left pleural effusion. No
pneumothorax. The mediastinal silhouette is unchanged. Patient appears to be
status-post recent cervical spine fusion with pedicle screws, rods, and
presumed cutaneous staples projecting over the neck.
## IMPRESSION:
Right greater than left parenchymal opacities are essentially unchanged and
remain concerning for infection.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11190732", "visit_id": "22662848", "time": "2166-02-22 09:11:00"} |
17167348-RR-18 | 168 | ## EXAMINATION:
ABDOMEN US (COMPLETE STUDY)
## INDICATION:
with epigastric/LUQ discomfort// Eval for biliary pathology
## LIVER:
The hepatic parenchyma appears within normal limits. The contour of the
liver is smooth. The millimetric hepatic cyst demonstrated on MRCP is not
well demonstrated on current ultrasound. There is no focal liver mass. The
main portal vein is patent with hepatopetal flow. There is no ascites.
## BILE DUCTS:
There is no intrahepatic biliary dilation.
## GALLBLADDER:
There is no evidence of stones or gallbladder wall thickening.
## PANCREAS:
The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas. The millimetric pancreatic cysts on
MRCP are not well visualized on current ultrasound.
## KIDNEYS:
Limited views of the kidneys show no hydronephrosis. There is an
extrarenal pelvis at the right kidney.
Right kidney: 9.3 cm
Left kidney: 10.1 cm
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
Normal abdominal ultrasound.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17167348", "visit_id": "N/A", "time": "2144-08-12 20:59:00"} |
14941285-RR-20 | 173 | ## EXAMINATION:
MRI AND MRA BRAIN PT12 MR HEAD
## INDICATION:
year old woman pregnant with severe bitemporal headache
with nausea/vomiting// subarachnoid hemorrhage? venous sinus thrombosis?
## MRI:
The brain is normal in volume and morphology. The ventricular profile is
normal. There is a single, punctate T2 and FLAIR white matter hyperintensity
adjacent to the left frontal operculum. No areas of slow diffusion. No
intracranial hemorrhage. The intracranial arteries demonstrate normal T2 flow
void. Minimal paranasal sinus mucosal thickening. The orbits appear normal.
The craniocervical junction appears normal. The pituitary gland appears
normal.
## MRV:
Normal flow signal is demonstrated within the superior sagittal sinus,
straight sinus, transverse sinuses, and sigmoid sinuses. The jugular bulbs and
proximal jugular veins are patent. Evaluation of the deep venous systems
reveals normal flow signal in the internal cerebral veins. The vein
is also unremarkable.
## IMPRESSION:
1. No intracranial hemorrhage. No infarct.
2. No evidence of dural venous sinus thrombosis.
3. A single punctate T2 and FLAIR white matter hyperintensity in the left
frontal white matter is nonspecific.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14941285", "visit_id": "N/A", "time": "2155-03-13 19:47:00"} |
16832788-RR-28 | 172 | ## EXAMINATION:
MR HEAD W/ CONTRAST MR HEAD
## INDICATION:
year old woman with metastatic thymic cancer to the brain.
Planning for CyberKnife SRS to brain metastasis.
## FINDINGS:
The patient's previously noted dural-based mass along the inferior surface of
the left temporal lobe, 1.9 x 1.7 x 1.5 cm on images 14:78 and 13:35, is again
seen. There is stable mild mass effect on the left temporal parenchyma. The
previously noted small enhancing focus in the right superior parietal cortex
is no longer visualized. No other enhancing lesion is seen. The ventricles
are age-appropriate. The sulci are mildly prominent due to mild age-related
parenchymal volume loss. Dural venous sinuses are patent. Major intracranial
arteries are grossly unremarkable, though not optimally assessed on this exam.
There is mild mucosal thickening in the paranasal sinuses.
## IMPRESSION:
1. Left temporal dural-based mass is again demonstrated for CyberKnife
planning.
2. The previously noted small enhancing focus in the right superior parietal
cortex is no longer visualized.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16832788", "visit_id": "N/A", "time": "2115-07-31 10:05:00"} |
15372292-RR-25 | 88 | ## EXAMINATION:
FEMUR (AP AND LAT) BILATERAL; BILAT HIPS (AP, LAT, AND PELVIS) 5
OR MORE VIEWS
## INDICATION:
year old woman with br cancer s/p fall out of bed with
bilateral hip/leg pain- two previous hip replacements// ? fracture
## FINDINGS:
The patient is status post bilateral total hip arthroplasty, and right total
knee arthroplasty, without evidence of hardware complication. There is no
fracture or dislocation. There is diffuse demineralization. Clips are seen
projecting over the pelvis.
## IMPRESSION:
No fracture or dislocation. No evidence of hardware complication.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15372292", "visit_id": "28234126", "time": "2164-04-12 10:24:00"} |
14614509-RR-25 | 147 | ## INDICATION:
year old woman with abdominal swelling // Please place JP
drain to drain seroma. s/p liposuction 2 months ago with recurrent seroma
## PROCEDURE:
1. Ultrasound-guided drainage of abdominal wall collection.
2. Placement of an 8 drainage catheter via a right lower quadrant
approach crossing to the left lower quadrant.
## OPERATORS:
Dr. radiology fellow and Dr.
radiologist, who personally supervised the trainee during the key components
of the procedure and reviewed and agrees with the trainee's findings.
## FINDINGS:
1. Abdominal wall seroma predominant in the right lower quadrant with
extension into the mid abdominal wall and left lower quadrant.
2. Removal of 250 cc serous fluid.
3. Decompressed abdominal wall fluid post drainage.
## IMPRESSION:
Placement of an 8 drain in the abdominal wall seroma via a right lower
quadrant approach extending to the left lower quadrant, with removal of 250 cc
serous fluid.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14614509", "visit_id": "N/A", "time": "2159-04-14 15:48:00"} |
18633144-RR-20 | 117 | ## HISTORY:
Pancreatic cancer, fever, and biliary stent.
ERCP was done without presence of a radiologist. Opacification of the biliary
tree and pancreatic duct is seen.
There is a single irregular stricture of malignant appearance seen at the
lower third of the common bile duct with moderate post-obstructive dilatation.
These findings are compatible with extrinsic compression.
biliary stent placed successfully.
Single irregular stricture of malignant appearance is seen at the head of the
pancreas and the pancreatic duct. Moderate post-obstructive dilatation.
According to GI endoscopy report, pus was aspirated from the main duct and
sent for culture. There is a single pigtail pancreatic stent placed.
For more details, please refer to GI endoscopy report.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18633144", "visit_id": "28078867", "time": "2167-05-09 14:12:00"} |
18763864-RR-30 | 150 | ## INDICATION:
Fever and cholestasis. Evaluate for liver infiltration and
hepatic .
## FINDINGS:
Trace amount of pericardial fluid. The lung bases are clear except
for a small amount of dependent atelectasis. The liver demonstrates no
suspicious lesion. The liver contour is smooth. The hepatic veins, portal
veins and SMV are patent. Spleen is homogeneous and normal in size measuring
9.7 cm in length. Pancreas and adrenal glands are unremarkable. There is a
9-mm cyst in the mid polar region of the left kidney. A parapelvic cyst is
noted in the right kidney measuring 1.3 cm in diameter. There is no small or
large bowel wall thickening. There is no enlarged retroperitoneal
lymphadenopathy. There is no free fluid or free air. No suspicious bony
lesion.
## IMPRESSION:
1. No evidence of candidiasis in the abdomen, especially in the spleen or
liver.
2. Bilateral renal cysts.
3. No enlarged lymphadenopathy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18763864", "visit_id": "28925335", "time": "2162-09-25 15:39:00"} |
15258463-RR-38 | 141 | ## FINDINGS:
The right lobe measures approximately 4.1 x 1.1 x 1.4 cm. The left
lobe measures approximately 4.1 x 1.1 x 1.3 cm.
On the right, there are several scattered colloid cysts. There is an isthmic
nodule measuring 5 x 3 x 4 mm. Additional scattered nodules are identified on
the right, measuring under 4 mm.
On the left, there is a calcified nodule measuring approximately 9 x 9 x 9 mm.
By report, this has slightly increased in size since the previous examination.
## IMPRESSION:
1. As before, there are several scattered cysts as well as small solid
nodules. The previously described calcified nodule may have
minimally increased in size when correlated with previous report. An attempt
will be made to obtain the previous examinations, at which point an addendum
can be issued.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15258463", "visit_id": "N/A", "time": "2163-12-19 08:31:00"} |
13985311-RR-9 | 211 | ## EXAMINATION:
ABDOMEN US (COMPLETE STUDY)
## INDICATION:
with abd pain since thurs// ?sbo ?cholecystitis ?renal stone
## LIVER:
The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
## BILE DUCTS:
There is no intrahepatic biliary dilation. The CHD measures 2.3
mm.
## GALLBLADDER:
Within the gallbladder, there is an approximately 13 mm
echogenicity consistent with stones/sludge. There is no gallbladder wall
edema or thickening. There was mild tenderness over the gallbladder
throughout the process of scanning.
## PANCREAS:
The pancreas is not well visualized, largely obscured by overlying
bowel gas. Visualized pancreatic head was normal.
## SPLEEN:
Normal echogenicity, measuring 12 cm.
## KIDNEYS:
The right kidney measures 13.2 cm. The left kidney measures 13.5 cm.
Limited views of the kidneys are without hydronephrosis bilaterally.
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
13 mm echogenicity within the gallbladder is consistent with stone/sludge.
Patient was tender over the right upper quadrant throughout the process of
scanning; however, there is no gallbladder wall thickening, edema or
pericholecystic fluid to suggest acute cholecystitis. If there is continued
clinical concern, nuclear medicine hepatobiliary scan could be performed.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13985311", "visit_id": "N/A", "time": "2114-08-02 15:02:00"} |
15083239-DS-6 | 848 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
BENIGN PROSTATIC HYPERTROPHY AND URINARY RETENTION
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
TRANSURETHRAL PHOTOVAPORIZATION OF THE PROSTATE
## HISTORY OF PRESENT ILLNESS:
with BPH, urinary retention s/p PVP with continued retention
## BRIEF CLINICAL HISTORY:
The patient is known to Dr.
undergone urodynamics showing detrusor contractility and
obstruction. He has had a previous laser photovaporization
using a GreenLight laser elsewhere and is still in retention.
The patient has been on a program of intermittent
catheterization. He is now here for transurethral resection to
see if enough tissue can be resected. The patient fully
understands the procedure, alternate therapies, benefits, and
risks, including bleeding, infection, damage to adjacent organs,
and need for reoperation. He wishes to proceed. He
understands that he may still continue to need catheterization.
## PAST MEDICAL HISTORY:
HTN
BPH
ED
Colonic polyps
HL
Cataract
Macular degeneration
Shingles
nephrolithiasis
## DRAINS:
coude-tip Foley catheter.
WdWn male, NAD, AVSS
Abdomen soft, nt, nd
thin male, pleasant, cooperative
extremities w/out edema
Foley in place, secured to thigh
## PERTINENT RESULTS:
8:30 am URINE Site: CYSTOSCOPY
## URINE CULTURE (PRELIMINARY):
ESCHERICHIA COLI. 10,000 ORGANISMS/ML.
PRESUMPTIVE IDENTIFICATION.
GRAM NEGATIVE ROD #2. 700 ORGANISMS/ML.
## POSTOPERATIVE DIAGNOSES:
Urinary retention and benign prostatic
hypertrophy.
## PROCEDURE:
Transurethral resection of prostate.
Mr. was admitted to Dr. service after
greenlight/TURP vaporization of the prostate. No concerning
intraoperative events occurred; please see dictated operative
note for details. There was description of a false passage at
bladder neck. The patient received antibiotic
prophylaxis. Patient's postoperative course was uncomplicated.
He received intravenous antibiotics and maintained on bedrest
and continuous bladder irrigation overnight. On POD1, the CBI
and foley catheter were discontinued, and he passed a voiding
trial. His urine was clear yellow without clots with post-void
residual less than voided volumes. He remained afebrile
throughout his hospital stay. At discharge, patient's pain well
controlled with oral pain medications, tolerating regular diet,
ambulating without assistance, and voiding without difficulty.
He is given explicit instructions to call Dr. follow-up.
## MEDICATIONS ON ADMISSION:
CIPROFLOXACIN - 250 mg Tablet - 1 Tablet(s) by mouth twice a day
NITROFURANTOIN MONOHYD/M-CRYST - 100 mg Capsule - 1 Capsule(s)
by
mouth twice a day
OXYBUTYNIN CHLORIDE - 5 mg Tablet Extended Rel 24 hr - 1
Tablet(s) by mouth once a day
## DISCHARGE MEDICATIONS:
1. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain, fever.
## 2. HYDROCODONE-ACETAMINOPHEN MG TABLET SIG:
One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
3. oxybutynin chloride 5 mg Tablet Extended Rel 24 hr Sig: One
(1) Tablet Extended Rel 24 hr PO once a day: DO NOT TAKE for
24hrs prior to FOLEY removal ( ).
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
## 5. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY (Daily).
6. bacitracin zinc 500 unit/g Ointment Sig: One (1) Appl Topical
QID (4 times a day) as needed for penile meatus irritation.
## 7. KEFLEX MG CAPSULE SIG:
One (1) Capsule PO four times a
day for 7 days.
Disp:*28 Capsule(s)* Refills:*0*
8. Urocit-K 5 5 mEq Tablet Extended Release Sig: One (1) Tablet
Extended Release PO once a day.
Disp:*30 Tablet Extended Release(s)* Refills:*2*
## DISCHARGE DIAGNOSIS:
BENIGN PROSTATIC HYPERTROPHY AND URINARY RETENTION
## DISCHARGE INSTRUCTIONS:
-Do not lift anything heavier than a phone book (10 pounds) or
drive until you are seen by your Urologist in follow-up
-You may continue to periodically see small amounts of blood in
your urine--this is normal and will gradually improve
-Resume all of your pre-admission medications, except HOLD
aspirin until you see your urologist in followup AND your foley
has been removed (if not already done)
-Complete a SEVEN DAY course of antibiotics (KEFLEX)
-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication.
Discontinue if loose stool or diarrhea develops. Colace is a
stool softener, NOT a laxative
-Do not eat constipating foods for weeks, drink plenty of
fluids to keep hydrated
-No vigorous physical activity or sports for 4 weeks or until
otherwise advised
-Tylenol should be your first line pain medication, a narcotic
pain medication has been prescribed for breakthrough pain >4.
Replace Tylenol with narcotic pain medication.
-Max daily Tylenol (acetaminophen) dose is 4 grams from ALL
sources, note that narcotic pain medication also contains
Tylenol
-Do not drive or drink alcohol while taking narcotics and do not
operate dangerous machinery. Also, if the Foley catheter and Leg
Bag are in place--Do NOT drive (you may be a passenger).
-Your Foley should be secured to the catheter secure on your
thigh at ALL times until your follow up with the surgeon.
-DO NOT have anyone else other than your Surgeon remove your
Foley for any reason.
-Wear Large Foley bag for majority of time, leg bag is only for
short-term when leaving house.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15083239", "visit_id": "25172982", "time": "2131-12-02 00:00:00"} |
18693141-RR-16 | 105 | ## INDICATION:
Post-pyloric tube needed for feeding patient with AMS, and trach.
## TUBE PLACEMENT:
The right naris was anesthetized with
lidocaine jelly. An 8 feeding tube was advanced under
fluoroscopic guidance until its tip reached the fourth portion of the
duodenum. Post-pyloric position was confirmed with an injection of
approximately 20 mL of Conray. The orogastric tube was seen removed under
fluoroscopic guidance, per the accompanying nurse. Incidental note is made of
laparoscopic gastric band and port device in expected position.
## IMPRESSION:
Successful placement of an 8 feeding tube
into the fourth portion of the duodenum. The tube is ready to use
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18693141", "visit_id": "28457974", "time": "2145-07-05 15:10:00"} |
14647276-RR-21 | 124 | ## INDICATION:
female with right-sided abdominal pain since .
Pain radiates to the back, and possibly feels also in right shoulder. Mild
nausea. Please evaluate for gallstones or cholecystitis.
## FINDINGS:
Liver contour is normal, but echogenicity is diffusely increased,
most consistent with fatty replacement. This limits sensitivity for evaluation
of focal intrahepatic lesions, though none are seen. There is no biliary
ductal dilatation or ascites. The gallbladder is normal. The pancreas is
obscured by overlying bowel gas. The main portal vein is patent, with
appropriate antegrade flow.
## IMPRESSION:
1. Normal gallbladder.
2. Diffuse fatty infiltration of the liver. Please note that in the setting
of fatty liver, more advanced forms of liver disease including cirrhosis
and/or fibrosis cannot be excluded by ultrasound.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14647276", "visit_id": "N/A", "time": "2165-04-18 20:43:00"} |
15186614-RR-8 | 133 | ## INDICATION:
Evaluate for portal vein thrombosis.
## FINDINGS:
The liver is diffusely coarse in echotexture with nodular contour, consistent
with cirrhosis. No discrete nodule seen, however. The main portal vein and
both the right and left portal veins show normal hepatopetal flow with low
flow. The gallbladder contains a large amount of sludge but is not
thick-walled. The common bile duct is not dilated, measuring 0.5 cm. The
spleen is enlarged, measuring 17.6 cm. The right kidney measures 12.8 cm, no
hydronephrosis or calculi seen. The left kidney measures 13.2 cm, no
hydronephrosis or calculi seen.
## IMPRESSION:
Coarse echogenic liver consistent with patient's known cirrhosis, no focal
liver lesion seen. The portal vein is patent. Large amount of sludge in the
gallbladder without evidence of cholecystitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15186614", "visit_id": "25266338", "time": "2130-01-07 14:09:00"} |
13168956-RR-32 | 174 | ## HISTORY:
A woman with possible sphenoid meningocele on MRI.
## FINDINGS:
There is near-complete opacification of the left aspect of the sphenoid sinus
with a fluid density structure. The walls of the sphenoid sinus have a mildly
sclerotic appearance which may indicate chronic sinus disease. There is focal
bony thinning and possible dehiscence of the lateral wall of the left sphenoid
sinus (series 400b, image 39).
The remainder of the paranasal sinuses and the visualized mastoids are clear.
The visualized brain parenchyma and orbits are normal. A partially empty sella
is noted. Calcifications of the cavernous portions of both internal carotid
arteries are noted.
## IMPRESSION:
There is likely a defect in the left lateral sphenoid wall. The bony walls of
the sphenoid have an appearance that is seen with chronic sinusitis, so it is
unclear whether the defect is secondary to chronic sinusitis with bony
dehiscence or a meningocele, given the rounded, fluid dense structure located
within the sphenoid sinus itself. CT cisternogram will help to make this
determination, if clinically indicated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13168956", "visit_id": "N/A", "time": "2174-04-09 11:16:00"} |
14420248-DS-22 | 1,673 | ## CHIEF COMPLAINT:
bright red blood per rectum
## HISTORY OF PRESENT ILLNESS:
Speaking with h/o HTN, DMII, ESRD on dialysis,
paroxysmal afib on 325 ASA, no warfarin due to bleeding risk,
and prior GI bleed due to ischemic colitis presenting w/
3 days of dark blood loose stools.
In the ED he was found to have a TTP epigastric region, no
rebound or rigidity and Rectal exam revealed gross dark blood,
nonmelanotic.
Pt states he never had any ABD pain with the bleeding and noted
that about two hours after eating lunch is when he experienced a
bloody bowel movement that was loose. He typically has loose
stools. He denies N&V (only at HD) and there is never any blood.
He denies fevers/chills.
In the ED, initial vitals were: 97.4 95 135/50 18 97% RA
- Labs were significant for H&H of 8.5/25.7 (baseline of 10) BNP
of 1505 (priors in the 5ks) Tnt of 0.05 (baseline 0.05), lactate
0.9, WNL coags, BUN/Cr and he missed HD today GI
bleed.
- Imaging revealed CT ABD w/o contrast negative, chest xray
negative for consolidation and only with mild vascular
congestion.
- GI was consulted and felt that this was not a brisk bleed and
the desicion was to admit to medicine.
Vitals prior to transfer were: 77 114/39 16 100% RA
Upon arrival to the floor, he is in NAD. He denies any SOB or
ABD pain and his only complaint is feeling hungry.
## PAST MEDICAL HISTORY:
1. Benign Hypertension
2. Type 2 Diabetes
3. Stage V chronic kidney disease from diabetic nephropathy
4. Hx of strokes and -> R arm and leg weakness with
slurred speech intermittently
5. Asthma
6. Hypercholesterolemia.
7. PVD
8. Seizures - complex partial
9. Hx of DVT/PE in
10. Schizophrenia
11. s/p L CEA
12. Left-to-right femoral-to-femoral bypass with PTFE, Right
femoral endarterectomy with profundoplasty
13. left arm AV fistula placement on -> occluded left
brachial artery -> emergent thrombectomy of the left brachial
artery on
## FAMILY HISTORY:
Mother died at age and father died at a young age of unknown
cause, sister died during childbirth in .
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
## NECK:
Supple, JVP not elevated, no LAD
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## LUNGS:
Clear to auscultation bilaterally, although decreased on
the left lower lobe.
## ABDOMEN:
Soft, non-tender, non-distended, bowel sounds present,
no organomegaly, no rebound or guarding
## RECTAL:
dark flecks of stool in the vault, not black, with
maroon colored blood. One external hemrrhoid noted.
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## NEURO:
CNII-XII intact, strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.
DISCHARGE PHYSICAL EXAM
## GENERAL:
Alert, oriented, no acute distress
## LUNGS:
CTA b/l no w/r/r
## CV:
RRR, nl S1 + S2, systolic murmur RUSB and LUSB
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly, minimal
brown stool in rectal vault
## EXT:
WWP, 2+ pulses, no edema
## SKIN:
Without rashes or lesions
## NEURO:
CN2-12 grossly intact, gait nl, walks with cane
## PERTINENT RESULTS:
ADMISSION LABS
07:52PM BLOOD WBC-9.9 RBC-2.72* Hgb-8.5* Hct-25.7*
MCV-95 MCH-31.3 MCHC-33.1 RDW-13.5 RDWSD-46.0 Plt
07:52PM BLOOD Neuts-69.6 Lymphs-17.7* Monos-9.3 Eos-2.6
Baso-0.4 Im AbsNeut-6.87*# AbsLymp-1.75 AbsMono-0.92*
AbsEos-0.26 AbsBaso-0.04
07:52PM BLOOD Plt
08:04PM BLOOD PTT-26.3
07:52PM BLOOD Glucose-105* UreaN-97* Creat-7.5*# Na-136
K-4.5 Cl-97 HCO3-20* AnGap-24*
07:52PM BLOOD proBNP-1505*
07:52PM BLOOD cTropnT-0.05*
07:52PM BLOOD Albumin-3.8 Calcium-8.3* Phos-5.0* Mg-1.8
07:58PM BLOOD Lactate-0.9
DISCHARGE LABS
10:55AM BLOOD WBC-5.4 RBC-2.56* Hgb-8.0* Hct-24.7*
MCV-97 MCH-31.3 MCHC-32.4 RDW-13.6 RDWSD-47.7* Plt
10:55AM BLOOD PTT-28.8
10:55AM BLOOD Plt
10:55AM BLOOD Glucose-166* UreaN-44* Creat-4.9*# Na-135
K-4.1 Cl-91* HCO3-30 AnGap-18
10:55AM BLOOD Calcium-8.5 Phos-4.5 Mg-1.9
MICROBIOLOGY
BLOOD CULTURE PENDING
IMAGING
CXR
Lung volumes remain low. Heart size is moderately enlarged,
accentuated by
the presence of low lung volumes. The aorta remains tortuous
and calcified at
the arch. Mediastinal contours appear relatively unchanged.
There is
crowding of bronchovascular structures with possible mild
pulmonary vascular
engorgement. Mild streaky opacities in the lung bases are
likely reflective
of atelectasis. No focal consolidation, pleural effusion or
pneumothorax is
present. Vascular stent projecting over the right apex is
unchanged. There
are no acute osseous abnormalities.
IMPRESSION
Low lung volumes with possible mild pulmonary vascular
congestion and
bibasilar atelectasis.
CT ABDOMEN PELVIS
1. No acute intra-abdominal process.
2. Bilateral lower lobe lung patchy parenchymal opacities have
improved since
suggestive of improving inflammatory process.
3. Distal aorta to left common femoral artery stent graft and
femoral to
femoral bypass graft patency cannot be evaluated without
contrast.
## BRIEF HOSPITAL COURSE:
Speaking with h/o HTN, DMII, ESRD on dialysis,
paroxysmal afib on 325 ASA, no warfarin due to bleeding risk,
and prior GI bleed due to ischemic colitis who presented
with 3 days of dark blood loose stools found to have
diverticulosis.
# Melena/hematochezia: The patient presented with maroon colored
blood in his stool as well one episodes of red blood in the
toilet. The patient was recently admitted with ischemic colitis
which occurred due to hypotension during dialysis. The patient
also has a history of polyps and angioectasis visualized on
previous GI imaging/colonoscopy. The patient was evaluated with
a CT of the abdomen and pelvis which showed diverticulosis
within the sigmoid colon. It was thought that this current
episodes of bleeding was related to one of these conditions. The
patient was evaluated by GI who believed this episode did not
represent any brisk bleeding and the patient was instructed to
follow up with GI for outpatient evaluation. The patient was
initially treated with DDAVP 0.3mcg/kg. The patient's H/H was
trended and remained stable and his bowel movements were
non-bloody at discharge. The patient will follow up with GI
after discharge for further evaluation.
# Atrial fibrillation: The patient has a history of atrial
fibrillation with CHADS-2 score of 3 (DM, CVA). The patient was
not on any rate or rhythm control and his warfarin had been held
in the past due to GI bleeding risk. The patient was being
treated with 325mg aspirin. This dose was changed to 81mg PO
qday. The patient should follow up with his primary care
physician for further evaluation and management.
# ESRD: On dialysis MWF, pt had missed HD session on the day of
admission due to his emergency room visit. The patient had one
HD session and will restart his home regimen after
discharge. He was continued on his home Nephrocaps 1 CAP PO
DAILY, Vitamin D UNIT PO DAILY, Multivitamins 1 TAB PO
DAILY. The patient's Ferrous Sulfate 325 mg PO DAILY was
initially held for accurate stool guiac. This medication was
restarted on discharge.
# DM II: Last A1C 6.4% from . The patient was continued on
his home glargine 10u qHS with the addition of ISS while
hospitalized.
# Depression: continued Sertraline 25 mg PO DAILY
# Seizure disorder: continued home Oxcarbazepine 300 mg PO BID
# Asthma: No evidence of acute exacerbation, continued
Fluticasone Propionate 110mcg 2 PUFF IH BID and albuterol prn:
wheezing
## TRANSITIONAL ISSUES:
- f/u with PCP and cardiology regarding aspirin dosing
- f/u with GI for outpatient evaluation of GI bleeding
- f/u with PCP in the next 2 weeks
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing
2. Aspirin 325 mg PO DAILY
3. Docusate Sodium 100 mg PO BID
4. Ferrous Sulfate 325 mg PO DAILY
5. Fluticasone Propionate 110mcg 2 PUFF IH BID
6. Multivitamins 1 TAB PO DAILY
7. Nephrocaps 1 CAP PO DAILY
8. Omeprazole 20 mg PO DAILY
9. Oxcarbazepine 300 mg PO BID
10. Senna 8.6 mg PO BID:PRN constipation
11. Sertraline 25 mg PO DAILY
12. Vitamin D UNIT PO DAILY
13. Glargine 10 Units Bedtime
## DISCHARGE MEDICATIONS:
1. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing
2. Aspirin 81 mg PO DAILY
3. Docusate Sodium 100 mg PO BID
4. Fluticasone Propionate 110mcg 2 PUFF IH BID
5. Glargine 10 Units Bedtime
6. Multivitamins 1 TAB PO DAILY
7. Nephrocaps 1 CAP PO DAILY
8. Omeprazole 20 mg PO DAILY
9. Oxcarbazepine 300 mg PO BID
10. Senna 8.6 mg PO BID:PRN constipation
11. Sertraline 25 mg PO DAILY
12. Vitamin D UNIT PO DAILY
13. Ferrous Sulfate 325 mg PO DAILY
## SECONDARY:
end stage renal disease on hemodialysis
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
Thank you for allowing us to participate in your care at .
You were admitted to the hospital because of blood in your bowel
movements. You were evaluated with a CT scan of your abdomen.
This showed diverticulosis which is a small outpouching of your
bowel wall. Please follow up with your outpatient GI doctors for
further of this condition. We also decreased one of
your medications, aspirin, to 81mg by mouth every day. Please
take this reduced dose of your medication and please follow up
with your PCP for further management of this medication. Please
call our gastroenterology office at to make an
appointment in 2 weeks.
Please weigh yourself every morning, call MD if weight goes up
more than 3 lbs.
We wish you the best!
Sincerely,
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14420248", "visit_id": "25884253", "time": "2159-05-12 00:00:00"} |
18477975-RR-56 | 192 | ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
year old woman with early s/p alloSCT with cough (history of
lung infiltrates) r/o infection, ? fungal, has skin nodules// year old
woman with early s/p alloSCT with cough (history of lung infiltrates) r/o
infection, ? fungal, has skin nodules
## FINDINGS:
Aorta and pulmonary arteries are normal in diameter. Small amount of
pericardial effusion is unchanged. Anemia is demonstrated. Left ventricular
apical enlargement might potentially represent previous myocardial infarct.
No mediastinal, hilar or axillary lymphadenopathy is present.
Image portion of the upper abdomen demonstrate high density of the liver
potentially related to previously blood transfusions and several stable cysts.
Airways are patent to the subsegmental level bilaterally. There is interval
improvement in left upper lobe peribronchovascular consolidations, series 5,
image 52, in the solid component of the cyst in the left lower lobe, series 5,
image 145. No new nodules masses or consolidations demonstrated.
Degenerdative disease is demonstrated in shoulders bilaterally but there are
no lytic or sclerotic lesions worrisome for infection or neoplasm.
## IMPRESSION:
Interval improvement in the findings in the left apex and left lower lobe.
Top normal aorta
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18477975", "visit_id": "N/A", "time": "2177-01-25 18:32:00"} |
17464078-RR-72 | 224 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
History: with RUQ pain // Eval portal vein thrombosis
## LIVER:
The liver is coarsened and nodular in echotexture. The contour of the
liver is nodular, consistent with cirrhosis. Large heterogeneous areas
throughout the liver likely represent previously-seen fibrosis in areas of
cavernous transformation or regenerative nodules, however are incompletely
assessed. Again noted is cavernous transformation of the portal vein, with
hepatopetal flow in the main portal. There is no ascites.
## BILE DUCTS:
The left intrahepatic ducts appear slightly less dilated compared
CT , and the right hepatic ducts appears stably dilated. The CHD
measures 9 mm.
## GALLBLADDER:
The patient is status post cholecystectomy.
## PANCREAS:
The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
## SPLEEN:
The spleen is markedly enlarged, measuring 25 cm. There is a simple
splenic cyst, unchanged compared with prior MRCP.
## KIDNEYS:
Limited views of the right kidney show no hydronephrosis.
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
1. Unchanged appearance of chronic portal vein thrombosis with cavernous
transformation.
2. Cirrhosis with massive splenomegaly. No ascites.
3. Multiple large heterogeneous areas throughout the liver likely reflect
previously seen fibrosis and regenerative nodules, however MRI is recommended
for further evaluation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17464078", "visit_id": "28324246", "time": "2157-08-27 01:21:00"} |
16583373-RR-78 | 565 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## INDICATION:
hx hemiplegia who p/w abd pain found to have G tube
cellulitis also s/p GT replacement. This am w hypoxia requiring ventimask (?
only 24%) then NRB, altered. Notably newly febrile to 101.2. Intermittently
hypotensive throughout admission to 90-110 systolic, improved w IVF. AF with
VR 140s. Triggered this morning for hypotension and tachycardia, in the ICU w/
concern for sepsis. Now with worsening abdominal tenderness. //
source and new abdominal pain // aspiration?
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.3 s, 69.7 cm; CTDIvol = 15.7 mGy (Body) DLP =
1,092.5 mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.4 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 2.4 s, 0.5 cm; CTDIvol = 13.4 mGy (Body) DLP =
6.7 mGy-cm.
Total DLP (Body) = 1,101 mGy-cm.
## LOWER CHEST:
Please refer to separate report of CT chest performed on the same day for
description of the thoracic findings. There is a large hiatus hernia
containing fluid within the hernial sac, in the lower mediastinum increasing
the risk for aspiration in this patient.
## GENERAL:
There is no intra-abdominal free air or free fluid.
## HEPATOBILIARY:
The liver parenchyma enhances homogeneously. There is a
subtle hypodensity in segment 4 a of the liver (2:89) that is not completely
characterized on this exam.
The hepatic veins, portal vein and its branches are patent.
The gallbladder is partially distended with hyperdense, likely calculi within
it. No pericholecystic inflammation..
## PANCREAS:
The pancreatic parenchyma is mildly atrophy diffusely. There is no
main duct dilation.
## SPLEEN:
The spleen is enlarged, measuring 16.3 cm in the craniocaudal axis..
## ADRENALS:
There is a homogeneously enhancing incompletely characterized left
adrenal nodule measuring 1.4 cm (2:106) that is unchanged compared to multiple
prior exams.. Nodular thickening of the right adrenal gland without a
discrete nodule.
## URINARY:
No hydronephrosis or solid enhancing renal masses seen on either
side. There is a right-sided nephroureteral catheter with mild thickening of
the right ureter, likely secondary to presence of a nephroureteral catheter.
a there is a partly exophytic simple cortical cyst arising from the interpolar
region of the right kidney measuring 2.8 cm in diameter.
## GASTROINTESTINAL:
Large hiatus hernia containing the stomach. There is a
large amount of fluid within the hernial sac increasing the risk for
aspiration.
No bowel obstruction. The patient has a percutaneous jejunostomy catheter in
place. The tip of the jejunostomy catheter is appropriately positioned within
the distal jejunum/proximal ileum. No rim enhancing fluid collections seen in
the skin or subcutaneous tissues around the jejunostomy catheter. No
intraperitoneal fluid collections identified.
## LYMPH NODES:
There are multiple subcentimeter short axis left para-aortic
lymph nodes that do not meet criteria for pathologic enlargement. No pelvic
lymphadenopathy noted..
## VASCULAR:
The abdominal aorta is tortuous and contains calcified
atherosclerotic plaque within it. No aneurysmal dilation. An IVC filter is
noted in place.
## PELVIS:
The bladder is minimally distended and unremarkable. The distal end of the
right nephroureteral catheter is located in the bladder.
No free fluid in the pelvis. Trace presacral soft tissue thickening noted.
## BONES AND SOFT TISSUES:
There is an unchanged subtle lucency within the inferior left pubic ramus
(2:243), indeterminate. Thoracotomy defect/old healed rib fractures are seen
in the left lower
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16583373", "visit_id": "N/A", "time": "2170-04-26 12:20:00"} |
19776354-RR-16 | 402 | ## HISTORY:
man with C cirrhosis, mid abdominal pain radiating to
the back, and there is loss. Evaluate for intra-abdominal pathology.
## FINDINGS:
Limited view of the lung bases is clear. There is no pleural effusion.
Visualized heart and pericardium are within normal limits.
CT scan of the abdomen with IV contrast:
Liver parenchyma enhances homogeneously however within the left lobe of the
liver and abnormally enhancing vascular pattern is seen reflecting shunting
secondary to a thrombosed left portal vein. There is also total occlusion of
the superior mesenteric and the splenic veins with back filling of the main
portal vein through collaterals. No focal liver lesions are detected. There
is no intra or extrahepatic biliary dilatation.
A 1 cm stone is again seen within the gallbladder. The gallbladder is not
distended. Gallbladder wall is thickened and edematous likely secondary to a
third-spacing. Moderate ascites is noted.
Spleen measures 14 cm and is homogeneous in enhancement.
Pancreas shows tiny cysts within the head, consistent with prior MRI
findings, but is otherwise unremarkable.
Adrenal glands are within normal limits.
Left and right kidneys enhance symmetrically and excrete contrast briskly with
no focal solid or cystic lesions and no evidence of hydronephrosis.
The stomach, duodenum, and loops of small bowel do not show wall thickening or
signs of obstruction. The colon is within normal limits. There is no
mesenteric or retroperitoneal lymphadenopathy. The aorta is of normal caliber
and major branches including the celiac axis, SMA and bilateral renal arteries
are within normal limits. Gastric and esophageal varices are noted.
CT of the pelvis with IV contrast:
Bladder and terminal ureters are within normal limits. Prostate and seminal
vesicles are unremarkable. There is no pelvic adenopathy. Free fluid is seen
within the cul-de-sac and the paracolic gutters.
## SKELETAL:
No suspicious lytic or sclerotic lesions are identified.
## IMPRESSION:
1. Complete occlusion of the splenic vein, superior mesenteric vein and left
branch of the portal vein with shunting of blood and back filling of the main
portal vein. Chronicity cannot be determined as no recent studies are
available for comparison. A multi phasic mesenteric/liver CTA scan or MRA is
recommended for followup.
2. New moderate ascites.
3. Cholelithiasis. Thickened and edematous gallbladder wall without
gallbladder distention is likely from spacing.
4. Gastric and esophagial varices.
## NOTIFICATION:
Findings were discussed with Dr. by Dr. on at the
time of discovery via telephone.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19776354", "visit_id": "N/A", "time": "2173-12-03 14:28:00"} |
15520217-RR-22 | 244 | ## INDICATION:
year old man with prostate cancer// rule out metastatic
disease, for new treatment, restage. Include pelvis
## FINDINGS:
The prostate gland measures 3.8 x 6.1 x 6.0 cm (AP x SI x TV), yielding a
calculated volume of 73 cc. The central gland was enlarged and showed a
heterogenous swirled and whorled appearance with well defined nodules,
indicative of BPH.
There is a moderate amount of hemorrhage within the peripheral zone, which
limits evaluation. Within the left posterolateral peripheral zone, midgland,
there is a T2 hypointense lesion with marked diffusion restriction measuring 7
x 11 x 17 mm (Axial series 5, image 20; coronal series 7, image 20; axial
series 6 & 650, image 44) in keeping with the patient's known prostate cancer.
Additional areas of T2 hypointensity within the midline prostate near the
prostatic base correspond to the normal central zone. Circumscribed T2
hypointense restricting nodule in the left apical transition zone has imaging
appearance most in keeping with a BPH nodule. No additional suspicious lesions
are identified.
The neurovascular bundles appear free of tumor. The seminal vesicles appear
normal in signal intensity and morphology. There is no significant adenopathy
and the visualized osseous structures appear grossly unremarkable.
## IMPRESSION:
1. 17 mm lesion within the left posterolateral peripheral zone (PI-RADS 5)
corresponding to the patient's known 9 prostate cancer.
2. No MRI evidence of extraprostatic extension, pelvic lymphadenopathy, or
pelvic metastases.
3. Moderate post-biopsy hemorrhage.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15520217", "visit_id": "N/A", "time": "2132-05-21 07:47:00"} |
17757894-RR-137 | 234 | ## HISTORY:
woman with left lower quadrant pain, chills and
diarrhea.
## CT ABDOMEN AND PELVIS:
Helical imaging was performed from the lung bases to
the pubic symphysis after uneventful administration of intravenous contrast.
Sagittal and coronal reformatted images were prepared.
## CT ABDOMEN:
Visualized lung bases are clear apart from minimal atelectasis.
The partially visualized heart is normal. The spleen, adrenals, pancreas,
gallbladder, and liver all appear within normal limits. The kidneys enhance
and excrete contrast symmetrically without masses or hydronephrosis. The
stomach and abdominal loops of small bowel appear normal. The abdominal aorta
and its branches appear widely patent. There is no free air, or free fluid
and there is no significant retroperitoneal or mesenteric lymphadenopathy.
## CT PELVIS:
There is minimal thickening of the descending colon with its wall
measuring up to 7 mm (300B:30). There is minimal pericolonic fat stranding.
There are no fluid collections in the pelvis. Remaining pelvic loops of small
and large bowel appear normal. There is a fibroid uterus, containing
calcifications, unchanged. The bladder appears normal. Adnexa are normal.
No free air is present. There is no significant adenopathy in the pelvis.
## BONE WINDOWS:
There are no suspicious appearing sclerotic or lytic lesions.
## IMPRESSION:
1. Thickening of the wall of the descending colon could reflect
underdistension, but mild colitis not excluded. Infectious causes most
likely, vascular less likely as mesenteric vasculature appears widely patent.
2. Fibroid uterus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17757894", "visit_id": "N/A", "time": "2124-09-28 21:09:00"} |
18290572-RR-7 | 360 | ## EXAMINATION:
CTA HEAD WANDW/O C AND RECONSQ1213CTHEAD
## HISTORY:
with s/p EVD placement. *** WARNING *** Multiple
patients with same last name!// eval for
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
802.7 mGy-cm.
2) Stationary Acquisition 7.5 s, 0.5 cm; CTDIvol = 81.7 mGy (Head) DLP =
40.8 mGy-cm.
3) Spiral Acquisition 2.9 s, 22.9 cm; CTDIvol = 30.3 mGy (Head) DLP = 692.1
mGy-cm.
Total DLP (Head) = 1,536 mGy-cm.
## CT HEAD WITHOUT CONTRAST:
The patient is status post right frontal approach EVD placement with the EVD
terminating in the midline near the right foramina of . Mild residual
pneumocephalus. Extensive subarachnoid hemorrhage appears fairly similar
compared to prior imaging. Ventricular profile is slightly increased compared
to prior imaging.
No new intracranial hemorrhage, mass or large acute territorial infarct.
Mucous retention cyst in the inferior aspect of the left maxillary sinus is
again noted. The mastoid air cells are clear.
## CTA HEAD:
Irregular saccular aneurysm arising from the left aspect of the distal basilar
artery at/immediately superior to the origin of the left superior cerebellar
artery with the aneurysm measuring 5 mm in maximal width and depth. The neck
of the aneurysm measures 4 mm diameter. There is a small daughter
aneurysm/irregular nubbin originating from its anterosuperior aspect measuring
2 mm in diameter. The rest of the vessels of the circle of and their
principal intracranial branches are patent with no evidence of marked
stenosis, occlusion, or aneurysm. Fetal origin of the right PCA appear. The
dural venous sinuses are patent.
## IMPRESSION:
Irregular saccular aneurysm arising from the left aspect of the distal basilar
artery at the origin of the left superior cerebellar artery with the aneurysm
measuring 5 mm in maximal width and depth. There is a small daughter
aneurysm/irregular nubbin originating from its anterosuperior aspect measuring
2 mm in diameter.
Extensive subarachnoid hemorrhage is unchanged. Patient is status post right
frontal approach EVD placement. The ventricular profile is slightly increased
in size compared to prior. No new intracranial hemorrhage or large acute
territorial infarct.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18290572", "visit_id": "28776469", "time": "2163-06-04 01:05:00"} |
13648123-RR-42 | 136 | ## EXAMINATION:
CAROTID SERIES COMPLETE
CLINICAL HISTORY year old woman with episode of syncope and bruit in the
left arm// reduction of flow in the carotids, especially left reduction
of flow in the carotids, especially left
## FINDINGS:
Duplex was performed of bilateral carotid arteries. There is mild
heterogeneous plaque in the proximal right ICA. No plaque is seen on the
left.
## RIGHT:
Peak velocities are 66, 63, and 65 cm/sec in the ICA, CCA and ECA
respectively. This is consistent with less than 40% right ICA stenosis. The
vertebral has antegrade flow.
## LEFT:
Peak velocities are 68, 57 and 57 cm/sec in the ICA, CCA and ECA
respectively. This is consistent with no stenosis of the left ICA. Vertebral
flow is antegrade.
## IMPRESSION:
Right ICA less than 40% stenosis. Left ICA no stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13648123", "visit_id": "N/A", "time": "2156-10-13 11:51:00"} |
14147907-RR-25 | 120 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
year old M with history of CAD, atrial fibrillation on
Coumadin, lymphoma, bladder cancer, and esophageal cancer with chief
complaint of dysphagia, inability to tolerate PO or secretions since .
Concern for food impaction.
## FINDINGS:
Cardiac silhouette size is top normal. The aorta is mildly tortuous.
Mediastinal and hilar contours are otherwise unchanged. No pneumomediastinum
is present. Lungs are hyperinflated with flattening of the diaphragms
compatible with underlying COPD. No focal consolidation, pleural effusion or
pneumothorax is present. No subdiaphragmatic free air is present. Bridging
anterior osteophytes are re- demonstrated in the thoracic spine compatible
with DISH.
## IMPRESSION:
COPD. No acute cardiopulmonary abnormality otherwise demonstrated including
no subdiaphragmatic free air or definite pneumomediastinum.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14147907", "visit_id": "20935059", "time": "2122-09-04 18:34:00"} |
15015775-RR-171 | 97 | ## INDICATION:
History: with seizure ? cva// ? hemorrhage ? mass
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.7 cm; CTDIvol = 48.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
Ventricles, cisterns and sulci appear stable. There is no mass effect,
hydrocephalus, or shift of normally midline structures. Gray-white
distinction appears preserved. No evidence of intracranial hemorrhage.
Surrounding soft tissue structures are unremarkable. Visualized paranasal
sinuses and mastoid air cells appear clear. There is no evidence for fracture
or bone destruction.
## IMPRESSION:
No evidence of acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15015775", "visit_id": "N/A", "time": "2192-06-01 19:15:00"} |
19757268-RR-28 | 114 | ## INDICATION:
Status post liver transplantation, a patient with hepatocellular
carcinoma, assessment for metastatic
## FINDINGS:
Small mediastinal lymph nodes are stable. None of them pathologically
enlarged. Coronary calcifications are extensive. No hilar axillary or
supraclavicular lymphadenopathy present. Aorta and pulmonary arteries are
unremarkable. Heart size is top-normal. No pericardial of pleural effusion
is seen. Image portion of the upper abdomen will be reviewed separately in
corresponding report will be issued
Airways are patent to the subsegmental level bilaterally. Lungs are clear
with no pulmonary nodules masses or consolidations. Right middle lobe
atelectasis is present.
No lytic or sclerotic lesions worrisome for infection or neoplasm
demonstrated.
## IMPRESSION:
No evidence of intrathoracic metastatic disease
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19757268", "visit_id": "N/A", "time": "2144-10-07 07:42:00"} |
19324558-DS-4 | 754 | ## ALLERGIES:
Sulfa (Sulfonamide Antibiotics) / cats / Dust mites /
ciprofloxacin
## CHIEF COMPLAINT:
Observation s/p ERCP with Stent Removal
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
ERCP with Stent Removal and Sphincterotomy
## HISTORY OF PRESENT ILLNESS:
with PMH of CAD s/p DES ( ), HTN, HL, and prior ERCP
with stone removal and stent placement, now presenting
for repeat ERCP. Patient reports he has felt in his usual state
of health over the past two weeks following his initial ERCP. He
has been holding his Plavix, and took his last dose on
. He presented today for a planned ERCP given that he
had been on Plavix during his prior procedure, precluding a
sphincterotomy at that time. His procedure today was notable for
removal of one stone, removal of his previously placed stent,
and a sphincterotomy. He tolerated the procedure well and denied
nausea or pain upon arrival to the floor.
## ROS:
A ten point review of systems was performed and negative
except as noted above.
## PAST MEDICAL HISTORY:
(Per OMR, confirmed with patient)
## PAST MEDICAL HISTORY:
1. Coronary artery disease.
2. Hypertension.
3. Hyperlipidemia.
4. Sciatica (Inactive)
5. Diverticulitis (Inactive)
6. Bullous retinoschisis.
7. Hypothyroidism.
8. Thyroid nodules.
9. Colonic polyps.
10. Obesity.
11. Pneumonia.
## PAST SURGICAL HISTORY:
1. Appendectomy at age .
2. Inguinal herniorrhaphy, bilaterally.
3. Cardiac catheterization. PCI RCA with a DES. .
## FAMILY HISTORY:
(Per OMR, confirmed with patient)
Father died with coronary artery disease, an MI, was a smoker.
Mother died having coronary artery disease, lung cancer, was a
smoker. Five siblings, one brother with COPD, another with
coronary artery disease, and sister with breast
cancer. No children.
## GEN:
Awake, alert, NAD, partner at bedside
## ABD:
Soft, NTND, positive bowel sounds
## EXT:
No edema or calf tenderness
## PSYCH:
Affect appropriate, good insight into own health
## ERCP:
Previously placed plastic biliary stent in the major papilla was
seen and then removed
Sphincterotomy was performed at the 12 o'clock position
successfully
7 mm stone and sludge at the lower third of the common bile duct
was seen and extracted
There was no evidence of choledochal cyst on this exam
The left and right hepatic ducts and all intrahepatic branches
were normal
Otherwise normal ercp to third part of the duodenum
## BRIEF HOSPITAL COURSE:
with CAD, HTN admitted following ERCP with stent removal and
sphincterotomy.
Active Issues
# Bile Duct Obstruction secondary to choledocolithias s/p ERCP:
Patient tolerated procedure well. He was kept NPO overnight with
LR at 200cc/hr and Zofran and Dilaudid as needed. His diet was
advanced as tolerated in the morning. Since a sphincterotomy was
performed, will re-start Plavix in three days ( ). No
current indication for antibiotics.
## # BRADYCARDIA:
Likely secondary to patient's home Atenolol as
well as the effects of anesthesia. Patient currently
asymptomatic. Monitor overnight and re-start home Atenolol
tomorrow morning if rates improve.
# CAD s/p stent; Benign Hypertension: Resumed home cardiac
regimen of Lisinopril and Aspirin, as well as Atenolol if heart
rate allows. No current complaints of chest pain or dyspnea.
Will recommend patient re-start Plavix in three days.
## TRANSITIONAL ISSUES:
- The patient should restart his plavix in 3 days time
- The patient should see a general surgeon as an outpatient for
cholecystectomy.
## MEDICATIONS ON ADMISSION:
1. Lisinopril 10 mg PO DAILY
2. Clopidogrel 75 mg PO DAILY
3. Atenolol 25 mg PO DAILY
4. Levothyroxine Sodium 100 mcg PO DAILY
5. Pregabalin 75 mg PO DAILY:PRN pain
6. Simvastatin 40 mg PO DAILY
7. Epinephrine 1:1000 0.3 mg IM ONCE MR1 allergic reaction
8. Aspirin 81 mg PO DAILY
9. Multivitamins 1 TAB PO DAILY
10. Fish Oil (Omega 3) Dose is Unknown PO Frequency is Unknown
11. Nitroglycerin SL 0.4 mg SL PRN chest pain
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Atenolol 25 mg PO DAILY
3. Levothyroxine Sodium 100 mcg PO DAILY
4. Lisinopril 10 mg PO DAILY
5. Multivitamins 1 TAB PO DAILY
6. Simvastatin 40 mg PO DAILY
7. Clopidogrel 75 mg PO DAILY
8. Epinephrine 1:1000 0.3 mg IM ONCE MR1 allergic reaction
## DURATION:
1 Dose
9. Fish Oil (Omega 3) 1000 mg PO DAILY
10. Nitroglycerin SL 0.4 mg SL PRN chest pain
11. Pregabalin 75 mg PO DAILY:PRN pain
## DISCHARGE DIAGNOSIS:
Primary Diagnosis
- Bile Duct Obstruction
- Coronary Artery Disease
- Hypertension
## DISCHARGE INSTRUCTIONS:
You were admitted to following an ERCP during which your
biliary stent was removed. Please continue to take all of your
medications. You should begin taking your plavix again in 3 days
time.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19324558", "visit_id": "29849257", "time": "2171-06-17 00:00:00"} |
13392573-RR-15 | 159 | ## INDICATION:
female with new pregnancy complaining of acute
abdominal/chest pain. LMP: .
## FINDNIGS:
An intrauterine gestational sac is seen and a single living embryo
is identified with a crown-rump length of 10.8 mm corresponding to a
gestational age of 7 weeks 1 day. This is 6 days less than menstrual dates of
8 weeks 0 days. Incidental note is made of a tiny perigestational bleed.
There is normal cardiac fetal motion with a fetal heart rate of 137 beats per
minute.
The right ovary is unremarkable. There is a complex left ovarian cyst with
internal echoes that measures 1.9 x 1.7 x 2.7cm which likely represents either
a hemorrhagic corpus luteum or endometrioma. Thre is trace pelvic free fluid.
## IMPRESSION:
1. Single live intrauterine pregnancy with size equals dates.
2. Complex left ovarian cyst likely representing a hemorrhagic corpus luteum
or endometrioma. This can be re-evaluated at the full fetal survey
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13392573", "visit_id": "N/A", "time": "2137-10-29 09:14:00"} |
12000432-RR-63 | 116 | ## INDICATION:
with history of right CVA, on Coumadin with neck pain
after fall at home. Evaluate for C-spine injury.
No prior examinations.
NON-CONTRAST CT OF THE CERVICAL SPINE WITH CORONAL AND SAGITTAL REFORMATS:
There is no acute fracture or malalignment. Vertebral body heights are
maintained. No prevertebral soft tissue swelling. Degenerative changes are
noted with broad-based disc osteophyte complex at C5-6 causing moderate canal
stenosis at this level. Moderate degenerative changes with loss of disc space
at C4-5, C5-6 and C6-7 are noted. The lung apices are unremarkable. There is
mild, likely chronic opacification of the right mastoid air cells.
## IMPRESSION:
No evidence of fracture or malalignment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12000432", "visit_id": "N/A", "time": "2148-08-26 10:37:00"} |
14353044-RR-29 | 156 | ## INDICATION:
man with renal cyst on recent CT.
## FINDINGS:
Note is made that this is a limited study due to the patient's body
habitus. The right kidney measures 11.1 cm and the left kidney measures 12.0
cm. No hydronephrosis is seen. The left kidney is difficult to visualize. A
simple cyst is seen in the upper portion of the left kidney on the lateral
margin measuring 1.5 x 1.7 x 1.6 cm. Despite diligent effort, the lower pole
cyst which was seen on the recent CT could not be identified due to the
technical limitations of the exam.
The bladder is collapsed on a Foley catheter.
## IMPRESSION:
Simple cyst seen in the upper pole of the left kidney. The lower
pole renal cyst could not be identified with ultrasound due to the technical
limitations of the scan. An MRI could be performed for better
characterization if clinically indicated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14353044", "visit_id": "27159126", "time": "2167-12-31 10:26:00"} |
11080959-RR-28 | 197 | ## EXAMINATION:
3 FOOT STANDING EXTREMITYBILAT
## INDICATION:
woman presenting with bilateral knee pain.
## FINDINGS:
A line drawn from the top of the femoral head to the tibial plafond on the
right side measures 90 cm and on the left side measures 80.9 cm for a total
leg length difference of 11 mm.These lines overlap the knee joints in a
relatively symmetric fashion without abnormal alignment.
Focused imaging of the pelvis demonstrates no acute fractures. Bilateral hip
osteoarthritis is mild. There are mild degenerative changes in the bilateral
sacroiliac joints. There is approximately 5-mm left upward pelvic tilt
compared to the left side.
There is normal osseous mineralization.
Focused imaging of the knees demonstrate right total knee replacement and
degenerative changes in the left knee, mild in the medial compartment. There
is a dedicated knee radiograph from the same day detailing findings in the
knees.
Focused imaging of the ankles demonstrates normal ankle mortises. There are no
signs for acute bony injury or significant degenerative changes.
## IMPRESSION:
1. No significant leg length discrepancy or abnormal lower extremity
alignment.
2. 5-mm left upward pelvic tilt.
3. Degenerative changes in knees and hips as above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11080959", "visit_id": "N/A", "time": "2139-11-26 11:02:00"} |
11141728-RR-22 | 189 | ## HISTORY:
Shortness of breath after surgery on . Assess for
pulmonary embolus.
## FINDINGS:
The thyroid is symmetric. The aorta and major branches are patent and normal
in caliber with note made of a bovine aortic arch, a normal variant. There is
no acute aortic pathology or calcific atherosclerotic vascular disease. The
heart and pericardium are unremarkable without pericardial effusion. There is
no mediastinal, hilar or axillary lymph node enlargement. Although this study
is not tailored for subdiaphragmatic evaluation, the imaged upper abdomen is
unremarkable aside from free intraperitoneal air consistent with recent
laparoscopic surgery. A small amount of air dissects into the subcutaneous
tissues of the lower thorax.
The lungs are well expanded and clear. The trachea and central airways are
patent to the segmental level. There is no pleural effusion or pneumothorax.
No focal pulmonary opacity is identified. The pulmonary arterial tree is well
opacified without evidence of filling defect to suggest pulmonary embolus.
Imaged osseous structures are unremarkable without suspicious lytic or blastic
bony focus to suggest osseous malignancy.
## IMPRESSION:
No pulmonary embolism or acute aortic pathology. Free intraperitoneal air in
keeping with recent laparoscopic salpingectomy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11141728", "visit_id": "N/A", "time": "2178-06-24 20:24:00"} |
19727917-DS-33 | 1,459 | ## ALLERGIES:
Augmentin / Morphine Sulfate
## CHIEF COMPLAINT:
Abdominal Pain and Fever
## HISTORY OF PRESENT ILLNESS:
female with multiple medical problems including metastatic
colon cancer, hepatocellular carcinoma, asthma, and Type 2
Diabetes Mellitus was admitted from the ED with abdominal pain
and fever.
She was admitted to from to the surgical
service with a small bowel obstruction. A discharge summary is
not available from that admission, but it appears that she was
discharged home without complication. CT scan on did
have the incidental finding of new left renal
hydroureteronephrosis. Shortly after that, she was seen at
Plastic Surgery Clinic at , where she states that one of her
abdominal wound was cleaned aggressively. Since that time
approximately, she reports increasing right lower quadrant pain
which she describes as the following: character was sharp and
burning, radiating to her right lower abdomen / right flank /
right hip, and worsened with any activity. She has been taking
percocet, which initially worked, but her pain now breaks
through the percocet.
Upon arrival in the ED, temp 97.4, HR 108, BP 152/0, RR 16, and
pulse ox 96% on room air. Exam was notable for mild drainage
from abdominal wound and tachycardia to 108. Labs are notable
for UA suggestive of UTI, Creatinine 1.5, and Hct 31. She
received cipro 400mg IV for urinary tract infection and was
admitted for further evaluation.
Review of systems:
(+) Per HPI. abdominal pain
(-) Denies fever, chills, night sweats, weight loss, headache,
sinus tenderness, rhinorrhea, congestion, cough, shortness of
breath, chest pain or tightness, palpitations, nausea, vomiting,
constipation, change in bladder habits, dysuria, arthralgias, or
myalgias.
## PAST MEDICAL HISTORY:
1. Asthma/COPD/Pulmonary Fibrosis
2. Obesity
3. Type 2 Diabetes Mellitus
4. Rheumatoid Arthritis with pulmonary involvement
5. Hypertension
6. h/o Herpes Zoster
7. Osteoporosis
8. s/p CCY
9. Right Artificial Eye
10. s/p R foot surgery s/p calceneal osteotomy
- course complicated by wound infection and dehiscence
11. Esophageal varices
12. Portal gastropathy
13. Metastatic Colon Cancer
- s/p resection with TAH, omentectomy, and small bowel resection
- course complicated by poorly healing wounds
14. Hepatocellular Carcinoma
- s/p cyberknife therapy
## FAMILY HISTORY:
Mother - died at from CAD
Father - died at with alcoholism
## GEN:
no acute distress, pleasant
## NECK:
Supple, No LAD, No JVD
## CV:
RR, NL rate. NL S1, S2. No murmurs, rubs or gallops
## LUNGS:
CTA, BS , No W/R/C
## ABD:
+ BS, soft, obese, mild tenderness to palpation in RLQ with
no rebound or guarding, two midline wounds with dressing in
place with yellowish drainage from inferior wound - no erythema
or tenderness
## NEURO:
A&Ox3. Appropriate. CN grossly intact with the
exception of right eye prosthetic. strength throughout.
Normal coordination. Gait assessment deferred
## PSYCH:
Listens and responds to questions appropriately, pleasant
## MICROBIOLOGY:
Blood Cx x 2 no growth at discharge
## URINE CX:
>100,000 e.coli, sensitivities pending at
time of discharge
## :
Abdominal wound cx:
BETA STREPTOCOCCUS GROUP B. SPARSE GROWTH.
STAPH AUREUS COAG +. SPARSE GROWTH
## STUDIES:
Renal US - Stable grade 2 left hydroureteronephrosis.
No hydronephrosis is seen in the right kidney.
CT Abd/Pelvis
1. Partial small-bowel obstruction likely secondary to adhesions
in the right lower quadrant.
2. Enlarging lingular nodule now measuring 7 mm. Short-interval
followup in three months is advised.
3. Cirrhotic liver with adjacent ascites and hypodense lesion in
segment VIII and two fiducial markers. Recurrent/residual
hepatocellular carcinoma cannot be excluded.
4. Splenic hypodensity, stable, likely cysts.
5. New left renal hydroureteronephrosis secondary likely to
post-surgical changes in the hysterectomy bed. Correlation with
creatinine and surgical operative note is recommended. Please
note, if there is concern for ureteral injury, a retrograde
urethrogram may be obtained to further assess.
6. Diverticulosis without evidence of diverticulitis.
7. Air-containing tract along the midline incision without
evidence of fluid collection.
8. L5 bilateral spondylolysis without spondylolisthesis. Stable
L4-5 anterolisthesis, grade female with multiple medical problems including metastatic
colon cancer, hepatocellular carcinoma, COPD, and Type 2
Diabetes Mellitus was admitted form th ED with adominal pain and
found to have urinary tract infection and acute renal failure.
##
1. URINARY TRACT INFECTION:
She had symptoms of urinary
frequency and urgency but no dysuria or fevers. She was started
on empiric cipro. On hospital day 2 her first urinary culture
returned with enterococcus, prompting change to amoxicillin for
treatment. However, her second culture then returned with
e.coli, sensitivities pending at time of discharge.
##
2. ACUTE RENAL FAILURE:
Baseline creatinine 0.8 increased to
1.6, starting weeks prior to admission, unclear etiology.
She was given fluid challenge with ivf with limited improvement
in her creatinine to 1.3 at time of discharge. Her hctz and
were held. She has stable unilateral hydronephrosis that was
discussed with urology but thought unlikely to be contributing.
This will need to be monitored on discharge.
##
3. ABDOMINAL PAIN:
She has subacute to chronic right lower
quadrant pain, etiology is unclear but may be related to
underlying aboinal adhesions or scar tissue. It is controlled
with percocet, and a lidocation patch was started to see it this
may help with pain control. Dr. surgeon, also
recommended consideration of alternative pain treatment
modalities, such as acupuncture.
##
4. ABDOMINAL WOUNDS:
chronic, she was evaluated by wound care
who made recommendations about changing her wound care. These
detailed instructions were faxed to her directly. Her
surgeon, Dr. the wounds and did not feel they
needed further treatment beyond this at this time.
5. Type 2 Diabetes Mellitus, controlled and without
complications: She was continued on glyburide and insulin
sliding scale.
6. COPD / Asthma / Pulmonary fibrosis: Given her difficulty
healing her abdominal wounds, the issue of her chronic
prednisone use was addressed. This was discussed with her
pulmonologist, Dr. agreed to try to taper her
prednisone. She was changed from 10mg every other day to 7.5mg
every other day. Prior to this her ambulatory sat was checked
and noted to fall from 96% on RA to 92% on RA. She has not had
any recent symptoms and her PFT's were obtained, read pending at
time discharge. She will follow up with Dr. . She was
continued on her inhaled medications and singulair.
##
7. ANXIETY:
She was continued on ativan prn.
##
8. BENIGN HYPERTENSION:
Given her renal failure her
antihypertensives were held. She will not take them and follow
up with Dr. blood pressure monitoring.
## MEDICATIONS ON ADMISSION:
1. Albuterol inhaler prn
2. Fluticasone 4 puffs bid
3. Glyburide 5mg PO daily
4. Humalog sliding scale
5. Ipratropium nebs prn
6. Ativan prn insomnia and anxiety
7. Singulair 10mg PO qhs
8. Percocet prn pain
9. Prednisone 10mg PO qod
10. Serevent 50mcg inh bid
11. Valsartan 80mg PO daily
12. HCTZ 12.5mg PO daily
13. Calcium Carbonate
14. Vitamin D3
15. Multivitamin
## DISCHARGE MEDICATIONS:
1. Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation BID (2 times a day).
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk
with Device Inhalation Q12H (every 12 hours).
## 4. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY (Daily).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
7. Insulin Lispro 100 unit/mL Solution Sig: as directed
Subcutaneous three times a day: per sliding scale.
8. DuoNeb 0.5-2.5 mg/3 mL Solution for Nebulization Sig: One (1)
unit Inhalation every six (6) hours as needed for shortness of
breath or wheezing.
9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day.
## 10. OXYCODONE-ACETAMINOPHEN MG TABLET SIG:
One (1) Tablet
PO 4 to 5 times daily prn as needed for pain.
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Prednisone 5 mg Tablet Sig: 1.5 Tablets PO every other day:
total dose 7.5mg.
Disp:*30 Tablet(s)* Refills:*2*
13. Amoxicillin 250 mg Capsule Sig: Two (2) Capsule PO Q12H
(every 12 hours) for 9 doses.
Disp:*18 Capsule(s)* Refills:*0*
14. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) patch Topical DAILY (Daily): 12 hours on 12 hours off,
to area of sharp, burning pain on abdomen.
Disp:*30 patch* Refills:*2*
## DISCHARGE DIAGNOSIS:
Urinary tract infection, acute renal failure, abdominal pain,
abdominal wounds, metastatic colon cancer, cirrhosis, type II
diabetes melitus, hypertension.
## DISCHARGE CONDITION:
Vital signs stable, afebrile, continued stable abdominal pain.
## DISCHARGE INSTRUCTIONS:
You were admitted with a urinary tract infection, kidney
failure, abdominal pain and abdominal wounds.
Your urinary tract infection was treated with antibiotics which
should be continued when you leave.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19727917", "visit_id": "28346775", "time": "2169-09-24 00:00:00"} |
11447159-RR-13 | 138 | ## INDICATION:
female, positive pregnancy test. LMP .
Patient has a prior history of two miscarriages.
## FINDINGS:
The uterus is identified in anteverted position. Within the
endometrial cavity, a gestational sac, yolk sac, and embryonic pole are
identified. An embryonic heart rate of 158 was detected transvaginally. The
crown-rump length measures 0.9 cm, correlating with 6 weeks 6 days gestation.
A heterogeneous fluid collection consistent with subchorionic hemorrhage is
identified in the lower uterine segment.
The left ovary is identified and demonstrates normal morphology measuring 3.9
x 2.1 x 2.8 cm. The right ovary is identified and measures 2.6 x 1.5 cm and
demonstrates normal morphology. No adnexal masses are appreciated.
## IMPRESSION:
1. Single live intrauterine pregnancy with fetal heart rate of 158 BPM.
Size equals dates
2. Small subchorionic hemorrhage.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11447159", "visit_id": "N/A", "time": "2145-07-04 08:03:00"} |
17677110-RR-105 | 490 | ## INDICATION:
with abdominal distension, N/V. Hx of metastatic esophageal
ca//?obstruction or ileus
## 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.
## LOWER CHEST:
Large left and small right pleural effusions grown from .
Adjacent atelectasis is mild. No pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic
or extrahepatic biliary dilatation. The gallbladder is decompressed with
percutaneous cholecystostomy tube in situ. Moderate perihepatic ascites is
increased from .
## 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:
Peg tube is noted. The stomach is markedly distended
containing slightly hyperdense fluid likely due to contrast administration.
The duodenum appears decompressed as do the proximal loops of jejunum. Fluid
distended and dilated loops of small bowel noted throughout the abdomen with
increased distention and dilation compared with prior. There are multiple
levels of partial obstruction due to known serosal implants in the setting of
peritoneal carcinomatosis. Fecalization of small bowel loops in right lower
quadrant reflective of slow transit. Abutting the right iliopsoas muscle,
locules of gas are likely intraluminal with tethered portion of the terminal
ileum. Large bowel is nondilated with hyperdense contrast residua from prior
CT. No definite pneumatosis or pneumoperitoneum. Oral contrast from prior
examination reaches the rectum.
## PELVIS:
Soft tissue mass in the left bladder is stable from . The
distal ureters are unremarkable. There is moderate to large volume free fluid
in the pelvis. Peritoneal lining appears thickened and hyperenhancing in
keeping with peritoneal carcinomatosis.
## REPRODUCTIVE ORGANS:
The prostate and seminal vesicles are normal.
## VASCULAR:
There is no abdominal aortic aneurysm. No significant
atherosclerotic disease is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
Surgical clips are seen in the anterior abdominal wall.
Tiny right gluteal fluid collection containing locules of air may represent a
tiny abscess or may reflect medication injection, correlate clinically.
## IMPRESSION:
1. Intervally progressed malignant small bowel obstruction in this patient
with known peritoneal carcinomatosis, with increase in extent of small bowel
distention and dilation, increasing ascites.
2. Tiny right gluteal fluid collection containing locules of air may represent
a tiny abscess or may reflect medication injection, correlate clinically.
3. Large left and small right pleural effusions have grown from .
4. Gastrostomy and percutaneous cholecystostomy tubes in appropriate position.
5. Stable appearance bladder masses consistent with metastasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17677110", "visit_id": "22974321", "time": "2115-10-01 18:51:00"} |
13915472-RR-18 | 215 | ## INDICATION:
woman with severe abdominal pain. Evaluate for
obstruction or other pathology.
## FINDINGS:
CT OF THE ABDOMEN WITH CONTRAST:
The lung bases are clear without evidence of
nodules, opacities, or pleural effusion. The heart size is normal. The liver,
spleen, kidneys, adrenal glands, pancreas, stomach, and gallbladder are within
normal limits.
High-density fluid is seen within the abdomen suspicious for hemorrhage or
leakage of contrast material. No free air is identified. Oral contrast is
seen only through the proximal bowel. Sections of the distal ileum demonstrate
abnormal enhancement. There may also be distal small bowel wall thickening;
however, this is difficult to fully appreciate as the bowel is underdistended.
No retroperitoneal or mesenteric lymphadenopathy is seen.
CT OF THE PELVIS WITH CONTRAST:
Again noted is high-density free pelvic fluid
extending from the abdomen, in addition to abnormally enhancing loops of
ileum. The uterus, rectum, and bladder are within normal limits. No pelvic or
inguinal lymphadenopathy is present.
## IMPRESSION:
High-attenuation free fluid in the abdomen and pelvis, concerning
for hemorrhagic ascites. In association with abnormally enhancing loops of
distal ileum, these findings are highly suggestive of bowel perforation.
Differential diagnosis for these findings is inflammatory bowel disease versus
infection.
Findings were posted to the ED dashboard at the time of review.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13915472", "visit_id": "22888218", "time": "2193-04-24 08:07:00"} |
12842440-RR-22 | 133 | ## STUDY:
CTA of the chest.
## INDICATION:
female with history of COPD, presenting with dropping
oxygen saturation. Subtherapeutic INR. Assess for pulmonary embolism.
## IMPRESSION:
1. No pulmonary embolism.
2. Irregular 1.8 cm soft tissue density within the right middle lobe most
likely represents scarring. A 3 months follow-up chest CT is recommended to
document stability, alternatively PET CT could be considered.
3. Pulmonary nodules as described, these will be reevaluated at the time of
follow-up CT
4. Small left pleural effusion.
5. Extensive emphysematous disease.
6. Scattered coronary vascular calcifications.
7. Mildly enlarged pulmonary artery which likely reflects an element of
pulmonary hypertension.
8. Multiple severe thoracic vertebral compression fractures of indeterminate
chronicity.
These findings were discussed with Dr. by Dr. the telephone
at 6:45 p.m. on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12842440", "visit_id": "22853701", "time": "2141-02-15 15:21:00"} |
10644222-DS-14 | 1,966 | ## HISTORY OF PRESENT ILLNESS:
This patient is a year old male with history of pituitary
macroadenoma on bromocriptin 2.5 mg, 2.5mm A2 ACA aneurysm,
personality d/o NOS, substance abuse on suboxone, who initially
presented to with HA x1 week with c/f possible
increased size of pituitary macroadenoma. Patient transferred to
for neurosurgery evaluation. On admission to , MRI
head showed stable size pituitary macroadenoma when compared to
imaging from . Prolactin level elevated at 456 (451 in
. Endocrine was consulted who recommended increasing
Bromocriptine to 5mg daily in hopes to avoid neurosurgery in the
future. Given that there was no need for surgical intervention,
plan to transfer to medicine for initiation of Bromocriptine
therapy and continued management of his chronic pain.
In regards to his pituitary macroadenoma, the patient was
initially diagnosed in when he presented to
with HA. CT imaging at that time revealed 0.2 (AP) x
1.6 (TV) x 1.2 (SI)cm pituitary mass found to have prolactin
level 544. He was started on cabergoline with plans to
with Endocrine as an out-patient, however, he had a severe
bullous rash reaction to the Cabergoline and was therefore
re-admitted. At that time, his medication was switched to
Bromocriptine 2.5mg nightly. No signs of other pituitary hormone
deficiencies. The patient now represented with worsening HA x
1week. Per neurosurgery, no indication for surgical intervention
at this time as no e/o optic nerve compression and macroadenoma
stable in size. Per Endocrine, plan to increase Bromocriptine to
5mg nightly with plans to repeat prolactin level on .
Patient remains admitted at this time for pain control and
continued management of his HA. Chronic pain service involved
and recommended dialudid Q4hrs prn, Amitriptyline 50 mg
qHS in addition to his suboxone 8mg daily. The patient is very
anxious about increasing his Bromocriptine medication given his
reaction to Carbergoline in the past (although has been stable
on bromocriptine 2.5mg daily) as well as his reported peripheral
visual field defects. The hope is to have visual field testing
performed as an in-patient and optimization of his pain regimen
with plans to closely with Endocrine as an out-patient
for continued management of his macroadenoma.
## PAST MEDICAL HISTORY:
- Anxiety
- Aneurysm
- Pituitary Macroadenoma
- Substance Abuse
- Personality D/O NOS
- Gastric bypass surgery
- Chronic pain
## SURGERY:
- Cervical fusion
- Gastric bypass
- Cholecystectomy
- Hernia repairs
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclerae anicteric, MMM, oropharynx clear; pupils equal
and reactive.
## NECK:
Supple, JVP not elevated, no LAD
## RESP:
Clear to auscultation bilaterally, no wheezes, rales,
ronchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABD:
+BS, soft, nondistended, nontender to palpation. No
hepatomegaly.
## EXT:
trace pitting edema; warm, well perfused, 2+ pulses, no
clubbing, cyanosis
## NEURO:
CNs2-12 intact, motor function grossly normal
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
EOMI, 2-3 cm raised contusion left medial scalp; sclerae
anicteric, MMM, oropharynx clear; pupils equal and reactive.
## NECK:
Supple, JVP not elevated, no LAD
## RESP:
Clear to auscultation bilaterally, no wheezes, rales,
ronchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABD:
+BS, soft, nondistended, slightly tender to palpation in
the LUQ, but no rebound or guarding. No hepatomegaly.
## EXT:
trace pitting edema; warm, well perfused, 2+ pulses, no
clubbing, cyanosis
## NEURO:
CNs2-12 intact, motor function grossly normal; sensory
function grossly normal.
## IMAGING:
MR and w/o contrast:
## MRI BRAIN:
There is no evidence of acute intracranial
hemorrhage, mass effect or large territorial infarction. A
mucous retention cyst is seen in the right maxillary sinus. The
visualized paranasal sinuses are otherwise unremarkable. The
sphenoid sinuses, ethmoid air cells, and frontal sinuses are
clear. The globes are unremarkable. The principal flow voids
are well preserved. No marrow signal abnormalities are
identified.
MRI of the pituitary: Re demonstrated is the patient's T2
hyperintense, T1 isointense, hypo enhancing pituitary lesion
measuring approximately 1.3 cm TRV by 1.4 cm AP by 1.4 cm cc
overall unchanged compared to the prior exam from .
There is no suprasellar or cavernous sinus invasion of the mass.
The infundibulum is displaced towards the left. The cavernous
carotid arteries appear unremarkable without evidence of
encasement or narrowing. There is no mass effect on the optic
chiasm.
## IMPRESSION:
1. No acute intracranial abnormalities identified.
2. Stable 1.4 cm pituitary mass compared to the prior exam from
.
## FINDINGS:
There is no evidence of infarction, hemorrhage, or edema. The
ventricles and sulci are normal in size and configuration.
Compared to , there is an unchanged hyperdensity in
the region of the pituitary gland, consistent with patient's
known pituitary .
There is no evidence of fracture. There is a small mucous
retention cyst in the left sphenoid sinus. The visualized
portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are otherwise clear. The visualized portion of the
orbits are unremarkable. The patient is edentulous. Visualized
on the scout only, there is C5-C6 ACDF. On the sagittal scout
images, there is an apparent fracture through 1 of the C6 screws
(series 1 a, image 1), this can be seen on prior CT examinations
dating back to .
## IMPRESSION:
1. No acute intracranial abnormalities. Specifically, no
evidence of subdural hematoma or other sequelae of trauma.
2. No evidence for calvarial fracture.
3. Compared to , unchanged hyperdensity in the
region of the
pituitary gland, consistent with patient's known pituitary
lesion.
4. Incidentally noted on scout images, unchanged from prior CT
examinations dating back to is an apparent
fracture through a C6 screw on the C5-C6 ACDF.
## BRIEF HOSPITAL COURSE:
Mr. is a year-old male with known pituitary
macroadenoma, managed medically by endocrinology as an
outpatient, who was transferred from an OSH after presenting
with progressively worsening headache x 72 hours.
## #PITUITARY MACROADENOMA:
Patient initially presented to OSH
where CT scan was concerning for possible increase in size of
macroadenoma. However, MRI-pituitary at showed stable size
of lesion without mass effect of the optic chiasm. Patient was
initially placed on neurosurgical service for consideration of
surgery. On exam, he had no focal neurologic deficits but was
poorly compliant with visual field exam and refusing fundoscopy.
Given no indication for surgery, decision was made to continue
with medical management for pain control and he was transferred
to medicine service. His prolactin level this admission was
elevated at 456 (was 451 in . Endocrine was consulted
and recommended bromocriptine increased from 2.5mg qHS to 5mg
qHS . Would anticipate Prolactin level will slowly drift down.
Repeat levels will be checked on as an outpatient. Of
note, the patient complained of chronic vision changes, namely
peripheral field deficits. Ophthalmology was consulted and
recommended outpatient peripheral field testing which he will
receive immediately upon discharge (is being discharged to his
outpatient appointment).
## #HEADACHES:
The chronic pain service was consulted on admission
as patient is on suboxone at home with pain poorly controlled.
He was given x1 Amitriptyline 25mg and started on Dilaudid PO.
He tolerated this well and was initiated on 25mg Amitriptyline
at bedtime and will continue on 50mg qHS. He will be discharged
with 3 days worth of Dilaudid and has begun a transition to
gabapentin (300 mg QHS for 1 week, 300 mg BID for 1 and then 300
mg TID with option to uptitrate as needed). We avoided NSAIDs
at the recommendation of the pain service given concern for
possibility of bleeding into macroadenoma. His home suboxone
was continued at 8mg-2mg. He will with his PCP and
can follow up with Pain Management after
discharge. Please review transitional issues below.
## #HEAD TRAUMA:
on the day of discharge, patient dismantled the TV
in his room and while doing so hit his head. He subsequently had
a CT head which showed no concerning findings for sequelae of
trauma including SDH. Neurologic exam was wnl after injury.
=========================================
## TRANSITIONAL ISSUES:
-**PMP reviewed given multiple patient requests for dilaudid,
clonazepam, and Adderall. In conjunction with chronic pain
service, it would be reasonable for 3 day course of dilaudid and
will write for 3 days of HOME klonopin and Adderall as well per
patient request. However, review of PMP does show that he has a
30 day supply available of these drugs since and
therefore should have a sufficient amount. Given new dilaudid
this admission, he will receive 3 day course only. We attempted
to contact PCP to alert of this plan. We would NOT recommend
ongoing narcotic use for his chronic pain. Please consider
uptitration of gabapentin if requires more pain control. Patient
was amenable to this plan.** PLEASE LIMIT NARCOTICS given
concern for drug seeking behavior.
- Amitryptiline added per chronic pain recommendation.
- His bromocriptine was increased from 2.5 to 5 mg per
endocrinology recommendation. He should have a repeat prolactin
checked on to assess for reduction in response to
increase in therapy.
- We have discharged him with 3 days of Dilaudid therapy and
have begun a transition to gabapentin. He is currently taking
300 mg QHS, if he tolerates this, it should be transitioned to
BID for 1 week and then TID moving forward. It can be uptitrated
afterwards, as needed. Please consider discontinuing his
Fiorcet.
- He is having peripheral vision field testing on at 11:30
AM as an outpatient at please the results.
- Recent labs suggestive of iron-deficiency (iron 21, ferritin
14); please have GI f/u in outpatient setting for source work-up
and/or colonoscopy.
- He is being continued on home Citalopram and Clonazepam for
anxiety.
-Scout films of CT head on the day of discharge notable for is
an apparent fracture through a C6 screw on the C5-C6 ACDF. Per
read, incidentally noted and consistent with prior CT studies
dating back from .
- CODE: Full (confirmed)
- COMMUNICATION: CONTACT/ HCP:
## MEDICATIONS ON ADMISSION:
Celexa 20mg daily
Adderal 20mg TID
Fioricet 1 tab PO q8h
Suboxone 8mg-2mg 1 tab SL BID
Bromocriptine qHS
clonopin 1mg BID PRN anxiety
## DISCHARGE MEDICATIONS:
1. Amitriptyline 50 mg PO QHS
RX *amitriptyline 50 mg 1 tablet(s) by mouth at bedtime Disp
#*14 Tablet Refills:*0
2. Gabapentin 300 mg PO QHS
RX *gabapentin 300 mg 1 capsule(s) by mouth at bedtime Disp #*14
## DURATION:
3 Days
RX *hydromorphone [Dilaudid] 4 mg 1 tablet(s) by mouth q6h PRN
Disp #*12 Tablet Refills:*0
4. Bromocriptine Mesylate 5 mg PO QHS
RX *bromocriptine 5 mg 1 capsule(s) by mouth at bedtime Disp
#*30 Capsule Refills:*0
5. Acetaminophen-Caff-Butalbital TAB PO Q8H:PRN Pain -
Moderate
6. Amphetamine-Dextroamphetamine 20 mg PO TID
7. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID
8. ClonazePAM 1 mg PO BID anxiety
9. Docusate Sodium 100 mg PO BID constipation
10.Outpatient Lab Work
Please check prolactin level and fax to
endocrinology)
ICD10 D35.2
## PRIMARY:
Pituitary macroadenoma with hyperprolactinemia
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
We have cared for you in the hospital for your pain as well as
your pituitary macroadenoma. The dose of your medication,
bromocriptine, was increased to 5 mg every day in conjunction
with endocrine. Please continue to take this medication and we
have set-up for you with endocrinology in the
outpatient setting. Part of this will involve getting
a prolactin level drawn on . In terms of your pain, we
have supplied you with a 3-day course of hydromorphone for your
pain and it is to be replaced with gabapentin; this is
consistent with the chronic pain service's recommendation. Your
PCP your pain medications; please see the
information below regarding follow up with the pain clinic.
Lastly, you are scheduled for peripheral vision testing on
at 11:30 AM on the Floor of the in
of . You must be early for your appointment.
We have appreciated taking part in your care.
Best wishes,
7 Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10644222", "visit_id": "21396212", "time": "2134-04-16 00:00:00"} |
19683803-RR-20 | 355 | ## HISTORY:
male with question of intracranial hemorrhage on CT
scan.
## FINDINGS:
There are small foci of restricted diffusion within the right
periventricular white matter, with additional small foci within the left
posterior temporal subcortical white matter as well as the right occipital
lobe. These findings are compatible with acute infarcts. Additionally,
T2/FLAIR hyperintense signal is evident within the right frontal and parietal
lobes, likely reflecting chronic infarct, within a watershed distribution.
Extensive periventricular white matter T2/FLAIR hyperintensities also likely
reflect chronic small vessel ischemic disease. There is no evidence of
hemorrhage. On gradient-echo images, there are scattered foci of
susceptibility throughout the parenchyma and sulci, particularly within the
region of the areas of chronic infarcts. These findings likely reflect
hemosiderin deposition related to prior ischemia, or could reflect amyloid
angiopathy. The previously seen linear focus of high attenuation within a
cortical sulci in the left parietal lobe seen on head CT may
reflect calcification. No mass, mass effect is identified. The ventricles
and sulci are prominent, likely reflecting atrophy. There is no evidence of
hydrocephalus. No abnormal enhancement is identified after contrast
administration.
The intracranial vertebral and internal carotid arteries and their major
branches appear normal without evidence of stenosis or occlusion or aneurysm
formation. The carotid and vertebral arteries are visualized from their
origins to the intracranial courses, without evidence of stenosis or
occlusion.
Mild mucosal thickening is present within the ethmoid sinuses and bilateral
maxillary sinuses. Additionally, there is a lobulated enlarged multinodular
thyroid partially imaged.
## IMPRESSION:
1. Acute infarcts within the right periventricular white matter and
subcortical white matter within the left posterior temporal and right
occipital lobes.
2. Areas of chronic infarcts within the right frontal and parietal lobes,
within a watershed distribution.
3. Multifocal areas of susceptibility, which may reflect hemosiderin related
to prior ischemia, or could be related to amyloid angiopathy. No evidence of
hemorrhage, with the previously noted small focus of subarachnoid hemorrhage
on CT , which may reflect area of calcification.
4. Extensive chronic small vessel ischemic disease.
5. Multinodular thyroid.
Findings were posted to the ED dashboard at the time of interpretation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19683803", "visit_id": "28893354", "time": "2181-07-17 08:59:00"} |
16982710-RR-58 | 252 | ## INDICATION:
woman with CNS involvement of lymphoma. Status post
gamma knife treatment. The patient is presenting with bilateral arm weakness
and back pain. Assessment for progression.
## FINDINGS:
Significant interval reduction is again seen in the size of the
left cerebellar lesion, notably from 12 to 9 mm in an axial angulation. The
lesion demonstrates more conspicuous intrinsic T1 hyperintensity, suggesting a
small degree of likely therapy-related hemorrhage. There is no definite
additional contrast enhancement. Also, there is no perilesional edema on
FLAIR imaging and no mass effect on the fourth ventricle.
New enhancing lesions are not identified.
Unchanged position of right frontal ventriculostomy catheter. There is no
interval change with regard to cerebral sulci and ventricles with normal size
and configuration. The gray-white matter differentiation of the cerebrum is
maintained. No abnormality is seen with regard to basal ganglia, brainstem,
and the craniocervical junction. Unchanged hyperintensity on
diffusion-weighted images is seen in the bilateral atria and likely relates to
blood products. There is no evidence of acute infarction, intracranial
hemorrhage, or new mass effect. The flow voids of the major intracranial
vessels are preserved. Discrete fluid retention is seen in the left sphenoid
sinus. The orbits and osseous structures are unremarkable.
## IMPRESSION:
1. Interval reduction of the left cerebellar lesion with evidence of discrete
hemorrhage but no mass effect on the fourth ventricle and no residual
enhancement.
2. No evidence of new lesions, intracranial hemorrhage, or infarction.
3. Unchanged position of ventriculostomy catheter with no new hydrocephalus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16982710", "visit_id": "24156402", "time": "2174-04-22 19:43:00"} |
11216730-RR-57 | 89 | ## INDICATION:
with esophagectomy and right lower lobe pneumonia on
outside hospital chest x-ray.
## FINDINGS:
There is no change from the prior study from , with mild
vascular engorgement of the pulmonary vasculature, right pleural effusion,
also accumulating at the minor fissure, and right atelectasis. The
cardiomediastinal silhouette and hila are normal. A NG tube ends in the chest
within a gastric pull-up.
## IMPRESSION:
1. No evidnece of pneumonia.
2. NG tube ends in the gastric pull-up within the chest.
3. Right pleural effusion, unchanged from .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11216730", "visit_id": "20404322", "time": "2135-11-21 20:40:00"} |
19907191-RR-59 | 97 | ## INDICATION:
year old man with metastatic colorectal CA with multiple brain
mets s/p subocc crani for tumor resection with new tachycardia; please perform
at BEDSIDE // r/o DVT given high risk (colorectal CA, tachycardiac); please
perform at BEDSIDE
## FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
## IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19907191", "visit_id": "29997536", "time": "2154-06-17 14:05:00"} |
19574180-RR-5 | 359 | ## INDICATION:
man in bicycle vs car accident, +LOC, + head
abrasions // tachycardic. Evaluate for trauma.
## HEART AND VASCULATURE:
The thoracic aorta is normal in caliber without
evidence of acute injury. The heart, pericardium, and great vessels are
within normal limits. No pericardial effusion is seen.
## AXILLA, HILA, AND MEDIASTINUM:
No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass or hematoma. There is normal
thymus tissue in the anterior mediastinum.
## PLEURAL SPACES:
No pleural effusion or pneumothorax.
## LUNGS/AIRWAYS:
Lungs are clear without masses or areas of parenchymal
opacification. The airways are patent to the level of the segmental bronchi
bilaterally.
## BASE OF NECK:
Visualized portions of the base of the neck show no abnormality.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. No
evidence of focal lesion or laceration. 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. No peripancreatic stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesion or laceration.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
No evidence of focal renal lesions or hydronephrosis. No perinephric
abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal. No evidence of
mesenteric injury.
No free fluid or free air in the abdomen.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. No free
fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The reproductive organs are unremarkable.
## LYMPH NODES:
No retroperitoneal or mesenteric lymphadenopathy. No pelvic or
inguinal lymphadenopathy.
## VASCULAR:
No abdominal aortic aneurysm or retroperitoneal hematoma. Mild
atherosclerotic disease is noted.
## BONES:
No acute fracture. No focal suspicious osseous abnormality.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
No acute sequelae of trauma.
## NOTIFICATION:
The findings, impression, and images were discussed with
, M.D. by , M.D. on the telephone on at 9:39 , 1
minutes after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19574180", "visit_id": "N/A", "time": "2168-02-17 21:14:00"} |
10665500-RR-47 | 194 | ## HISTORY:
procedure for probable adenocarcinoma with altered mental
status. Evaluate for intracranial pathology.
No priors are available.
NON-CONTRAST HEAD CT
## FINDINGS:
There is no evidence for intracranial hemorrhage, mass effect,
shift of normally midline structures, or hydrocephalus. Regions of
hypoattenuation are noted within the corona radiata bilaterally, consistent
with chronic small vessel infarction; however, no acute major vascular
territorial infarcts are noted.
Globes are intact and soft tissues are unremarkable.
Atherosclerotic calcification is noted within the distal vertebral arteries
and carotid siphons bilaterally.
The left mastoid air cells and partially opacified. The right mastoid air
cells are sclerotic and may relate to prior episodes of mastoiditis or
congenital non- pneumatization. Mild mucosal thickening is noted within the
right maxillary sinus and sphenoid sinus. The patient is status-post left
occipital craniotomy. Please provide information as to the reason for this
procedure.
## IMPRESSION:
1. No acute intracranial pathology identified.
2. Sinus disease as described above, likely related to chronic inflammatory
process and/or patient's intubated status; however, correlation should be made
for any findings to suggest acute sinusitis/mastoiditis.
3. S/P left occipital craniotomy- please provide reason for this procedure.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10665500", "visit_id": "27403642", "time": "2182-02-19 12:16:00"} |
13494259-DS-6 | 1,314 | ## ALLERGIES:
live vaccines / tramadol / ibuprofen
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
1. Laparoscopic reduction of hiatal hernia.
2. Closure of diaphragm with pledgets
## HISTORY OF PRESENT ILLNESS:
Mr. is a with hx of CAD s/p CABG x 5 by
Dr. , Hyperlipidemia, COPD withc/o of shortness of
breath when bending over to tie his shoes orlying down and
abdominal distention; intermittent reflux symptoms
managed with Omeprazole. EGD showed irregular Z line
atGEJ and esophageal hiatal hernia; normal mucusa in stomach
andduodenum. Barium Swallow showed a moderate-sized
hiatal hernia; mild gastroesophageal reflux. Referred for hernia
repair
## TTE :
EF 40%, inferior and infero-lateral HK. MR slightly
worse with moderate to severe d/t CHF, diuretic increase to 40
mg
He reports that his symptoms started about a month ago. He
has noted DOE with climbing 1 flight of stairs, worse with
bending down to tie his shoes. He can only sleep on his back as
he notes increase shortness of breath laying on either side. he
reports abdominal distention as well with "pain in stomach" and
sour taste feeling in his mouth managed with Omeprazole. At
first
he thought the dyspnea was related to his heart problems and is
currently undergoing work up with his Cardiologist, nuclear
stress test scheduled in a couple of weeks.
Otherwise denies chest pain, palpitations, dizziness, nausea,
regurgitation. No other complaints.
## PAST MEDICAL HISTORY:
PAST MEDICAL/SURGICAL HISTORY
HYPERLIPIDEMIA
HYPERTENSION
ASTHMA
POLYARTHRALGIA
POLYMYALGIA RHEUMATICA
FATIGUE
PULMONARY NODULE
HYPERGLYCEMIA
PNEUMONIA
SEBORRHEIC KERATOSIS
ACTINIC KERATOSIS
ACROCHRODON
SKIN CANCERS
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PROSTATE NODULE
DIABETES TYPE II
NOCTURIA
HEMATOCHEZIA
GASTROESOPHAGEAL REFLUX
VITAMIN D DEFICIENCY
CORONARY ARTERY DISEASE s/p CABG x 5 in
MICROALBUMINURIA
SLEEP DISORDER
DEPRESSION
MACULAR DEGENERATION
## FAMILY HISTORY:
Mother died at a young age
Father cancer
## OFFSPRING:
son died at age of MI ( )
Other
## SCORE:
6.
GENERAL
[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:
HEENT
[x] NC/AT [] EOMI [] PERRL/A [x] Anicteric
[] OP/NP mucosa normal [] Tongue midline
[] Palate symmetric [] Neck supple/NT/without mass
[x] Trachea midline [] Thyroid nl size/contour
[ ] Abnormal findings:
RESPIRATORY
[x] CTA/P [x] Excursion normal [ ] No fremitus
[] No egophony [] No spine/CVAT
[ ] Abnormal findings:
CARDIOVASCULAR
[x] RRR [x] No m/r/g [] No JVD [] PMI nl [x] No edema
[x] Peripheral pulses nl [] No abd/carotid bruit
[ ] Abnormal findings:
GI
[x] Soft [x] NT [x] ND [] No mass/HSM [+] No hernia
[ ] Abnormal findings:
GU [x] Deferred
[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE
[ ] Abnormal findings:
NEURO
[x] Strength intact/symmetric [x] Sensation intact/ symmetric
[] Reflexes nl [x] No facial asymmetry [x] Cognition intact
[] Cranial nerves intact [ ] Abnormal findings:
MS
[x] No clubbing [x] cyanosis [x] No edema [x] Gait nl
[] No tenderness [] Tone/align/ROM nl [] Palpation nl
[] Nails nl [ ] Abnormal findings:
LYMPH NODES
[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl
[] Inguinal nl [ ] Abnormal findings:
SKIN
[x] No rashes/lesions/ulcers
[] No induration/nodules/tightening [ ] Abnormal findings:
PSYCHIATRIC
[x] Nl judgment/insight [] Nl memory [] Nl mood/affect
[ ] Abnormal findings:
## PERTINENT RESULTS:
WBC RBC Hgb Hct MCV MCH MCHC RDW
RDWSD Plt Ct
05:57 10.4* 4.50* 12.2* 39.2* 87 27.1 31.1* 16.9*
54.0* 178
Glucose UreaN Creat Na K Cl HCO3 AnGap
05:57 143 4.8
## BRIEF HOSPITAL COURSE:
Mr. was admitted to the hospital and taken to the
Operating Room where he underwent a laparoscopic reduction of
hiatal hernia and closure of diaphragm with pledgets. He
tolerated the procedure well and returned to the PACU in stable
condition. He maintained stable hemodynamics and his pain was
controlled with IV Tylenol. He was hydrated with IV fluids and
remained NPO.
On post op day #1 he denied any nausea, vomiting or abdominal
fullness and was started on a liquid diet which he tolerated
well. He was gradually advanced to soft solids and remained
asymptomatic. His abdominal port sites were healing well and his
pain was controlled with oral Tylenol and oxycodone. He was up
and walking and was very steady on his feet and his room air
saturations were 96%. He was able to void without difficulty.
After an uneventful recovery he was discharged to home on
and will follow up with Dr. in 2 weeks.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. brimonidine-timolol 0.2-0.5 % ophthalmic (eye) BID right eye
2. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 mL
inhalation QID:PRN SOB/wheezing
3. Metoprolol Succinate XL 50 mg PO BID
4. Rosuvastatin Calcium 40 mg PO QPM
5. Furosemide 20 mg PO DAILY
6. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain
7. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID
8. Omeprazole 40 mg PO BID
9. Calcium 500 + D (calcium carbonate-vitamin D3) 500
mg(1,250mg) -400 unit oral DAILY
10. Potassium Chloride 10 mEq PO DAILY
11. Aspirin 81 mg PO DAILY
12. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN
wheezing
13. FoLIC Acid 1 mg PO DAILY
14. amLODIPine 5 mg PO DAILY
15. Lotemax (loteprednol etabonate) 0.5 % ophthalmic (eye) QID
right eye
16. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP LEFT EYE QID
17. Ketorolac 0.5% Ophth Soln 1 DROP LEFT EYE QID left eye
18. vit A-vit C-vit E-zinc-copper unit-mg-unit
oral DAILY 2 caps
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H
RX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8)
hours Disp #*100 Tablet Refills:*0
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day
Disp #*60 Capsule Refills:*2
3. Milk of Magnesia 30 mL PO Q12H:PRN Constipation - First Line
4. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain -
Moderate
Reason for PRN duplicate override: Alternating agents for
similar severity
RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp
#*10 Tablet Refills:*0
5. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN
wheezing
6. amLODIPine 5 mg PO DAILY
7. Aspirin 81 mg PO DAILY
8. brimonidine-timolol 0.2-0.5 % ophthalmic (eye) BID right eye
9. Calcium 500 + D (calcium carbonate-vitamin D3) 500
mg(1,250mg) -400 unit oral DAILY
10. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID
11. FoLIC Acid 1 mg PO DAILY
12. Furosemide 20 mg PO BID
13. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 mL
inhalation QID:PRN SOB/wheezing
14. Ketorolac 0.5% Ophth Soln 1 DROP LEFT EYE QID left eye
15. Lotemax (loteprednol etabonate) 0.5 % ophthalmic (eye) QID
right eye
16. Metoprolol Succinate XL 50 mg PO BID
17. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain
18. Omeprazole 40 mg PO BID
19. Potassium Chloride 10 mEq PO DAILY
20. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP LEFT EYE QID
21. Rosuvastatin Calcium 40 mg PO QPM
22. vit A-vit C-vit E-zinc-copper unit-mg-unit
oral DAILY 2 caps
## DISCHARGE INSTRUCTIONS:
Call Dr. if you experience:
-Fevers > 101 or chills
-Difficult or painful swallowing
-Nausea, vomiting.
-Increased shortness of breath
Pain
-Take Tylenol on a standing basis to reduce opiod use.
-Take stool softners while taking narcotics
-No driving while taking narcotics
Activity
-Shower daily. Wash incision with mild soap and water, rinse,
pat dry
-No tub bathing, swimming or hot tubs until incision healed
-No lotions or creams to incision
-Walk times a day for minutes increase to a Goal of
30 minutes daily
## DIET:
Soft solids as tolerated. If you have any difficulty
swallowing soft solids try a liquid diet for days then
advance to soft solids again.
Eat small frequent meals. Sit in chair for all meals. Remain
sitting up for minutes after all meals
NO CARBONATED DRINKS
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13494259", "visit_id": "22163906", "time": "2131-11-21 00:00:00"} |
10776738-DS-15 | 1,442 | ## CHIEF COMPLAINT:
"It's not that complicated, it's very simple, the counselor who
called the authorities is intimidated by me".
## HISTORY OF PRESENT ILLNESS:
Pt is a yo M with h/o schizophrenia vs. bipolar d/o who was
sent on by group home for evaluation for threatening
behavior. Pt had been sectioned 2 days ago by group home, but
left and could not be located. He returned to the home today,
and the police were called to take him to
for psych eval. At that eval they felt that he did not
meet criteria, and discharged the pt back to the home.
The pt was back at the home for about 1 hr before he again had
verbal altercation with staff and was sent to for eval.
.
Per pt, there is a particular staff member, , who he
believes has a "vendetta" against him and is "bothered" by him,
but he does not know why. He states "if I said to him 'ice cream
is delicious' he would be intimidated". He states that this
counselor "uses E [emotions] over I [intellect] on a constant
basis". The pt acknowledges that he can be "aggressive,
insulting, but not dangerous". He believes this counselor has
"malice" and is "deceitful". He voices multiple complaints about
the home that appear paranoid: that he has multiple electronic
devices (including 7 radios) that are not working and he
believes someone has tampered with, that there are rules for him
that are not enforced with other residents at the home (such as
privileges for staying home or being on other floors or in other
people's rooms), and that staff and residents are going into his
room when he is not home (he reports recently finding his room
"ransacked"). Despite this, he reports that he has been feeling
"upbeat, optimistic", sleeping and eating well, with good energy
and "improving" concentration.
.
Per the group home, the pt was only med compliant for wks
following discharge from in , and has been taking his
meds intermittently for the past few months. He has become
increasingly paranoid, believing that people are "setting him up
to fail". They note that he has been belligerent with staff as
well. They report that he has been missing on a number of
occasions recently; he went to just over a month ago and to
last week, and was arrested on a train in on the way back
from for belligerent behavior.
.
The pt states that he has been intermittently taking meds
recently because Dr. prescribed him Geodon, which he
read could have "fatal" complications due to his prolapsed heart
valve. He feels that because "the same mind" is writing his
other prescriptions, they all could be potentially dangerous.
When asked about his recent travels, he states that he went to
, not , because he "is a " and has a
"rich history for black and press" and he was hoping to
get a job there. He went to "for a business venture" as well.
He states that he got in trouble on the Acela train because he
"stands out" as the Acela is "the most prestigious line". Pt
states that he is an excellent and .
.
Pt's father states that the pt is doing "very poorly" due to his
med non-compliance. He notes "erratic" behavior and "extreme
paranoia" which he feels is "potentially dangerous". He states
that the pt went to his sister's apt last week at 2:30AM and was
banging on the windows for her to let him in, and he was very
upset that she was not being a good sister when she did not let
him in. He also reports that the pt was arrested . evening
for writing graffitti.
## PSYCH HISTORY:
H/o polysubstance abuse, pt reports this is not active.
## PER OMR:
muliple hospitalizations, first at age and most
recent at in . H/o multiple SAs and previous
incarceration for attempted murder against mother (grabbed wheel
while she was driving) but bailed out of jail.
## PSYCHIATRIST:
Dr. , next appt , last seen 2
months ago.
## THERAPIST:
, next appt , last
seen 2 months ago.
.
## FAMILY PSYCHIATRIC HISTORY:
Currently denies, per OMR pt
reported cousin with mental illness in the past.
## APPEARANCE:
middle aged AAM, moderately groomed, lying on
stretcher in T-shirt and shorts
## BEHAVIOR:
initially cooperative, then refuses to cooperate
when he understands he will be admitted, good eye contact,
scratching stomach frequently
## SPEECH:
very talkative with high level vocabulary and
careful word choice, nl rate, volume, and prosody
## THOUGHT FORM:
tangential, occasionally forgets train of
thought but quickly returns to story
## THOUGHT CONTENT:
denies SI/HI ("I'm too arrogant and
narcissistic, it would be beneath me"), denies AH/VH, +PI that
staff at group home are against him, some ? grandiose thinking
(e.g. ability to get job as ), no IOR
## PSYCH:
Pt. was admitted to Deaconess 4. In the ED, prior to
arrival on the unit, he was agitated to the point that he
required chemical restraint, with IM Haldol and Ativan, and
physical restraint. On arrival here he refused physical exam
and was still quite agitated and paranoid. He felt that the
group home had "one set of rules for , and another set of
rules for everyone else." He felt that they had snuck into his
room and "ransacked" it, and that they had tampered with several
of his tape players, causing them to stop working. He felt that
one staff member in particular, "had it out for me," and was
harassing him.
He was initially monitored closely with 5 minute checks, and had
several outbursts with staff. He did not require chemical or
physical restraint, and was able to be redirected.
He initially agreed to take his Lithium, but refused his Abilify
because it had been prescribed by Dr. had
prescribed him a "life threatening" medication in the past (he
felt that Geodon Dr. could be life
threatening because of his mitral valve prolapse, and therefore
suspected that all other medications he prescribed might be
dnagerous for him) On HD #2, after discussion with the team, he
did agree to try the Abilify as well. He improved steadily over
the next week on the Lithium and Abilify. He was much less
paranoid with staff and treaters, and had no more behavioral
issues. He did not miss or refuse any medication doses over the
next week.
.
The staff at his group home were contacted, and agreed to have
him back when he was stabilized. They met with Mr. and
the team on the day of discharge. His outpatient therapist,
, was contacted as well. She reported that he had been in
the process of changing his care from Mass Mental to the , at his request, as well as the request of his
mother. We discussed this with Mr. and with the staff at
his group home. Since the process of finding a new therapist at
the was likely to take awhile, the group
home recommended following up with his established team at
, including , his therapist there, and Dr.
psychiatrist. They will continue to work on
coordinating a transfer of care, either to a different team at
, or to when a therapist appointment can
be arranged. Mr. was in agreement with that plan, and
follow up was arranged with Mental.
.
## NAUSEA:
reported vague, diffuse abdominal pain and nausea after
meals, as well as a burning taste in the back of his throat and
"belching." His description sounded most consistent with GERD,
and his abdominal exam was benign. He was afebrile and had no
diarrhea in house. The nausea improved with Protonix, and was
resolved by the day of discharge.
## MEDICATIONS ON ADMISSION:
Pt has been taking these intermittently:
Abilify 15mg daily
Lithium 300mg qAM and 600mg qhs
Fish oil 1000mg daily
## DISCHARGE MEDICATIONS:
1. Aripiprazole 15 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lithium Carbonate 300 mg Capsule Sig: One (1) Capsule PO QAM
(once a day (in the morning)).
3. Lithium Carbonate 300 mg Capsule Sig: Two (2) Capsule PO QHS
(once a day (at bedtime)).
4. Medication changes
Fish Oil was stopped in house, and should not be restarted after
discharge
## AXIS I:
Schizoaffective disorder, bipolar type
## APPEARANCE:
Sits quietly for exam. Good eye contact, smiling
## SPEECH:
Fluent, normal rate and volume today.
## AFFECT:
Pleasant, reciprocal today, well related.
## THOUGHT PROCESS:
Linear, able to abstract
## THOUGHT CONTENT:
Denies PI. Denies SI. Denies HI.
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital because of threatening
behavior at your group home. We restarted your Lithium and
Abilify with your agreement, and your behavior approved. We
recommend that you continue to take these regularly after you
are discharged.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10776738", "visit_id": "23203008", "time": "2126-06-07 00:00:00"} |
19784432-RR-28 | 403 | ## EXAMINATION:
CT abdomen and pelvis
## INDICATION:
year old man with anemia not responsive to transfusions. Also
with abdominal distention. Please assess for intra-abdominal bleed.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 8.2 s, 53.4 cm; CTDIvol = 28.4 mGy (Body) DLP =
1,498.1 mGy-cm.
Total DLP (Body) = 1,498 mGy-cm.
## LOWER CHEST:
There are bilateral small pleural effusions. There is also a
trace pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder distended containing high-density material
compatible with sludge as noted on ultrasound.
## PANCREAS:
There is a focus of calcification in pancreatic body (series 3,
image 20) likely due to prior injury. There is no pancreatic ductal
dilatation. There is no peripancreatic stranding.
## SPLEEN:
The spleen is enlarged measuring 14.4 cm, previously measures 16 cm
ultrasound dated .. There is a 0.8 cm low-density lesion in
the spleen (series 3, image 24) too small to adequately characterize.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is mild perinephric
stranding, nonspecific.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits.
## PELVIS:
The urinary bladder is partially distended and appears unremarkable.
There is no free fluid in the pelvis. Moderate-sized bilateral fat containing
inguinal hernias are noted.
## REPRODUCTIVE ORGANS:
The prostate is moderately enlarged measuring 5.8 cm.
The seminal vesicles are unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Moderate atherosclerotic
disease is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Marked degenerative changes are seen in the included thoracic and lumbar spine
characterized by anterior osteophytic lipping and loss of intervertebral disc
heights.
## SOFT TISSUES:
There is a small fat containing right inguinal hernia.
## IMPRESSION:
1. No evidence of intra-abdominal and pelvic bleeding.
2. Bilateral small pleural effusions.
3. Distended gall bladder containing sludge.
4. Splenomegaly slightly improved from prior ultrasound on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19784432", "visit_id": "28454436", "time": "2118-11-07 17:29:00"} |
15554479-RR-50 | 358 | ## INDICATION:
man with non-small cell lung cancer and recently
progressed disease on Erlotinib. Patient is to start new treatment, here for
assessment of interval change.
## CT CHEST WITH CONTRAST:
There is no focal thyroid lesion. A retrosternal
anterior mediastinal lymph node now measures 1.3 x 1.9 cm, previously 1 x 1.5
cm (2:20). An additional lymph node anterior to the proximal right main
bronchus measures 2 x 1.2 cm, previously 1.7 x 1 cm (2:25). Additional small
mediastinal lymph nodes do not meet CT size criteria for lymphadenopathy.
There is no axillary lymphadenopathy. The heart is normal in size. Trace
pericardial effusion is within physiologic norm. The aorta and pulmonary
arteries are normal in caliber.
The 4.4 x 6.3 cm lobulated suprahilar primary mass has increased in size since
, previously 3.5 x 5.8 cm (3:15). It insinuates behind the
esophagus, invading the mediastinal fat and encasing the azygos vein. There
is possible subtle osseous destruction along the right lateral aspect of the
adjacent thoracic vertebra (3:15) with subtle loss of cortical margin.
Narrowing and obstruction of the apical segment right upper lobe bronchus is
unchanged.
At least some of the innumerable metastatic nodules predominating the right
lung are also increased in size. These mainly distribute along fissures and
pleura but are also intraparenchymal in location. For example, a 2.2 x 1.9 cm
pleural lesion abutting the lateral right major fascia (2:42) was previously
2.1 x 1.6 cm. A previously 6-mm intraparenchymal lesion is now 9 mm in
longest dimension (3:39). The left lung is largely spared with the exception
of a single nodule in the anterior segment of the left upper lobe (3:29). In
addition, pleural involvement is as evidenced by thickening of the pleura
along the right lung base, with subtle enhancement. There is no pleural
effusion.
Limited subdiaphragmatic evaluation demonstrates no gross abnormality. Focal
sclerosis in the left sixth rib is stable since . No concerning lytic or
blastic osseous lesion is detected.
## IMPRESSION:
Increasing lung and pleural nodules, accompanied by increasing
lymphadenopathy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15554479", "visit_id": "N/A", "time": "2182-03-18 12:12:00"} |
10619088-RR-25 | 115 | ## FINDINGS:
There is no intracranial hemorrhage, mass effect, or acute/subacute
infarction. Ventricles and sulci are enlarged, reflecting parenchymal volume
loss. There is a prominent, round, T2-hyperintense focus in the left
subinsular region, likely a lacunar infarct (4:12) or dilated perivascular
space. Additionally, note is made of remote left cerebellar hemispheric
infarcts. FLAIR images reveal periventricular and deeper white matter signal
hyperintensities, reflecting a background of mild chronic microvascular
disease. Incidental note is made of multiple right maxillary sinus mucus
retention cysts.
## IMPRESSION:
Mild chronic microvascular disease and moderate parenchymal
volume loss. Note is also made of prior left cerebellar hemispheric infarct
and left subinsular lacunar infarct or prominent perivascular space.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10619088", "visit_id": "N/A", "time": "2187-12-16 09:30:00"} |
18151201-RR-52 | 408 | MR OF THE CERVICAL SPINE WITHOUT CONTRAST,
## HISTORY:
woman with history of C5 injury, now with "radiculitis"
in right hand.
## FINDINGS:
The study is compared with remote CECT of the neck soft tissues,
dated (which did not include reformations). The cervical vertebrae
are normal in height, signal intensity, and alignment. The normal cervical
lordosis is maintained. There is no abnormality of the pre- or paravertebral
soft tissues. The craniocervical junction is unremarkable and the cervical
spinal cord is, overall, normal in caliber and signal intensity through the
T4-5 level. However, there is a vague, ovoid 8-mm focus of faint
T2-hyperintensity, centered in the cord substance at the C6-7 level, with most
severe degenerative change, which may represent myelomalacia (3:9).
There is severe degeneration of the C6-7 disc with bulging and superimposed
moderately large right paracentral disc-endplate/uncovertebral spondylotic
complex; this flattens the ventral cord, slightly indenting its right lateral
aspect at the exiting C7 nerve root entry zone. There is also facet arthrosis
contributing to relatively severe narrowing of the right neural foramen with
possible exiting nerve root impingement at this site ( ).
However, allowing for the difference in modalities, the appearance is overall
not significantly changed since the CT.
There is less marked degeneration of the C4-5 disc with a small central
protrusion which does not significantly efface the ventral CSF or indent the
spinal cord. There is degeneration of the C5-6 disc with a broad-based but
shallow disc-endplate spondylotic complex, which does not significantly efface
the ventral CSF or contact the cord. Uncovertebral spondylosis results in
moderate narrowing of the neural foramina, bilaterally; this, too, does not
appear significantly changed. Though there is multilevel desiccation of the
cervical intervertebral discs, no other significant bulge or focal herniation
is identified.
## 1. C6-7:
Disc degeneration with moderately large right paracentral
disc-spondylotic complex which indents the ventral cord, likely impinging upon
the exiting right C7 nerve root, both at its root entry zone as well as in
that foramen; these findings do not appear significantly changed since the
remote CT.
2. Faint T2-hyperintensity within the cord substance at the C6-7 level may
represent chronic myelomalacia.
## 3. C4-5 AND C5-6:
Relatively minor degenerative disease, without significant
canal narrowing or cord compression; there is moderate bilateral neural
foraminal narrowing at the C5-6 level, which also does not appear
significantly changed since the CT.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18151201", "visit_id": "N/A", "time": "2174-01-03 14:20:00"} |
10952531-RR-20 | 126 | ## HISTORY:
male status post fall down 15 stairs.
## NON-CONTRAST HEAD CT:
There is no hemorrhage, mass, mass effect, or acute
large territorial infarction. Gray-white matter differentiation is preserved.
The ventricles and sulci are normal in size and morphology. There is no shift
of the usually midline structures. Suprasellar and basilar cisterns are
widely patent. There is no scalp hematoma or acute skull fracture. There is
complete opacification of the right frontal sinus, partial ethmoid air cell
opacification and bilateral maxillary sinus mucous retention cysts consistent
with inflammation. The mastoid air cells are well aerated. Sphenoid sinuses
remain patent. There is a right nasal bone fracture, age indeterminate
## IMPRESSION:
1. No acute intracranial process.
2. Pansinusitis.
3. Right nasal bone fracture, age indeterminate.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10952531", "visit_id": "26501620", "time": "2131-08-09 21:27:00"} |
10224048-RR-23 | 51 | ## CLINICAL INDICATION:
History of pancreatic pseudocyst and intra-abdominal
fluid collection.
## IMPRESSION:
1. Omental fat necrosis from pancreatitis decreased in size compared to
prior. Normal-appearing residual pancreas.
2. Nearly or completely occluded left common iliac stent with evidence of
collateral arterial flow to reconstitute the external iliac artery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10224048", "visit_id": "N/A", "time": "2137-02-01 08:46:00"} |
13307568-RR-5 | 113 | ## EXAMINATION:
UNILAT LOWER EXT VEINS RIGHT
## HISTORY:
with known popliteal cyst, likely drainage
tomorrow. // DVT? Popliteal cyst rupture?
## 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 posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
Within the medial popliteal fossa, there is a 7.5 x 2.1 x 0.9 cyst
demonstrating mild internal complexity.
## IMPRESSION:
1. No evidence of deep venous thrombosis in the right lower extremity veins.
2. 7.5 x 2.1 x 0.9 cm right cyst with mild internal complexity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13307568", "visit_id": "27999422", "time": "2173-11-06 18:57:00"} |
12445879-RR-64 | 937 | ## INDICATION:
year old man with transplant renal artery stenosis // please
treat stenosis
## 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
150 mcg of fentanyl and 1 mg of midazolam throughout the total intra-service
time of 1 and 20 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:
units of intravenous heparin.
## CONTRAST:
88 ml of Visipaque contrast.
## PROCEDURE:
1. Left common femoral arteriogram to determine appropriateness
for Angio-Seal deployment.
2. Right common iliac arteriogram to determine approach to transplant renal
artery.
3. Right external iliac arteriogram with cone beam CT to determine
orientation, severity and approach to treating the ostial stenosis.
4. Main renal transplant arteriogram to determine direction of flow and
patency.
5. Intrarenal Transplant arteriogram after angioplasty to confirm forward
flow.
6. Balloon angioplasty of a ostial transplant renal artery stenosis using 5
and 6 mm balloons.
7. Pre angioplasty and post angioplasty pressure measurements to determine
pressure gradients between the main renal artery and the right external iliac
artery.
8. Angio-Seal deployment.
## PROCEDURE DETAILS:
Following the discussion of the risks, benefits and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per protocol. Both groins were
prepped and draped in the usual sterile fashion.
Using palpatory and fluoroscopic guidance, the left common femoral artery was
punctured using a micropuncture set at the level of the mid-femoral head. A
0.018 wire waspassed easily into the vessel lumen. A small skin incision was
made over the needle. Then the inner dilator and wire were removed and a
wire was advanced under fluoroscopy into the aorta. The micropuncture
sheath was exchanged for a 5 sheath which was attached to a continuous
heparinized saline side arm flush.
A left common femoral arteriogram was performed through the sheath showing
normal anatomy with a low common femoral artery bifurcation.
wire was advanced through the sheath into the aorta. An Omni
flush catheter and glidewire were used to select the right common femoral
artery. The catheter was then removed and a 6 sheath was
advanced over the wire into the common iliac artery. A common iliac
arteriogram was performed to determine approach to the transplant renal
artery. The Cobra catheter was then advanced to attempts selection of the
transplant renal artery. Due to difficult navigation of the ostial stenosis, a
right external iliac arteriogram with a cone beam CT was performed to
determine orientation, severity and upper is treating the ostial stenosis.
Rotational cone-beam CT angiography was performed to help delineate the
anatomy. Multiplanar CT images were reconstructed and 3D volume-rendered
images of the arterial anatomy required post-processing on an independent
workstation under direct physician (Dr. . These images were
used in the interpretation, decision making for intervention and reporting of
this procedure.
Using the cobra catheter and a glidewire, the main renal artery was accessed.
The catheter was advanced to the main renal artery and the main renal
arteriogram was performed to determine forward flow. Pressure measurements
were obtained in the external iliac artery and the main renal artery prior to
angioplasty. The glidewire was then exchanged for wire. Over the
wire first a 5 mm balloon was advanced over the stenosis. Balloon angioplasty
was performed. A main renal arteriogram and intrarenal arteriogram was
performed following balloon angioplasty to confirm forward flow. Pressure
measurements were repeated in the external iliac and main renal artery. Due to
the residual pressure gradient, decision was made to pursue 6 mm balloon
angioplasty. A 6 mm balloon was advanced over the wire. Balloon
angioplasty was performed. Repeat pressure measurements were obtained in the
external iliac and main renal artery. The main renal arteriogram confirmed
former flow. An external iliac arteriogram confirmed excellent angiographic
result. The wires and catheters were then removed.
A common femoral arteriogram was performed prior to use of a closure device.
Manual pressure was held until hemostasis was achieved.
## FINDINGS:
1. Patent right common iliac, external iliac and internal iliac arteries with
a transplant renal artery arising from the mid external iliac artery medially.
2. Right external iliac cone beam CT arteriogram showing a tight greater than
70% ostial stenosis with tortuous course of the vessel immediately following
the stenosis.
3. Pre treatment common iliac mean arterial pressure of 114 mm of mercury and
main renal mean arterial pressure of 58 mm of mercury. The pressure gradient
is 46 mm of mercury.
4. Balloon angioplasty of the ostial stenosis with a 5 mm balloon with mild
improvement angiographic result.
5. Post 5 mm PTA, external iliac mean arterial pressure of 98 mm of mercury
and main renal mean arterial pressure of 75 mm of mercury. The pressure
gradient is 23 mm of mercury.
6. Post 6 mm PTA, external iliac mean arterial pressure of 78 mm of mercury
and main renal mean arterial pressure of 75 mm of mercury. The mean pressure
gradient is 3 mm of mercury.
7. Post treatment angiogram showing excellent angiographic result with near
resolution of the ostial stenosis.
8. Left common femoral arteriogram showing a low common femoral bifurcation
amenable to Angio-Seal deployment.
## IMPRESSION:
Approximately 70% ostial transplant renal artery stenosis successfully treated
with a 6 mm balloon with resolution of the pressure gradient.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12445879", "visit_id": "N/A", "time": "2184-10-13 09:48:00"} |
16090837-RR-60 | 209 | ## EXAMINATION:
ANKLE AP AND LAT STANDING RIGHT
## INDICATION:
year old man with right foot and ankle pain// evaluate for
bony injury vs. arthritis
## FINDINGS:
There is diffuse osteopenia and surrounding soft tissue swelling. No obvious
lytic or sclerotic fracture line or significantly displaced fracture fragment
is identified. Subtle bony irregularity along the medial malleolus of the at
the base of the medial malleolus is noted--if this corresponds to a site of
focal tenderness it could represent a very subtle fracture, possibly an
insufficiency fracture. No other fracture and no dislocation is detected
about the right ankle. There are small posterior and plantar calcaneal spurs
and dense vascular calcification.
## IMPRESSION:
Diffuse osteopenia.
Subtle irregularity of the trabeculae and cortex along the medial malleolus
could represent normal variation with mild degenerative change. However, if
this corresponds to a focal site of tenderness, the possibility of a
nondisplaced fracture, possibly an insufficiency fracture, would be
considered. If clinically indicated,, MRI of the ankle, or, alternatively,
follow-up radiographs in days could help for further assessment.
Soft tissue swelling. Vascular calcification.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 11:40 into the Department of Radiology critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16090837", "visit_id": "N/A", "time": "2149-03-16 10:27:00"} |
18786690-RR-15 | 281 | ## INDICATION:
Trauma with right shoulder pain and pleuritic chest pain.
## CHEST:
The thyroid is normal. There is no mediastinal, hilar, or axillary
lymphadenopathy. The aorta is unremarkable. The heart size is normal and
there is no pericardial effusion. Dense coronary artery calicifications are
seen. The lungs are clear, without focal consolidation. There is bibasilar
dependent atelectasis. No pneumothorax or pleural effusion is evident.
## ABDOMEN:
The liver enhances homogeneously without focal lesions. The
gallbladder is surgically absent. The spleen, pancreas, and adrenal glands
are unremarkable. The kidneys enhance symmetrically and excrete contrast
without hydronephrosis. Bilateral renal hypodensities are too small to
characterize but likely represent simple cysts. The abdominal aorta and its
major branches are unremarkable other than a mild amount of atherosclerosis
without aneurysmal dilatation. The stomach, large and small bowel are normal.
There is no free air or free fluid.
## PELVIS:
The bladder, rectum and sigmoid are normal. Calcifications are seen
within a normal-sized prostate. There is no free pelvic fluid.
## BONES:
There is a comminuted fracture of the right humeral head. No
dislocation is present. Acute non-displaced fractures are seen at the right
first and second ribs. Age-indeterminate fractures are seen in the right
third through sixth ribs. Old rib fractures are seen within the left ribs.
There are age-indeterminate compression fractures seen at T12 and T6. There
are no suspicious osseous lesions.
## IMPRESSION:
1. Comminuted fracture of the right humeral head and acute, non-displaced
fractures of the right first and second ribs. No pneumothorax or hemothorax.
2. No intra-abdominal solid organ injury.
3. Age-indeterminate fractures at the third through sixth right ribs and
compression fractures of T12 and T6.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18786690", "visit_id": "23972607", "time": "2174-09-04 08:35:00"} |
19319186-RR-23 | 138 | ## INDICATION:
, h/o type 1 choledochal cyst s/p robot-assisted excision of
cyst with RNY HJ to extrahepatic duct, c/b HJ stricture requiring dilation and
PTBD, presenting with abdominal pain, N/V// Evaluate for stricture/obstruction
at J-J junction
## DOSE:
Acc air kerma: 5 mGy; Accum DAP: 208.1 uGym2; Fluoro time: 36 seconds
## FINDINGS:
Thin barium was administered with the patient upright.
A percutaneous transhepatic biliary drain is seen with pigtail in the right
upper quadrant.
Barium passed freely through the esophagus into the stomach and then into the
proximal small bowel. After about 10 minutes, contrast had passed beyond the
expected location of the jejunojejunal anastomosis, into the distal small
bowel. There is no evidence of leak or obstruction.
## IMPRESSION:
1. No evidence of stricture or obstruction at the jejunojejunal anastomosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19319186", "visit_id": "24744887", "time": "2159-10-10 13:21:00"} |
19487795-RR-216 | 154 | REMOVAL OF HEMODIALYSIS CATHETER
## INDICATION:
woman with end-stage renal disease, on hemodialysis,
with tunneled line infection. For removal of the tunneled hemodialysis line.
## OPERATORS:
Dr. (fellow) and Dr. (attending radiologist).
Dr. was present for the key portions of the procedure.
## ANESTHESIA:
Local anesthesia was provided with lidocaine 1% buffered
solution.
## PROCEDURE AND FINDINGS:
The patient was brought to angiographic suite and
placed in semi-upright position. The existing catheter was prepped and draped
in usual sterile fashion. The fluid from the catheter was withdrawn. Local
anesthesia was applied with lidocaine 1% buffered solution. Blunt dissection
was used then to remove the hemodialysis catheter. Manual pressure was
applied on the venotomy site to achieve hemostasis. Sterile dressings were
applied. The patient tolerated the procedure well. No immediate
post-procedure complications were noted.
## IMPRESSION:
Uncomplicated removal of the tunneled hemodialysis line. Tip of
the catheter was sent to the lab for culture as requested.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19487795", "visit_id": "27823909", "time": "2154-02-07 14:22:00"} |
14694914-RR-30 | 223 | ## HISTORY:
male with nontraumatic subarachnoid hemorrhage, status
post bilateral ICA coiling, now with new change in neurologic exam noted
earlier this evening.
.
## FINDINGS:
Multiple bilateral infarcts continue to evolve, best seen at the
splenium of the corpus callosum, right greater than left, and diffusely
throughout the bilateral frontal lobes, right greater than left.
Additionally, there is a new, large area of sulcal effacement, and loss of
gray-white matter differentiation in the right MCA territory.
A small amount of subarachnoid blood continues to be seen layering along
cortical sulci in the bilateral posterior frontoparietal regions. Bilateral
internal carotid artery aneurysm coils are again seen, with regional streak
artifact slightly limiting evaluation. Partial opacification of the left
maxillary sinus and ethmoid air cells has improved since prior exam. There
remains partial opacification of the mastoid air cells bilaterally.
The ventricles and basal cisterns are unchanged in size and configuration.
## IMPRESSION:
1. New large area of sulcal effacement and loss of gray-white differentiation
in the right MCA territory, highly concerning for evolving infarction.
2. Continued evolution of numerous bilateral previously noted watershed
infarcts, particularly prominent in the bilateral frontal lobes, right greater
than left.
3. Interval evolution of subarachnoid blood layering along the sulci in the
posterior frontoparietal region.
Above urgent findings were discussed with Dr. at 8:30 p.m. on
.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14694914", "visit_id": "27978527", "time": "2112-03-13 20:17:00"} |
16304867-RR-21 | 136 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## HISTORY:
s/p fall from wheelchair, unclear LOC// eval for
bleed
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 12.0 s, 20.4 cm; CTDIvol = 48.8 mGy (Head) DLP =
994.8 mGy-cm.
Total DLP (Head) = 1,032 mGy-cm.
## FINDINGS:
There is no evidence of infarction,hemorrhage,edema,or mass. The ventricles
and sulci are normal in size and configuration.
Mild soft tissue swelling is seen overlying the right frontal and temporal
regions. There is no evidence of fracture. The visualized portion of the
paranasal sinuses, mastoid air cells, and middle ear cavitiesare essentially
clear. The visualized portion of the orbits are unremarkable.
## IMPRESSION:
1. Small soft tissue swelling overlying the right frontal and temporal
regions. No calvarial fracture.
2. No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16304867", "visit_id": "25689797", "time": "2123-08-20 16:22:00"} |
15826088-RR-78 | 89 | ## HISTORY:
male status post fall and shortness of breath, to assess
for cardiopulmonary process.
## FINDINGS:
There is stable appearance to the sternotomy suture as well as the fusion rods
in the thoracolumbar spine. There is elevation of the left hemidiaphragm,
which is new since the prior examination. The cardiomediastinal silhouette is
stable. There is no focal pulmonary consolidation.
## CONCLUSION:
Elevation of the left hemidiaphragm, which is new since the prior examination.
A PA and left lateral radiograph is recommended for further evaluation of the
elevated left hemidiaphragm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15826088", "visit_id": "26953587", "time": "2115-04-04 11:32:00"} |
11295854-DS-7 | 2,080 | ## ATTENDING:
Complaint:
year old young woman with recurrent Hodgkin's lymphoma who is
being admitted for her cycle of IGEV(Ifosfamide,
Gemcitabine, Navelbine, and Methylprednisolone).
## HISTORY OF PRESENT ILLNESS:
On the floor, pt feels well. She feels a bit nervous in
anticipation of nausea given her experience during her last
hospitalization.
.
REVIEW OF SYSTEMS (per OMR admit note , reviewed with
patient on admission):
(+) Her appetite has improved over the past week and she is
eating and drinking better.
(-) She denies fevers, chills, night sweats, cough, nasal or
sinus congestion, sore throat. She denies nausea, vomiting,
diarrhea, or abdominal pain. She denies chest pain, shortness
of breath, headaches, or lightheadedness. She notes no bleeding
or increased bruising. She notes no new rashes. She has no
numbness or tingling of her extremities.
## PER OMR:
is a year old young woman who presented in at
the age of with neck swelling and 10 pound weight loss. She
underwent cervical lymph node biopsy and was found to have
nodular sclerosing Hodgkins disease, Stage IIA. By
immunohistochemistry, the large atypical cells were CD30 and
CD15 positive and negative for CD45 and CD20. LMP1 stain for
EBV was negative. PET CT staging showed a large anterior
mediastinal mass measuring 10 x 2.5 x 8 with heterogenous FDG
uptake ranging from mild to a maximum of 10.3. She also had FDG
avid bilateral supraclavicular and right paratracheal
lymphadenopathy. There was no abnormal FDG uptake below the
diaphragm. She is status post five cycles of ABVD with her last
chemo given on followed by mediastinal and involved
field radiation, which was completed on . Restaging
PET scan on showed mild FDG uptake and a prevascular
lymph node with enlargement of the node. The area of uptake was
within the residual mass, which was concerning for recurrence.
The area was felt to be difficult to biopsy technically and the
decision was made to follow with serial scans which remained
essentially stable and felt not to be area of recurrence. PET-CT
on showed increased FDG-avidity in the mediastinal
mass(SUV 9.47) and a node adjacent to the pulmonary artery(SUV
7.75). On , underwent a right thoracoscopy and
biopsy of the anterior mediastinal mass with pathology
consistent with relapsed HOdgkin's lymphoma(CD15 and CD30+ and
rare RS cells).
.
Given her recurrent disease in the prior radiation field, the
plan is for to receive chemotherapy and proceed to
autologous stem cell transplant provided she has chemorepsonsive
disease. In preparation for this, she underwent echocardiogram
which showed an EF of 60%. Pulmonary function tests showed an
FVC of 109%, FEV1 of 90%, TLC of 97%, and DLCO of 92%. Prior to
her first cycle of therapy, underwent successful egg
harvesting. She had a normal PAP and HPV testing. Repeat PET
scan on showed stable disease from . She had
a Hickman placed at her admission and she received her first
cycle of IGEV on . She overall tolerated this
relatively well, but noted increased nausea around days 4 - 7
which delayed her discharge. On her second
hospital day, her line site was noted to be red, painful and had
some increased serosanguineous drainage. There was concern for
possibly a tunnel line infection and cultures were drawn from
the line and taken from around the site. had one set of
blood cultures grow out Corynebacterium species. All subsequent
cultures have been negative. Her intake was somewhat decreased
but she is now eating and drinking better. She also noted some
increased bone pain with the Neupogen. counts have
recovered and she is being admitted for her cycle
of IGEV.
.
MEDICAL HISTORY:
1. Reurrent Hodgkin's lymphoma as outlined above.
2. Abnormal TFTs:
- h/o of XRT to
- : TSH 4.6, T4
- will follow since at risk for thyroid dysfunction
3. Panic disorder/agoraphobia: started after diagnosis of HL.
4. Abnormal pap smear:
- Pap: ASCUS, HPV + Colpo negative for HPV,
can resume normal screening
## PER OMR:
Mother, father alive and well without any significant
medical problems. Her two siblings, a brother and a sister are
also well. There is no oncologic history.
## PHYSICAL EXAM:
Exam on admission :
## VS:
T 97.8 P , 89 BP 110/56 RR 18 %O2 Sat 99% RA
Wt. per hospital scale: 124.2 lbs, Ht 66 inches, BMI 20.0 Kg/m2
## HEENT:
Sclera anicteric. MMM. No OP lesions.
## LN:
No cervical, supraclavicular, axillary LAD
## CARDIAC:
RRR, nl S1, S2, no m/r/g
## ABD:
s/nt/nd, +BS, no HSM, negative sign
## EXT:
No edema b/l, wwp, 2+ DP pulses b/l
site: dsg c/d/i, no surrounding erythema or induration
.
Exam at discharge :
Tm 99.5 Tc 99.5 BP 98/72 HR 110 100% RA
## HEENT:
Sclera anicteric. MMM. White plaque on tongue, mild
erythema in posterior pharynx
## LN:
No cervical, supraclavicular, axillary LAD
## CHEST:
Clear to ascultation b/l without ronchi or wheezes.
## CARDIAC:
RRR, nl S1, S2, no m/r/g
## ABD:
s/nt/nd, +BS, no HSM, negative sign
## EXT:
No edema b/l, wwp, 2+ DP pulses b/l
site: dsg c/d/i, no surrounding erythema or induration
## EKG:
NSR 65, normal axis and intervals, no TWI or ST
segment changes.
## BRIEF HOSPITAL COURSE:
is a woman with recurrent Hodgkin's lymphoma,
admitted for her second cycle of IGEV chemotherapy.
# Recurrent Hodgkin's lymphoma - Pt underwent IGEV therapy per
the following schedule.
-Ifosfamide Day
( )
-Mesna Day
( )
-Gemcitabine Day 1&4
( )
-Navelbine Day 1
( )
-Methylprednisolone 100mg IV Day
( )
-Neupogen 24h after completing Chemotx
( )
-Zyrtec 10mg daily, to start day before neupogen for bone pain
(start
She did have some nausea (see below) after chemo, but otherwise
tolerated it well. She was able to tolerate PO and was taking in
2L fluids daily before discharge.
# Nausea - Due to nausea during her last chemo administration,
was on the following anti-emetic regimen.
-Emend 125 mg Day 1 ( )
-Emend 80 mg Day ( )
-Zofran 8 mg IV BID with the Emend Day ( )
-Granisetron patch Day 4 ( ) continuing for 7 days (thru
, but patch was stopped to see if this will help
with her more delayed nausea.
-Ativan 0.5-1mg PO/IV q8H: PRN anxiety, nausea
-Zyprexa 2.5mg PO BID:PRN refractory nausea
Her nausea was well controlled on the above regimen. She felt
that zyprexa was the most helpful medication for her. Although
her granisetron patch was originally scheduled to be worn
through , she was having headaches and developed a mild
transaminitis and patch was stopped on .
# Transaminitis - Pt's LFTs were mildly elevated in two days
prior to discharge. It was attributed to medication effect,
possibly from her granisetron patch. She was instructed to
follow up to have her LFTs checked as an outpatient.
# Thrush - pt developed oral thrush without difficulty
swallowing. She was started on Nystatin mouth wash with
continued use after dicharge.
# Temperature increase - on the day of discharge, pt's
temperature was 99.5. She had no localizing symptoms. She did
have mild erythema in the posterior pharynx without symptoms.
She was discharged with strict instructions to take her
temperature prior to going to bed on day of discharge and return
if her Temp was 100.4 or higher, without taking tylenol. She was
also instructed to return for any new concerning symptoms.
# Lupron - Pt's last lupron shot was 3.75mg on . Plan is
to check her LFTs on in the clinic, and if
they are normal, pt will get her lupron shot at that visit. If
she does not receive a shot on , this should be addressed
at her office visit.
was deemed medically stable and fit for discharge on
with follow up in the and clinics.
Following this cycle of therapy, undergo PET
scanning to asses her response. Provided she has
chemoresponsive disease, she will proceed with Cytoxan for stem
cell mobilization and collection.
## MEDICATIONS ON ADMISSION:
(reviewed by NP on with patient, no changes prior to
admission :
APREPITANT [EMEND] - 125 mg (1)-80 mg (1)-80 mg (1) Capsule,
Dose Pack - 1 Capsule(s) by mouth for three days
APREPITANT [EMEND] - 80 mg Capsule - 1 (One) Capsule(s) by mouth
once a day for 2 more days with each cycle of chemotherapy
FILGRASTIM [NEUPOGEN] - 300 mcg/0.5 mL Syringe - 0.5 ml once a
day start hours after completion of chemo. Continue until
told to stop by Dr. [ ] - 3.1 mg/24 hour Patch Weekly - 1 patch q
3 weeks apply for 7 days
LORAZEPAM [ATIVAN] - 0.5 mg Tablet - 1 to 2 Tablet(s) by mouth
every six (6) hours to eight (8) hours as needed.
ONDANSETRON HCL [ZOFRAN] - 8 mg Tablet - 1 Tablet(s) by mouth
every six (6) hours as needed for nausea
OXYCODONE - 5 mg Tablet - Tablet(s) by mouth every 3 hours
as needed for pain
PROCHLORPERAZINE MALEATE - 5 mg Tablet - 1 Tablet(s) by mouth
every six (6) hours as needed for nausea
## DISCHARGE MEDICATIONS:
1. Filgrastim 300 mcg/mL Solution Sig: Three Hundred (300) mcg
Injection Q24H (every 24 hours).
2. Granisetron 3.1 mg/24 hour Patch Weekly Sig: One (1) patch
Transdermal once a week for 1 weeks: Apply for 7 days total (day
1 = .
3. Lorazepam 0.5 mg Tablet Sig: Tablets PO every hours
as needed for nausea/anxiety.
4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
Disp:*60 Tablet(s)* Refills:*2*
5. Zofran 8 mg Tablet Sig: One (1) Tablet PO every six (6) hours
as needed for nausea.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*2*
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*2*
8. Oxycodone 5 mg Tablet Sig: Tablet PO Q3H (every 3
hours) as needed for pain: Do not drive or lift heavy objects if
you are taking this medication.
9. Prochlorperazine Maleate 5 mg Tablet Sig: One (1) Tablet PO
every six (6) hours as needed for nausea.
10. Saline Flush 0.9 % Syringe Sig: as directed syringe
Injection once a day: Flush each lumen with 10 mL Normal saline
followed by Heparin daily and PRN.
11. Heparin (Porcine) in NS 10 unit/mL Kit Sig: per line care
per line care Intravenous once a day: Flush with 10 mL Normal
saline followed by Heparin daily and PRN per lumen.
12. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Dulcolax 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO once a day as needed for
constipation.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
14. Nystatin 100,000 unit/mL Suspension Sig: Five (5) mL PO four
times a day as needed for thrush: Take until your thrush
resolves and you are told to stop by Dr. .
Disp:*1 bottle* Refills:*0*
## DISCHARGE DIAGNOSIS:
1. Hodgkin's Lymphoma
2. Nausea
## DISCHARGE CONDITION:
Stable, afebrile, able to tolerate food and drink, nausea
controlled, HR 110s
## DISCHARGE INSTRUCTIONS:
You were admitted for IGEV chemotherapy, which you tolerated
well. Your nausea was better controlled this admission with your
specialized regimen. You were able to drink fluids and were
deemed medically stable to go home on .
## CHANGES TO YOUR MEDICATIONS:
1. STOP Emend as you have completed the course while in the
hospital
2. START Neupogen 300mcg daily until told to stop by Dr.
3. START Zyrtec 10mg daily to help prevent bone pain until told
to stop by Dr.
4. START Famotidine 20mg twice a day- please discuss with Dr.
long you should be on this medication.
4. START Senna 8.6mg twice a day if needed for constipation
5. START Docusate 100mg twice a day if needed for constipation
6. START Dulcolax 10mg daily if needed for constipation
7. START Nystatin oral mouth wash four times a day for thrush
8. Your last lupron shot was for 3.75mg on . We will
check your LFTs on and if they are normal, you will get
your lupron shot at that visit.
Please seek immediate medical attention if you develop fever
>100.4F, chills, inability to tolerate food or water, pain with
urination, blood in the stool, black stool, abdominal pain,
chest pain, shortness of breath, swelling in your ankles or
belly, trouble breathing when lying flat, or any new concerning
symptom.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11295854", "visit_id": "21249850", "time": "2157-01-13 00:00:00"} |
19357564-RR-33 | 239 | ## INDICATION:
year old woman with uterine cancer, on surveillance.
Asymptomatic adrenal nodule seen on imaging// Left adrenal nodule seen on CT,
present since at least . Please further assess with MRI
## FINDINGS:
Lower thorax: Unremarkable.
## LIVER:
The liver is not cirrhotic there is no hepatic steatosis. No
concerning liver lesion within the limitation of a non-contrast MRI.
## BILIARY:
No intra or extra biliary duct dilatation. The gallbladder is
unremarkable.
## PANCREAS:
The pancreas is homogeneous. No main duct dilatation.
## ADRENAL GLANDS:
There is a 3.8 x 2.2 cm left adrenal nodule demonstrating
overall hyperintense T2 signal as well as drop of signal in the out of phase
sequence. The right adrenal is unremarkable.
## KIDNEYS:
Unremarkable besides a 2.6 cm right interpolar cortical cyst. No
hydronephrosis.
## GASTROINTESTINAL TRACT:
No bowel obstruction. Uncomplicated sigmoid
diverticulosis.
## PELVIS:
The urinary bladder is unremarkable. Status post hysterectomy. No
adnexal mass. No pelvic lymphadenopathy.
## LYMPH NODES:
No abdominal lymphadenopathy. No ascites.
## VASCULATURE:
No abdominal aortic aneurysm. Limited assessment of the vessel
in the absence of IV contrast.
## OSSEOUS AND SOFT TISSUE STRUCTURES:
No concerning bone lesions. There is a
focal signal abnormality in the left subcutaneous tissue of the abdominal wall
unchanged from prior and likely representing scarring.
## IMPRESSION:
Limited study as the patient could not tolerate the complete exam and was
breathing inconsistently during the exam.
Previously described left adrenal nodule corresponds to a 3.8 cm left adrenal
adenoma.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19357564", "visit_id": "N/A", "time": "2113-08-27 08:09:00"} |
11317873-RR-23 | 174 | ## INDICATION:
year old man with LLE cellulits, IVDU, expanding wound //
concern for necrotizing fasciitis
## FINDINGS:
Subcutaneous edema and fat stranding is seen overlying the lateral left knee
extending down to the left dorsum, with foot not completely imaged. There is
skin thickening with a focal area of discontinuity of the skin likely an ulcer
along the lateral aspect (3:159) at the level of the mid tibia. There is
thickening of the fascial layers from the knee extending distally. There is
no subcutaneous or intramuscular free air. No abscesses are seen. No
osteolytic or blastic bone lesions involving the visualized portions of the
femur, patella, as well as the tibia and fibula.
## IMPRESSION:
Small focal ulcer at the lateral mid calf associated with skin thickening,
subcutaneous edema, fat stranding, and fascial thickening of the left lower
extremity extending from the left lateral knee to the left dorsum, with the
left foot not completely imaged. These findings correspond with cellulitis,
with no evidence of necrotizing fasciitis/myositis or abscesses. No evidence
of osteomyelitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11317873", "visit_id": "N/A", "time": "2187-06-27 01:04:00"} |
15471804-DS-20 | 1,028 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## CHIEF COMPLAINT:
abdominal pain, nausea, vomiting
## HISTORY OF PRESENT ILLNESS:
speaking male with history of renal cell
carcinoma s/p nephrectomy and small bowel obstruction likely
secondary to strongyloides s/p ivermectin and small bowel
resection, hypothyroidism present with abdominal pain, nausea,
vomiting since 4pm the day prior to admission.
.
The patient was in his usual state of health until the day prior
to presentation. He was sitting at work when he developed
periumbilical abdominal pain. He states that it was crampy,
increased in intensity and did not radiate anywhere. The pain
increased with standing up. The pain came in waves every 30
minutes. He also became nausea and vomited multiple times with
green mucous but no blood. He had two normal bowel movements at
4pm and 8pm without relief of pain. There was no blood in his
bowel movements. He presented to the emergency department
because he was worried that he may be having another small bowel
obstruction. He denies chest pain, shortness of breath,
diaphoresis, radiation, diarrhea, constipation, sick contacts,
travel history, fever, chills, cough. The patient notes that he
did eat lamb for the first time in years on New Years. His
wife also ate the lamb and had no symptoms.
.
In the ED, initial vitals: T 98.7, HR 94, BP 138/89, SaO2 97%
RA. The patient was given aspirin and zofran with complete
relief of his abdominal pain. A KUB and CXR were read as
unremarkable. CE were sent and were negative. An EKG showed PWI
and TWI in V1-V2, which were new from prior EKGs. No evidence of
ST changes or Q waves. The patient was admitted for rule out
myocardial infarction. He had no further abdominal or
gastrointestinal systems.
.
Vitals on transfer: HR 76, BP 124/93, RR 16, SaO2 98% RA. On the
floor the patient felt at baseline and did not have abdominal
pain.
.
## ROS:
Denies fever, chills, night sweats, headache, vision
changes, rhinorrhea, congestion, sore throat, cough, shortness
of breath, chest pain, diarrhea, constipation, BRBPR, melena,
hematochezia, dysuria, hematuria.
## PAST MEDICAL HISTORY:
meningioma, s/p craniotomy
seizure disorder
renal cell ca, s/p right nephrectomy
symptomatic gallstones, s/p open cholecystectomy
hypothyroidism
hemorroids, s/p banding
s/p left inguinal hernia repair
## FATHER:
deceased at years old of intestinal tumor
## GENERAL:
Well appearing, speaking male, NAD
## HEENT:
Normocephalic, atraumatic, no pallor, no scleral icterus,
EOMI, MMM, OP without lesions
## CARDIAC:
RR, nl rate, no murmurs, rubs or gallops appreciated
## LUNG:
CTAB, no wheeze or crackles
## ABDOMEN:
Soft, nontender, nondistended, +BS, no masses noted, no
organomegaly noted
## NEURO:
Alert, strength in all extremities, CN grossly intact
## PSYCH:
Listens and responds to questions appropriately, pleasant
## CXR FINDINGS:
The lungs are clear. There is no
pneumothorax or pleural effusion. Cardiac silhouette, hilar, and
mediastinal contours appear normal. The pleural surfaces are
normal in appearance. There are slight degenerative changes in
the thoracolumbar spine. IMPRESSION: No acute cardiopulmonary
process.
## KUB FINDINGS:
There are multiple clips throughout the
right abdomen, stable. On the upright view there are a few
air-fluid levels which may be within loops of colon. There are
no dilated loops of bowel, however, to suggest obstruction.
There is no free air. There are no abnormal-appearing abdominal
masses. Partially visualized osseous structures appear normal
apart from mild degenerative changes at bilateral hips with
osteophyte formation along the superior acetabular roof.
## IMPRESSION:
No evidence for bowel obstruction. Non-specific
bowel gas
pattern.
EKG Normal sinus rhythm. Low voltage in the standard
leads. Possible left atrial abnormality.
## BRIEF HOSPITAL COURSE:
male with past medical history of small bowel
obstruction, multiple abdominal surgeries presents with
abdominal pain, nausea and vomiting which resovled with Zofran.
#. Abdominal Pain: The patient states that he was concerned that
he may be having another small bowel obstruction. He vomited and
felt nauseous as well as had periumbilical pain. He has been
having bowel movements and passing gas at normal frequency. He
states that his abdomen felt distended yesterday but has since
resolved. His symptoms resolved after administration of Zofran.
He had not further episodes of abdominal pain and was able to
eat breakfast and lunch without return of symptoms. He was ruled
out for MI as well. He was discharged with outpatient follow up.
## #. EKG ABNORMALITIES:
Nonspecific changes to the anterior leads.
Symptoms not likely cardiac in nature given location, onset, and
progression of symptoms. Two sets of enzymes were negative and
EKG unchanged. Has low risk and few cardiac risk factors.
#. Seizure disorder: continued dilantin and phenobarbital per
outpatient regimen.
.
#. Hypothyroidism: continued synthroid per outpatient regimen.
.
Other problems were chronic in nature and did not require
management as an inpatient.
## MEDICATIONS ON ADMISSION:
- phenobarbitol 30mg qAM, 90mg qPM by mouth
- dilantin 100mg qAM, 200mg qPM by mouth
- Synthroid daily
## DISCHARGE MEDICATIONS:
1. Phenobarbital 30 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
2. Phenobarbital 30 mg Tablet Sig: Three (3) Tablet PO QPM (once
a day (in the evening)).
3. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO QAM (once a day (in the morning)).
4. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO QPM (once a day (in the evening)).
5. Levothyroxine 50 mcg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
## PRIMARY DIAGNOSIS:
1. Abdominal pain, nausea, vomiting
.
## SECONDARY DIAGNOSIS:
1. history of renal cell carcinoma
2. hypothyroidism
3. history of small bowel obstruction
## DISCHARGE INSTRUCTIONS:
You were admitted with abdominal pain, nausea and vomiting. You
were given a dose of Zofran which treated your nausea. You pain,
nausea and vomiting resolved and you felt better. You had an
x-ray of your stomach which was not consistent with small bowel
obstruction. We also tested your heart and you did not have a
heart attack. You were able to eat food and felt good enough to
go home. You were discharged with follow up with Dr.
in two weeks. You should be evaluated for diabetes and may
benefit from daily aspirin.
.
No changes were made in your home medications.
.
Please attend your follow up appointments and listed below.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15471804", "visit_id": "29296614", "time": "2132-09-18 00:00:00"} |
11360887-DS-7 | 1,564 | ## CHIEF COMPLAINT:
ESRD here for kidney transplant
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
deceased donor renal transplant
## HISTORY OF PRESENT ILLNESS:
Patient is a male with ESRD secondary to
hypertension/diabetes mellitus on hemodialysis since via a
right upper extremity AV fistula, congestive heart failure,
hypertension. He was called in this morning for a kidney
transplant. He reports feeling well with no recent illness,
blood transfusion or hospitalization. His last hemodialysis was
yesterday and went well. Patient notes he had a Shingrix
vaccine
2 weeks ago. It was explained to the patient that a DCD kidney
was offered with an increased chance of delayed graft function,
and patient accepted the organ. He overall has no complaints at
this time.
## ROS:
(+) per HPI
(-) Denies pain, fevers chills, night sweats, unexplained weight
loss, fatigue/malaise/lethargy, changes in appetite, trouble
with
sleep, pruritis, jaundice, rashes, bleeding, easy bruising,
headache, dizziness, vertigo, syncope, weakness, paresthesias,
nausea, vomiting, hematemesis, bloating, cramping, melena,
BRBPR,
dysphagia, chest pain, shortness of breath, cough, edema of,
urinary
frequency, urgency
## PAST MEDICAL HISTORY:
ESRD on HD
Diabetes mellitus type 2
Congestive heart failure
Anemia
Supraventricular tachycardia
Melanoma in situ status post resection
Obesity
Hypertension
## PAST SURGICAL HISTORY:
Right AV fistula
Cataract surgery
Melanoma of right arm resection
## FAMILY HISTORY:
Mother CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
ARTHRITIS
PACEMAKER PLACEMENT
HEART FAILURE
Father HEART ATTACK
Sister Living
## HEENT:
No scleral icterus, mucus membranes moist
## PULM:
Breathing comfortably on room air
## ABD:
Soft, nondistended, nontender, no rebound or guarding
## EXT:
warm and well perfused. Right upper extremity AVF
aneurysmal with strong thrill, no overlying skin ulceration.
.
Exam at Discharge:
24 HR Data (last updated @ 2315)
## WT:
222.9 lb/101.11 kg
Fluid Balance (last updated @ 549)
Last 8 hours Total cumulative -395ml
## IN:
Total 240ml, PO Amt 240ml
## OUT:
Total 635ml, Urine Amt 475ml, Right JP 160ml
Last 24 hours Total cumulative -710ml
## IN:
Total 900ml, PO Amt 900ml
## OUT:
Total 1610ml, Urine Amt 550ml, Right JP 1060ml
## WOUND:
[X ]CD&I Hematoma at and below the incision line [X ]JP
serous ~ 1 Liter output day before discharge, JP creatinine same
as serum
## BRIEF HOSPITAL COURSE:
On , he received DCD kidney, not BBID, left kidney to
right external iliac artery and vein with single renal artery
and vein. JJ ureteral stent and 19 drain. 17:43
## CIT. WIT:
24 min extubation to flush + 31 min sewing. Surgeon
was Dr. .
.
w/ ESRD T2DM on HD TThS via L brachiocephalic fistula,
CAD c/b NSTEMI, HTN, OSA on CPAP, s/p living unrelated renal
transplant who experienced delayed renal graft function postop
requiring hemodialysis until graft functions. He was dialyzed on
a schedule with last HD on . Urine output
averaged 1100cc on . Abdominal JP drain output was
serosanguinious. Output was 495cc/day on . JP fluid
creatinine was 8.8 that was similar to serum indicating no
urinary leak. JP output increased to 790 cc on and then
915cc on . Incision was intact with staples. There was
extensive ecchymosis around his incision that tracked to his
lateral side, but was not on his flank.
.
He received instruction on managing the JP drain. Renal duplex
was wnl. Creatinine decreased to 6.4 on after HD on .
Potassium was averaging 5.3 (pre HD to 4.1 on .
.
BP was elevated and anti-HTN meds were changed to carvedilol and
amlodipine with spb in the 140-150 range with HR in the 68-80
range. Weight was 101kg up from 98Kg (admission)
.
Right arm avf was functioning and was aneurysmal. He will
resumed HD at his outpatient unit in at
at Dialysis on .
.
Immunosuppression consisted of 4 doses of Thymoglobulin,
Steroids were tapered, Cellcept twice daily was well tolerated
until when he experienced loose watery stool. Stool for
C.diff was negative and on cellcept was changed to 500mg
qid after having 4 watery BMs. Tacrolimus was dosed per daily
trough levels. Next Tacrolimus level will be
.
DM-insulin drip was required for hyperglycemia from steroids.
provider was consulted and adjusted his insulin
back to glargine and Humalog sliding scale. The educator
was able to review sliding scale Humalog with him.
.
Transitional issues: f/u twice weekly labs for transplant
monitoring. Next labs . HD on schedule
Dr has been made aware of patients request to have AV
fistula evaluated for possible intervention in the future.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Atorvastatin 40 mg PO QPM
2. Diltiazem Extended-Release 240 mg PO DAILY
3. Doxazosin 6 mg PO BID
4. Levemir 10 Units Bedtime
5. Isosorbide Mononitrate (Extended Release) 120 mg PO BID
6. Metoprolol Tartrate 50 mg PO BID
7. olmesartan 20 mg oral DAILY
8. sevelamer CARBONATE 2400 mg PO TID W/MEALS
9. B complex-vitamin C-folic acid 0.8 mg oral DAILY
10. etelcalcetide 5 mg/mL injection unknown
## DISCHARGE MEDICATIONS:
1. Acetaminophen mg PO Q8H:PRN Pain - Mild
Maximum 6 of the 500 mg tablets daily
2. amLODIPine 10 mg PO DAILY
3. CARVedilol 25 mg PO BID
HOLD for SBP <110 or HR <60
4. Ciprofloxacin HCl 500 mg PO Q24H Duration: 1 Dose
take 1 hour prior to ureteral stent removal by urologist
5. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line
Take only if not having daily bowel movement
6. Famotidine 20 mg PO DAILY
7. Mycophenolate Mofetil 500 mg PO QID
8. Nystatin Oral Suspension 5 ml PO QID
9. Sodium Polystyrene Sulfonate 15 gm PO DAILY:PRN elevated
potassium
take only when instructed by the transplant coordinator
10. Sulfameth/Trimethoprim SS 1 TAB PO DAILY
11. Tacrolimus 5 mg PO Q12H
12. ValGANCIclovir 450 mg PO 2X/WEEK (MO,TH)
13. Doxazosin 4 mg PO DAILY
14. Doxazosin 2 mg PO HS
15. Levemir 8 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
16. sevelamer CARBONATE 800 mg PO TID W/MEALS
17. Atorvastatin 40 mg PO QPM
18. B complex-vitamin C-folic acid 0.8 mg oral DAILY
19. HELD- etelcalcetide 5 mg/mL injection unknown This
medication was held. Do not restart etelcalcetide until seen in
clinic with nephrologist
## DISCHARGE DIAGNOSIS:
ESRD now s/p kidney transplant
HTN
DM
Delayed graft function
Aneurysmal AV fistula
## DISCHARGE INSTRUCTIONS:
arranged to see you at home.
Please call the transplant clinic at for fever of
101, chills, nausea, vomiting, diarrhea, constipation, inability
to tolerate food, fluids or medications, yellowing of skin or
eyes, increased abdominal pain, incisional redness, drainage or
bleeding, dizziness or weakness, decreased urine output or dark,
cloudy urine, swelling of abdomen or ankles, weight gain or 3
pounds in a day, pain/burning/urgency with urination, or any
other concerning symptoms.
.
Bring your pill box and list of current medications to every
clinic visit.
.
You will be continuing hemodialysis at your dialysis
unit upon discharge from the hospital. The transplant clinic
will continue to follow closely to determine when this is no
longer necessary.
.
You will have labwork drawn every and as
arranged by the transplant clinic, with results to the
transplant clinic (Fax . CBC, Chem 10, AST, T
Bili, Trough Tacro level, Urinalysis.
.
*** On the days you have your labs drawn, do not take your Tacro
until your labs are drawn. Bring your Tacro with you so you may
take your medication as soon as your labwork has been drawn.
.
Please measure and record your urine output in the urinal
provided until you are instructed by the transplant clinic that
you can stop. Bring the record with you to your transplant
clinic follow up visits
.
Drain and record the JP drain output twice daily and as needed
so that the drain is never more than ½ full. Call the office if
the drain output increases by more than 100 cc from the previous
day, becomes bloody or develops a foul odor.
.
Change the drain dressing once daily or after your shower. Do
not allow the drain to hang freely at any time. Inspect the site
for redness, drainage or bleeding. Make sure there is a stitch
at the drain site.
.
Follow your medication card, keep it updated with any dosage
changes, and always bring your card with you to any clinic or
hospital visits.
.
You may shower. Allow the water to run over your incision and
pat area dry. No rubbing, no lotions or powder near the
incision. You may leave the incision open to the air. There is
some bruising around and below the incision, this will resolve
over time.
.
No tub baths or swimming
No driving until cleared by surgeon.
Avoid direct sun exposure. Wear protective clothing and a hat,
and always wear sunscreen with SPF 30 or higher when you go
outdoors.
Drink enough fluids to keep your urine light in color. Your
appetite will return with time. Eat small frequent meals, and
you may supplement with things like carnation instant breakfast
or Ensure.
Regular immunocompromised
Wash all fruits and vegetables
Assure all foods are well cooked
No grapefruit or grapefruit containing products
Check your blood sugars and blood pressure at home. Report
consistently elevated values to the transplant clinic
Do not increase, decrease, stop or start medications without
consultation with the transplant clinic at . There
are significant drug interactions with anti-rejection
medications which must be considered in medication management
following transplant.
Consult transplant binder, and there is always someone on call
at the transplant clinic with any questions that may arise
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11360887", "visit_id": "29112288", "time": "2130-09-01 00:00:00"} |
19723237-DS-18 | 1,427 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## CHIEF COMPLAINT:
Dr. me to come to the emergency room because my
weight was too low at today's check"
## HISTORY OF PRESENT ILLNESS:
Ms. yo female with h/o anorexia and multiple admissions
for abdominal pain referred to ED today from her PCP's office
due to drop in weight from 45.9 kg at time of discharge on
to 37.5 kg at today's office visit. She states that she is here
freely and that she was admitted at the recommendation of Dr.
because the emergency room doctors were concerned
about cardiac ischemia.
.
At time of interview, patient complains of ongoing abdominal
pain since . Patient states the pain is periumbilical,
stabbing in nature, and radiating to the sides. It is constant
throughtout the day and worse following any food consumption. It
improves with placement of a hot water bottle. Her last bowel
movement was two days ago after an enema. The enema was
performed because she has not had an enema for several days.
.
Patient states that since discharge, she has been consuming only
4 packets of cream of wheat each day and 3 boost shakes. She was
evaluated by a Nutritionist on who recommended that she
increase to 5 Boost drinks daily. She did tolerate this for the
one day prior to admission. She attempted to consume a
sandwich two nights ago but states that this caused her to
vomit. She has had no episodes of vomiting since that time but
she reports continuous nausea. She denies any self-induced
vomiting. She endorses use of only the laxatives prescribed by
her physicians.
.
Review of systems is positive for worsening depression over the
past few weeks, constipation, abdominal pain, continuous nausea.
Patient reports dizziness with position changes. She reports an
average of two crying spells daily, insomnia, increased sleep
latency, and increased frequency or waking throughout the night.
She state that she awakens at 3 a.m. She denies fellings of
guilt or suicidal/homocidal ideations. She denies shortness of
breath, chest pain, dysuria, fevers, chills, or sensation of
hunger. She denies any new stressors in her life. She states
that she feels safe at home.
.
Per telephone conversation with husband, he was extremely
surprised today that her weight is lower. He states she has been
eating 3 meals daily, consuming 1500 calories per day. He feels
as though "she has been working really hard to get enough
nutrition" and states that he has not observed any of the
typical restrictive behaviors related to her eating disorder. He
feels weight loss is related to her abdominal pain.
.
In the ED, patient received 2 liters NS, Zofran 4 mg IV,
Thiamine 100 mg, Folate 1 mg, MVI, and ASA 325 mg. Pychiatry
evaluation was performed in the ED with recommendation for
admission under eating disorder protocol guidelines.
## PAST MEDICAL HISTORY:
1) Anorexia (since age , weight peaked at 105 (in the summer),
~ 85 lbs (lowest weight 80). Reports last inducing vomiting
years ago (but during prior admission was seen in the ED
attempting to induce vomiting). She has had multiple inpatient
hospitalizations at eating disorder facilities, the first in
high school and most recently years ago at .
2) Depression and Anxiety requiring 4 inpatient admissions.
Multiple med trials. No past suicide attempts.
3) Chronic abdominal pain of no clear organic etiology (negative
work up in th past)
4) Recurrent h/o constipation requiring manual disimpaction
5) s/p MVA yrs ago with paresthesias of her lower extremities
6) h/o thyroid dysfunction
## BROTHER:
abuse
No h/o abdominal pain, depression, eating disorders, other
cancers
## GEN:
cachectic, young WF, NAD
## HEENT:
NC/AT, conjunctivae pink, sclera anicteric, MMM, OP
clear, no dental erosions, dental fillings, no mouth lesions
## NECK:
supple, non-tender submandibular LN
## :
NR/RR, +S1/S2, soft SEM LUSB
## PUL:
normal respiratory effort, CTAB, no wheezes/rales/rhonchi
## :
concave, +BS, diffuse tenderness to deep palpation, no
rebound/guarding
## SKIN:
warm, no rashes, no bruises, no lanugo
## EXT:
thin, 2+ radial and 1+ DP bilat, no edema
## PSYCH:
blunted affect, maintains eye contact throughout exam,
denies A/V hallucinations, no SI/HI
## STUDIES:
CXR: No acute pulmonary process
## KUB:
No free air with a non-obstructive bowel gas pattern
## BRIEF HOSPITAL COURSE:
Ms. is a yo female with a history of anorexia and
abdominal pain who presents with refractory weight loss
.
1) Anorexia: This was likely associated with her eating
disorder, recent medical evaluation for her abdominal discomfort
did not reveal any common or esoteric etiologies for her
abdominal discomfort, these studies including a colonoscopy, MRI
to evaluate for SMA syndrome. She was started on an eating
protocol and was tolerating boost shakes without difficulty on
discharge, her weight was calculated as above 75% of IBW, and
she had no electrolyte abnormalities on discharge. She was had
normal thyroid function tests on admission, a negative
toxicology streen, and urinalysis on admission. She was
maintained on multivitamins, and a 1:1 sitter while inpatient.
Psychiatry was consulted and referrals are being made for
outpatient eating disorder placement.
## .
2) EKG CHANGES:
Patient with more pronounced non-specific TWI in
anterior leads on admission EKG. She ruled out by cardiac
enzymes, and then was maintained on telemetry without event.
.
3) Abdominal pain: Previous work-up has been negative for any
organic cause. She had a slightly elevated calcium level on
admission which resolved with IVF on admission.
## 4) HYPERCALCEMIA:
Serum calcium elevated to 10.3 (uncorrected)
at time of admission, possibly related to osteopenia. She had a
normal PTH during her hospital course, her vitamin D and
prealbumin levels were pending on discharge. She was
administered calcium and vitamin D. She should consider an
outpatient bone scan.
.
5) Depression: continued on Duloxetine, Risperdal, Clonazepam,
Lorazepam per outpatient regimen. She is to follow up with her
outpatient psychiatrist
.
## MEDICATIONS ON ADMISSION:
Duloxetine 120 mg PO qam
Clonazepam 2 mg PO BID
Risperidone 0.5 mg PO qAM and q Noon
Tetracycline 500 mg BID
Colace 100 mg BID
Metoclopramide QID
Pantoprazole 40 mg PO q 12 hours
Senna 8.6 mg BID
Gabapentin 300 mg TID
Lorazepam 1mg PO qNoon with lunch
Multivitamin daily
Risperidone 2 mg PO HS
Zolpidem CR 25 mg PO HS
Bisacodyl 10mg daily
Lactulose mL qHS
Zofran PRN
## DISCHARGE MEDICATIONS:
1. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Four (4)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
2. Clonazepam 1 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
3. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
4. Tetracycline 250 mg Capsule Sig: Two (2) Capsule PO Q12H
(every 12 hours).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed.
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*0*
11. Risperidone 1 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
12. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
13. Mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).
Disp:*15 Tablet(s)* Refills:*0*
14. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
15. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
## 16. MULTIVITAMIN,TX-MINERALS TABLET SIG:
One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
17. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
## DISCHARGE CONDITION:
Stable, HD, RR stable
## DISCHARGE INSTRUCTIONS:
You were admitted for your weight loss and started on a eating
disorder protocol and noted to regain weight and be above 75% of
your ideal body weight.
Please follow up with your psychiatric providers.
If you experience increase abdominal pain, weight loss, suicidal
ideations, homicidal ideations, or any other concerning symptom.
Please call your primary care doctor or go to the nearest
emergency room.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19723237", "visit_id": "23580964", "time": "2125-11-20 00:00:00"} |
17427308-RR-70 | 249 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
year old woman with CHF, PPM SSS now with multifocal PNA
and increasing transaminitis w/delirium. Any new process to explain rise? //
new onset transaminitis in setting of sepsis from multifocal PNA. Not
currently resolving. hep serologies negative.Any new process to explain rise?
## FINDINGS:
Extremely limited evaluation as the patient was combative and fighting back
the ultrasound technologist on the table.
In segment 6 there is a 1.7 x 2.0 cm hyperechoic lesion. Doppler evaluation
could not be obtained due to the patient's noncooperation. The imaging
appearance is compatible with a hemangioma, although the lesion remains
incompletely characterized. If there is any history of underlying malignancy
or of known liver disease, further evaluation with cross-sectional imaging
(either CT or MRI) is recommended to further characterize this lesion.
There is no intra or extrahepatic biliary ductal dilation. The common hepatic
duct measures up to 4 mm.
The gallbladder is unremarkable appearance, with no cholelithiasis or other
abnormality.
Limited views of the right kidney demonstrate no hydronephrosis.
Beyond this, the examination is nondiagnostic.
## IMPRESSION:
1.7 x 2.0 cm hyperechoic lesion in segment 6 of the liver, compatible with a
hemangioma but incompletely characterized, as detailed above. If there is any
history of underlying malignancy or known liver disease, further evaluation
with cross-sectional imaging (either CT or MRI) is recommended to further
characterize this lesion.
No definite cause for the patient's transaminitis identified.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17427308", "visit_id": "24760124", "time": "2156-11-05 14:34:00"} |
10770695-RR-39 | 90 | ## INDICATION:
year old woman with goiter and hypothyroid// evaluate for
abnormality
## THE RIGHT LOBE MEASURES:
(transverse) 1.9 x (anterior-posterior) 2.3 x
(craniocaudal) 4 point a cm.
The left lobe measures: (transverse) 2.0 x (anterior-posterior) 1.9 x
(craniocaudal) 4.7 cm.
Isthmus anterior-posterior diameter is 0.4 cm.
Thyroid parenchyma is slightly heterogeneous, however with normal vascularity.
The heterogeneity of the parenchyma is improved, reflecting known thyroiditis.
## IMPRESSION:
Thyroid parenchyma is slightly heterogeneous, likely due to thyroiditis,
although improved compared to prior.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10770695", "visit_id": "N/A", "time": "2181-09-23 12:11:00"} |
15401139-DS-6 | 1,477 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
- Laparoscopic proctocolectomy with ileal pouch,
anal anastomosis, diverting loop ileostomy. Flexible
sigmoidoscopy
## HISTORY OF PRESENT ILLNESS:
This is a man with ulcerative
colitis, reasonably controlled symptoms, but developed
significant pseudopolyps, inability to monitor his rectum on
initial scoped were reasonably spared, so we were discussing
either abdominal colectomy with ileorectal anastomosis versus
the pouch depending on how the rectum looks. Risks and
benefits including, but not limited to infection, bleeding,
leak, need for more procedure, injury to surrounding organs,
urinary, sexual dysfunction, need for more procedures were
discussed. Patient understood and agreed to the procedure.
## PAST MEDICAL HISTORY:
psoriasis
HTN
neuropathy
IDDM
hepatitis C
heroin addiction (on suboxone)
ulcerative colitis
## PAST SURGICAL HISTORY:
s/p left total knee replacement
s/p right hip surgery x
s/p amputation left foot metatarsal
## SOCIAL HISTORY:
30 pack-year smoking history. History of IV
heroin, cannabis. Former EtOH abuse. Sober since
## ABD:
soft, nt/nd, ostomy p/p/v, incisions c/d/I
ext: wwp
## BRIEF HOSPITAL COURSE:
Mr. presented to holding at on for a
lap TAC/proctectomy with J-pouch, loop ileostomy . He tolerated
the procedure well without complications (Please see operative
note for further details). After a brief and uneventful stay in
the PACU, the patient was transferred to the floor for further
post-operative management.
## NEURO:
Pain was well controlled on oral dilaudid. He will
follow up with his suboxone provider 1 week to resume
suboxone and further management of pain medications per his
primary provider.
## CV:
Vital signs were routinely monitored during the patient's
length of stay.
## PULM:
The patient was encouraged to ambulate, sit and get out
of bed, use the incentive spirometer, and had oxygen saturation
levels monitored as indicated.
## GI:
The patient was initially kept NPO after the procedure. The
patient was later advanced to and tolerated a regular diet at
time of discharge. His ostomy output was noted to be high so he
was started n psyllium wafers and loperamide to help control his
ostomy output.
## GU:
Patient had a Foley catheter that was removed at time of
discharge. Urine output was monitored as indicated. At time of
discharge, the patient was voiding without difficulty.
## ID:
The patient's vital signs were monitored for signs of
infection and fever. The patient was started on/continued on
antibiotics as indicated.
## HEME:
The patient had blood levels checked post operatively
during the hospital course to monitor for signs of bleeding. The
patient had vital signs, including heart rate and blood
pressure, monitored throughout the hospital stay.
On the patient was discharged to home w/ services. At
discharge, he was tolerating a regular diet, passing flatus,
stooling, voiding, and ambulating independently. He will
follow-up in the clinic in weeks. This information was
communicated to the patient directly prior to discharge.
## POST-SURGICAL COMPLICATIONS DURING INPATIENT ADMISSION:
[ ] Post-Operative Ileus resolving w/o NGT
[ ] Post-Operative Ileus requiring management with NGT
[ ] UTI
[ ] Wound Infection
[ ] Anastomotic Leak
[ ] Staple Line Bleed
[ ] Congestive Heart failure
[ ] ARF
[ ] Acute Urinary retention, failure to void after Foley D/C'd
[ ] Acute Urinary Retention requiring discharge with Foley
Catheter
[ ] DVT
[ ] Pneumonia
[ ] Abscess
[x] None
Social Issues Causing a Delay in Discharge:
[ ] Delay in organization of services
[ ] Difficulty finding appropriate rehab hospital disposition.
[ ] Lack of insurance coverage for services
[ ] Lack of insurance coverage for prescribed medications.
[ ] Family not agreeable to discharge plan.
[ ] Patient knowledge deficit related to ileostomy delaying
dispo
[x] No social factors contributing in delay of discharge.
## MEDICATIONS ON ADMISSION:
buprenorphine-naloxone mg sl bid
Oxycodone-Acetaminophen (ENDOCET) mg q6h prn pain
Lisinopril 20 mg qd
Collagenase Clostridium (SANTYL) 250 unit/g top bid prn: ulcer
Insulin Glargine (LANTUS) 30 units qam
Insulin Lispro (HUMALOG) sliding scale
Thiamine HCl (VITAMIN B-1) 100 mg qd
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO TID
2. Glargine 30 Units Breakfast
3. Lisinopril 20 mg PO DAILY
4. Psyllium Wafer 2 WAF PO BID
RX *psyllium [Metamucil] 1.7 g 1 wafer(s) by mouth three times a
day Disp #*90 Wafer Refills:*0
5. HYDROmorphone (Dilaudid) mg PO Q3H:PRN pain
RX *hydromorphone [Dilaudid] 4 mg 1 tablet(s) by mouth Q3H Disp
#*60 Tablet Refills:*0
6. Lorazepam 0.5-1 mg PO Q4H:PRN anxiety, withdrawal
7. Buprenorphine 4 mg SL QID
8. Diphenoxylate-Atropine 1 TAB PO Q6H
RX *diphenoxylate-atropine [Lomotil] 2.5 mg-0.025 mg 1 tablet(s)
by mouth every six (6) hours Disp #*120 Tablet Refills:*0
## DISCHARGE INSTRUCTIONS:
were admitted to the hospital after a Laparoscopic
proctocolectomy with ileal pouch, anal anastomosis, diverting
loop ileostomy, and flexible sigmoidoscopy for surgical
management of your ulcerative colitis. have recovered from
this procedure well and are now ready to return home.
Samples from your colon were taken and this tissue has been sent
to the pathology department for analysis. will receive these
pathology results at your follow-up appointment. If there is an
urgent need for the surgeon to contact regarding these
results they will contact before this time. have
tolerated a regular diet, are passing gas and your pain is
controlled with pain medications by mouth. may return home
to finish your recovery.
have a new ileostomy. The most common complication from a
new ileostomy placement is dehydration. The output from the
stoma is stool from the small intestine and the water content is
very high. The stool is no longer passing through the large
intestine which is where the water from the stool is reabsorbed
into the body and the stool becomes formed. must measure
your ileostomy output for the next few weeks. The output from
the stoma should not be more than 1200cc or less than 500cc. If
find that your output has become too much or too little,
please call the office for advice. The office nurse or nurse
practitioner can recommend medications to increase or slow the
ileostomy output. Keep yourself well hydrated, if notice
your ileostomy output increasing, take in more electrolyte drink
such as Gatorade. Please monitor yourself for signs and symptoms
of dehydration including: dizziness (especially upon standing),
weakness, dry mouth, headache, or fatigue. If notice these
symptoms please call the office or return to the emergency room
for evaluation if these symptoms are severe. may eat a
regular diet with your new ileostomy. However it is a good idea
to avoid fatty or spicy foods and follow diet suggestions made
to by the ostomy nurses.
monitor the appearance of the ostomy and stoma and care
for it as instructed by the wound/ostomy nurses. stoma
(intestine that protrudes outside of your abdomen) should be
beefy red or pink, it may ooze small amounts of blood at times
when touched and this should subside with time. The skin around
the ostomy site should be kept clean and intact. Monitor the
skin around the stoma for bulging or signs of infection listed
above. Please care for the ostomy as have been instructed by
the wound/ostomy nurses. will be able to make an appointment
with the ostomy nurse in the clinic 7 days after surgery.
will have a visiting nurse at home for the next few weeks
helping to monitor your ostomy until are comfortable caring
for it on your own.
have laparoscopic surgical incisions on your abdomen
which are closed with internal sutures and a skin glue called
Dermabond. These are healing well however it is important that
monitor these areas for signs and symptoms of infection
including: increasing redness of the incision lines,
white/green/yellow/malodorous drainage, increased pain at the
incision, increased warmth of the skin at the incision, or
swelling of the area. Please call the office if develop any
of these symptoms or a fever. may go to the emergency room
if your symptoms are severe.
may shower; pat the incisions dry with a towel, do not rub.
The small incisions may be left open to the air. If closed with
steri-strips (little white adhesive strips) instead of
Dermabond, these will fall off over time, please do not remove
them. Please no baths or swimming for 6 weeks after surgery
unless told otherwise by Dr. Dr. .
will be prescribed a small amount of the pain medication
##########
Please take this medication exactly as prescribed. may take
Tylenol as recommended for pain. Please do not take more than
4000mg of Tylenol daily. Do not drink alcohol while taking
narcotic pain medication or Tylenol. Please do not drive a car
while taking narcotic pain medication.
No heavy lifting greater than 6 lbs for until your first
post-operative visit after surgery. Please no strenuous activity
until this time unless instructed otherwise by Dr. Dr.
.
Thank for allowing us to participate in your care! Our hope
is that will have a quick return to your life and usual
activities. Good luck!
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15401139", "visit_id": "24926200", "time": "2186-07-23 00:00:00"} |
11503113-RR-22 | 563 | ## EXAMINATION:
MRI AND MRA BRAIN AND MRA NECK PT11 MR
## INDICATION:
year old woman with vascular risk factors and prior R CEA and
R CRAO p/w monocular vision loss// eval for stroke, also do MRA head and neck
time of flight to eval for vessel patency
## MRI BRAIN:
There is a small punctate focus of high signal on DWI sequences within the
right temporal lobe subcortical white matter (04:14), without definite ADC
correlate and with probable T2/FLAIR signal hyperintensity (10:12).
Otherwise, no other candidate areas for acutely restricted diffusion are
identified. There is a known large chronic infarct involving the left
inferior parietal lobule, posterior left temporal lobe, stable since .
Moderate chronic small vessel ischemic changes. Small stable chronic left
cerebellar infarct. Absent flow void in the petrous, cavernous segment left
ICA, stable since .
There are foci of superficial cerebral chronic be
related to amyloid angiopathy.
The ventricles and sulci are enlarged compatible with age related atrophic
changes. Superimposed ex vacuo dilatation of the left occipital horn of the
left lateral ventricle is noted adjacent the area of chronic infarction. No
evidence for mass, mass effect, or edema.
There is extensive mucosal thickening seen throughout the ethmoid air cells
and bilateral maxillary sinuses, with an air-fluid level seen within the left
maxillary sinus. Nasal septal perforation, defect measures 2 cm, new since
. The remainder of the visualized paranasal sinuses, middle ear cavities,
and mastoid air cells are well aerated and clear. The orbits are within
normal limits bilaterally.
MRA BRAIN, neck:
The visualized portions of the proximal and mid left V2 segments appear
completely occluded, with subsequent recanalization of the distal left V2
segment and V3 segment, similar. There is multifocal irregular narrowing
involving the visualized right V1 and proximal right V2 segments. The right
vertebral artery otherwise remains patent.
Right ECA is occluded, new since prior.
Left common carotid, internal carotid arteries are occluded.
The distal V4 segments, basilar artery, and bilateral posterior cerebral
arteries appear widely patent and normal. The left posterior communicating
artery is patent.
The left ICA is occluded, stable since prior.. Patent left PCOM, left A1, M1.
Patent A-comm.
The distal right petrous ICA demonstrates mild irregular narrowing, with
severe narrowing of the cavernous right ICA, worsened. Flow in the ICA
proximal and distal to this area is present, however, flow of distal
cavernous, paraclinoid and ICA terminus, with diminished flow related
enhancement.
There is moderate irregular narrowing of the proximal right M1 segment. The
more distal right middle cerebral artery branches are patent. Mild irregular
narrowing of the left A1 segment is seen. Atherosclerotic narrowing right M2
segments, similar the left middle cerebral artery appears patent, as do the
bilateral anterior cerebral arteries. Moderate narrowing left P2 segment.
There is 2.2 x 2.2 mm right MCA M1 segment trifurcation aneurysm measuring 1.1
mm at the neck, also present in .
## IMPRESSION:
1. Right M1 trifurcation 2.2 mm aneurysm.
2. Small subacute infarct posterior right temporal lobe, 7 to 10-days-old.
3. Large chronic left MCA, tiny chronic left cerebellar infarcts, stable.
4. Paranasal sinus disease, suggestion of acute sinusitis.
5. Occluded left ICA, similar to prior.
6. Worsened, now severe, right cavernous segment ICA narrowing, with
diminished flow in patent ICA distal to this..
7. Occluded proximal left vertebral artery, similar.
8. Intracranial atherosclerotic disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11503113", "visit_id": "21710929", "time": "2130-06-01 10:50:00"} |
10963812-RR-4 | 220 | ## EXAM:
CTA of the neck.
## CLINICAL INFORMATION:
Patient with motor vehicle accident with right-sided
swelling, rule out vascular injury.
## NECK CT:
CT neck without contrast demonstrates soft tissue swelling in the right
carotid space and adjacent to the right sternocleidomastoid muscle with
stranding of the fat. No fractures are identified.
## CT ANGIOGRAPHY OF THE NECK:
The CT angiography of the neck demonstrates no evidence of vascular injury to
the carotid or vertebral arteries. Both jugular veins are also patent without
evidence of injury or extravasation.
There is slight blush visualized within the soft tissue swelling as seen on
the head and neck CTA adjacent to the sternocleidomastoid muscle. This is
related to a tiny branch of the external carotid artery. This may indicate
slow extravasation within the hematoma in this region. Delayed images
demonstrate contrast in this region confirming this finding.
## IMPRESSION:
1. CT neck demonstrates soft tissue swelling indicating hematoma adjacent to
the right carotid artery and internal jugular vein and deep to the
sternocleidomastoid muscle.
2. No evidence of injury of the carotid, or vertebral arteries or jugular
veins on the CTA of the neck.
3. Faint extravasation within the hematoma from a small branch of external
carotid artery. Findings were discussed with emergency room at the time of
interpretation of this study by Dr. .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10963812", "visit_id": "29217647", "time": "2123-08-07 01:25:00"} |
18054700-DS-3 | 583 | ## CHIEF COMPLAINT:
cc: altered mental status
## HISTORY OF PRESENT ILLNESS:
This is a year-old with the history below who presented
to ED last night after being found with AMS, intoxication. Pt
reported abdominal pain and ongoing cocaine and etoh abuse. He
was unable to provide further history other than to say he has a
history of UC (IBD). found to be guaiac negative but markedly
anemic (Hb 6). Given two units prbc. CXR neg. RUQ US and CTAP
both showed pancreatitis and mult pseudocysts including a large
pseudocyst in the tail of the pancreas. He was also found to
have bt shank edema, erythema, and wamth, and to be complaining
of pain. He was felt to possibly have bilateral
cellulitis and was given V/C/F and admitted
## POSITIVES ON REVIEW OF SYSTEMS:
chest pain and abdominal pain
(basically in the same area, epigastrium and lower chest,
confluent region of pain). Denies radiation, modifying factors.
Cannot indicate how long it has been present. pain
as above. Says this is new. Denies blood pr. Says he has had
loose stools.
All other systems reviewed and negative.
For further specific detail, pt denies: visual changes,
numbness/weakness, shortness of breath, fevers, nausea,
vomiting, bleeding, rash, joint aches/pains.
## PAST MEDICAL HISTORY:
Ongoing PSA (etoh, cocaine)
Denies HIV, hepatitis
UC
## FAMILY HISTORY:
Family history reviewed and found to be
noncontributory to this illness
## VS:
Afebrile and vital signs stable (reviewed in bedside
record)
## GENERAL APPEARANCE:
pleasant, comfortable, no acute distress,
somewhat somnolent, does not want to bothered.
## EYES:
PERLL, EOMI, bt conjuctival injection, anicteric
## ENT:
no sinus tenderness, MMM, oropharynx without exudate or
lesions, no supraclavicular or cervical lymphadenopathy, no JVD,
no carotid bruits, no thyromegaly or palpable thyroid nodules
## RESPIRATORY:
CTA b/l with good air movement throughout
## CARDIOVASCULAR:
RR, S1 and S2 wnl, systolic murmur, no
rubs
or gallops
## GASTROINTESTINAL:
nd, +b/s, soft, ttp in epigastrium, no masses
or HSM
## EXTREMITIES:
bt shanks with edema, warmth, erythema, and ttp,
from ankle to knees, does not extent to knees or above.
## SKIN:
warm, no skin ulcerations noted, erythema of shanks as
above
## NEUROLOGICAL:
Alert, oriented to self, time, date, reason for
hospitalization. Does not know hospital they brought me
to'. Cn II-XII intact. strength throughout. No sensory
deficits to light touch appreciated. No pass-pointing on finger
to nose. 2+DTR's-patellar and biceps. No asterixis, no pronator
drift, fluent speech.
## GU:
no catheter in place
## IMPRESSION:
No radiographic evidence of pneumonia.
CT abdomen/Pelvis
## IMPRESSION:
1. Pancreatitis involving distal pancreas with large pseudocyst
measuring 10 cm. 3 other pseudocysts measure 1.4 cm or less.
2. Diffuse vertebral body fusion by marginal syndesmophytes may
reflect
ankylosing spondylitis.
RUQ U/S
Heterogeneous appearance of pancreatic tail is consistent with
pancreatitis
seen on CT from same day.
## BRIEF HOSPITAL COURSE:
The pateint was admitted to the hospital for management of
polysubstance abuse/withdrawal. He was placed on CIWA and did
not score. For his pancreatitis, he was seen by
surgery who recommended no surgical intervention given the
patient was asymptomatic. The pateint was kept NPO with IV
fluids. The morning after admission, the patient reported he was
going to leave to eat and take a shower. He walked off the floor
and did not engage in conversation regarding is ongoing medical
conditions.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. This patient is not taking any preadmission medications
## DISCHARGE DIAGNOSIS:
Alcohol abuse/withdrawal
Pancreatitis
Possible Cellulitis
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18054700", "visit_id": "20975700", "time": "2142-10-20 00:00:00"} |
15114531-RR-146 | 342 | ## HISTORY:
Urinary retention and saddle paresthesia, evaluate for cord
compression.
## FINDINGS:
There is no evidence of cord compression.
The patient is status post anterior spinal fusion from C4-C7. There is
minimal indentation of the anterior cord at C3-C4 and C6-C7, otherwise no
high-grade stenosis is noted in the cervical spine. There are uncovertebral
and facet joint osteophytes resulting in severe left C3-C4, moderate left
C4-C5, moderate left C5-C6, and moderate to severe right C6-C7 neural
foraminal narrowing. There is no evidence of abnormal enhancement.
In the thoracic spine, there are a few Schmorl's nodes, there are minimal
multilevel disc protrusions without spinal canal narrowing. No neural
foraminal narrowing is identified. No abnormal enhancement is visualized. At
T10 vertebral body, there are T2 hyperintense lesions likely representing
hemangiomas.
The patient is status post laminectomy and spinal fusion from L4-S1. An
interbody cage device is visualized at L5-S1. There is T2 hyperintensity in
the subcutaneous and posterior paraspinal soft tissues likely related to
recent procedure and representing inflammation. There is a slightly irregular
fluid collection in the surgical bed extending from L4 to the inferior aspect
of L5, difficult to measure, adjacent to the L5 screws medially, with
peripheral enhancement likely related to postsurgical changes, however the
presence of the infected fluid is a consideration. There is enhancement of
the epidural soft tissues at these levels concentrically extending into the
anterior epidural space with enhancement of some nerve roots that could
represent arachnoiditis. No evidence of epidural abscess is identified.
The patient is status post right nephrectomy.
## IMPRESSION:
1. No spinal cord compression.
2. Status post L4-S1 posterior spinal fusion with rim enhancing fluid in the
surgical cavity which could represent a postsurgical seroma, however
superimposed infected fluid is a consideration.
3. Enhancement of several lumbar nerve roots likely representing
arachnoiditis, however meningitis cannot be excluded. No evidence of epidural
abscess.
4. Status post C4-C7 anterior spinal fusion without hardware complication.
WET READ by on TUE 4:33 AM.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15114531", "visit_id": "26181974", "time": "2159-09-04 02:07:00"} |
10952022-RR-50 | 104 | ## EXAM:
MRI OF THE NECK.
## CLINICAL INFORMATION:
Patient with lymphoma and posterior neck pain with
intermittent dysarthria. Question of glossopharyngeal neuralgia.
## FINDINGS:
There is no evidence of discrete mass identified in the neck. The
cavernous sinus and the soft tissues of the neck are symmetric in appearance.
No significant lymphadenopathy is seen. The airway is maintained. At the
skull base, there is no evidence of infiltrative lesion seen around the
jugular foramina. No mass lesion is seen adjacent to the jugular veins.
## IMPRESSION:
No significant abnormalities on MRI of the neck identified. No
mass lesion is seen or significant lymphadenopathy is seen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10952022", "visit_id": "22580646", "time": "2138-01-02 07:31:00"} |
14604475-RR-35 | 124 | ## HISTORY:
woman with non-small cell lung cancer and worsening
dyspnea and orthopnea.
## FINDINGS:
The tip of a left-sided Port-A-Cath catheter is in the cavoatrial
junction. A right upper mediastinal mass appears stable in size with mass
effect upon the Port-A-Cath catheter. There is a new large right pleural
effusion with adjacent compressive atelectasis. There are multifocal
opacities within the left lung, new since the prior examination. There is no
left sided effusion. No pneumothorax is present. The cardiac silhouette
appears normal in size.
## IMPRESSION:
1. New large right pleural effusion.
2. Multifocal opacities in the left lung, which may be due to edema,
pneumonia, or spread of tumor.
3. Stable appearance to right upper mediastinal mass.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14604475", "visit_id": "24636936", "time": "2165-09-08 16:24:00"} |
11433235-RR-60 | 255 | CTA OF THE HEAD AND NECK DATED
## CLINICAL HISTORY:
woman with right headache and photophobia.
## CT HEAD:
The ventricles, sulci, and cisterns are age appropriate. There is
no mass effect, midline shift, hemorrhage or extra-axial fluid collection.
There is no evidence of infarction. The parenchyma is normal in appearance.
There is no displaced calvarial fracture. The orbits and soft tissues are
intact. The visualized paranasal sinuses and mastoid air cells are clear.
## CTA HEAD:
There is normal enhancement of the intracranial internal carotid
arteries, anterior cerebral arteries and middle cerebral arteries. The
anterior communicating artery complex is normal in appearance.
The vertebral and basilar arteries demonstrate normal enhancement. The
posterior cerebral arteries are symmetric and normal in appearance. Posterior
communicating artery is identified, although the right is not definitely
identified.
There is no evidence of hemodynamically significant stenosis, dissection, or
aneurysm.
The major venous structures enhance normally.
## CTA NECK:
The common carotid, internal carotid and external carotid arteries
are normal enhancement. There is no evidence in hemodynamically significant
stenosis or dissection. The left internal carotid artery measures 4 mm in
minimal diameter in its distal cervical component. The right internal carotid
artery measures 3 mm in minimal luminal diameter in the distal cervical
component.
The vertebral arteries are symmetric and normal in appearance.
The visualized soft tissues are unremarkable. There is no cervical
lymphadenopathy.
Visualized bones are normal in appearance. There is no osseous destructive
lesion.
## IMPRESSION:
Unremarkable CTA of the head and neck. No evidence of
hemodynamically significant stenosis, dissection or aneurysm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11433235", "visit_id": "N/A", "time": "2150-12-25 01:09:00"} |
13098308-RR-88 | 627 | ## EXAMINATION:
CTA ABD AND PELVIS
## INDICATION:
year old woman with a history of pancreatic and breast cancer,
s/p 6 cycles of FOLFIRINOX and repeat CK// assess for disease response
## ABDOMEN AND PELVIS CTA:
Non-contrast and multiphasic post-contrast
images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.5 s, 29.4 cm; CTDIvol = 7.2 mGy (Body) DLP = 208.1
mGy-cm.
2) Spiral Acquisition 10.7 s, 69.7 cm; CTDIvol = 7.4 mGy (Body) DLP = 512.3
mGy-cm.
Total DLP (Body) = 720 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT CHEST
W/CONTRAST)
## VASCULAR:
There is no abdominal aortic aneurysm. There is minimal calcium burden in the
abdominal aorta and great abdominal arteries. There is a replaced left
hepatic artery arising from the left gastric artery. The mass encases the
celiac axis and SMA. There is less than 180 degrees of soft tissue contact
with the main portal vein and SMV.
## LOWER CHEST:
Please refer to the separate report of CT chest performed on the
same day for description of the thoracic findings.
## HEPATOBILIARY:
The liver demonstrates low attenuation, consistent with hepatic
steatosis. There is no evidence of focal lesions. There is no evidence of
intrahepatic or extrahepatic biliary dilatation. The gallbladder is contains
stones, without evidence of gallbladder wall thickening or pericholecystic
fluid.
## PANCREAS:
The patient is status post Whipple procedure. There is a grossly
stable 2.3 x 2.1 cm hypodense lesion within the resection bed in the area of
multiple fiducials (4; 104). There is a stable 7 mm hypodense lesion in the
pancreatic tail, likely an IPMN (4; 107). 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.
Subcentimeter hypodense lesions in bilateral kidneys are too small to
characterize, likely cortical cysts. There is a stable calcified left renal
artery aneurysm (4; 115). There is no evidence of stones or hydronephrosis.
There are no urothelial lesions in the kidneys or ureters. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The patient is status post Whipple procedure. Small bowel
loops demonstrate normal caliber, wall thickness and enhancement throughout.
Colon and rectum are within normal limits. Appendix is not visualized. There
is no evidence of mesenteric lymphadenopathy.
## RETROPERITONEUM:
There is no evidence of retroperitoneal lymphadenopathy.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
## REPRODUCTIVE ORGANS:
Within the endometrial cavity, there is an enhancing soft
tissue mass and a small amount of fluid (7; 56). Bilateral adnexae are within
normal limits.
## BONES:
Degenerative changes are seen in the lumbar spine.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. Stable soft tissue density within the pancreatic resection bed. There is
unchanged encasement SMA and celiac trunk, and contact with the main portal
vein and SMV.
2. Enhancing endometrial mass is concerning for malignancy. Recommend pelvic
ultrasound and gynecology oncology consult for further evaluation.
3. Stable 7 mm hypodense lesion within the pancreatic tail, likely IPMN.
4. Hepatic steatosis.
5. Please see the separate report from the same day CT chest for intrathoracic
findings.
## RECOMMENDATION(S):
Pelvic ultrasound and gynecology oncology consult for
further characterization of enhancing endometrial mass.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 11:12 into the Department of Radiology
critical communications system for direct communication to the referring
provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13098308", "visit_id": "N/A", "time": "2172-04-01 08:26:00"} |
14788898-RR-7 | 302 | ## REASON FOR EXAMINATION:
Evaluation of the patient with fever and significant
aspiration event.
## FINDINGS:
The ET tube tip terminates approximately 4 cm above the carina. The NG tube
terminates in the stomach. The catheter inserted through the
femoral approach terminates in the subsegmental branch of right lower lobe
pulmonary artery and should be pulled back at least 7 cm. Assessment of the
airways demonstrates patent airways bilaterally, but secretions are present,
in particular in the left lower lobe bronchus. There are no substantially
enlarged mediastinal, hilar or axillary lymph nodes within the limitations of
this non-enhanced study technique. Heart size is normal. No pericardial
effusion is seen. Bilateral, right more than left pleural effusion is
present. Right lower lobe consolidation is noted consistent with provided
history of aspiration. There are also multiple centrilobular nodules and
opacities involving both upper and lower lobe, right more than
left, also potentially reflecting aspiration event. No evidence of cavitation
is seen to suggest necrotizing pneumonia or abscess, but widespread
involvement of the lungs by infectious process is a possibility.
Centrilobular and paraseptal (predominantly paraseptal) emphysema is noted in
the lung apices with multiple bullae seen along the mediastinum. No discrete
masses are present.
There are no lytic or sclerotic lesions worrisome for infection or neoplasm
demonstrated.
## IMPRESSION:
1. Extensive airspace consolidation, multifocal, predominantly involving the
posterior basal segment of right lower lobe, but seen through the lungs with
opacities present as well, concerning for aspiration or
potentially aspiration pneumonia.
2. Small-to-moderate right pleural effusion.
3. Malpositioned catheter with its tip terminating at the level of
the segmental branch of right lower lobe pulmonary artery should be pulled
back at least 7 cm.
4. Apical paraseptal emphysema.
## ADDENDUM:
Findings were discussed with Dr. the phone by Dr.
at 11 a.m. on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14788898", "visit_id": "25042358", "time": "2154-06-10 23:00:00"} |
11645567-RR-90 | 122 | ## INDICATION:
year old woman with pericardial effusion and thyroid mass//
s/p chest tube placement, eval for pneumo
## IMPRESSION:
Dobhoff tube is unchanged with tip in the stomach. There has been interval
placement of a right base pleural pigtail catheter with slight decrease in
size of a now small layering right-sided pleural effusion, with persistent
adjacent densities in the right lung base, likely compressive atelectasis.
Similarly, a left base pleural pigtail catheter has been placed, with
essential resolution of the previously seen left-sided effusion. There is no
pneumothorax. Slight haziness of the lung fields suggest central pulmonary
vascular congestion with mild edema. The cardiomediastinal silhouette is
otherwise unchanged. A left-sided PICC terminates in the upper SVC,
satisfactory.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11645567", "visit_id": "28535502", "time": "2160-08-26 17:52:00"} |
16330993-RR-23 | 310 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old man s/p R evac now on heparin gtt// ? interval
changes of SDH
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
## FINDINGS:
The patient is again status post right frontal craniotomy evacuation of a
subdural hematoma with expected postoperative change.
Seen again is a dominant right frontal extra-axial collection measuring up to
1.0 cm in maximum thickness, grossly unchanged the previous examination. A
smaller component is seen posteriorly at the high parietal cerebral convexity
(02:24), measuring 3-4 mm and slightly less conspicuous from previous
examination.
Local mass effect is similar with partial effacement of the adjacent sulci.
Additionally, 5 mm of leftward midline shift is also minimally changed. There
is partial effacement of the right lateral ventricle.
Otherwise, the remainder of the ventricular system is normal and unchanged.
The basal cisterns remain patent. There is no evidence for impending downward
herniation at this time.
There is no evidence for large vascular territorial infarction by CT. No mass
or parenchymal edema is identified. A soft tissue hematoma/postoperative
seroma overlying the craniotomy site on the right has become less conspicuous.
There is complete right and partial left opacification of the mastoid air
cells. Mucosal thickening is seen involving the bilateral maxillary sinuses.
The remainder of the paranasal sinuses are grossly clear. The visualized
portion of the orbits are unremarkable.
## IMPRESSION:
1. Modest interval decreased conspicuity of dominant right cerebral convexity
subdural hematoma.
2. No definite evidence for new intracranial hemorrhage. No convincing
evidence for acute vascular territorial infarction by CT.
3. Stable extent of local mass effect and 5 mm of leftward midline shift.
Status post right frontal craniotomy with expected postoperative change.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16330993", "visit_id": "20255397", "time": "2144-06-12 11:04:00"} |
13492657-RR-40 | 133 | ## INDICATION:
year old woman with thyroid nodule. yr. follow-up.// F/U
nodule
## THE RIGHT LOBE MEASURES:
(transverse) 1.3 x (anterior-posterior) 1.1 x
(craniocaudal) 4.7 cm.
The left lobe measures: (transverse) 2.0 x (anterior-posterior) 1.4 x
(craniocaudal) 4.1 cm.
Isthmus anterior-posterior diameter is 0.3 cm.
The thyroid parenchyma is homogenous and has normal vascularity. A 1.9 x 1.4 x
1.3 cm isoechoic nodule with a few cystic components located in the mid to
lower pole of the left thyroid lobe, previously measuring 1.9 x 1.3 x 1.3 cm,
is unchanged in appearance compared to the prior study.
## IMPRESSION:
Unchanged left thyroid nodule. Recommend year follow-up thyroid ultrasound.
## RECOMMENDATION(S):
year follow-up thyroid ultrasound.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13492657", "visit_id": "N/A", "time": "2182-04-08 14:25:00"} |
19270999-DS-13 | 1,139 | ## ALLERGIES:
Erythromycin Base / Bactrim
## CHIEF COMPLAINT:
Altered mental status after overdose
## HISTORY OF PRESENT ILLNESS:
This is a y.o. male with HIV (CD4 540 in , HIV VL
, depression, and history of polysubstance abuse who
presented with altered mental status after taking an overdose.
Per the patient he had recently been having problems with his
social situation. He resides in house with his male partner and
another roommate. He reported that roommate is extremely
disrespectful of his property in general and that this had led
him to become progressively more angry and frustrated. His
frustration had become so great that on the day prior to
presentation he returned to his parent's home. He was agitated
and seemed slightly paranoid to his parents but otherwise was
acting his normal self. Per his parents' report he went to bed
approximately midnight. The patient admitted taking a large
amount of wellbutrin that night saying he wanted "it all to go
away." He will not firmly articulate whether he had any
intention to end his life. The following morning his father
discovered him around 6:00 am hanging off the couch, picking at
invisible objects in the air, and babbling to himself. He had
some abnormal movements, which his father who is a pyschiatrist
did not think appeared epileptiform. Generally, he appeared a
bit rigid and continued to babble. This prompted his father to
bring him to the hospital.
In the ED vital signs were normal and urine and serum tox were
negative except for benzodiazepines, which he had received prior
to the test. Head CT, UA, and CXR were WNL. The patient
received IV ceftriaxone 2 gm x 1, vancomycin 1 gm IV x 1 and
went on to have LP (which was negative for a pleiocytosis).
Toxicology was also consulted as the patient appeared flushed
and warm but without fevers and they thought his presentation
was most likely consistent with anticholinergic toxicity (though
there was never any clear anticholinergic ingestion). He
received 4 mg IV lorazepam in the ED for agitation. He was
initially to go to medicine but on toxicology reevaluation he
was unresponsive to sternal rub and then noted to desaturate to
85% on RA. Non-rebreather placed with O2 sat 99% then down to
94-96%. He was intubated for airway protection with etomidate 20
mg IV x 1 and succinylcholine 130 mg IV x 1 and then transferred
to the ICU.
## PAST MEDICAL HISTORY:
-HIV w/CD4 of 540 in efavirenz/emtricitabine/tenofovir
in past)
-Depression
-History of polysubstance abuse (cocaine, EtOH, ecstasy, crystal
meth): Sober
-History of MSRA pneumonia
-History of MRSA skin infections
-History of syphilis (treated)
-History of abnormal anal pap with low grade lesion (HPV)
## HEENT:
Normocephalic, anicteric, eyes half opened, pupils large
but reactive to light
## NECK:
No masses or lymphadenopathy, no thyroid nodules
appreciated
## PULM:
Clear to auscultation bilaterally, expansion equal
bilaterally,
## ABD:
Soft, NT, ND, BS+, no organomegaly or masses appreciated
## EXTREM:
Warm and well perfused, no C/C/E, 2+ DP pulses
bilaterally
## NEURO:
Somnolent, odd affect, appears to be gazing into space,
CNII-XII grossly intact, strength in all extremities
## ECG :
Sinus tachycardia. Otherwise, within normal limits. No previous
tracing
available for comparison.
## ECG :
Sinus rhythm. Compared to the previous tracing heart rate is
reduced.
## ECG :
Sinus rhythm. Normal tracing. Proper chest lead positioning.
Compared to the previous tracing of the findings are
similar.
## AP VIEW OF THE CHEST:
Allowing for low lung volumes, mild septal
thickening
and peribronchial thickening may indicate early interstitial
pneumonia or
bronchitis. There is no focal opacity or consolidation in the
lungs. The
heart size is top normal, but there is no evidence of pulmonary
edema or
vascular congestion. No appreciable pleural effusion or
pneumothorax is
present.
## IMPRESSION:
No acute intracranial process.
Please note that MRI is more sensitive for subtle lesions, if
there is a
clinical concern.
## NOTE ADDED IN ATTENDING REVIEW:
Incidentally noted are relative
low-lying
cerebellar tonsils with abundant surrounding CSF at the foramen
magnum level, likely representing slight tonsillar ectopia, a
normal variant.
## BRIEF HOSPITAL COURSE:
y.o. M with HIV (last CD4 540), depression, and history of
polysubstance abuse presenting with altered mental status post
overdose of buproprion.
## 1) ALTERED MENTAL STATUS/OVERDOSE:
Initially, primary suspicion
per toxicology was for anticholinergic toxidrome given apparent
visual hallucinations, patient being warmed and flushed, and
other signs. Buproprion has some anticholinergic effect and
intially there was some concern for a coingestion of the
efavirenz/emtricitabine/tenofovir combination the patient had
previously been on for HIV and which would be another possible
culprit for anticholinergic toxicity. Of note, the patient's
tox screen was negative for tricyclclics or acetaminophen.
Given presumed anticholinergice toxicity the toxicology service
recommended supportive care as the patient was not unstable.
They also recommended repeat ECG monitoring and considering
diagnostic use of sodium bicarb, as shortening of the QRS with
bicarb administration could indicate cardiotoxicity affecting
the conducting system. This was attempted for a QRS of 104 with
no change after bicarbonate administration. Overall, the QRS
never was >110 and never exceeded normal limits so there was
extremely minimal suspicion for any cardiac toxicity
predisposing to arrythmia. In addition to anti-cholinergic
toxicity it was also considered possible the patient was
demonstrating an element of serotonin syndrome with his possible
rigidity, tachycardia, and ? hyperthermia. Overall, his
symptoms had dramatically resolved by his second hospital day
when his mental status steadily improved following extubation.
His vital signs remained stable and he denied any physical
complaints.
## 2) OVERDOSE:
The patient overdosed on medications for unclear
reasons. His statement that he "wanted things to go away," his
inability to contract for safety at home, and his impulsive
action in the same home as two extremely supportive mental
health professionals were very concerning for future danger
after discharge. Therefore, he was admitted to inpatient
psychiatry from the medical floor.
## 3) RESPIRATORY FAILURE:
The patient was intubated primarily for
airway protection in the ED. As his mental status resolved he
no longer needed this and was extubated without incident. He
never demonstrated further signs of respiratory distress.
4)HIV: The patient has HIV but a CD4 540 recently at
. He has no signs of opportunistic
infections. There is no immediate indication for treatment
despite his viral load and he can discuss further treatment with
his outpatient providers.
## 5) HISTORY OF POLYSUBSTANCE ABUSE:
The patient has not abused
illicit drugs in >6 months. He will discuss continued sobriety
with his outpatient therapist.
The patient tolerated a full diet. He received SC heparin for
DVT prophylaxis. He was full code.
## DISCHARGE INSTRUCTIONS:
You were admitted after an overdose. You were monitored and
your breathing was supported. Your physical problems resolved
but you will need further treatment for your mental health
issues. Therefore you are being discharged to the inpatient
psychiatry unit.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19270999", "visit_id": "23711108", "time": "2140-02-29 00:00:00"} |
17753504-DS-15 | 1,346 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
Mr. is a speaking w/
complicated urologic history of CKD III, benign
prostate hypertrophy and para-urethral stricture status post
suprapubic tube (taken down in , type two diabetes, NSVT,
lung adenocarcinoma s/p RFA, UTIs, HTN, hyperlipidemia, and COPD
who presents with cough. We are unable to obtain complete
history or ROS since the patient answers the first question via
translator phone that he has no pain, but will not answer any
further questions. Per the ER note, "He has been having
[days] of productive cough and [right] lower chest wall pain. He
denies any associated fevers, chills, abdominal pain, N/V/D,
known sick contacts. He was also noted to be confused per his
daughter. does not exacerbate his chest pain. His
chest pain is exacerbated by pressing on the area that hurts. He
says that this is the area where he had lung cancer before, but
per review of records he had LUL adenocarcinoma and underwent
RFA. He has also been having of urinary incontinence." I
call his daughter to get collateral history who states that he
seems more listless and tired over the past few days, but knows
his name and where he is. She also notes urinary symptoms with
some difficulty in urination. It is unclear how consistently he
is taking his medications.
## PAST MEDICAL HISTORY:
-CKD, DM II, HTN, HLD
-Tobacco abuse, COPD, Lung cancer s/p LUL RF ablation
-complicated urological history including BPH, TURP and
urethral balloon dilation , suprapubic tube removed w/
subsequent vesicocutaneous fistula s/p partial cystectomy ,
urinary incontinence, and urinary retention
## FAMILY HISTORY:
Unknown as per the patient.
## -VITALS:
reviewed, SpO2 93% on room air, tmax 98.9F, BP
110/61-125/61, HR
-GENERAL: Alert and in no apparent distress
-HEENT: moist mucus membranes, PERRL, EOMi, atraumatic,
normocephalic
-CV: RRR, no murmur
-RESP: clear b/l without wheeze, room air
-GI: soft, non-tender, bowel sounds present. Lower abdomen does
feel distended.
-GU: no foley
-Skin: warm and dry without rashes
-NEURO: no focal neurological deficits, CN grossly intact
-PSYCH: normal thought content, normal mood and affect
## CT HEAD W/ CONTRAST:
1. No evidence for acute intracranial
abnormalities. MRI would be more
sensitive for intracranial metastatic disease or acute
infarction, if clinically warranted. 2. Paranasal sinus disease.
Aerated secretions in the left sphenoid sinus may represent
active inflammation or may be related to prolonged supine
positioning in the inpatient setting; please correlate
clinically.
## CXR:
Hyperinflated lungs without focal consolidation.
Evaluation of a previously ablated left upper lobe nodule is
better seen on the dedicated CT chest from . No
definite rib fractures are seen.
## BRIEF HOSPITAL COURSE:
h/o complicated urologic history (BPH, para-urethral
stricture s/p suprapubic tube taken down in , DM II, HTN,
and COPD presents with cough and encephalopathy.
1. Acute hypoxic respiratory failure with COPD exacerbation due
to Influenza B
-Tamiflu (renal dosing 30mg PO BID). Fever likely due
to flu but antibiotics started and completed 5 day course
(levoquin, ceftriaxone/azithro). He also completed prednisone
40mg . Patient without home benefit of oxygen so
remained in the hospital until able to wean O2. Supportive care
with incentive spirometry, acapella, duonebs (resume home
ipratropium at discharge), Guaifenesin, and tessalon for cough.
2. w/ low urine output h/o CKD
-Baseline creatinine 1.3 up to 1.8 . In setting of low
urine output and poor PO suspect this is prerenal and given IV
fluids with improvement in creatinine to 1.4. Patient encouraged
to maintain PO intake at discharge.
3. Acute encephalopathy
-Likely in setting of acute illness worsened by steroids, which
have completed. Now he seems more confused in the mornings,
which is likely hospital-acquired delirium.
4. DM II
-Started on lantus due to hyperglycemia on steroids, which was
increased from 10units to 13 units on . Given improved
glycemic control off steroids lantus was tapered off at time of
discharge. In spite of suspected noncompliance with oral
medications (metformin and glipizide) HbA1C 8.2% , which
is within goal for this year old man. Given this
consideration discharged him on metformin; glipizide increases
risk of hypoglycemic given his variable PO intake. Suspect he
would not be compliant with insulin.
5. Urinary retention w/ complicated urological history including
BPH, TURP and urethral balloon dilation , suprapubic tube
removed w/ subsequent vesicocutaneous fistula s/p partial
cystectomy , urinary incontinence, and urinary retention
-Chronic problem with fluctuations in urological symptoms
including incontinence, retention, and irritative symptoms. He
follows with urology last seen with
where oxybutynin was stopped, but it appears that he may
have still be taking it. placed due to retention,
oxybutynin stopped, and tamsulosin started. removed prior
to discharge with successful voiding trial. It seems that he
missed his follow up appointment and scheduled a follow
up appointment with urology.
6. Constipation
-Continue bowel regimen.
7. Medication reconciliation
-As per documentation the admitting physician called his
pharmacy who stated that he ran out of the Lisinopril 10mg
daily, Glipizide 2.5mg, and Metoprolol Succinate 25mg XL. It
does not seem that he takes his medications at home with
regularity and unable to do accurate medication reconciliation.
Reduced nonessential medications at discharge and gave new
prescriptions with instructions to follow up with PCP.
Chronic Medical Problems
## 1. HTN:
continue Metoprolol succinate and lisinopril. He has
had some SBP in the 100s stopped chlorthalidone (given risk for
electrolyte abnormalities and volume depletion). Recommend up
titration lisinopril if needed for hypertension.
## 2. HLD:
continue simvastatin, aspirin
3. Lung cancer s/p LUL RF ablation: remains in remission with
surveillance CT reassuring, due for repeat imaging in
year.
>30 minutes spent on discharge planning
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. Chlorthalidone 12.5 mg PO DAILY
3. MetFORMIN XR (Glucophage XR) mg PO DAILY
4. Ditropan XL (oxybutynin chloride) 5 mg oral DAILY
5. Simvastatin 20 mg PO QPM
6. Tiotropium Bromide 1 CAP IH DAILY
## DISCHARGE MEDICATIONS:
1. Acetaminophen 325-650 mg PO Q4H:PRN Pain - Mild/Fever
RX *acetaminophen [Acetaminophen Pain Relief] 500 mg
tablet(s) by mouth Q6 hours as needed Disp #*100 Tablet
## REFILLS:
*0
2. Albuterol Inhaler PUFF IH Q4H:PRN shortness of breath
RX *albuterol sulfate [ProAir HFA] 90 mcg puff inh Q4 hours
as needed Disp #*1 Inhaler Refills:*0
3. GuaiFENesin mL PO Q6H cough
RX *guaifenesin [Cough Syrup] 100 mg/5 mL 5 mL by mouth Q6 hours
## PRN REFILLS:
*0
4. Lisinopril 5 mg PO DAILY
RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
## REFILLS:
*0
5. Metoprolol Succinate XL 25 mg PO DAILY
RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp
#*30 Tablet Refills:*0
6. Polyethylene Glycol 17 g PO DAILY constipation
RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 1 powder(s)
by mouth daily Refills:*0
7. Tamsulosin 0.4 mg PO QHS
RX *tamsulosin 0.4 mg 1 capsule(s) by mouth at bedtime Disp #*30
## CAPSULE REFILLS:
*0
8. Aspirin 81 mg PO DAILY
RX *aspirin [Adult Aspirin Regimen] 81 mg 1 tablet(s) by mouth
daily Disp #*30
## TABLET REFILLS:
*0
9. MetFORMIN XR (Glucophage XR) mg PO DAILY
RX *metformin 1,000 mg 2 tablet(s) by mouth daily Disp #*60
## TABLET REFILLS:
*0
10. Simvastatin 20 mg PO QPM
RX *simvastatin 20 mg 1 tablet(s) by mouth at bedtime Disp #*30
Tablet Refills:*0
11. Tiotropium Bromide 1 CAP IH DAILY
RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 cap
inh daily Disp #*30 Capsule Refills:*0
## DISCHARGE DIAGNOSIS:
Influenza
Acute respiratory failure with hypoxia
COPD exacerbation
Urinary retention
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted with the flu and treated with oxygen,
antibiotics, and breathing treatments. You can continue to use
your inhalers and cough medications for cough or SOB.
You had some urinary retention requiring temporary placement of
a foley catheter, which was removed at discharge. Please follow
up with urology.
It was a pleasure taking care of you.
-Your team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17753504", "visit_id": "26454249", "time": "2185-04-06 00:00:00"} |
10925066-DS-9 | 872 | ## ALLERGIES:
Adderall XR / Concerta / Strattera / Penicillins /
Sulfa(Sulfonamide Antibiotics)
## CHIEF COMPLAINT:
Right Upper Quadrant Abdominal pain
## HISTORY OF PRESENT ILLNESS:
Ms. is a with HLD, OA, hypothyroid and asymptomatic
Right carotid stenosis who comes in with three days of
increasing abdominal pain. She was seen the day of admission by
her PCP who drew labs. She was called at home by her PCP who
advised her to come to the ED, which she did. After having
repeat LFTs drawn which were elevated, she had a ultrasound
which showed a thickened gallbladder wall, large stones, and a
normal 3mm CBD. She denies fevers, nausea or vomiting. ACS was
consulted for possible operative management of her
cholelithiasis with cholecystitis.
## PHYSICAL EXAM:
Physical Exam upon presentation:
## HEENT:
No scleral icterus, mucus membranes moist
## PULM:
Clear to auscultation b/l, No W/R/R
## ABD:
Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses
## DRE:
normal tone, no gross or occult blood
## EXT:
No edema, warm and well perfused
## HEENT:
No scleral icterus, mucus membranes moist
## PULM:
Clear to auscultation b/l, No W/R/R
## ABD:
Soft, nondistended, nontender, no rebound or guarding,
normoactive bowel sounds, no palpable masses. Laparoscopic
incisions clean, dry, and intact.
## EXT:
No edema, warm and well perfused
## IMPRESSION:
1. Features consistent with acute on chronic cholecystitis.
2. Periportal edema with heterogenous enhancement on arterial
phase imaging
suggestive of an inflammatory process.
3. No intra- or extra-hepatic biliary dilatation. The common
bile duct
measures 6 mm, within normal limits. No intraductal filling
defect.
## IMPRESSION:
1. Markedly abnormal thick walled distended gallbladder filled
with stones,
though negative Sonographic sign and minimal subjective
pain. Given
the extremely elevated LFTs, findings may be secondary acute
hepatic
dysfunction (hepatitis) in a patient with cholelithiasis. An
atypical
cholecystitis in a patient with liver dysfunction remains within
the
differential.
2 No intra- or extra-hepatic biliary ductal dilatation.
## BRIEF HOSPITAL COURSE:
Ms. ultrasound findings were concerning for
cholecystitis w/ possible choledocholithiasis. After admission,
she under MRCP evaluation of the gallbladder and common bile
duct, which was suggestive of chronic cholecystitis without
choledocholithiasis. Because there was no common bile duct
distention or filling defect, ERCP was not deemed necessary, and
pt was taken for laparoscopic cholecystectomy. The operation was
uncomplicated and the patient tolerated it well. She tolerated a
regular diet on POD 1 and her pain was well controlled on PO
medications. She was discharged home with return precautions and
with follow-up in clinic.
## MEDICATIONS ON ADMISSION:
Aspirin Low Dose
Calcium 600
Fish Oil
Glucosamine Magnesium
Multivitamin
Vitamin D
Levothyroxine,
Methylphenidate
Trazodone
## DISCHARGE MEDICATIONS:
1. Levothyroxine Sodium 88 mcg PO DAILY
2. MethylPHENIDATE (Ritalin) 10 mg PO BID
3. Oxycodone-Acetaminophen (5mg-325mg) TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen 5 mg-325 mg tablet(s) by mouth
q4hr Disp #*50 Tablet Refills:*0
4. Outpatient Lab Work
Please obtain liver functions tests including lipase. (ICD-9:
790.5)
Please fax results to Acute Care Surgery Clinic,
. Phone: .
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the acute care surgery service for acute
cholecystitis (infection of the gallbladder). You underwent a
laparoscopic cholecystectomy.
Please call your doctor or go to the emergency department if:
*You experience new chest pain, pressure, squeezing or
tightness.
*You develop new or worsening cough, shortness of breath, or
wheeze.
*You are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience an unusual discharge.
*Your pain is not improving within 12 hours or is not under
control within 24 hours.
*Your pain worsens or changes location.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*You develop any concerning symptoms.
## GENERAL DISCHARGE INSTRUCTIONS:
Please resume all regular home medications, unless specifically
advised not to take a particular medication. Please take any
new medications as prescribed.
Please take the prescribed analgesic medications as needed. You
may not drive or heavy machinery while taking narcotic analgesic
medications. You may also take acetaminophen (Tylenol) as
directed, but do not exceed 4000 mg in one day.
Please get plenty of rest, continue to walk several times per
day, and drink adequate amounts of fluids. Avoid strenuous
physical activity and refrain from heavy lifting greater than 20
lbs., until you follow-up with your surgeon, who will instruct
you further regarding activity restrictions. Please also
follow-up with your primary care physician.
## INCISION CARE:
*Please call your surgeon or go to the emergency department if
you have increased pain, swelling, redness, or drainage from the
incision site.
*Avoid swimming and baths until cleared by your surgeon.
*You may shower and wash incisions with a mild soap and warm
water. Gently pat the area dry.
*If you have staples, they will be removed at your follow-up
appointment.
*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips days after surgery.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10925066", "visit_id": "25143975", "time": "2173-06-16 00:00:00"} |
17661275-RR-19 | 238 | ## INDICATION:
year old man with severe multi-vessel coronary artery disease.
Evaluate for carotid stenosis
## RIGHT:
The right carotid vasculature has mild heterogeneous atherosclerotic plaque
within the internal carotid artery.
The peak systolic velocity in the right common carotid artery is 80 cm/sec.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 74, 105, and 64 cm/sec, respectively. The peak end
diastolic velocity in the right internal carotid artery is 32 cm/sec.
The ICA/CCA ratio is 1.3.
The external carotid artery has peak systolic velocity of 52 cm/sec.
The vertebral artery is patent with antegrade flow.
## LEFT:
The left carotid vasculature has moderate heterogeneous atherosclerotic plaque
within the internal carotid artery.
The peak systolic velocity in the left common carotid artery is 91 cm/sec.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 84, 165, and 150 cm/sec, respectively. The peak end
diastolic velocity in the left internal carotid artery is 60 cm/sec.
The ICA/CCA ratio is 1.8.
The external carotid artery has peak systolic velocity of 95 cm/sec.
The vertebral artery is patent with antegrade flow.
## IMPRESSION:
1. Mild right heterogeneous atherosclerotic plaque within the internal
carotid artery without hemodynamically significant stenosis (less than 40%).
2. Moderate left heterogeneous atherosclerotic plaque within the internal
carotid artery resulting in 60-69% stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17661275", "visit_id": "N/A", "time": "2147-10-21 13:01:00"} |
14062834-RR-89 | 170 | CT OF THE HEAD WITHOUT CONTRAST, .
## HISTORY:
male with thrombocytopenia from liver disease and recent
fall after being hit by a car, with tinnitus and occasional "flashes of
light";? subdural or parenchymal bleeding.
## FINDINGS:
The study is compared with the most recent NECT of the
overall appearance is unchanged. There is no intra- or extra-axial
hemorrhage, the midline structures are in the midline and the ventricles and
cisterns are normal in size and unchanged in size and configuration. The
gray-white matter differentiation is maintained, with no evidence of cerebral
edema and the posterior fossa structures are unremarkable. Incidentally noted
is extensive atherosclerotic calcification of the intracranial vessels.
There is relatively mild mucosal thickening with tiny mucus-retention cysts
involving scattered anterior and posterior ethmoidal air cells, bilaterally,
as before. The mastoid air cells and middle ear cavities are clear, and no
fracture is seen.
## IMPRESSION:
No acute intracranial abnormality and no change since the study
of .
## COMMENT:
These findings were discussed with Dr.
clinician), by telephone at , .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14062834", "visit_id": "N/A", "time": "2175-05-10 11:02:00"} |
15940484-RR-19 | 110 | ## CHEST:
Frontal and lateral views
## INDICATION:
year old man s/p assault attempted hanging, having
clavicular pain // r/o fracture
## FINDINGS:
There has been interval removal of the endotracheal tube nasogastric tube.The
lungs are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. The cardiac, hilar and mediastinal silhouettes are
unremarkable.
The stomach is significantly distended with air and fluid.
## IMPRESSION:
1. The stomach is significantly distended compared to prior exam.
2. No evidence of clavicular fracture.
3. No acute cardiopulmonary process.
## NOTIFICATION:
The findings were discussed by Dr. with Dr.
on the telephoneon at 11:12 AM, 15 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15940484", "visit_id": "26714721", "time": "2163-09-01 20:56:00"} |
17700737-RR-28 | 621 | ## EXAMINATION:
CT abdomen with contrast.
## INDICATION:
woman with history of HCV and cirrhosis. Now with
elevated AFP > 500. Evaluation to rule out HCC.
## 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) Spiral Acquisition 3.1 s, 34.1 cm; CTDIvol = 2.0 mGy (Body) DLP = 66.4
mGy-cm.
2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5
mGy-cm.
3) Stationary Acquisition 8.9 s, 0.2 cm; CTDIvol = 118.3 mGy (Body) DLP =
23.7 mGy-cm.
4) Spiral Acquisition 4.3 s, 28.0 cm; CTDIvol = 7.1 mGy (Body) DLP = 194.3
mGy-cm.
5) Spiral Acquisition 7.5 s, 48.7 cm; CTDIvol = 6.9 mGy (Body) DLP = 333.4
mGy-cm.
6) Spiral Acquisition 3.9 s, 25.3 cm; CTDIvol = 7.1 mGy (Body) DLP = 176.2
mGy-cm.
Total DLP (Body) = 796 mGy-cm.
## LOWER CHEST:
Mild dependent atelectasis bilaterally. There is no evidence of
pleural or pericardial effusion.
## HEPATOBILIARY:
The liver contour is nodular, consistent with known cirrhosis.
There is an ill-defined hepatic lesion measuring approximately 1 cm at the tip
of segment VI, which appears hyperdense on arterial phase (series 6, image 64)
and washes out to appear hypodense on delayed phase (series 16, image 57).
There is a 1.1 cm cyst seen in segment II of the liver (series 10, image 31),
unchanged since . No other focal hepatic lesions are seen. 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. There is a
small splenic hypodensity which is too small to characterize.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is not visualized.
## PELVIS:
The urinary bladder and distal ureters 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. Moderate atherosclerotic
disease is noted.
## CTA:
Mild atherosclerotic disease is noted in the abdominal aorta. Celiac
axis and SMA are patent, with no evidence of aneurysm. There is mild
atherosclerotic disease at the origin of the right renal artery.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. Ill-defined hepatic lesions measuring approximately 1 cm at the tip of
segment VI (6;63), which appear hyperdense on arterial phase and appear to
wash out and become hypodense on delayed phase, is concerning for possible
neoplasm. An MRI abdomen is recommended for further characterization of these
lesions.
2. Nodular liver consistent with cirrhosis. Stable hepatic cyst in segment
II.
## RECOMMENDATION(S):
Given the patient's history of HCV and cirrhosis, an MRI
abdomen is recommended for further characterization of the hepatic lesions at
the tip of segment VI (6;63).
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 13:35 into the Department of Radiology
critical communications system for direct communication to the referring
provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17700737", "visit_id": "N/A", "time": "2163-11-04 14:45:00"} |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.