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13578203-RR-13 | 126 | ## CLINICAL HISTORY:
woman with VP shunt and high white count,
mental retardation. Assess shunt.
## FINDINGS:
AP and lateral skull, AP neck and chest as well as the abdomen were
provided.
## FINDINGS:
A right parietal bone access VP shunt is seen with ventriculostomy
extending to the approximate level of the right lateral ventricle. Shunt
tubing extends also through a separate entry point in the right occipital bone
and shunt tubing then travels inferiorly through the soft tissues of the right
neck, right chest. Tubing is seen terminating in the right lower quadrant.
There is no sign of shunt kinks or discontinuity. The lungs appear clear
bilaterally. Bowel gas pattern is unremarkable. Bones appear intact.
## IMPRESSION:
Shunt positioned as described without evidence of kinks or
discontinuity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13578203", "visit_id": "N/A", "time": "2131-07-31 17:27:00"} |
17822878-RR-44 | 236 | DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM,
## CLINICAL INFORMATION:
Pain in the right axillary tail/lower axilla at the
site of previous biopsy revealing a benign reactive lymph node. Now for
further evaluation.
## FINDINGS:
Routine views of both breasts were performed using GE digital
mammography. Comparison made with .
Both breasts demonstrate a heterogeneously dense glandular pattern. Overlying
the right pectoralis muscle in the axilla, there are a few new surgical clips
seen from patient's excisional biopsy of a benign lymph node. No dominant
mass, significant clustered calcification, or architectural distortion is
seen. Stable benign intramammary lymph node is again noted in the upper outer
superficial right breast.
For further evaluation of focal axillary tail/lower axillary pain, ultrasound
was performed. No fluid collection is identified. At the inferior aspect of
the surgical scar in the upper outer quadrant, a 1 x 1.1 x 0.5 cm benign-
appearing lymph node is seen. There is an adjacent smaller benign- appearing
lymph node measuring 0.3 x 0.5 x 0.3 cm. No suspicious mass is identified.
## IMPRESSION:
New surgical clips overlying the right axillary region consistent
with patient's surgical excisional biopsy of a lymph node revealing benign
reactive process. Ultrasound directed to the area of focal pain reveals no
suspicious mass. Incidentally noted are two benign-appearing lymph nodes
at the inferior aspect of the scar. Results discussed with the patient.
BI-RADS 2 - benign.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17822878", "visit_id": "N/A", "time": "2137-05-03 14:48:00"} |
18887130-RR-158 | 187 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old woman with neutropenic fever and headache //
evaluate for intracranial bleed, stroke
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP =
752.0 mGy-cm.
Total DLP (Head) = 752 mGy-cm.
## FINDINGS:
Metallic streak artifact related to prior supraclinoid ICA embolization and
dental amalgam streak severely limits the study at the skullbase. Within this
confine:
There is no evidence of acute large territory infarct, hemorrhage, edema, or
mass effect. There is prominence of the ventricles and sulci suggestive of
age-related involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
## IMPRESSION:
Metallic streak artifact related to prior supraclinoid ICA embolization and
dental amalgam streak artifact severely limits evaluation near the skullbase.
Within this confine:
1. No acute intracranial abnormalities on noncontrast head CT. Specifically
no large territory infarct or intracranial hemorrhage. The paranasal sinuses
appear clear. The mastoid air cells are clear.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18887130", "visit_id": "28046425", "time": "2186-03-11 14:39:00"} |
11721267-RR-15 | 93 | ## INDICATION:
Head strike last night with persistent pain and dizziness.
## FINDINGS:
There is no evidence of hemorrhage, edema, mass, mass effect, or
large vascular territory infarction. The ventricles and sulci are normal in
size and configuration for the patient's age. The basal cisterns are patent.
There is preservation of gray-white matter differentiation.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells and right middle ear cavity are clear. Cerumen is present in the left
middle ear cavity. The soft tissues are unremarkable.
## IMPRESSION:
No acute intracranial abnormality.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11721267", "visit_id": "N/A", "time": "2150-12-20 21:44:00"} |
18725847-RR-61 | 418 | ## INDICATION:
Recent diagnosis invasive lobular carcinoma left breast. Evaluate
extent of disease and screen the right breast.
## FINDINGS:
Breast tissue is heterogeneously dense.
Background enhancement is mild to moderate.
In the right breast, there are scattered subcentimeter T2 bright nodules
consistent with cysts. There are also scattered foci of enhancement.
In the left breast, there is a spiculated enhancing mass at the 6 o'clock
position posterior depth corresponding to the biopsy-proven invasive lobular
carcinoma. On MR, the mass measures 2.2 cm AP x 0.7 cm craniocaudal x 1.8 cm
transverse. There is artifact within the mass from a biopsy marking clip
status post ultrasound core biopsy. CAD imaging shows rapid washout, also
supporting a diagnosis of malignancy. In the left breast, o'clock
position, there are two nodular areas of enhancement at an anterior depth,
containing two biopsy marking clips. This corresponds with the areas which
were biopsied with ultrasound guidance on and , and yielded
"stromal fibrosis" following the first ultrasound-guided core biopsy and
"dense fibrous breast tissue with columnar cell change and hemosiderin laden
macrophages, no malignancy" at the second biopsy. The more anterior nodular
area of enhancement measures 1.2 cm in greatest dimension and the more
posterior and inferior nodular area of enhancement measures 8 mm in greatest
dimension. Kinetics demonstrate progressive enhancement in these areas. There
is an additional lobulated enhancing nodule in the upper inner quadrant of the
left breast approximately at a middle depth. This nodular area of enhancement
measures 6 mm in greatest dimension and demonstrates progressive enhancement
kinetics. On T2 imaging, a portion of the nodule is T2 hyperintense.
## IMPRESSION:
1. Spiculated enhancing mass left breast 6 o'clock position corresponding to
biopsy-proven invasive lobular carcinoma.
2. Nodular areas of enhancement at the o'clock position of the left
breast with progressive enhancement kinetics, corresponding to the areas which
were biopsied with ultrasound and showed benign pathology. Given the variable
appearance of lobular carcinoma at MR, excision of this area is still
recommended based on imaging appearance.
3. 1.2 cm lobulated enhancing nodule upper inner quadrant of the left breast,
which may represent a fibroadenoma. Targeted ultrasound and biopsy is
recommended if the patient is planning breast conservation therapy.
4. No evidence of malignancy in the right breast.
BI-RADS 6 - known carcinoma. Targeted ultrasound and biopsy of the nodule in
the upper inner quadrant of the left breast recommended.
Findings E-mailed to Dr. in Breast Care
Center on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18725847", "visit_id": "N/A", "time": "2158-06-25 19:20:00"} |
14249143-RR-21 | 298 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
Mr. is an year old man invasive gastric cancer,
diastolic CHF, AF, hematuria, CAD and chronic HBV infection, who presented
with generalized weakness and abnormal lab results at nursing home. // s/p
fall on anticoagulation
## DOSE:
Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 16.4 cm; CTDIvol = 49.0 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
Acute right parafalcine subdural hemorrhage measuring up to 5 mm (series 2,
image 24). There is also a small amount of serpentine acute blood adjacent to
the right falx suggesting subarachnoid hemorrhage (series 2, image 23). No
shift of normally midline structures. Is prominence of the ventricles and
sulci suggest cortical atrophy, likely age related. Hypodensities within the
left basal ganglia may represent old lacunar infarcts. No large acute
territorial infarct. The basilar cisterns are patent. Extensive internal
carotid artery calcifications are noted.
No evidence of a fracture. There is partial opacification of the paranasal
sinuses. Aerosolized secretions are noted in the right maxillary sinus.
There is mild mucosal thickening of the left maxillary sinus. There is mild
mucosal thickening of the left sphenoid sinus. The right sphenoid sinus is
clear. Frontal sinuses clear. The right frontal sinuses hypoplastic or
absent. The mastoid air cells are underpneumatized, particularly on the
right. The lens of been replaced. The orbits are otherwise unremarkable.
## IMPRESSION:
1. Small 5-mm focal acute right parafalcine subdural hemorrhage.
2. Small subarachnoid hemorrhage along the right falx.
3. No evidence of fracture.
4. Paranasal sinus disease as above.
## NOTIFICATION:
The findings were discussed by Dr. with Dr.
on the telephoneon at 6:11 AM, 1 minutes after discovery of
the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14249143", "visit_id": "24965477", "time": "2177-01-04 05:11:00"} |
15265088-RR-20 | 166 | ## TYPE OF EXAMINATION:
Chest PA and lateral.
## INDICATION:
Preoperative to aortic valve replacement and possible coronary
artery bypass surgery in patient with history of aortic stenosis.
## FINDINGS:
PA and lateral chest views were obtained with patient in upright
position. The heart is mildly enlarged. The configuration indicates a
prominence of the left ventricular contour, finding which in conjunction with
the moderately widened thoracic aorta is suggestive of hypertension. Most
striking prominence of the ascending aorta is noted and no conclusive evidence
for aortic valve calcifications is seen on the PA and lateral chest views.
Pulmonary vasculature is not congested and no acute pulmonary infiltrates are
present. Lateral and posterior pleural sinuses are free of fluid
accumulations. Noteworthy is a moderately sized hiatal hernia in retrocardiac
position with typical air-fluid level. Our records do not include a previous
chest examination available for comparison.
## IMPRESSION:
No evidence of acute pulmonary congestion or infiltrates on
preoperative chest examination. Observe presence of a moderately sized hiatal
hernia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15265088", "visit_id": "N/A", "time": "2160-01-11 15:19:00"} |
19407684-RR-34 | 168 | PORTABLE AP UPRIGHT CHEST RADIOGRAPH
## HISTORY:
woman with cough and fever. Evaluate for pneumonia.
## FINDINGS:
The cardiac silhouette is indistinct but appears normal in size.
The hilar and mediastinal contours appear grossly unremarkable; however, the
evaluation is limited due to patient rotation. There is marked calcification
of the aortic arch. There is right apical pleural scarring, unchanged. There
is increased interstitial markings superiorly and bilaterally suggestive of
underlying emphysema. The lungs also appear slightly lucent. There is
elevation of the left hemidiaphragm as well as left basilar atelectasis. The
left cardiac border as well as diaphragm is obscured, likely related to
basilar atelectasis or an early left basilar pneumonia. There is a small left
pleural effusion. The right lung appears clear. There are degenerative
changes noted of the thoracolumbar spine. Bones are diffusely osteopenic.
Otherwise, there are no soft tissue or osseous structural abnormalities.
## IMPRESSION:
1. Left basilar consolidation representative of atelectasis or early
pneumonia.
2. Small left pleural effusion.
3. Underlying apical emphysema. Right apical scarring.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19407684", "visit_id": "24667745", "time": "2119-01-19 08:52:00"} |
14190536-RR-11 | 837 | ## EXAMINATION:
MR CERVICAL, THORACIC AND LUMBAR SPINE W/O CONTRAST
## INDICATION:
Patient with multiple myeloma and severe low back pain, concern
for cord compression.
## FINDINGS:
There is diffuse heterogeneity of signal throughout the entire spine
compatible with infiltrative process from multiple myeloma. Anterior wedge
compression fractures of T9 and T11 are present, with loss of over 50 % of
anterior vertebral body height at the level of T9 and more than 75 % of at the
level of T11. There is also compression deformity of T12 spanning the whole
vertebral body with at least 50 % of height. There is minimal
retropulsion of a bony fragment at T11 described in detail in the thoracic
portion of this report, but there is no evidence of spinal canal stenosis or
cord compression. No other fracture is identified throughout the spine. There
is no prevertebral soft tissue swelling or paraspinal soft tissue abnormality.
Degenerative changes are seen throughout the spine:
## CERVICAL SPINE:
The aerodigestive tract is unremarkable. Imaged portions of
the lungs and cerebellum are normal.
## C1-C2:
The lateral masses are symmetric with respect to the dens. No spinal
canal narrowing. No abnormality of the alar ligaments.
## C2-C3:
There is normal disc height. No disc bulge or spinal canal or neural
foraminal narrowing is present.
## C3-C4:
Minimal disc bulge without spinal canal stenosis or neural foramina
narrowing.
## C4-C5:
Minimal disc bulge without spinal; canal stenosis or neural foramina
narrowing.
## C5-C6:
There is low T2 signal of the disc, loss of disc space and disc bulge
resulting in mild indentation into the spinal canal but no contact with the
cord. Mild right neural foramen narrowing is present. Unremarkable left neural
foramen.
## C6-C7:
There is normal disc height. No disc bulge or spinal canal or neural
foraminal narrowing is present.
## C7-T1:
There is normal disc height. No disc bulge or spinal canal or neural
foraminal narrowing is present.
## THORACIC SPINE:
There are anteriorly wedged compression fractures of T9 and
T11 as well as compression deformity of T12 resulting in exaggeration of the
thoracic kyphosis without vertebral malalignment. The thoracic spinal cord
shows normal morphology and signal intensity. The posterior elements and
paraspinal soft tissues are normal.
T1 through T7: There is no disc herniation, or spinal canal or neural
foraminal stenosis.
## T7-T8:
There is low T2 signal of the disc, loss of disc space and minimal disc
bulge resulting in mild indentation into the spinal canal but no contact with
the cord.
T8-T9 through T10:T11: There is minimal disc bulge at all levels resulting in
mild indentation into the spinal canal but no contact with the cord. No neural
foramina narrowing.
## T11-T12:
There is retropulsion of a small bony fragment from the
posterosuperior corner of T12 with superimposed disc bulge resulting in
moderate spinal canal stenosis and impingement of the disc upon the cord which
appears deformed but without definite signal abnormality at this level -
apparent central linear high T2 signal in the cord is not confirmed in the
axial views and likely the result of artifact. Bilateral neural foramina
narrowing is present with contact seen between the disc and the exiting T12
roots on both sides.
## LUMBAR SPINE:
The vertebral body height and alignment is maintained.
## T12-L1:
There is minimal disc bulge resulting in mild indentation into the
spinal canal but no contact with the cord. No neural foramina narrowing.
## L1-L2:
There is low T2 signal of the disc, loss of disc space and disc bulge
resulting in mild indentation into the spinal canal but no contact with the
cord. Mild right neural foramen narrowing. Normal left neural foramen.
L2-L3 and L3-L4: There is no disc herniation, spinal canal or neural foraminal
stenosis.
## L4-L5:
There is low T2 signal of the disc and disc bulge resulting in mild
indentation into the spinal canal but no contact with the cord. No neural
foramina narrowing is seen.
## L5-S1:
There is no disc herniation, or spinal canal or neural foraminal
stenosis.
The conus medullaris and cauda equina have normal morphology and signal
intensity.The conus medullaris terminates at the L1 level. The posterior
elements and paraspinal soft tissues are normal.
No gross abnormality is seen in the included structures of the posterior
mediastinum and retroperitoneum.
## IMPRESSION:
1. Diffuse heterogeneity of signal throughout the entire spine compatible with
infiltrative process from multiple myeloma.
2. Anteriorly wedge compression fractures of T9 and T11 as well as compression
deformity of the whole vertebral body of T12 are present, with only minimal
retropulsion of a bony fragment at T11-T12 that although impinges upon the
thecal sac and deforms the cord, does not result in cord compression. No cord
signal abnormality identified.
3. Degenerative changes of the spine resulting in multilevel neural foramina
narrowing, more conspicuous at T11-T12, are described in detail in the body of
the report.
## NOTIFICATION:
The findings were discussed by Dr. with Dr. on
the telephone on at 8:45 AM, immediatley after discovery of the
findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14190536", "visit_id": "N/A", "time": "2180-09-01 18:13:00"} |
12544973-RR-14 | 749 | ## EXAMINATION:
CT abdomen and pelvis with contrast
## NO PO CONTRAST; HISTORY:
with abdominal pain, vomiting s/p
left nephrectomy 5 days agoNO PO contrast // Obstruction, abscess, 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.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 0.6 s, 6.5 cm; CTDIvol = 8.2 mGy (Body) DLP = 52.9
mGy-cm.
2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 48.1 mGy (Body) DLP =
24.1 mGy-cm.
3) Spiral Acquisition 5.2 s, 56.5 cm; CTDIvol = 12.8 mGy (Body) DLP = 722.9
mGy-cm.
Total DLP (Body) = 800 mGy-cm.
## LOWER CHEST:
Bibasilar atelectasis is noted. There is trace bilateral pleural
effusion. There is no pericardial effusion. Multiple collateral vessels are
seen at the level of the left scapula possibly related to partial venous
obstruction.
## ABDOMEN:
Study is moderately degraded by streak artifact from previously administered
barium contrast within the colon and motion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is mild intrahepatic and
extrahepatic biliary dilatation which may be secondary to cholecystectomy,
however this is new since .
## 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:
Patient is status post left nephrectomy with postsurgical staples
and foci of free air noted in the left nephrectomy bed. The right kidney is
of normal and symmetric size with normal nephrogram. Subcentimeter
hypodensity in the inferior pole of the right kidney is too small to
characterize likely simple cyst. There is no right hydronephrosis. There is
no perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. Assessment of the
colon is limited by oral contrast with in the ascending, transverse, and
proximal and distal colon. Within these limitations, no significant
abnormalities detected. The appendix is normal.
## PELVIS:
The urinary bladder is distended and contains contrast. Foci of gas
within the anterior bladder may be secondary to recent instrumentation. There
is mild free fluid in the pelvis. At the level of the postsurigcal clips in
the left hemipelvis there is a small nondrainable fluid collection (4:59).
## REPRODUCTIVE ORGANS:
A 2.4 x 3.0 cm round cystic lesion with rim enhancement
in the left hemipelvis likely represents a left adnexal cyst within the left
ovary which could be reassessed with ultrasound the patient has pain in this
region.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
A small area of hemorrhage hemorrhage in the subcutaneous
tissues with stranding and foci of air overlying the left anterior abdominal
wall is likely postsurgical.
## IMPRESSION:
1. Study is moderately degraded by streak artifact from previously
administered barium contrast with in the colon and motion.
2. Status post left nephrectomy with postsurgical staples and foci of air
noted in the surgical site and left hemipelvis. At the level of the
postsurigcal clips in the left hemipelvis there is a small nondrainable fluid
collection.
3. A 2.4 x 3.0 cm round cystic lesion with rim enhancement in the left
hemipelvis likely represents a left adnexal cyst within the ovary. If the
patient has pain in this region follow-up with ultrasound could be performed.
4. There is mild free fluid in the pelvis.
5. Gas within the distended bladder is likely secondary to recent
instrumentation.
6. A small hemorrhage in the subcutaneous tissues with stranding and foci of
air overlying the left anterior abdominal wall likely postsurgical.
7. There is mild intrahepatic and extrahepatic biliary dilatation which may be
secondary to cholecystectomy, however this is new since . Recommend
correlation with LFTs.
8. Free intraperitoneal air in keeping with recent surgery is noted for which
clinical and radiographic follow-up may be performed to ensure resolution.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 10:38 AM, 15 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12544973", "visit_id": "27794528", "time": "2186-04-01 03:47:00"} |
17321845-RR-10 | 165 | ## INDICATION:
Assess for obstruction or strictures in neo-bladder.
## ABDOMEN, SINGLE VIEW:
Nonspecific bowel gas pattern. Clips are seen in the
lower pelvis and right lower quadrant likely related to cystectomy and ileal
conduit. No suspicious lytic or blastic lesion but extensive degenerative
changes in the lumbar spine.
## POUCHOGRAM:
After insertion of a Foley catheter into the ileal conduit,
Conray was introduced via gravity and 60 cc, there was immediate reflux to the
mid ureteral level. After raising the container of Conray, reflux was seen
through the left pelvicaliceal system. Then, reflux was seen into the distal
right ureter to the mid ureteral region. Given this reflux with gravity, no
Conray injection was performed. The patient noted pain as the container of
Conray was raised. No stricture was seen to the level of the reflux: mid
ureteral on the right and pelvicalyceal on the left.
## IMPRESSION:
Bilateral conduit ureteral reflux early and pronounced on the
left, and both occurring prior to maximal distension.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17321845", "visit_id": "N/A", "time": "2116-04-25 10:21:00"} |
17392100-RR-10 | 101 | ## INDICATION:
woman with history of recurrent pleural effusions,
status post talc pleurodesis.
## PORTABLE AP UPRIGHT CHEST:
The left pigtail pleural catheter is in the same
position. The small left apical pneumothorax is stable. A small loculation
alongside the lingula of the persistent small left pleural effusion is new. A
small right pleural effusion is stable in volume but different in
distribution.
## IMPRESSION:
1. Stable, small left apical pneumothorax. New small loculation of left
pleural effusion alongside the lingula. Left pleural drain unchanged in
position.
2. Small to moderate right pleural effusion, also stable in volume but
different in distribution.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17392100", "visit_id": "23263814", "time": "2167-03-29 09:32:00"} |
13160555-RR-49 | 261 | CT CHEST WITHOUT CONTRAST
## REASON FOR EXAM:
man with prior history of smoking with right
upper lobe nodule. Evaluate for change.
## FINDINGS:
Right upper lobe peribronchovascular partially nodular opacities
increased. Right basilar peribronchial opacities also increased, could be
atelectasis. Small-to-moderate right and tiny left pleural effusions are new.
2-mm left upper lobe (4a:62) and 4 mm left lower lobe (4a:57) nodules are
unchanged. There is no new lung nodule. Mild paraseptal upper lobe emphysema
is unchanged. Mild areas of bronchiectasis in both bases are too subtle to
depict today given marked motion artifacts. Calcified nodules are likely
unchanged. An aberrant right subclavian artery is again noted. Mediastinal
lymph nodes are still scattered but not enlarged using CT criteria. Signs of
anemia are suggested by relative hypodensity of intracardiac blood.
Cardiomegaly is mild. Fluid is still present in pericardial recesses. Airways
are patent to segmental level.
This study was not tailored for subdiaphragmatic evaluation, but the upper
abdomen is unremarkable. There is no bone lesion suspicious for malignancy.
## IMPRESSION:
1. Worsening right upper lobe peribronchovascular opacity with
bronchiolectasis, could be worsening infection, should be followed shortly in
two to three months after antibiotic treatment. Malignancy is much less
likely given variations between CTs since . New small-to-moderate and
tiny left pleural effusion also favor infection, less likely residual edema.
2. Signs of previous granulomatous exposure. Unchanged 4-mm and less lung
nodules since , do not warrant further followup.
3. Mild upper lobe emphysema.
4. Aberrant right subclavian artery, a normal variant.
5. Signs of anemia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13160555", "visit_id": "N/A", "time": "2121-10-31 14:28:00"} |
11819173-RR-14 | 177 | ## EXAMINATION:
ANKLE (AP, MORTISE AND LAT) RIGHT
## INDICATION:
year old man with right Achilles pain. Review of OMR
indicates a history of previous Achilles tendon repair.
## FINDINGS:
The Achilles tendon silhouette is enlarged, with a fusiform configuration. A
9 x 2 and mm ossification within the mid Achilles tendon is compatible with a
dystrophic calcification. The calcification lies approximately 8.1 cm above
the posterosuperior corner of the Achilles. No bony donor site is identified.
There is mild stranding in fat pad. Note is made of a
configuration along the posterosuperior calcaneus.
No acute fracture, dislocation, or gross degenerative change is detected. The
tibial talar joint space is preserved and congruent and no talar dome
osteochondral lesion is identified. No bone erosion. No additional soft
tissue calcification or radiopaque foreign body is identified.
## IMPRESSION:
1. Fusiform enlargement of the Achilles tendon silhouette, with small
dystrophic calcification noted within the tendon. The appearance is
suggestive of Achilles tendinopathy. However, this appear in should be
correlated with details of the previous surgical history.
2. Small calcaneal deformity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11819173", "visit_id": "N/A", "time": "2140-02-13 13:19:00"} |
15677328-RR-23 | 139 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST
## INDICATION:
with fall. Evaluate for fracture or bleed.
## FINDINGS:
Vertebral body heights are maintained and there is no evidence of fracture.
Multilevel degenerative changes characterized by intervertebral disc height
loss, marginal osteophyte formation, and endplate sclerotic changes.
Multilevel moderate central canal narrowing is demonstrated, most pronounced
at the C3/4, C5/6 and C6/7 levels due to posterior disc osteophyte complexes.
Uncovertebral osteophytes result in mild neural foraminal narrowing at
multiple levels. Multiple level facet arthropathy is also seen. No acute
alignment abnormality is identified.
No prevertebral soft tissue abnormality. No lymphadenopathy is present by CT
size criteria. The thyroid is unremarkable. The visualized lung apices are
clear. Dense atherosclerotic calcification is seen at the carotid
bifurcations bilaterally.
## IMPRESSION:
Multilevel degenerative changes with no acute alignment abnormality or
fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15677328", "visit_id": "23970916", "time": "2188-10-25 17:55:00"} |
15622747-RR-49 | 135 | ## INDICATION:
w/CAD s/p CABG, spinal stroke, iron def anemia presenting
with worsening dyspnea and edema // Eval for congestion
## FINDINGS:
AP portable upright view of the chest. Midline sternotomy wires are noted.
Overlying EKG leads are present. There is mild opacity at the left lung base
most suggestive of atelectasis though difficult to entirely exclude pneumonia
the correct clinical setting. Elsewhere lungs are clear. No edema.
Cardiomediastinal silhouette is stable. Aorta is mildly calcified. Bony
structures are intact. Degenerative changes are noted at the left shoulder
with high-riding left humeral head which appears to contact the undersurface
of the left acromion. No free air below the right hemidiaphragm.
## IMPRESSION:
Subtle opacity at the left lung base likely atelectasis though difficult to
entirely exclude pneumonia in the correct clinical setting. Otherwise
unremarkable.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15622747", "visit_id": "27318319", "time": "2124-05-01 12:30:00"} |
14000215-RR-50 | 98 | ## EXAM:
Right wrist, four views and right shoulder, three views.
## RIGHT SHOULDER:
Three views of the right shoulder were obtained. No evidence
of acute fracture or dislocation is seen. The right acromioclavicular joint
is intact. The right upper outer hemithorax demonstrates low lung volumes.
## RIGHT WRIST:
Four views of the right wrist were obtained. No evidence of
acute fracture or dislocation is seen. There is minimal degenerative change
at the first carpometacarpal joint. There appears to be a small subchondral
cyst in the lunate, measuring 2-3 mm.
## IMPRESSION:
No evidence of acute fracture or dislocation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14000215", "visit_id": "N/A", "time": "2189-03-18 19:51:00"} |
19992875-RR-43 | 385 | ## HISTORY:
man with history of primary biliary cirrhosis and
elevated total bilirubin. Evaluation for vessel patency.
## FINDINGS:
The left lung base demonstrates a linear area of scarring and atelectasis,
likely related to postsurgical changes from left-sided thoracotomy, as seen on
chest CT from .
The previously demonstrated hepatomegaly is again seen, and is unchanged in
size since the prior study, again measuring approximately 24 cm in
craniocaudal dimension, as before. Subcentimeter T2 hyperintense foci within
the right hepatic lobe are again seen, and are consistent with biliary
hamartomas. No suspicious focal liver lesions are identified. No intra or
extrahepatic biliary ductal dilatation is noted. The gallbladder is
collapsed.
The spleen is also enlarged, and is increased in size compared with the prior
study, now measuring 22.5 cm in craniocaudal dimension, previously measuring
21 cm. No focal lesions are identified within the spleen.
The pancreas is unremarkable and there is no pancreatic ductal dilatation or
focal lesions. No retroperitoneal, mesenteric or portal hepatic lymph
adenopathy is present. The previously seen area of cortical scarring in the
superior pole of the right kidney is unchanged in appearance since the prior
study. Additionally, there is a 1.3 cm T2 hyperintense renal cyst in the
inferior pole of the right kidney which is unchanged (4:44). Otherwise, the
kidneys are unremarkable and excrete contrast symmetrically. The bilateral
adrenal glands are also unremarkable.
The portal vein is patent with no evidence of the thrombus. The hepatic
arterial supply is also patent.
Note is made of a replaced right hepatic artery, arising from the superior
mesenteric artery and a replaced left hepatic artery, arising from the left
gastric artery. The common hepatic artery arises from the celiac axis, and
appears to supplies only the gastroduodenal artery.
The intra-abdominal loops of large and small bowel are unremarkable and there
is no abnormal bone marrow signal.
## IMPRESSION:
1. Stable hepatomegaly with stable biliary hamartomas with no evidence of
suspicious focal hepatic or splenic lesions identified.
2. Hepatic vasculature is patent. Notable variant hepatic arterial anatomy
with replaced right as well as left hepatic arteries.
3. Mild interval progression of splenomegaly.
4. Stable right inferior pole renal cyst and right upper pole cortical
scarring.
5. Atelectasis and scarring in the left lung base, likely related to prior
left thoracotomy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19992875", "visit_id": "N/A", "time": "2160-07-03 13:19:00"} |
16008060-RR-42 | 321 | ## HISTORY:
Status post minimally invasive esophagectomy in for T1b
adenocarcinoma of the esophagus, status post laparoscopic cholecystectomy on
.
## FINDINGS:
Please see the dedicated chest radiology division for thoracic findings.
The liver enhances homogeneously without any focal hepatic lesions. No
intrahepatic biliary dilatation is noted, and the portal veins and hepatic
veins appear patent. The gallbladder has been surgically removed. The spleen
appears normal in size and shape. The pancreas enhances homogeneously without
any ductal dilation or peripancreatic stranding.
The adrenal glands appear normal in size and shape bilaterally. A 2.6 x 3.1 x
2.6 cm left upper pole renal cyst is noted (4:60,8:46). Smaller subcentimeter
hypodensities in the right kidney are too small to characterize but likely
represent cysts (4:72,8:40). The kidneys are normal in size bilaterally, and
they show appropriate contrast excretion without evidence of hydronephrosis or
perinephric stranding.
The patient is status post esophagectomy with gastric pull-through. The small
bowel opacifies with oral contrast without wall thickening or obstruction.
The appendix is not well visualized, but there no secondary findings to
suggest appendicitis. The large bowel contains stool without evidence of wall
thickening or obstruction. There is no intraperitoneal free air or free
fluid.
The abdominal aorta is of normal caliber without aneurysmal dilatation. There
aorta and its major branches appear patent. There are no mesenteric or
retroperitoneal lymph nodes enlarged by CT size criteria.
The bladder is minimally distended without any focal wall thickening. The
prostate is enlarged. The rectum contains stool and is unremarkable. There
is no pelvic free fluid. No pelvic sidewall or inguinal lymph nodes are
enlarged by CT size criteria. No hernias are appreciated.
There are no suspicious osteolytic or osteoblastic lesions seen to suggest
malignancy.
## IMPRESSION:
1. Status post esophagectomy with gastric pull-through without evidence of
local recurrence or metastatic disease in the abdomen or pelvis.
2. Enlarged prostate gland.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16008060", "visit_id": "N/A", "time": "2176-12-27 08:18:00"} |
18719217-RR-10 | 202 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
woman with fall and trauma to back of head. Evaluate
for intracranial hemorrhage.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.5 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
## FINDINGS:
No evidence of acute infarction, hemorrhage, edema, or mass effect.
Hypodensity within the left frontal lobe is expected in the setting of
resolving parenchymal hemorrhage. Gray-white matter differentiation is
preserved throughout. The ventricles and sulci are normal in size and
configuration for the patient's age.
Small, 7 mm extra-axial structure arising from the left vertex could be a
meningioma, unchanged (series 601b, image 63; series 2, image 26).
No evidence of fracture. Soft tissues changes and at radiopaque material in
the posterior occiput are less pronounced compared to the prior exam. The
visualized portion of the paranasal sinuses, mastoid air cells, and middle ear
cavities are essentially clear. The visualized portion of the orbits are
unremarkable.
## IMPRESSION:
1. No intracranial hemorrhage.
2. Nearly resolved left frontal lobe intraparenchymal hemorrhage.
3. No fracture.
4. Chronic soft tissue changes overlying the right occiput from prior injury,
improving.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18719217", "visit_id": "N/A", "time": "2162-04-17 22:02:00"} |
11908889-RR-34 | 121 | ## CLINICAL HISTORY:
Pancreatic resection of presumed neuroendocrine tumor.
## FINDINGS:
Intraoperative ultrasound was performed for Dr. to assess the
surrounding structures about a rapidly enhancing mass lesion which was seen on
prior CT examinations at the pancreatic body/tail.
Via laparoscope, exophytic lesion arising from the inferior aspect of the
pancreas near the tail is visualized and measured at approximately 1.4 cm x
0.8 cm in size and demonstrating marked vascularity. Arising from its
superior margin towards the body of the pancreas is a prominent vascular
structure. This appears distant from the main pancreatic duct, although the
main duct is difficult to visualize due to its non-distended state.
## IMPRESSION:
Intraoperative ultrasound guidance for Dr. pancreatic
mass excision.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11908889", "visit_id": "28669753", "time": "2142-02-18 11:14:00"} |
19235859-RR-23 | 487 | ## EXAMINATION:
MR PITUITARY CONTRAST MR
## INDICATION:
year old woman with a medial pituitary stalk mass// Please
evaluate for change
## FINDINGS:
Study is moderately degraded by motion. Within these confines:
Again seen arising from or inseparable from the right more than left anterior
aspect of the infundibulum, or possibly arising from the very superior aspect
of the pituitary gland itself, is a rounded, circumscribed, mildly T2
hyperintense, T1 isointense to normal adenohypophysis, non- or minimally
enhancing mass measuring up to 8 x 7 x 7 mm, unchanged in size since study of
.
Seen anteriorly and laterally adjacent (to the left) of the lesion is
enhancing soft tissue which likely represents normal pituitary infundibulum.
A more rounded, 3 mm focus of homogeneous enhancing tissue seen at the
posterosuperior margin of the mass is also felt to represent normal, displaced
infundibulum (see series 9, image 8 as well as series 8, image 9), unchanged
in size.
Inferior to the lesion, within the sella turcica, there is normal-appearing,
homogeneously enhancing anterior pituitary gland. The neurohypophysis is
normally located.
The mass contacts and inserts mild upward mass effect on the optic chiasm,
stable (6:8). The mass protrudes superiorly into the suprasellar cistern
which otherwise remains patent at the right and left lateral aspects of the
lesion. The cavernous intracranial carotid flow voids are normal. The
cavernous sinus enhances normally.
## IMPRESSION:
1. Study is moderately degraded by motion.
2. Grossly stable approximately 8 mm homogeneous, mildly T2 hyperintense,
non-enhancing or minimally enhancing rounded mass appearing to arise from the
pituitary infundibulum or upper margin the pituitary in size and mass effect
on optic chiasm. Differential considerations again include pituitary
microadenoma arising from the superior aspect of the pituitary gland, Rathke's
cleft cyst. If the 3 mm focus of enhancement at the posterosuperior margin of
the mass represents an enhancing component of the mass rather than normally
displaced pituitary infundibulum, differential includes craniopharyngioma,
though this is less likely given the absence of calcifications of this lesion
on prior contrast CT. Pituicytoma, germinoma, and lymphoma are additional
differential considerations at are less likely given the enhancement pattern.
Recommend attention on follow-up imaging.
## RECOMMENDATION(S):
Grossly stable approximately 8 mm homogeneous, mildly T2
hyperintense, non-enhancing or minimally enhancing rounded mass appearing to
arise from the pituitary infundibulum or upper margin the pituitary in size
and mass effect on optic chiasm. Differential considerations again include
pituitary microadenoma arising from the superior aspect of the pituitary
gland, Rathke's cleft cyst. If the 3 mm focus of enhancement at the
posterosuperior margin of the mass represents an enhancing component of the
mass rather than normally displaced pituitary infundibulum, differential
includes craniopharyngioma, though this is less likely given the absence of
calcifications of this lesion on prior contrast CT. Pituicytoma, germinoma,
and lymphoma are additional differential considerations at are less likely
given the enhancement pattern. Recommend attention on follow-up imaging.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19235859", "visit_id": "N/A", "time": "2187-09-05 08:02:00"} |
11775843-RR-24 | 517 | ## EXAMINATION:
MRI CERVICAL AND THORACIC PT21 MR SPINE
## INDICATION:
patient with multiple sclerosis, found down, status
epilepticus, motor sensory and cognitive deficits. Evaluate for spinal cord
lesions.
## FINDINGS:
Study is severely degraded by motion. Cervical spine fat-suppressed imaging
is nondiagnostic. Within these confines:
## CERVICAL:
The alignment of the cervical spine is maintained. There are type 2
endplate degenerative changes at C5-C6. The vertebral body heights are
preserved.
Question C5-6 level cervical spinal cord signal abnormality versus artifact
(see 04:11, . There is no evidence of abnormal enhancement.
## C2-C3:
There is no spinal canal or neural foraminal narrowing.
## C3-C4:
There is a central and right paracentral disc protrusion with annular
fissure causing mild spinal canal stenosis without spinal cord compression.
There is bilateral facet and uncovertebral joint arthropathy without
significant neural foraminal narrowing.
## C4-C5:
There is a disc bulge with ligamentum flavum thickening and bilateral
facet and uncovertebral joint arthropathy without spinal canal stenosis.
There is severe right and moderate left neural foraminal narrowing.
## C5-C6:
There is central and paracentral disc protrusion with ligamentum flavum
thickening and bilateral facet and uncovertebral joint arthropathy resulting
in moderate spinal canal stenosis with severe right and moderate left neural
foraminal narrowing.
## C6-C7:
There is a disc bulge with ligamentum flavum thickening and bilateral
facet and uncovertebral joint arthropathy resulting in mild spinal canal
stenosis with mild left and no right neural foraminal narrowing.
## C7-T1:
There is no spinal canal or neural foraminal narrowing.
## THORACIC:
The alignment of the thoracic spine is maintained. There is no suspicious
marrow replacing lesion. The spinal cord is normal in caliber and morphology
without abnormal signal intensity. There is disc desiccation at T5-T6 with
loss of intervertebral disc space. There is mild wedging of T6 and T7
vertebral bodies with a superior endplate Schmorl's node at T6. There is a
T5-T6 disc protrusion indenting the ventral thecal sac. Otherwise, there is
no spinal canal or neural foraminal stenosis.
## OTHER:
The visualized L1 level demonstrates a compression fracture with approximately
75% loss of vertebral body height and suggestion of STIR hyperintense signal
anteriorly, suggestive of relatively subacute compression fracture. There is
mild retropulsion of the superior endplate indenting the ventral thecal sac
without spinal canal stenosis or cord compression. There is no neural
foraminal narrowing.
Small left-sided pleural effusion is noted.
## IMPRESSION:
1. Study is severely degraded by motion, and fat-suppressed imaging is
nondiagnostic.
2. Within limits of study, no definite abnormal enhancement.
3. Cervical spondylosis worse at C5-C6 with moderate spinal canal stenosis and
moderate-to-severe multilevel neural foraminal narrowing as described above.
4. Question C5-6 level nonenhancing cervical spinal cord signal lesion versus
artifact.
5. Extremely limited imaging of lumbar spine suggests L1 vertebral body
compression fracture with bony retropulsion component. If clinically
indicated, consider dedicated lumbar spine imaging when patient can tolerate
exam.
6. Small left-sided pleural effusion.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 6:05 pm, 3 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11775843", "visit_id": "27756499", "time": "2148-12-23 09:21:00"} |
18554398-RR-15 | 113 | ## INDICATION:
with pneumonia, c/f volume overload. Evaluate for pulmonary
edema.
## FINDINGS:
Lung volumes are low. Increased opacification in the right hemithorax is
similar to recent outside hospital chest radiograph and concerning for
underlying pneumonia. There is mild prominence of the central pulmonary
vasculature without evidence of overt edema. The cardiomediastinal silhouette
is enlarged but stable. Probable small bilateral pleural effusions. No
pneumothorax. Stable calcifications along the bilateral diaphragmatic
surfaces compatible with prior asbestos exposure.
## IMPRESSION:
1. Increased opacification of the right lower hemithorax is concerning for a
right middle lobe pneumonia.
2. Mild prominence of the central pulmonary vasculature without evidence of
overt edema.
3. Probable small bilateral pleural effusions.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18554398", "visit_id": "28045280", "time": "2168-12-25 05:17:00"} |
16134954-DS-22 | 1,651 | ## HISTORY OF PRESENT ILLNESS:
This is a with PMHx of HIV (CD4 count was 422 , only presenting for wound
evaluation of worsening skin lesions that are more consistently
painful, larger and more numerous and pustular.
The patient is a poor historian and collateral was obtained from
Health chart review and discharge
summary. Of note, patient originally at and
thought to be folliculitis and was prescribed bactrim and
cephalexin 4 days ago. Patient then went to the ED
( ) for skin lesions and found to have CAP. The lesions
were biopsied but there was no infecting agent found in either
pathology or culture. Pt was treated for strep. pneumonia with
ceftriaxone and discharged on amoxicillin and naproxen. Patient
reports he is taking two medications given to him by the
hospital, though he can't name them. He also reports that he
takes his HIV medications daily (adherent to medications, all
pills arrive to home prepackaged). Productive cough and skin
lesions improved throughout the course of the hospitalization at
. Today he denies fever, nausea, vomiting, diarrhea,
productive cough, abdominal pain, chills, sweats, or chest pain.
The patient himself denies any medical history or any taking any
medications. He reports he developed multiple occasionally
painful nonpruritic erythematous lesions over his chest about 2
months ago. Over the past week a lesion over his sternum started
to enlarge with surrounding erythema, warmth and drainage.
Additionally, he reports a new lesion on the left side of his
neck but the rest have improved.
## PAST MEDICAL HISTORY:
HIV on HAART(CD4 322, VL 22 as of Dx
Meningoencephalitis, Toxoplasmosis ( )
Cognitive Deficits Due Cerebrovascular Disease or Meningitis
R-hemiparesis s/p CNS Toxo
PCP ( )
Hx of Herpes Zoster Ophthalmicus
Internal Hemorrhoids
Coronary Artery Disease, LAD s/p coronary stent
Hypothyroidism
Anemia, Beta-Thal
Hepatitis B (VL >38 million,
Seizure d/o
Hearing loss since childhood(communicates more by writing)
Cataract
Foot Pain Bilateral
## M:
, alive and well, hx uterine ca
## F:
deceased. old age
Brother also healthy
## 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, no wheezes, rales,
rhonchi
## ABDOMEN:
Soft, non-tender, non-distended, bowel sounds present,
no organomegaly, no rebound or guarding
## SKIN:
numerous ~1cm oval atrophic plaques with purpuric center,
some with overlying flaccid bullae on trunk, neck, left medial
ankle, few follicular based pustules on back, upper sternum with
large red/purple annular plaque with raised border and
central/inferior ulceration with serous exudate, no oral lesions
or nail changes, non blanching erythematous macules on bilateral
lower extremities.
## 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 EXAM
## GENERAL:
Alert, oriented x 3, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear, no evidence of
leukoplakia. Erythema at right upper gingiva which he says is
painful.
## NECK:
supple, JVP not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## SKIN:
numerous ~1cm oval atrophic plaques with purpuric center,
some with overlying flaccid bullae on trunk, neck, left medial
ankle, few follicular based pustules on back, upper sternum with
large red/purple annular plaque with raised border and
central/inferior ulceration with serous exudate, no oral lesions
or nail changes
## IMPRESSION:
1. Increased interstitial markings concerning for atypical
pneumonia.
2. The sternum is not well assessed on this study.
MR CHEST
## IMPRESSION:
Superficial plaque-like lesion centered in the dermal and
immediately
subdermal layers of the anterior chest wall. Minimal
interstitial edema/
enhancement in the subcutaneous fat below it. No fluid
collection.No
involvement of the underlying musculature or bone.
MICROBIOLOGY
============
BCx , negative
Wound culture No growth
Tissue
Time Taken Not Noted Log-In Date/Time: 7:22 pm
## TISSUE SOURCE:
Skin biopsy r/o pox virus (molluscum).
GRAM STAIN (Final :
NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.
## ANAEROBIC CULTURE (PRELIMINARY):
NO GROWTH.
POTASSIUM HYDROXIDE PREPARATION (Final :
NO FUNGAL ELEMENTS SEEN.
## FUNGAL CULTURE (PRELIMINARY):
NO FUNGUS ISOLATED.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
## ACID FAST CULTURE (PRELIMINARY):
PENDING
Time Taken Not Noted Log-In Date/Time: 7:22 pm
## TISSUE SOURCE:
Skin biopsy r/o pox virus (molluscum).
## VIRAL CULTURE:
R/O CYTOMEGALOVIRUS (Preliminary):
No Cytomegalovirus (CMV) isolated.
CYTOMEGALOVIRUS EARLY ANTIGEN TEST (SHELL VIAL METHOD) (Final
:
Negative for Cytomegalovirus early antigen by
immunofluorescence.
Refer to culture results for further information.
8:51 pm BLOOD CULTURE ( MYCO/F LYTIC BOTTLE)
## HIV VIRAL LOAD :
22 copies/ml
BCx NGTD
## BRIEF HOSPITAL COURSE:
BRIEF SUMMARY
=============
Mr. is a pleasant with PMHx of HIV (CD4 count was 322
on , only
presenting for wound evaluation of a large centrally located
skin lesion on his chest.
The patient reports that these lesions have been present for two
months, and was seen at in for the same problem. At
, they were biopsied, which results highly concerning for
infection, although no organisms were seen on staining. During
the current admission, the large chest lesion appeared
cellulitic, so he was initially treated with vancomycin.
Dermatology was consulted, with subsequent biopsy of the large
lesion. ID was also consulted, and an extensive infectious
workup was performed (most of which was pending at discharge).
The antibiotics were discontinued prior to his discharge due to
low likelihood of his lesion being a staph cellulitis. Biopsy
results during this admission were again highly suspicious for
infection, but nothing was seen in stain. Cultures pending at
time of discharge. The patient was discharged to follow up with
his PCP and infectious diseases as an outpatient.
ACUTE ISSUES
============
#Skin lesions:
The patient presented to the ED with a painful, large, red
central chest lesion as well as several smaller non-painful
lesions over his back, chest, arms, and legs (sparing palms and
soles). He reports that these lesions had been present for two
months, and he was previously seen at in for the
same skin lesions (minus the new large lesion). At , he
underwent biopsy of one of the small lesions, with results
highly concerning for infection, although no organisms were seen
on staining. Between that admission and the present admission,
he developed a large painful chest lesion at the his
chest. Given concern for cellulitis, he was initially treated
with vancomycin. Dermatology was consulted, with subsequent
biopsy of the large chest lesion. ID was also consulted, and an
extensive infectious workup was performed, with nothing
revealing found (some of which was pending at discharge,
however). The antibiotics were discontinued a few days prior to
his discharge due to low likelihood of his lesion being a staph
cellulitis. Biopsy results during this admission were again
highly suspicious for infection, but no organisms were seen on
micro stain. Given the lack of findings, dermatology recommended
adding PCR testing of the tissue for blasto, histo, coccioido,
MTB, and atypical mycobacteria (pending at discharge). His pain
was treated with oxycodone, and he was discharged to follow up
with his PCP and infectious diseases as an outpatient to follow
up his pending results. Please see labs section of the discharge
summary for specific lab tests/findings.
## CHRONIC
#HIV:
Patient reports adherence to HAART regimen and has a
history of multiple HIV related complications including CNS
toxo, PCP PNA and herpes zoster opthalmicus. CD4 during this
admission was 322, with HIV viral load of 22 copies/ml
- continued HAART: Raltegravir 400 mg PO BID, RiTONAvir 100 mg
PO BID, Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY,
Darunavir 600 mg PO BID
#Hypothyroidism
- continued home levothyroxine
#Beta-thalassemia
- H/H stable
#CAD
- Continued home Metoprolol
#GERD
- continued home loratidine
TRANSITIONAL ISSUES
===================
- Culture results and several labs were pending at the time of
discharge. Please follow these up as an outpatient
- Please remove the patient's sutures on his chest lesion at his
next PCP appointment on
- At his next PCP visit, please ensure that the patient has made
it to follow up with infectious diseases (scheduled for
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. Raltegravir 400 mg PO BID
3. RiTONAvir 100 mg PO BID
4. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY
5. Darunavir 600 mg PO BID
6. Loratadine 10 mg PO DAILY
7. Metoprolol Succinate XL 50 mg PO DAILY
8. Levothyroxine Sodium 50 mcg PO DAILY
9. Hydrocortisone Cream 1% 1 Appl TP BID
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Darunavir 600 mg PO BID
3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY
4. Hydrocortisone Cream 1% 1 Appl TP BID
5. Levothyroxine Sodium 50 mcg PO DAILY
6. Loratadine 10 mg PO DAILY
7. Metoprolol Succinate XL 50 mg PO DAILY
8. Raltegravir 400 mg PO BID
9. RiTONAvir 100 mg PO BID
10. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen 5 mg-325 mg 1 tablet(s) by mouth
q4-6h Disp #*15 Tablet Refills:*0
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted to the hospital after you developed a red and
painful spot on your chest as well as several other non-tender
spots on your skin. You were treated with antibiotics initially,
and underwent a biopsy to determine the cause of these spots.
You were evaluated by your infectious disease physicians, who
recommended several tests to help us figure out the cause of
these. These results #### prior to your discharge, and you were
discharged home to follow up with your primary care doctor, the
infectious disease doctors, and a dermatologist (skin doctor).
We wish you the best,
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16134954", "visit_id": "29037670", "time": "2128-08-03 00:00:00"} |
13777050-RR-134 | 184 | ## HISTORY:
Chronic bilateral subdural hematomas, evaluate for residual blood.
Patient is post-op.
## NON-CONTRAST HEAD CT:
Comparison is made to exam and
MRI.
Patient is noted to be status post left frontal craniotomy with indwelling
extra-axial drain with near-complete resolution of previously identified mixed
density subdural hematoma with only a small chronic appearing component noted
inferiorly. There is expected post-operative pneumocephalus. No new regions
of acute hemorrhage are identified. There is resolution of previously
identified minimal rightward subfalcine herniation. The right subdural
hematoma displays no significant interval change from prior exam. The
appearance of the brain parenchyma and ventricular system is unchanged. Mild
soft tissue swelling and expected subcutaneous emphysema is noted along the
surgical site with the soft tissues and globes appearing otherwise
unremarkable. Mucosal thickening involving the maxillary sinuses is stable.
## IMPRESSION:
Status post drain placement along the left superior cerebral convexity with
near-complete resolution of acute-on-chronic appearing left-sided subdural
hematoma and resolved rightward subfalcine herniation. Unchanged appearance
to predominantly chronic appearing right-sided subdural hematoma. No new
regions of hemorrhage identified.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13777050", "visit_id": "21764468", "time": "2141-08-16 20:53:00"} |
16669225-RR-79 | 101 | ## EXAMINATION:
C-SPINE NON-TRAUMA VIEWS IN O.R.
## INDICATION:
year old woman with central cord syndrome// eval cspine
## FINDINGS:
Bony structures are severely demineralized, this markedly limits evaluation on
radiographs. C1-C7 visualized on the lateral projection. There is mild
anterolisthesis of C 2 on C3. There is severe multilevel degenerative disc
disease from C3 through C7. No definite fracture seen. No destructive lytic
or sclerotic bone lesion seen. Visualized portions of the lung apices are
grossly clear.
## IMPRESSION:
Evaluation is limited due to severe demineralization. Severe degenerative
disc disease from C3 through C7. No definite fracture seen.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16669225", "visit_id": "N/A", "time": "2159-11-28 14:19:00"} |
19497408-DS-17 | 1,037 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## CHIEF COMPLAINT:
Excessive thirst, urinary frequency, fatigue
## HISTORY OF PRESENT ILLNESS:
Mr. is a year old male with no significant medical
history who presents with 2 weeks of increased urinary frequency
and excessive thirst. He says he has been urinating up to 50
x/day. He denies dysuria. He also describes "not feeling like
himself" with increased fatigue and malaise. He also describes
a decreased appetite accompanied by a 40-50 pound weight loss
over the past month. He denies abdominal pain, n/v, diarrhea,
constipation, sob, cp. He feels otherwise well. He denies
depressive symptoms
.
In the ED, initial vs were: T P BP R O2 sat. Patient was given
5L NS and received IV KCl
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias. All
other review of systems are negative.
## FAMILY HISTORY:
Mom and brother with diabetes
## GENERAL:
Alert and oriented, appears fatigued with a blunted
affect
## HEENT:
Sclera anicteric, MMM, oropharynx clear. No
lymphadenopathy.
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
ronchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds
hyperactive, no rebound tenderness or guarding, no organomegaly
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## NEURO:
Alert and oriented x 3. CNII-XII intact. No focal
neurologic motor or sensory defecits.
## - EKG :
Sinus rhythm. Left axis deviation. Possible left
anterior fascicular block.J point elevation with early
repolarization in the precordial leads may be anormal variant.
No previous tracing available for comparison.
## # HYPERGLYCEMIA:
Mr. arrived at the ED following symptoms
of polydipsia and polyuria for two weeks and progressive fatigue
and a 40 lb weight loss over the last month. He had a blood
sugar in the 900s and urinary glucose over 1000 with trace
ketones in the ED consistent with a new diagnosis of DM. He had
no anion gap or metabolic acidosis, and was thus consistent with
Hyperosmolar Hyperglycemic non-ketoacidosis. He was
aggressively rehydrated with over 7L of normal saline in the ED
and on the floor with 20 mEq KCl overnight bringing his glucose
down to the 300s-400s by HOD#2. was consulted and
recommended glargine 30 units/day with an insulin sliding scale
at meals. His sugars remained in the 200-300s throughout HOD#2,
but improved overnight in to the mid-high 100s. On HOD#3 his
sugars spiked again to the 300s, and recommended
increasing his Lantus to 36U daily, and increased his sliding
scale. He also met with the nutritionist for diabetic diet
teaching. His blood glucose levels subsequently normalized by
discharge between 135-300. He was provided with insulin
injection and sliding scale teaching by the nurses, and he was
scheduled for a follow up the following week with . He
was also advised to remain out of work as a for the
until he is evaluated by .
.
#Social work: Mr. struggled to cope with his new diagnosis
of diabetes. He often became tearful when discussing it. He met
with social work here regarding his, and it was recommended that
he follow up with the psychologists at . He was given
their contact information
.
# ECG changes: An ECG performed in the ED on arrival showed ST
vs. J point elevations in leads V3-V4 which were felt to be
unconcerning for myocardial ischemia due to lack of reciprocal
changes and the lack of cardiac symptoms. A repeat ECG was
unchanged, and cardiac enzymes were negative x 2 (TropT and
CK-MB). He never endorsed any chest pain or shortness of breath
.
# Shoulder pain: On the morning of , Mr. complained of
new onset, throbbing shoulder pain ( ) that he felt was due
to how he was sleeping on it. His symptoms persisted but were
markedly improved with acetaminophen.
## DISCHARGE MEDICATIONS:
1. BD Insulin Pen Needle UF Mini 31 x Needle Sig: as
directed Miscellaneous as directed.
Disp:*300 needles* Refills:*0*
2. BD Ultra Fine Lancets Misc Sig: as directed
Miscellaneous as directed.
Disp:*300 lancets* Refills:*0*
## 3. GLUCOSTIX TEST STRIP SIG:
as directed Miscellaneous as
directed.
Disp:*300 strips* Refills:*0*
4. Lantus Solostar 100 unit/mL (3 mL) Insulin Pen Sig: as
directed Subcutaneous as directed: 36 units per day at
breakfast or as otherwise directed by your physician.
Disp:*12 pens* Refills:*0*
5. Humalog KwikPen 100 unit/mL Insulin Pen Sig: Three (3) boxes
of 5 pens each (100 units per pen) Subcutaneous as directed:
Please take four times per day as directed by sliding scale
Disp:*3 boxes (5 pens per box, 100 units per pen)* Refills:*2*
## PRIMARY:
Hyperosmolar Hyperglycemic Non-Ketoacidosis
Diabetes Mellitus
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted to the hospital because you were having
increased urination, and you were found to have very high blood
sugars consistent with a new diagnosis of diabetes. You were
followed closely by our diabetes experts from who
helped us to start your insulin while in the hospital. Your
symptoms and blood sugar improved, but you will still require
close follow up at as an outpatient.
We also had our nutritionist see you in the hospital to give you
some information on how to adjust your diet with the diabetes.
We hope that you are able to make the changes they recommend.
We also had our nurses teach you how to check your finger blood
glucose levels and inject insulin.
You were not taking any medications prior to coming to the
hospital. However we have added the following diabetes
medications which you should administer as you were taught:
## -LANTUS (GLARGINE):
Inject 36 units each morning or as otherwise
directed
-Humalog insulin: Please check your sugars before each meal and
give yourself humalog insulin as directed by your sliding scale
as attached.
Please note your follow-up appointments below. We have written
prescriptions for the materials you will need to check your
blood sugars and give your insulin.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19497408", "visit_id": "25833652", "time": "2176-04-27 00:00:00"} |
18568321-RR-9 | 390 | ## EXAMINATION:
CT abdomen pelvis with contrast
## INDICATION:
year old man with unintentional weight loss, post
prandial dyscomfort, no previous cancer screening// Please evaluate abd/pelv
for mass/obstruction
## 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) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5
mGy-cm.
2) Stationary Acquisition 1.8 s, 0.2 cm; CTDIvol = 24.1 mGy (Body) DLP =
4.8 mGy-cm.
3) Spiral Acquisition 6.9 s, 44.9 cm; CTDIvol = 5.3 mGy (Body) DLP = 234.9
mGy-cm.
Total DLP (Body) = 241 mGy-cm.
## LOWER CHEST:
Visualized lung fields are within normal limits.
Trace left pleural effusion.
There is no evidence of 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 collapsed.
## 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 hydronephrosis. Few small cortical cysts bilaterally,
the larger is a left interpolar 1.1 cm. There is no perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber, wall thickness, and enhancement throughout. The colon and
rectum are within normal limits. The appendix is normal.
## PELVIS:
The urinary bladder with Foley catheter balloon is almost empty .
Minimal free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The prostate is enlarged, 5 cm, and 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. Mild atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
No evidence of malignancy. No evidence of obstruction, masses or
lymphadenopathy.
Minimal free fluid in the pelvis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18568321", "visit_id": "29634611", "time": "2179-07-10 17:37:00"} |
18035552-RR-23 | 152 | ## INDICATION:
Fetal survey; known fibroids complicating pregnancy.
## LMP:
.
Transabdominal imaging shows a single live intrauterine gestation in
transverse presentation. The placenta is fundal without evidence of previa.
There are multiple fibroids present. The largest fibroid is located in the
lower uterine segment more to the right measuring 9.6 x 5.3 x 5.9 cm. A
second fibroid is seen posteriorly in the fundal region measuring 5.2 x 3.5 x
4.7 cm. No fetal morphologic abnormalities are detected. Views of the head,
face, heart, outflow tracts, stomach, kidneys, cord insertion site, bladder,
spine and extremities are normal.
The following biometric data were obtained:
## EFW:
246 g.
Compared to the prior exam there has been appropriate interval growth.
## IMPRESSION:
Normal fetal survey. Multiple fibroids are present with the
largest located in the lower right uterine segment. The placenta is in the
fundus away from the fibroids.
gb
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18035552", "visit_id": "N/A", "time": "2176-08-27 09:45:00"} |
19798925-RR-50 | 196 | ## EXAMINATION:
RENAL TRANSPLANT U.S. RIGHT
## INDICATION:
year old woman with PMHx HCV/ ETOH cirrhosis c/b HRS and ESRD
s/p simultaneous liver-kidney transplantation (CMV intermediate
risk, PHS increased risk donor and hep C positive donor to hep C positive
patient) on cyclosporine, MMF, c/b recurrent post transplant UTI with
resistant E.coli and Klebsiella who presents due to increased Cr concerning
for acute reaction.// transplant kidney US
## FINDINGS:
The right lower quadrant transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.72-0.79 within the
elevated range. The main renal artery shows a normal waveform, with prompt
systolic upstroke and continuous antegrade diastolic flow, with peak systolic
velocity of 166 cm/sec. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
## IMPRESSION:
Patent renal transplant vasculature with minimally elevated resistive indices
of the intrarenal arteries compared to prior ultrasound. No hydronephrosis or
perinephric fluid collections identified.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19798925", "visit_id": "20326081", "time": "2179-08-08 15:15:00"} |
13693064-RR-21 | 207 | ## EXAMINATION:
ultrasound examination of the left small finger
## INDICATION:
year old man with left digit tendon rupture s/p repair
x2// ? rupture vs adhesion of left digit FDP tendon
## FINDINGS:
The patient is status post rupture and repair of the flexor digitorum
profundus x2 (FDP). There has been partial excision of the flexor digitorum
superficialis (FDS). The distal portion of the FDS is seen at the level of
the MCP joint. It is not seen distal to this level compatible with partial
excision.
The FDP tendon is seen to attach normally to the distal phalanx. Adjacent
post surgical changes are noted. The FDP tendon appears intact without
evidence of re-tear. However, there is a large amount of scarring in the
palmar soft tissues overlying the tendon at the level of the proximal middle
phalanx. No significant increased vascularity. Upon dynamic imaging with
passive flexion and extension at the PIP joint, the FDP tendon appears
adherent to the adjacent soft tissues likely secondary to scarring/adhesions.
## IMPRESSION:
Small finger FDP tendon appears adherent to the adjacent soft tissues likely
secondary to scarring/adhesions. No evidence of tendon re-tear.
Partial excision of the small finger distal FDS tendon to the level of the MCP
joint.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13693064", "visit_id": "N/A", "time": "2147-10-14 13:17:00"} |
13531814-RR-54 | 164 | ## INDICATION:
Hip pain, for evaluation.
## REPORT:
Bony mineralization is essentially normal. There is minor symmetric hip
narrowing with some dependent superior joint space narrowing and a little
osteophyte formation. There is a ? expansile ill-defined lucency with
sclerotic border of the left inferior pubic ramus, probably reflecting a cyst
or fibrous dysplasia, unchanged from the prior study. Dedicated hip views
again show minor degenerative change. There is suggestion of some sclerosis
of the femoral head, which may represent early avascular necrosis. MRI is
suggested for further evaluation here.
## CONCLUSION:
There is suggestion of perhaps some sclerosis of the right
femoral head, suggesting early AVN. MRI is suggested to further evaluate.
There are minor degenerative changes in both hips.
Unusual appearance of the left pubic ramus. This may just be simple
projectional change.
The MR from is reviewed and there is a small subchondral
cyst in that study, but no evidence of avascular necrosis and no specific
abnormality of the pubic ramus either.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13531814", "visit_id": "N/A", "time": "2179-01-24 13:35:00"} |
16400373-RR-11 | 427 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## NO PO CONTRAST; HISTORY:
with right sided abdominal pain,
nausea, please eval for appendicitis NO PO contrast // appendicitis
## SINGLE PHASE CONTRAST:
MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 6.7 s, 52.6 cm; CTDIvol = 10.0 mGy (Body) DLP = 525.3
mGy-cm.
Total DLP (Body) = 540 mGy-cm.
## LOWER CHEST:
There is moderate bibasilar atelectasis. Mild lingular
atelectasis is seen. There is no evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
Redemonstrated is a 1.8 x 1.6 cm right hepatic lobe cyst, unchanged compared
to prior. There are numerous additional subcentimeter hypoattenuating hepatic
lesions, which are too small to fully characterize, but likely represent
hepatic cysts or biliary hamartomas. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits.
## PANCREAS:
The pancre2as 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 solid 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 rectum is
distended with air. The colon is within normal limits. The appendix is
nondilated and contains air with no adjacent mesenteric fat stranding.
## PELVIS:
The urinary bladder is distended but otherwise normal in appearance.
The distal ureters are unremarkable. There is no free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The uterus and bilateral adnexae are grossly within
normal limits.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. No significant
atherosclerotic disease is noted. There is persistent narrowing near the
origin of the celiac axis with distal reconstitution.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. No evidence of appendicitis or other acute abdominopelvic abnormality.
2. Persistent narrowing near the origin of the celiac axis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16400373", "visit_id": "N/A", "time": "2146-06-17 17:07:00"} |
19858494-RR-84 | 440 | ## HISTORY:
man with necrotizing pancreatitis, pancreatic duct
disruption, here with increasing abdominal fluid, assess the pancreatic duct.
## FINDINGS:
The liver is not nodular in contour and no focal liver lesions are seen. The
portal vein and hepatic veins are patent. The hepatic arterial anatomy is
conventional, however, the dynamic post-contrast phases are somewhat limited
due to non-breathhold technique.
The gallbladder is distended and contains sludge, but is otherwise
unremarkable in appearance. The common bile duct measures 9 mm with
transition in the pancreatic head to a more normal caliber common bile duct.
No significant intrahepatic duct dilatation.
The pancreas is diffusely abnormal and with decreased signal intensity on
T1-weighted images, however, following contrast administration, the pancreatic
parenchyma enhances normally. There is no convincing evidence of pancreatic
necrosis on this study. The pancreatic duct appears to be patent and intact
throughout its course, although it is narrowed in the central portion of the
body of the pancreas. No duct disruption is identified.
There are large peripancreatic necrotic fluid collections seen. The contents
of these collections are moderately T1 hyperintense suggesting component of
hemorrhagic material.
A right-sided retroperitoneal collection has a drain in situ, and this
collection is contiguous with the collection anterior to the pancreatic body.
This is difficult to measure accurately because of the diffuse heterogeneity,
but does not appear to have changed significantly compared to the the prior
study. There is a left-sided loculated fluid collection in the
retroperitoneum measuring 7.8 x 3.9 cm containing heterogeneous debris,
unchanged compared to the prior CT. A fluid collection adjacent to the
greater curve of the stomach measures 3.3 x 2.8 cm, also unchanged.
The spleen is not enlarged, but is diffusely low in signal intensity on
T2-weighted images and there is loss of signal on in-phase compared to
out-of-phase T1-weighted images, suggesting with siderosis. The adrenal
glands are unremarkable in appearance. There is mild right hydronephrosis
with a dilated right ureter down to the level of the retroperitoneal
collection. The kidneys are otherwise unremarkable.
Vertebral body hemangioma in T8. Bilateral pleural effusions are unchanged,
atelectasis or consolidation in the right lower lobe is incompletely evaluated
on this study. A gastric tube is noted in adequate position.
## IMPRESSION:
1. No overt pancreatic duct disruption.
2. Changes of acute pancreatitis with multiple large intra-abdominal fluid
collections containing hemorrhagic or necrotic debris, these are not changed
significantly when compared to the prior study. No necrotic parenchyma
identified.
3. Gallbladder sludge.
4. Bilateral pleural effusions with atelectasis or consolidation in the right
lower lobe.
5. Possible splenic siderosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19858494", "visit_id": "27361663", "time": "2186-05-17 16:15:00"} |
13665644-RR-43 | 267 | The examination was performed on this lady as a 30-month followup
following randomization into the TINSAL-CV trial, research account . The
examination includes abdomen for liver fat, body fat, coronary artery calcium
score and coronary arteriogram for measurement of calcified and noncalcified
plaque. Imaging was performed using the Aquilion One CT scanner.
## ABDOMEN:
Expanded views of the abdomen were reconstructed in the axial,
sagittal and coronal planes. The liver was imaged Using 135 kVp. Using 135
kVp, the attenuation value for the left lobe was 61.1, right lobe 59.1 and
spleen 49.7. Using the same factors in , the respective values were
59, 58, and 48 for the spleen. The spleen, gallbladder, kidneys, adrenals and
pancreas are all normal. Mild degenerative changes are noted in the spine.
## CHEST:
A stent is noted in the LAD and possibly a short stent in the
diagonal. The lungs are clear. The pulmonary arteries and veins are normal
with no evidence of emboli. There is no evidence of hilar adenopathy.
## CARDIAC:
The cardiac images were acquired in a prospective gated fashion at
75% of the RR interval capturing the heart in a single beat and reconstructed
on the Vitrea workstation. Metoprolol was not needed for heart rate control.
0.4 mg of nitroglycerin was given sublingually to dilate the coronary
arteries. The detailed report of the cardiac findings is not included in the
medical record because of the research nature but transmitted directly to the
referring cardiologist.
## TOTAL RADIATION DOSE:
The total effective radiation dose was 11.23
millisieverts with the cardiac portion contributing 3.43 millisieverts.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13665644", "visit_id": "N/A", "time": "2173-12-25 11:15:00"} |
19005999-RR-66 | 326 | ## INDICATION:
sarcoma // DO NOT MOVE, TO RESCHEDULE , rule out
progression or new lesions.
## FINDINGS:
There is a new intra-axial mass in the left parietal lobe, likely in the
postcentral gyrus, measuring approximately 3.1 x 3.1 x 3.0 cm (AP, transverse,
SI). The mass demonstrate peripheral intrinsic T1 hyperintensity, with
central T1 hypointensity, as well as predominantly T2/FLAIR hyperintensity.
There is associated surrounding vasogenic edema resulting in mild mass effect
on the adjacent parenchyma. Additionally, the mass demonstrate diffusion
restriction. The intrinsic T1 hyperintensity limits the evaluation of with
the mass demonstrates enhancement are not.
There is also a new small lesion in the body of the left corpus callosum that
demonstrate T1 hypointensity, T2 and FLAIR hyperintensity, and diffusion
restriction. It measures approximately 8 x 8 x 11 mm.
There is is a new small enhancing lesion in left superior parietal lobule
(10:99). This lesion also demonstrates T2/FLAIR hyperintensity and
isointensity on T1 weighted images.
There is stable redemonstration of postsurgical changes of right frontal
craniotomy.
There is no evidence of midline shift. The ventricles and sulci are normal in
caliber and configuration. The vascular flow voids are grossly unremarkable.
The dural venous sinuses are patent. Stable mucous retention cyst in the
bilateral maxillary sinuses with associated mucosal thickening in the
bilateral ethmoid air cells. The bilateral mastoid air cells are clear. No
abnormal marrow signal.
## IMPRESSION:
1. New large hemorrhagic lesion with surrounding vasogenic edema in the left
parietal lobe, and additional enhancing lesions in the a body of the left
corpus callosum and left superior parietal lobules, raises concern for new
metastatic disease, in keeping with patient history of sarcoma.
2. Stable postsurgical changes of right frontal craniotomy.
3. Moderate paranasal sinus disease as described above.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 13:03 into the Department of Radiology
critical communications system for direct communication to the referring
provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19005999", "visit_id": "N/A", "time": "2147-03-01 09:10:00"} |
17560931-RR-50 | 537 | ## HISTORY:
with abdominal pain, dark stools // Ischemic
colitis
## FINDINGS:
The lung bases are clear. Limited imaging of the heart reveals no pericardial
effusion or cardiomegaly.
## CT ABDOMEN:
There are several small hypodense foci in the liver which are too small to
characterize, for example 7 mm lesion superiorly in segment 8 (series 4, image
181), and 7 mm lesion superiorly in segment 4B (series 4b, image 183). On the
arterial phase, there are several areas of transient perfusion abnormality,
located at segment 6 (series 4 a, image 31), segment 4B (series 4 a, image
29), and segment 3 (series 4 a, image 27). If there is a persistent
hyperdensity in segment 4B on venous phase likely representing a underlying
hemangioma. The cause of the additional transient perfusion changes is not
identified on this study.
The portal and hepatic veins are patent. There is no intra or extrahepatic
biliary dilatation. The gallbladder is normal. The pancreas enhances
homogeneously. The spleen and adrenal glands are normal. The kidneys enhance
and excrete contrast promptly. There are no concerning renal lesions.
There is no retroperitoneal or abdominal adenopathy. No free air or free fluid
is present. The stomach and intra-abdominal loops of small bowel are normal
caliber and appearance. The appendix is visualized in the right lower
quadrant appears normal. There is mild sigmoid diverticulosis without
evidence of diverticulitis.
## CT PELVIS:
The remainder of the bowel is normal. Minimal submucosal fat in
the anteriorly in the bladder wall may be due to prior inflammatory episodes.
(series 601b, image 81).
There are metallic densities compatible with fiducial markers in the prostate.
There is no free pelvic fluid. There is no inguinal or pelvic adenopathy.
## OSSEOUS STRUCTURES:
No concerning osteoblastic or osteolytic lesion
identified. A sclerotic focus in the left iliac bone measuring 1 cm is stable
in size in appearance since . Osseous changes throughout the left ilium
appear stable from and consistent with Paget's disease.
## CTA:
The aorta contains calcified atherosclerotic plaque. There is
conventional hepatic arterial anatomy. The celiac, superior mesenteric,
bilateral renal and inferior mesenteric arteries are patent. Multifocal
plaque in the bilateral iliac arterial system. , with mild narrowing of the
bilateral common iliac and right external iliac arteries. There is severe,
near occlusive focal narrowing of the mid left external iliac artery (series
4a, image 120).
Inferior vena cava, superior mesenteric vein and superior mesenteric veins are
patent. The portal vein is patent.
## IMPRESSION:
1. Normal bowel wall enhancement. The superior mesenteric and inferior
mesenteric arteries are patent.
2. No active extravasation.
3. The left external iliac artery demonstrates focal near occlusive severe
atherosclerotic stenosis (series 4a, image 120).
4. Mild sigmoid diverticulosis without evidence of diverticulitis.
5. Possible mild contrast reaction including itching of the face and neck as
well as congestion.
6. Left hemipelvic Paget's disease.
7. Likely benign lesions in the liver may represent combination of cysts and
hemangiomas, suggest further assessment with nonemergent ultrasound or MRI.
## NOTIFICATION:
The possible mild contrast reaction was called immediately to
Dr. by Dr. on at 12:54 .
#7 of impression above was entered by Dr. on at 19:38
into the Department of Radiology critical communications system for direct
communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17560931", "visit_id": "N/A", "time": "2162-05-30 12:13:00"} |
12758384-RR-32 | 152 | ## INDICATION:
AIDS, lymphoma, febrile neutropenia. Evaluate for source of
infection.
## BONE WINDOWS:
Sclerotic focus in the left intertrochanteric region again
seen, possibly representing bone island. No new suspicious lytic or blastic
lesion identified.
## IMPRESSION:
1. Multiple new subcentimeter nodular densities seen at the visualized lung
bases. These are nonspecific in appearance, and possibly represent
inflammatory or infectious etiology, although given patient's history, short
interval three-month followup would be recommended to document resolution.
2. At least three hypoattenuating lesions seen within the liver, possibly
cysts or hemangiomas, too small to characterize by CT. These could be further
evaluated by ultrasound as clinically indicated.
3. Unchanged appearance of multiple cystic lesions within the kidneys and
superior aspect of the spleen. Again, these are too small to characterize by
CT, and if indicated, MRI could be helpful for further evaluation.
4. Improving splenomegaly.
5. Decrease in size of bilateral inguinal lymphadenopathy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12758384", "visit_id": "N/A", "time": "2169-10-27 17:01:00"} |
17542886-RR-17 | 103 | NON-CONTRAST HEAD CT SCAN
## HISTORY:
Left middle cerebral artery aneurysm rupture. Evaluate for
ventricular size.
## FINDINGS:
Comparison with the prior study performed 12 hours before reveals
no appreciable change in the mildly dilated supratentorial ventricular system.
The subarachnoid blood, distributed throughout the basal cisterns, as well,
does not appear substantially changed. There is no new shift of normally
midline structures. There remains effacement of the cerebral cortical sulci,
likely a manifestation of mild cerebral edema.
The surrounding osseous and soft tissue structures are unremarkable.
## CONCLUSION:
Negligible interval change in appearance of study from examination, obtained 12 hours before the present examination.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17542886", "visit_id": "29012018", "time": "2180-09-02 08:12:00"} |
18587826-RR-16 | 96 | ## HISTORY:
with right sharp intermittent pain today //
evaluate for torsion
## FINDINGS:
The uterus is anteverted and measures 6.3 x 2.7 x 4.9 cm. The endometrium is
homogenous and measures 1 mm.
The ovaries are normal. A small amount of fluid is noted around the left
ovary. There is a trace amount of free fluid in the pelvis.
## IMPRESSION:
Normal appearance of the uterus and bilateral ovaries. A small amount of
fluid is noted surrounding the left ovary and a trace amount of free fluid is
seen in the pelvis, considered physiologic.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18587826", "visit_id": "N/A", "time": "2185-05-10 11:20:00"} |
16969063-RR-87 | 159 | ## HISTORY:
Left thyroid mass seen on a previous chest x-ray.
## FINDINGS:
The right lobe of the thyroid is homogenous in echotexture and
measures 44 x 20 x 16 mm. Note is made of a small hypoechoic nodule in the
isthmus measuring 10 x 4 x 11 mm. There is a diffusely multinodular
appearance to the enlarged left lobe of the thyroid with the inferior pole
predominantly occupied by cystic nodules. A large heterogeneous nodule at the
mid portion of the left lobe measures 39 x 35 x 84 mm and a large conglomerate
of the cystic lesions at the lower pole of the left measures 38 x 37 x 33 mm.
The nodules are predominantly hypovascular.
## IMPRESSION:
Multinodular left thyroid with mixed solid and cystic components
as detailed above. Given size, recommend biopsy for further evaluation. Note
that the more cranial nodule on the left is likely more amenable to biopsy
given its predominantly isoechoic material.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16969063", "visit_id": "24115526", "time": "2140-04-19 13:16:00"} |
12411239-RR-23 | 197 | ## REASON FOR EXAMINATION:
Followup of a patient after large uterine mass
excision after massive fluid resuscitation.
Portable AP chest radiograph compared to , obtained at 8:34 p.m.
The ET tube tip currently is 3.6 cm above the carina, although note is made
that the tip might impinge the right tracheal wall. The NG tube tip is in the
stomach. The right internal jugular line tip is low in the right atrium
approximately 3 cm below the cavoatrial junction. The heart size is normal.
Prominence of the aortopulmonic window is again noted, unchanged and may
represent the pulmonary hypertension or lymphadenopathy.
The evaluation of lung parenchyma demonstrates minimal vascular engorgement
but no overt failure. There is no appreciable pleural effusion. There is no
pneumothorax.
## IMPRESSION:
1. No evidence of failure. Mild vascular engorgement.
2. Too low position of the right internal jugular line which should be pulled
back for 3 cm to place it in distal SVC.
3. Bulging of the aortopulmonic window contour may be related to pulmonary
artery or prominent lymphadenopathy. Evaluation with chest CT might be
considered if clinically warranted.
Findings discussed with Dr. the phone at the time of
dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12411239", "visit_id": "23028159", "time": "2163-02-23 04:23:00"} |
12428510-RR-74 | 107 | ## FINDINGS:
In the lumbar spine, an analysis of L1-L4 reveals a BMD of 1.154
g/cm2, equivalent to a T-score of -0.3 and a Z-score of 0.1. This is within
normal limits. In comparison with the baseline study of , there has
been a significant 2.5% increase in BMD.
In the femoral neck region, the mean BMD is 0.829 g/cm2, equivalent to a
T-score of -1.5 and a Z-score of -0.8. This is in the osteopenic range. In
comparison with the baseline study, there has been a significant 12.7%
decrease in BMD.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12428510", "visit_id": "N/A", "time": "2196-05-21 15:54:00"} |
14042101-DS-5 | 1,324 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
"Palpitations and shortness of breath".
## HISTORY OF PRESENT ILLNESS:
y.o woman with past medical history significant for type II
DM who presents to the hospital for palpitations and
tachycardia. The patient reports that she has been having these
episodes for over a year, where she feels palpitations that are
associated with shortness of breath and fatigue. In the past
these episodes would last approximately 10 minutes and occurred
on average once a week. However, over the past week she has been
having these episodes with increasing frequency with each
episode lasting longer. Today, she went to her pcp for this
problem and her longest episode yet, which was lasting for 2
hours during her time at her doctor's office. An ECG was
performed at the office which found her to be in an SVT with
rates as high as 170s. 911 was called and EMS arrived, who gave
her two doses of adenosine 6mg and 12mg which broke the rhythm
and reverted her to sinus. She has never lost consciousness.
.
In the emergency room, she was in sinus and received IV fluids.
On arrival to the floor, the patient denied any chest pain or
shortness of breath, however had another episode of tachycardia
on the floor with sudden onset. An ECG was performed which
showed retrograde p waves and no delta waves consistent with an
AVNRT and this rhythm was converted to sinus by carotid massage.
She remained CP free throughout.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
## 2. CARDIAC HISTORY:
-CABG:
none
-PERCUTANEOUS CORONARY INTERVENTIONS: none
-PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:
Retinopathy
Depression
severe for years, rendering her bedbound
GERD
occasional "bile duct obstruction causing nausea"
## FAMILY HISTORY:
Parents with diabetes, history of stroke and AD in the family.
No fhx of MI, arrythmia, or sudden cardiac death.
## VS:
T 98 bp 120/72 p 73 rr 20 sat 99% on RA
## GENERAL:
WDWN woman in NAD. Oriented x3. Mood, affect
appropriate.
## HEENT:
NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
No carotid bruits.
## CARDIAC:
PMI located in intercostal space, midclavicular
line. tachycardic, normal S1, S2. No m/r/g. No thrills, lifts.
No S3 or S4.
## LUNGS:
No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
## ABDOMEN:
Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
## EXTREMITIES:
No c/c/e. No femoral bruits.
## SKIN:
No stasis dermatitis, ulcers, scars, or xanthomas.
## LEFT:
Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ 2+
At discharge:
v/s 98.0 98.0 106/70 130->80 after carotid massage 18
gen: obese female in NAD
eyes: PERRL, EOMI, anicteric
ent: MMM
neck: supple no JVD
cv: tachycardic, no murmurs
resp: ctab no w/r/c
abd: +bs, soft, nt, mildly distended
ext: wwp, trace LLE edema, DP 2+ bilat
neuro: A&Ox3
psych: pleasant, mood appropriate
## CXR:
Single frontal view of the chest was obtained.
This study is
slightly underpenetrated. Given this, no focal consolidation,
pleural
effusion, or evidence of pneumothorax is seen. There is mild
pulmonary
vascular congestion. The cardiac silhouette is not enlarged. The
aorta is
calcified and tortuous. IMPRESSION: Mild pulmonary vascular
congestion. No focal consolidation seen.
## ECHO:
The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy with normal cavity size
and regional/global systolic function (LVEF>55%). There is no
ventricular septal defect. Right ventricular chamber size and
free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Physiologic
mitral regurgitation is seen (within normal limits). The
tricuspid valve leaflets are mildly thickened. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion. IMPRESSION: Mild symmetric left
ventricular hypertrophy with preserved global and regional
biventricular systolic function. No significant valvular
abnormality seen.
## ECG:
Regular narrow complex tachycardia of uncertain
mechanism. Low QRS voltage. Diffuse ST-T wave changes. Findings
are non-specific. Since the previous tracing of the same date
regular narrow complex tachycardia has replaced sinus
tachycardia.
## BRIEF HOSPITAL COURSE:
yo woman with history of diabetes and hypertension presented
with tachycardia and palpitations. ECG is consistent with SVT,
most likely common AVNRT, responsive to adenosine and carotid
massage.
.
#SVT: There was a short R-P interval on ECG making the
differential common AVNRT, AVRT with a fast accessory pathway,
or AT with PR delay. However, retrograde p-waves were
consistent with AVNRT. The patient broke with adenosine in the
ambulance and after carotid massage while inpatient. She has
had repeated episodes that are recently more persistent and
symptomatic. A TSH was normal. She was started on metoprolol
to decrease the incidence of SVT. She was taught the Valsalva
maneuver for breakthrough SVT despite metoprolol. An
appointment was made for her with Dr. to discuss
options for SVT treatment.
.
#Type 2 Diabetes: years in duration, and complicated
by retinopathy.
Metformin and glyburide were held while she was NPO, and a
sliding scale of insulin was used for coverage.
.
#Hypertension: Stable. She notes history of hypertension to
systolic 170's when not on medications. Metoprolol was added to
her medication regimen. Her lisinopril dose was halved as a
result.
.
#Depression: Notes year history of severe depression, now
resolved. The patient denies being on any psychotropic
medications currently. Mood appropriate.
.
#Constipation: Typically has regular bowel movements. TSH was
within normal limits. She was given a bowel regimen.
## MEDICATIONS ON ADMISSION:
metformin 500mg bid
lisinopril 10mg daily
glyburide dose uncertain
zolpidem 5mg qhs
vitamin B12 daily dose uncertain
aspirin prn airplaine rides
## DISCHARGE MEDICATIONS:
1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.
4. glyburide Oral
5. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
6. Vitamin B-12 Oral
## SECONDARY DIAGNOSIS:
Hypertension, Diabetes mellitus, Depression
## DISCHARGE CONDITION:
Hemodynamically stable, HR , no further arrhythmia since
9am . Ambulating without difficulty
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital with palpitations and fatigue.
Your symptoms were secondary to an abnormal heart rhythm which
you have had in the past. We started you on a medication called
metoprolol to slow your heart rate and try and prevent you from
having this abnormal rhythm. Additionally, if you have this
fast heart rate at home, you can try to bear down as if having a
bowel movement as we discussed when you were int he hospital.
Please also avoid caffeine and alcoholic beverages as this can
increase the risk of the abnormal heart rhythm. You will also
have a follow-up appointment with Dr. to discuss
different ways including medications and a potential procedure
to stop this rhythm.
We made the following changes to your medications:
1. We started metoprolol 25mg PO twice daily
2. We decreased your lisinopril from 10mg to 5mg daily
Please keep all of your follow-up appointments as below.
Please call to schedule an ultrasound of the heart called an
echocardiogram at .
It was a pleasure taking care of you.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14042101", "visit_id": "26779287", "time": "2168-09-30 00:00:00"} |
15244599-RR-59 | 121 | ## EXAMINATION:
DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS
## INDICATION:
year old woman with cirrhosis, SBP s/p Dobhoff placement //
evaluate for dobhoff placement evaluate for dobhoff placement
## IMPRESSION:
2 CHEST RADIOGRAPHS SHOW REPOSITIONING OF THE ESOPHAGEAL FEEDING TUBE WITH THE
WIRE STYLET IN PLACE FROM THE LOWER ESOPHAGUS TO THE GASTROESOPHAGEAL
JUNCTION. IT WOULD STILL NEED TO BE ADVANCED ABOUT 8 CM TO MOVE THE
APPROPRIATELY INTO THE STOMACH.
MOST SIGNIFICANT INTERVAL CHANGE IS NEW LEFT PERIHILAR OPACIFICATION WHICH
COULD BE LARGE SCALE PNEUMONIA OR ASYMMETRIC PULMONARY EDEMA, PARTICULAR IF
PATIENT LIES ON HER LEFT SIDE. MILD CARDIOMEGALY IS ONLY A LITTLE LARGER
TODAY THAN IT WAS ON . MODERATE RIGHT PLEURAL EFFUSION IS LARGER.
THERE IS NO PNEUMOTHORAX.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15244599", "visit_id": "22612897", "time": "2170-08-05 17:59:00"} |
14136035-RR-11 | 249 | ## INDICATION:
Abdominal enlargement with pericardial effusion; evaluate for
malignancy.
## ABDOMEN:
Dependent atelectasis is mild. A moderate pericardial effusion is
simple appearing. Punctate right breast calcifications are incompletely
evaluated. A punctate hypoattenuating focus in segment 2 of the liver (3, 18)
is too small to characterize, but believed to represent a cyst. The liver is
otherwise unremarkable. The spleen and pancreas are within normal limits.
There is mild thickening of both adrenal glands, without discrete nodule.
Hypoattenuating foci in both kidneys likely represent cysts, although some are
too small to characterize. There are no pathologically enlarged lymph nodes
within the abdomen or pelvis. A portocaval node measures 9 mm in short axis.
There is no ascites or bowel dilatation. Atheromatous change of the abdominal
aorta and common iliac arteries is moderate. There is moderate
circumferential wall thickening of the hepatic flexure. The terminal ileum
appears unremarkable.
## PELVIS:
The rectum, sigmoid colon, uterus and bladder are unremarkable.
Multiple prominent parauterine vessels are noted.
## OSSEOUS STRUCTURES:
Levoconvex lumbar scoliosis is mild, with associated
multilevel degenerative changes.
## IMPRESSION:
1. Moderate simple-appearing pericardial effusion, of unknown etiology.
2. Thickening of both adrenal glands is most suggestive of adrenal
hyperplasia.
3. Moderate circumferential thickening of the right hepatic flexure may be
infectious or inflammatory in nature. However, neoplasm cannot be excluded
and correlation with colonoscopy is recommended.
The finding regarding the hepatic flexure and need for followup was entered
into the critical results dashboard by at approximately 5:15
p.m. on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14136035", "visit_id": "N/A", "time": "2165-08-15 12:09:00"} |
16041733-RR-50 | 176 | ## EXAMINATION:
BILATERAL 2D SCREENING MAMMOGRAM AND 2D SYNTHESIZED VIEWS, 3D
BREAST TOMOSYNTHESIS, INTERPRETED WITH CAD
## FINDINGS:
Tissue density: B- There are scattered areas of fibroglandular density.
## RIGHT BREAST:
There is no suspicious dominant mass, architectural distortion,
or suspicious grouped microcalcifications within the right breast.
## LEFT BREAST:
There is a 4.5 mm asymmetry within the lower central left breast
posterior depth best seen on MLO tomosynthesis image 41 without definite
correlate on CC images. There is no additional suspicious dominant mass,
architectural distortion, or suspicious grouped microcalcifications within the
left breast.
## RIGHT BREAST:
No mammographic evidence of malignancy within the right breast.
## LEFT BREAST:
4.5 mm asymmetry lower central left breast for which additional
imaging is required.
## RECOMMENDATION(S):
Diagnostic mammogram left breast with possible ultrasound.
## NOTIFICATION:
The mammography department will attempt to contact the patient
to arrange for additional evaluation per department protocol; the patient will
be sent a letter requesting her return and her clinician will be sent a copy
of this report.
## BI-RADS:
0 Incomplete - Need Additional Imaging
Evaluation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16041733", "visit_id": "N/A", "time": "2173-12-18 13:08:00"} |
11354329-DS-17 | 973 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
ERCP with sphincterotomy
EUS with FNA
## CC:
abd pain
y/o M s/p lap chole in c/b post-op pancreatitis.
MRCP at the time was normal. Re-presented in with nausea,
vomiting, and abdominal pain. A CT scan showed inflammed
pancreas w/ peripancreatic changes and enlarged body. No
abscess, pseudocyst, or calcifications were noted. MRCP
confirmed pancreatitis but was o/w unremarkable. The patient is
being admitted for elective ERCP and CT-A of pancreas.
ERPC showed pancreatic duct stricture mid body. No definite
filling defects in CBD. Sphincterotomy performed.
Patient with some mild post ERCP pain, but not significantly
more than pre-ERCP pain. Epigastric, dull, non-radiating. No
n/v.
## PAST MEDICAL HISTORY:
1. HTN
2. HLD
3. diverticular disease
4. Coronary artery disease s/p MI
## GEN:
Well appearing, no acute distress, awake, alert,
appropriate, and oriented x 3
## SKIN:
warm to touch, no apparent rashes.
## HEENT:
No conjunctival pallor, no scleral jaundice, OP clear,
no cervical LAD
## CV:
RRR no audible m/r/g, pulse 2+, no edema
## ABD:
soft, mild epigastric tenderness, bowel sounds wnl.
## NEURO:
strength and sensation intact bilaterally.
## CT ABD/PANCREAS (PANCREAS PROTOCOL):
1. Subtle enlargement of pancreatic body with mild
peripancreatic stranding, suggestive of residual pancreatitis,
with edema being a potential cause of pancreatic ductal
narrowing. Differential consideration includes autoimmune
pancreatitis, although appearance is not classic. Clinical
correlation with IgG4 level may be considered. Although no focal
mass is seen, follow-up to resolution is recommended to exclude
an underlying neoplasm.
2. No pancreatic mass.
3. Infrarenal chronic abdominal aortic dissections.
ERCP
Normal major papilla
Cannulation of the biliary duct was successful and deep with a
sphincterotome after a guidewire was placed.
Contrast medium was injected resulting in complete
opacification.
The common bile duct, common hepatic duct, right and left
hepatic ducts, biliary radicles and cystic duct were filled with
contrast and well visualized.
The course and caliber of the structures were normal with no
evidence of extrinsic compression, no ductal abnormalities, and
no filling defects
A sphincterotomy was performed in the 12 o'clock position using
a sphincterotome over an existing guidewire for management of
possible microlithiasis/sludge as a cause of his pancreatitis.
Cannulation of the pancreatic duct was successful and deep with
a sphincterotome after a guidewire was placed.
Contrast medium was injected resulting in complete opacification
A single stricture that was 10 mm long was seen at the main
pancreatic duct in the body of the pancreas.
This could be as a result of the recent pancreatitis, or due to
a malignancy.
Otherwise normal ercp to third part of the duodenum
EUS An ill-defined mass / abnormal parenchyma was noted
in the body of the pancreas - these changes were suggestive of
focal acute pancreatitis, however a neoplasm could not be ruled
out - FNA was performed.
## BRIEF HOSPITAL COURSE:
male with recent pancreatitis was admitted for elective
ERCP to find etiology of recent pancreatitis. He underwent an
ERCP which revealed a stricture at the pancreatic duct, thought
secondary to either pancreatitis or possibly malignancy. He
underwent sphincterotomy in case cholelithiasis may have played
a role in his pancreatitis. He also underwent CTA Pancreas,
which did not reveal a pancreatic mass. EUS was also performed
which revealed an abnormality in the pancreas, although again it
was unclear if this represented pancreatitis or a pancreatic
mass. FNA was taken, and the patient is to follow-up as an
outpatient with the ERCP team regarding these results and
further follow-up.
He was continued on the rest of his home medications, with the
exception of aspirin. He was recommended to hold aspirin for the
next 7 days.
## MEDICATIONS ON ADMISSION:
Lisinopril 20 daily, Atenolol 50 daily, Vicodin, Nexium 40
daily, Multivits, Lovastatin 20 daily, Diltiazem 12h ext mg
bid, Naproxen, amiloride-hydrocholothiazide daily.
## DISCHARGE MEDICATIONS:
1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
## 4. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO once a day.
5. Lovastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
6. Diltiazem HCl 60 mg Capsule, Sust. Release 12 hr Sig: One (1)
Capsule, Sust. Release 12 hr PO twice a day.
## 7. AMILORIDE-HYDROCHLOROTHIAZIDE MG TABLET SIG:
One (1)
Tablet PO once a day.
8. Dilaudid 2 mg Tablet Sig: Tablet PO every four (4)
hours as needed for pain for 5 days: This medication may make
you drowsy. Do not drive or use heavy machinery until you know
how this medication affects you. .
Disp:*30 Tablet(s)* Refills:*0*
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for constipation.
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day as needed for constipation.
## SECONDARY DIAGNOSES:
1. Coronary Artery Disease
2. Hyperlipidemia
3. Hypertension
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital for evaluation of your
pancreatitis. You underwent a CT scan of your pancreas, ERCP,
and endoscopic ultrasound, which all revealed pancreatitis. We
are awaiting the final results of your biopsy, and Dr.
will be in touch with you regarding your results.
We have made the following changes to your medications:
- aspirin: Please do not take this medication for one week after
your procedure. You may restart this medication on .
- senna / docusate: We would encourage you to take these stool
softeners while you are on pain medication to help prevent
constipation.
- dilaudid: This is a pain medication. This medication may make
you drowsy. Do not drive or use heavy machinery until you know
this medication affects you.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11354329", "visit_id": "24058482", "time": "2156-07-28 00:00:00"} |
10813891-RR-2 | 97 | ## INDICATION:
female with early pregnancy, referred to assess
dating.
## FINDINGS:
Transabdominal and transvaginal ultrasound examinations were
performed, the latter to better visualize the fetal sac. There is a single
live intrauterine gestation with heart rate of 130 beats per minute. The
crown-rump measures 6 mm which represents a gestational age of 6 weeks 3 days
which corresponds satisfactorily to menstrual dating of 6 weeks 4 days. The
ovaries are normal with a right sided hemorrhagic corpus luteal cyst. There
is physiologic free fluid within the pelvis.
## IMPRESSION:
Single live IUP with size equals dates.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10813891", "visit_id": "N/A", "time": "2174-12-15 14:43:00"} |
18602000-DS-12 | 1,540 | ## HISTORY OF PRESENT ILLNESS:
As per HPI by admitting MD:
## HPI(4):
Ms. is a female with past medical
history of ulcerative colitis w/ recent flare requiring high
dose
steroids, recent new stroke, Afib, who is admitted for recurrent
fevers.
The patient presented to the ED by recommendation from her GI
doctor Dr. . She reports that starting abruptly yesterday,
she developed urinary frequency and fevers to 101.6 at home. She
had associated malaise and dysuria. She felt that it was similar
to UTI's, which she has had many of. She is also
complaining of ongoing abdominal pain that she has been having
since her recent UC flare began.
Of note, the patient was admitted from through
for
a UC flare and was treated with IV steroids and initiated on
Remicade, and was discharged on prednisone 40 mg po daily with
plans to follow up with GI to taper the steroids and continue
remicade. At that time, she was also diagnosed with new Atrial
fibrillation. After discussion with the patient and CHADS2VASC
of
only 2, as well as active bloody diarrhea, decision was made to
hold anticoagulation.
The patient was readmitted on with visual symptoms and
diagnosed with new ischemic stroke, likely embolic from Afib.
She
was started on apixaban at that time.
## LABS:
UA negative, UCX and BCx sent, WBC 19.6, hgb 10.8, phos
2.3, otherwise within normal limits.
CXR, which I interpreted, showed no focal pneumonia or other
obvious airspace disease.
She was given one packet of neutral-phos
Decision was made to admit for further workup.
On arrival to the floor the patient has had no further fevers,
her urinary frequency has improved, and she feels back to
normal.
She corroborated the above. She also reports that her bowel
movements have been improving significantly, now just having
about 2 nonbloody BM's daily (was as many as BM's w/ blood
during her flare).
## ROS:
Pertinent positives and negatives as noted in the HPI. All
other systems were reviewed and are negative.
## PAST MEDICAL HISTORY:
-Acute stroke , likely embolic from new Atrial
fibrillation
-Ulcerative colitis
-Atrial fibrillation, diagnosed during admission for UC
flare.
-Hypertension
- Esophagus
-Raynaud's
-Plantar fasciitis
-Rosacea
-Dry eye
-Fibroid embolization
-Fibroid removal
-Cluster headaches
## FAMILY HISTORY:
Mother and sister with HTN
Maternal grandmother with stroke
- stomach cancer
## VITALS:
Afebrile and vital signs stable (see eFlowsheet)
## GENERAL:
Alert and in no apparent distress
## EYES:
Anicteric, pupils equally round
## ENT:
Ears and nose without visible erythema, masses, or trauma.
Oropharynx without visible lesion, erythema or exudate
## CV:
Heart regular, no murmur, no S3, no S4. No JVD.
## RESP:
Lungs clear to auscultation with good air movement
bilaterally. Breathing is non-labored
## GI:
Abdomen soft, non-distended, non-tender to palpation. Bowel
sounds present. No HSM
## GU:
No suprapubic fullness or tenderness to palpation
## MSK:
Neck supple, moves all extremities, strength grossly full
and symmetric bilaterally in all limbs
## SKIN:
No rashes or ulcerations noted
## NEURO:
Alert, oriented, face symmetric, gaze conjugate with
EOMI,
speech fluent, moves all limbs, sensation to light touch grossly
intact throughout
##
97.7 PO BP:
115/74 HR: 61 RR: 18 O2 sat:
96% O2 delivery: RA
Gen - well appearing, sitting up in bed
HEENT - moist oral mucosa, PERRL
- rrr, s1/2, no murmurs
Pulm - CTA b/l, no w/r/r
GI - soft, non tender, non distended, + bowel sounds
Ext - no peripheral edema or cyanosis
Skin - warm and dry, no rashes
Psych - calm and cooperative
## DISCHARGE:
==========
blood cultures with Strep species
and blood cultures no growth to date
## NCHCT ( ):
1. Dental amalgam streak artifact limits study. The previously
described subacute infarct at the right frontal semiovale and
subcortical white matter are better demonstrated on MRI MRA
dated
.
2. No new large territory infarction or hemorrhage.
3. Atrophy, probable small vessel ischemic changes, and
atherosclerotic vascular disease as described.
## CXR ( ):
No acute intrathoracic findings, particularly, no findings
concerning for pneumonia.
## CT A/P W/CONT ( ):
1. Wall thickening of the descending colon and distal transverse
colon with mild inflammatory changes in the surrounding
abdominal
fat and peritoneal fascia consistent with acute colitis.
2. Featureless appearance of the descending colon and mild fatty
infiltration of the wall is likely sequela of colitis.
## BRIEF HOSPITAL COURSE:
female with past medical history of ulcerative
colitis w/ recent flare ( ) requiring high dose steroids
and initiation of remicade, recent diagnosis of afib with acute
stroke (initiated on apixaban) admitted with fevers now found to
have sigmoid abscess and GPC bacteremia.
# Fevers:
# GPC Bacteremia:
# Sigmoid abscess:
Initially unclear etiology so CT torso obtained and notable for
~2cm x 1cm abscess in the sigmoid colon also with PVT that is
likely due to septic thrombophlebitis. Blood Cx positive
for GPCs in pairs. ID consulted and recommended IV ceftriaxone
2g daily and PO flagyl TID, for an extended course of 6 weeks.
Per discussion with radiologist, abscess not likely amenable to
drainage due to size. She will be seen by ID as an
outpatient for clinical monitoring. Case discussed with both ID
and GI, will need a repeat CT scan as an outpatient to
accurately determine duration of antibiotic therapy but planning
for 6 weeks from discharge. A PICC line was placed before
discharge.
-Ceftriaxone 2g daily x 6 weeks
-Metronidazole 500mg po TID x 6 weeks
-Labs per OPAT recs
-PICC lined placed
# Ulcerative colitis:
# Recent UC flare:
She was initially on rectal mesalamine but in early
had sigmoidoscopy showing diffuse inflammation so she was
initiated on remicade and IV steroids, and eventually discharged
on on prednisone 40mg daily with plan for outpatient
remicaide and prednisone taper. Prednisone taper continued to
20mg at time of discharge with outpatient plan to stay on 20mg
daily until seen by GI as an outpatient. If her steroids are not
tapered further she should be evaluated for prophylactic
calcium/vit D (already on GI ppx).
# Atrial fibrillation:
# Recent embolic stroke:
Recently admitted for small R frontal infarct, likely
due embolic from afib for which apixaban was initiated.
Currently in NSR with well-controlled rates. CHADsVASC 3.
Continued apixaban and metoprolol. covering MD discussed
with neurology, does not need to be on atorvastatin as her CVA
was embolic in setting of atrial fibrillation. Based on lipid
profile, does not require statin based on ASCVD risk score.
Additionally her LFT's are slightly elevated at the time of
discharge so it is held for this reason as well.
# Leukocytosis
Likely in the setting of infection and now trending down
appropriately. Still elevated but trend improved. Will need this
followed as an outpatient
## # HTN:
Was previously taking losartan which has been held due to
normotension.
# Low serum TSH without hyperthyroidism:
TSH undetectable this admission and last but FT4 WNL, likely c/w
nonthyroidal illness vs steroid effect. Needs repeat TFTs in
weeks.
## # INFLUENZA PROPHYLAXIS:
Tamiflu x 7 additional days
# Chronic dry eye: Continue restasis
# Transitional
-TFTs weeks
-CBC within the next week (part of OPAT labs)
-Repeat LFTs within the next week (part of OPAT labs)
-f/u with GI and ID as an outpatient to help determine duration
of antibiotic treatment
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Metoprolol Succinate XL 200 mg PO DAILY
2. Omeprazole 20 mg PO DAILY
3. PredniSONE 40 mg PO DAILY
4. Restasis 0.05 % ophthalmic (eye) BID
5. Apixaban 5 mg PO BID
6. Estradiol 0.01 % (0.1 mg/gram) vaginal 1X/WEEK ( )
7. Atorvastatin 40 mg PO QPM
## DISCHARGE MEDICATIONS:
1. CefTRIAXone 2 gm IV Q24H
RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 g IV once a
day Disp #*45 Intravenous Bag Refills:*0
2. MetroNIDAZOLE 500 mg PO Q8H
RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day
Disp #*120 Tablet Refills:*0
3. OSELTAMivir 75 mg PO DAILY Duration: 10 Days
RX *oseltamivir 75 mg 1 capsule(s) by mouth once a day Disp #*7
## CAPSULE REFILLS:
*0
4. PredniSONE 20 mg PO DAILY
RX *prednisone 20 mg 1 tablet(s) by mouth once a day Disp #*30
## TABLET REFILLS:
*0
5. Apixaban 5 mg PO BID
6. Estradiol 0.01 % (0.1 mg/gram) vaginal 1X/WEEK ( )
7. Metoprolol Succinate XL 200 mg PO DAILY
RX *metoprolol succinate 200 mg 1 tablet(s) by mouth once a day
Disp #*30 Tablet Refills:*0
8. Omeprazole 20 mg PO DAILY
9. Restasis 0.05 % ophthalmic (eye) BID
10. HELD- Atorvastatin 40 mg PO QPM This medication was held.
Do not restart Atorvastatin until your liver enzymes are checked
and normalize
## DISCHARGE DIAGNOSIS:
# sigmoid abscess
# pylephlebitis
# GPC bacteremia
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the hospital with fevers. You underwent an
extensive infectious work-up, which revealed and abscess in your
colon as well as bacteria in your blood. You were seen by our
infectious doctors and require several weeks of
antibiotics. You will continue treatment at home.
Please have your thyroid function tests repeated in weeks.
You will also need your liver enzymes and blood counts checked
on a weekly basis as part of your antibiotic therapy.
Please continue to take all medications as prescribed and follow
up with all appointments as detailed below.
We wish you the best.
Sincerely,
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18602000", "visit_id": "25967308", "time": "2135-11-11 00:00:00"} |
14023173-RR-2 | 424 | ## INDICATION:
male with history of MDS, myelodysplastic syndrome,
diagnosed with bone marrow biopsy on when he was found to have
fatigue, drop counts on CBC, refractory anemia and excessive blast, now
transferring from for management and question of
transformation to acute leukemia.
## FINDINGS:
Lung bases demonstrate small bilateral basilar pleural effusions, greater on
the right with basilar atelectasis. The remaining lungs are otherwise clear.
The heart is normal in size. Sequela of anemia is noted within the heart on
the non-contrast images. Mitral valve calcification is noted.
The liver is normal in size. A focal hypodensity is noted within the hepatic
lobe (2:24), incompletely characterized without IV contrast. No intrahepatic
or extrahepatic biliary ductal dilatation. The gallbladder is distended. The
spleen is normal. The pancreas is normal. The bowel is normal.
Both adrenal glands are normal.
Redemonstration of large subcapsular right-sided hematoma of the right kidney
with stable to slight increase in size since comparison
examination. This measures 8 x 8.5 x 11.4 cm in the AP, transverse and CC
, previously 8 x 7.9 x 11 cm. There is redemonstration of the
hyperdense fluid tracking into the right perirenal space and about the IVC.
Trace amount of fluid is also noted tracking into the bilateral posterior
pararenal spaces and left paracolic gutter as previously seen, without
significant interval change.
A stable hypodense lesion in the left kidney superior pole. Nephrolithiasis
in the inferior pole of the left kidney.
No significant retroperitoneal lymphadenopathy is noted. Moderate
atherosclerotic disease of the abdominal aorta.
## CT PELVIS:
Mild amount of hyperdense fluid is persistent in the presacral space, tracking
from the above hematoma. Post-surgical changes in the lower pelvis are not
clearly seen due to adjacent artifact from left hip prosthesis.
## BONES:
Left total hip arthroplasty. Facet arthropathy and degenerative disc disease
in lower lumbar spine and lower thoracic spine.
## IMPRESSION:
Stable to minimal interval increase in size of the right subcapsular renal
hematoma. However, there is stable amount of hematoma tracking into the
retroperitoneum as described without significant interval change. An
underlying mass is difficult to exclude on this non contrast examination. 6
month follow up MRI may be helpful for characterization; This time frame would
allow for some resolution of the hematoma and would provide for better
visualization of any underlying mass.
The above findings were discussed with Dr. at 8:30 a.m. on
. Additionally, the recommendation for awaiting 6 months for
a follow up evaluation for MRI was discussed with Dr. at 5:30
pm
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14023173", "visit_id": "28467541", "time": "2151-04-23 21:37:00"} |
19354547-RR-9 | 97 | ## EXAMINATION:
BILAT LOWER EXT VEINS
## INDICATION:
Evaluate for DVT in a patient with the lower extremity edema
after fall.
## FINDINGS:
There is normal compressibility, flow, and augmentation of the bilateral
common femoral, femoral, and popliteal veins. Normal color flow and
compressibility are demonstrated in the posterior tibial and peroneal veins on
the left. The right calf veins are not particularly well assessed.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa ( ) cyst.
## IMPRESSION:
No evidence of deep venous thrombosis in the right or left lower extremity
veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19354547", "visit_id": "29104573", "time": "2135-07-09 17:57:00"} |
17239250-RR-25 | 189 | ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## INDICATION:
with epigastric pain and elevated lipase, assess for
pancreatitis.
## LUNG BASES:
The imaged lung bases are clear. The imaged portion of the heart
is unremarkable.
## ABDOMEN:
The liver enhances normally without focal concerning lesion. Main
portal vein is patent. No biliary ductal dilation is seen. The gallbladder
is normal. There is no biliary ductal dilation. There is mild peripancreatic
fluid surrounding the pancreatic head and uncinate process which raises
concern for acute pancreatitis. No evidence of complication. Pancreatic duct
is not dilated. Spleen is normal. Adrenals are normal. Kidneys enhance and
excrete normally. The stomach and duodenum appear normal.
## PELVIS:
Loops of small bowel demonstrate no signs of ileus or obstruction.
There is an entero-enteric anastomosis in the left mid abdomen which appears
unremarkable. There is no secondary evidence for appendicitis. The colon is
unremarkable. Urinary bladder is decompressed. The prostate is unremarkable.
No pelvic sidewall or inguinal adenopathy.
## BONES:
No worrisome lytic or blastic osseous lesion is seen. Transitional
anatomy is noted with partial lumbarization of S1.
## IMPRESSION:
Acute pancreatitis centered at the pancreatic head/uncinate process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17239250", "visit_id": "27499286", "time": "2175-05-04 12:28:00"} |
18121763-RR-34 | 113 | ## STUDY:
Limited right upper quadrant ultrasound liver and gallbladder.
## INDICATION:
HIV positive and rising LFTs.
## FINDINGS:
The liver displays normal echotextural pattern without focal lesion
detected. There is no intra- or extra-hepatic biliary ductal dilatation with
the common bile duct measuring 3 mm. Limited views of the right kidney
display no hydronephrosis or other abnormality. No gallbladder is visualized,
consistent with history of previous cholecystectomy. The pancreas is
unremarkable, although the tail is not well visualized secondary to overlying
bowel gas. The main portal vein is patent with normal hepatopetal flow. The
spleen is normal in size and echotexture, measuring 9.8 cm.
## IMPRESSION:
Unremarkable limited right upper quadrant ultrasound.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18121763", "visit_id": "N/A", "time": "2178-01-13 13:15:00"} |
15220389-RR-21 | 293 | ## INDICATION:
woman with stable nodules right upper quadrant
thought likely to represent complicated cysts which have demonstrated two-year
stability by mammogram.
Comparison is made to prior mammograms from
and and ultrasound right breast and .
BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM WITH COMPUTER-AIDED DETECTION:
There are scattered fibroglandular densities. The partially circumscribed
nodules and nodular asymmetries in the right upper outer breast, anterior/mid
breast depth are unchanged for at least years with some of the nodules
decreasing in size when compared to prior studies. There are scattered
benign-appearing calcifications without suspicious groups. No new or
spiculated mass, suspicious clusters of microcalcifications or architectural
distortion.
## ULTRASOUND RIGHT BREAST:
Targeted ultrasound of the upper outer right breast was performed. At 11
o'clock, 2 cm from the nipple, there is a complicated cyst measuring 9 x 8 x 9
mm, this demonstrates a fluid-debris level with no internal vascularity and is
stable for one year.
At 10 o'clock, 3 cm from the nipple, there are two further hypoechoic nodules,
also likely representing complicated cysts. The larger of these has decreased
in size from 12 x 11 x 10 mm to 9 x 11 x 7 mm compatible with a collapsing
complicated cyst. The smaller nodule adjacent to this has decreased from 4 mm
to 3 mm. Further subcentimeter scattered simple cysts are seen. No new or
suspicious mass.
## IMPRESSION:
Stable/decreased size of the circumscribed nodule/nodular
asymmetries in the upper outer right breast, compatible with simple cysts.
These have demonstrated three-year stability by mammography and two-year
stability from prior ultrasound. The patient may resume annual screening one
year.
These results and recommendation were discussed with the patient who agrees
with this plan.
BI-RADS 2 - benign findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15220389", "visit_id": "N/A", "time": "2183-12-04 09:04:00"} |
11722506-RR-19 | 176 | ## HISTORY:
Right knee and lower leg surgery with right lower leg and ankle
pain, skin erythema along the anterior lower leg.
## FINDINGS:
A lateral plate is seen fixating the proximal medial tibia with 2 proximal and
2 distal screws. Lucency is noted within the medial proximal tibia which is
related to prior orthopedic procedure. Additionally, 2 screws are noted
coursing through the lateral proximal tibia. No evidence of hardware
loosening or failure is demonstrated. There are degenerative changes
involving all 3 compartments of the knee, but most severe within the medial
compartment with moderate joint space narrowing and osteophyte formation.
Tiny suprapatellar joint effusion is noted. No acute fracture or dislocation
is seen.
Within the ankle and tibia and fibula, no acute fracture or dislocation is
present. The ankle mortise is symmetric. The talar dome is smooth. Minimal
spurring is noted at the tibiotalar joint. There is no focal lytic or
sclerotic osseous abnormality. No radiopaque foreign bodies or subcutaneous
gas is noted.
## IMPRESSION:
No acute fracture or dislocation. No evidence of hardware complications.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11722506", "visit_id": "N/A", "time": "2134-02-11 12:19:00"} |
14588919-RR-65 | 202 | ## CLINICAL INFORMATION:
woman with right flank pain, question
stone.
.
## LUNG BASES:
The lung bases are clear without pleural or pericardial effusion.
## ABDOMEN:
Evaluation of abdominal viscera is limited by lack of intravenous
contrast. There is no intrahepatic biliary ductal dilatation. The
gallbladder is normal appearing. The spleen is normal in size. The adrenals
are normal in size bilaterally. Kidneys are normal in size and appearance
bilaterally without surrounding inflammatory change. There is no renal
calculus identified, nor hydronephrosis. No ureteral calculus is seen. There
are no calculi seen within the bladder. The pancreas is unremarkable.
The stomach is filled with ingested contents. Loops of small bowel are normal
in caliber. The small-bowel mesentery appears normal. The aorta is normal in
caliber along its course.
## PELVIS:
The patient is status post appendectomy with surgical staple line
seen at the level of the cecum. The pelvic organs, rectum, bladder, and colon
all appear normal. There is no intraperitoneal free fluid or free air. There
is no pelvic side wall lymphadenopathy.
## BONE WINDOWS:
There is no concerning lytic or blastic osseous lesion.
## IMPRESSION:
1. No renal or ureteral calculus, or cause for acute right flank pain. No
hydronephrosis.
2. Status post appendectomy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14588919", "visit_id": "N/A", "time": "2187-11-03 19:03:00"} |
12501269-RR-224 | 354 | ## PROCEDURE:
CT chest without contrast.
## REASON FOR EXAM:
Evaluate for mass or post-obstructive pneumonia.
## FINDINGS:
There is new multifocal ground-glass opacities throughout both
lungs, worse in the right middle lobe, right lower lobe and left upper lobe in
addition to multiple tiny centrilobular nodules, bronchiolectasis and mild
airway thickening. Some of these centrilobular nodules are confluent in
areas, for example in the right lower lobe (5.219).
Linear atelectasis in the left lower lobe with mild bronchiectasis is the
residua of consolidation on the previous CT. A large hiatal hernia raises the
possibility of recurrent aspiration, particularly in the presence of a lower
lobe bronchiectasis and recurrent consolidation. However, a concurrent
atypical infection is also possible. Lymph node enlargement is slightly less
than on the previous study and is now 10 mm in the paratracheal region, was 14
mm.
A well-circumscribed nodule in the right lower lobe (4.133) is slightly larger
than , was 12 mm, is now 13.8 mm, although the differences could be due to
differences in technique. No new pulmonary nodules, pleural effusion, mass.
Airways are widely patent to subsegmental levels bilaterally.
The right main pulmonary artery is 27 mm, borderline enlarged. The aorta and
heart size are normal with no pericardial effusion. Calcification in the
aortic annulus and coronary arteries is moderate.
Limited review of the upper abdomen is unremarkable except to note
calcification in the abdominal aorta at the origin of the visceral arteries
and fatty replacement of the pancreas.
No destructive or sclerotic bone lesion is present.
## IMPRESSION:
1. Resolution of the left lower lobe consolidation with residual left lower
lobe atelectasis and mild bronchiectasis.
2. New multifocal ground-glass opacities with mild bronchiolectasis and
bronchiectasis, bronchial wall thickening and centrilobular nodules are likely
due to a combination of recurrent aspiration--the patient has a
moderate-to-large hiatal hernia--and concurrent atypical infection, probably
viral.
3. Minimal increase in right lower lobe well-circumscribed nodule could be
accounted for by differences in technique; follow up in one year would be
prudent.
4. Diffuse triple vessel coronary artery and aortic valve calcification.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12501269", "visit_id": "23215128", "time": "2138-06-01 09:54:00"} |
12716861-RR-96 | 384 | ## EXAMINATION:
CT abdomen and pelvis
## INDICATION:
year old woman with a history of diverticulitis status post
sigmoid colectomy and diverting loop ileostomy status post ileostomy takedown
. Now presenting with prior ostomy wound requiring dressing with
packing and has constant pain lower right quadrant flanking prior ostomy
site.// Please evaluate for source of right lower quadrant pain. ?Abscess,
## SINGLE PHASE SPLIT BOLUS CONTRAST:
MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP =
6.0 mGy-cm.
2) Spiral Acquisition 4.2 s, 46.4 cm; CTDIvol = 10.1 mGy (Body) DLP = 469.1
mGy-cm.
3) Spiral Acquisition 0.8 s, 9.0 cm; CTDIvol = 4.8 mGy (Body) DLP = 42.7
mGy-cm.
4) Spiral Acquisition 0.8 s, 9.0 cm; CTDIvol = 4.8 mGy (Body) DLP = 42.7
mGy-cm.
Total DLP (Body) = 560 mGy-cm.
## LOWER CHEST:
The left lung base is clear. The right hemidiaphragm is elevated.
## HEPATOBILIARY:
Liver is unremarkable. Cholelithiasis is again noted.
## PANCREAS:
The pancreas is unremarkable.
## SPLEEN:
The spleen is unremarkable.
## ADRENALS:
The adrenal glands are unremarkable.
## URINARY:
The kidneys are unremarkable.
## GASTROINTESTINAL:
Post sigmoid colectomy with sigmoid sutures. New changes of
ileostomy take down with mild soft tissue stranding and wall thickening around
the anastomotic site are noted and could be postsurgical. No free air, fluid
collection or extraluminal contrast to suggest leak. Stranding and a few foci
of air are seen in the subcutaneous fat overlying the right lower quadrant,
also expected post recent intervention. The appendix is unremarkable.
## PELVIS:
The uterus and adnexa are unremarkable on CT for age.
## LYMPH NODES:
There is no abdominal or pelvic lymphadenopathy.
## VASCULAR:
Moderate atherosclerotic disease is noted.
## BONES:
There are no aggressive bone lesions. There is mild retrolisthesis of
L5 on S1. Severe compression deformity of L2 is unchanged.
## SOFT TISSUES:
Redemonstration of ventral hernia containing nonobstructive
loops of small bowel.
## IMPRESSION:
Mild soft tissue stranding around the ileoileal anastomosis and within the
subcutaneous soft tissues of the right lower quadrant, likely related to
recent intervention. No drainable fluid collection or leak demonstrated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12716861", "visit_id": "N/A", "time": "2138-08-30 14:27:00"} |
17188320-RR-19 | 152 | ## EXAMINATION:
ANKLE (AP, MORTISE AND LAT) RIGHT
## INDICATION:
year old woman s/p R pilon ORIF and ex-fix// s/p R pilon ORIF
and ex-fix s/p R pilon ORIF and ex-fix
## FINDINGS:
The patient is status post open reduction internal fixation of markedly
comminuted fractures of the distal right tibia and fibula. There has been
interval placement of a lateral plate over the distal fibula with multiple
screws as well as a syndesmotic screw. An external fixation device is also
present. The alignment is overall near anatomic. A small butterfly fragment
from the fibular fracture again projects over the syndesmoses. The mortise
appears congruent on the provided nonweightbearing views and the talar dome is
intact. No new fractures or evidence of hardware related complications.
## IMPRESSION:
Status post open reduction internal fixation of the lower right leg as
described above. No evidence of acute hardware related complications.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17188320", "visit_id": "20189092", "time": "2111-10-24 19:36:00"} |
10108435-RR-188 | 421 | ## HISTORY:
man with recent STEMI, GI bleed, and status post
catheterization, now presenting with low blood pressure and hematocrit drop.
Evaluate for possible retroperitoneal bleed.
## STUDY:
CT abdomen and pelvis without contrast. MDCT images were acquired
from the lung bases to the pubic symphysis. Multiplanar reformatted images
are displayed in 5-mm slice thickness.
## CT ABDOMEN WITHOUT CONTRAST:
In the visualized lung bases, there are mild-to-
moderate dependent bibasilar atelectasis. There is trace amount of bilateral
pleural effusion. The heart is within normal limits. There is a small amount
of pericardial effusion. In the abdomen, the liver is without focal lesions.
The gallbladder has tiny hyperdense foci in the dependent position (image
2a:25) but is otherwise normal. The stomach, duodenum, loops of small bowel,
and colon are normal within the limits of the non-contrast study.
The pancreas has small focal fatty changes, normal for age. The spleen,
adrenal glands, kidneys are unremarkable. There is an IVC filter in the
infrarenal vein position. There are multiple small venous varices in the
retroperitoneum, consistent with a history of DVT and subsequent collateral
venous varice formation. There is no discernable lymphadenapathy. There is no
evidence of free fluid to suggest hematoma. There is no free air in the intra-
abdominal cavity.
## CT PELVIS WITHOUT CONTRAST:
The bladder is normally distended without focal
abnormality. The prostate is normal in size. The colon and small bowel are
normal. There is no discernable lymphadenopathy. There is no free fluid in
the retroperitoneum. There is no free air in the pelvis.
## BONE WINDOW:
There is an unchanged L1 anterior wedge deformity with evidence
of mild retropulsion. The superior endplate deformity in L3 is also
unchanged. There is multilevel disc narrowing with moderate-to-severe facet
joint arthropathy and secondary degenerative changes especially in the lower
lumber. The right SI joint is fused, and the left SI joint has significant
narrowing with a small bone island in the left iliac bone. There are no
suspicious blastic or lytic osseous lesions. There is vascular calcification
in the descending aorta, common iliac arteries and splenic artery. The
underlying soft tissues are unremarkable.
## INDICATION:
1. No evidence of retroperitoneal bleeding/hematoma.
2. IVC filter at the infrarenal vein position with evidence of collateral
venous varice formation.
3. Unchanged deformity in L1 and L3 vertebral bodies.
4. Unchanged marked underlying degenerative diseases.
The findings of the study have been communicated to the primary team, Dr.
by phone at 1:30 p.m. on the date of the study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10108435", "visit_id": "21874806", "time": "2184-04-25 12:20:00"} |
16931484-RR-44 | 183 | ## INDICATION:
year old man with abdominal aneurysm// follow up on AAA repair
## FINDINGS:
The aorta measures 2.4 cm in the proximal portion, 2.7 cm in mid portion and
5.6 cm in the distal abdominal aorta. There has been interval increase in
size of the known fusiform aneurysm now measuring up to 5.6 cm in maximal AP
dimension (previously 4.2 cm in . There is moderate calcified
atherosclerotic plaque.
Wall-to-wall color flow is seen within the aorta with appropriate arterial
waveforms.
The common iliac arteries are aneurysmal. The right common iliac artery
measures 1.7 cm and the left common iliac artery measures 1.5 cm.
The right kidney measures 10.1 cm and the left kidney measures 10.8 cm.
Limited views of the kidneys are without hydronephrosis.
## IMPRESSION:
Interval increase in the size of the known fusiform aortoiliac aneurysm
measuring up to 5.6 cm maximal AP (previously 4.2 cm in .
## NOTIFICATION:
The findings were discussed with , by
, on the telephone on at 10:55 am, 5 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16931484", "visit_id": "N/A", "time": "2204-02-12 10:02:00"} |
10368757-RR-36 | 148 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
male with history of prior head trauma, presenting
with persistent nasal drainage and headache. Concern for CSF leak.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 6.0 s, 20.0 cm; CTDIvol = 53.0 mGy (Head) DLP =
1,060.0 mGy-cm.
Total DLP (Head) = 1,060 mGy-cm.
## FINDINGS:
CT cisternogram study demonstrates expected hyperdensity within the sulci and
cisterns. There is no evidence of contrast material outside the expected
regions to suggest CSF leak. No evidence to suggest fistula.
Again demonstrated are fractures involving the left frontal bone with
persistent focal depression and bilateral nasal bone fractures again seen.
The mastoid air cells are clear.
## IMPRESSION:
1. Expected filling within the sulci and cisterns without evidence to suggest
CSF leak or fistula.
2. Again noted are nasal bone fractures and depressed left frontal bone
fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10368757", "visit_id": "N/A", "time": "2115-01-07 13:27:00"} |
12522208-RR-41 | 226 | ## INDICATION:
year old man with memory loss with HTN, DM, and ESRD on
dialysis// ? medial lobe atrophy or white matter disease.
## FINDINGS:
There is no evidence of acute intracranial hemorrhage or acute territorial
infarction. Ventricles and sulci are prominent secondary to age related
involutional changes. Periventricular and deep subcortical T2/FLAIR white
matter hyperintensities are likely sequelae of chronic microangiopathy. No
diffusion abnormalities are detected. Chronic infarction is seen involving
the right cerebellum with adjacent increased FLAIR signal abnormality likely
secondary to gliosis, ocular ischemic changes identified in the right side of
the pons (image 7, series 5, image 83, series 101). Symmetric bilateral
hippocampal atrophy seen. Bilateral basal gangliar calcifications are seen.
Mild mucosal sinus thickening is seen involving the ethmoid air cells. The
remainder the visualized paranasal sinuses, mastoid air cells, and middle ear
cavities are clear. Left replacement is identified in the right eye globe
otherwise the orbits are unremarkable. The patient is status post right lens
replacement surgery. The principal vascular flow voids are well preserved.
## IMPRESSION:
1. No acute intracranial abnormalities identified. Chronic microangiopathy.
2. Chronic infarction is seen involving the right cerebellum.
3. Symmetric bilateral hippocampal atrophy, may be secondary to age related
involutional changes, however is a finding seen in the presence of dementia.
4. Lacunar ischemic change is identified towards the right side of the pons
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12522208", "visit_id": "N/A", "time": "2154-09-03 16:40:00"} |
14550633-DS-21 | 1,440 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
: Deceased donor kidney transplant
## HISTORY OF PRESENT ILLNESS:
Ms. is a y/o speaking female with a
medical history of ESRD on HD, CAD s/p CABG, PVD, HTN, DM2 who
presents after being called in for renal transplant. She denies
CP, SOB, n/v/abd pain. She feels well and overall had no
complaints.
## PAST MEDICAL HISTORY:
ESRD on HD (TuThSa)
Failed left AVF
Right AV graft created in
Angioplasty of the right mid-graft and basilic vein at AV care
on .
CAD s/p CABG ( )
Myelodysplastic syndrome
PVD
DM2
HTN
## FAMILY HISTORY:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
## HEENT:
AT/NC, EOMI, PERRL, MMMs
## CARDIAC:
RRR, S1/S2, III/VI SEM heard best at LUSB
## LUNG:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## ABDOMEN:
nondistended, +BS, nontender in all quadrants, no
rebound/guarding
## EXTREMITIES:
Old LUE AV fistula w/o palpable thrill or murmur.
RUE AV fistula also w/o palpable thrill or murmur. No overlying
erythema or induration. Moving all extremities well, no
cyanosis, clubbing or edema
## NEURO:
A&Ox3. Moving all extremities equally. No focal deficits
appreciated.
## BRIEF HOSPITAL COURSE:
On , she underwent Deceased donor kidney transplant after
receiving induction immunosuppression. Surgeon was Dr.
. Please refer to operative report for complete details.
Intraop, after the vascular anastomoses, the
kidney reperfused, although was slow initially as the patient's
blood pressure was in the . BP improved after decreasing
sedation. A 19 drain was placed in the retroperitoneum.
Postop, she was producing small amounts of urine.
Immediately postop, potassium was elevated at 6.6. IV meds
(insulin/dextrose)were administered with lowered potassium.
Renal duplex demonstrated arterial waveforms slightly delayed
acceleration time throughout.
On postop day 1, urine output was still low and potassium was
still elevated for which IV meds were readministed. Hemodialysis
was then performed with lowering of the potassium.
She continued to have low urine outputs. Hct was low (23 from
postop day 1 and 2 units of prbc were administered with
hct increase to 32.5. However, over the hospital course, hct
decreased again to 20 on postop day 7. Another 2 units of PRBC
were transfuse with hct increase to 27 which remained stable.
She received a total of 4 doses of ATG (75mg each dose),
steroids were tapered to off, cellcept was adjusted to 500mg qid
for GI complaints and Prograf was started on postop day 3. Doses
were adjusted daily per trough levels.
BP was elevated in 160s. Home dose of Isosorbide was resumed and
amlodipine was added. BPs improved with SBP in 140-120 range.
Diet was advanced and tolerated. Glucoses were elevated in
200-300s. was conculted and insulin adjusted to Lantus
and sliding scale humalog with improved control.
JP drain was removed on . On , she complained of
diarrhea. Stool was sent for c.diff and was negative. Cellcept
was adjusted to 500mg qid. She was started on loperamide for
diarrhea with resolution.
Hemodialysis was performed on and then
held for increasing urine output. It was also discovered on
, that the patient was saving all of her urine for
recording. After discussion with interpreter, she
started to save urine and it was noted that she had made 1000+
cc for the day. Creatinine decreased to 4.9. Repeat renal duplex
on showed increased resistive indices to 1.0 with no
diastolic flow. Renal vein and artery were patent. No fluid
collection was noted.
She and her family received medication and transplant teaching
via the interpreter. Meds were delivered.
determined that patient had no needs. Caregroup was
arranged. She was discharged to home in stable condition. HD was
on hold pending f/u labs and urine output. Next lab draw on
at lab 7 by 9am. Of note, her
outpatient HD spot was given away therefore, she was given Lasix
80mg once on , and was to take another dose on (dose
provided).
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Amlodipine 10 mg PO DAILY
2. Aspirin 81 mg PO DAILY
3. Atorvastatin 80 mg PO DAILY
4. Doxazosin 1 mg PO HS
5. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY
6. Lisinopril 20 mg PO DAILY
7. Metoprolol Succinate XL 100 mg PO DAILY
8. Multivitamins 1 TAB PO DAILY
9. Omeprazole 20 mg PO DAILY
10. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
11. sevelamer CARBONATE 1600 mg PO BID
12. cilostazol 50 mg ORAL BID
13. Acetaminophen 650 mg PO Q8H:PRN pain
14. Furosemide 80 mg PO DAILY
15. Nephrocaps 1 CAP PO BID
16. Cinacalcet 30 mg PO DAILY
17. Cyanocobalamin 1000 mcg PO DAILY
18. Sodium Polystyrene Sulfonate 30 gm PO 1X/WEEK (MO)
19. FoLIC Acid 1 mg PO DAILY
20. Glargine 12 Units Bedtime
Humalog 6 Units Breakfast
Humalog 7 Units Lunch
Humalog 2 Units Dinner
## DISCHARGE MEDICATIONS:
1. Acetaminophen 650 mg PO Q8H:PRN pain
Maximum of 8 tablets(325mg tabs) per day
2. Amlodipine 10 mg PO DAILY
3. Aspirin 81 mg PO DAILY
4. Atorvastatin 40 mg PO DAILY
5. cilostazol 50 mg ORAL BID
6. FoLIC Acid 1 mg PO DAILY
7. Omeprazole 20 mg PO DAILY
8. Mycophenolate Mofetil 500 mg PO QID
9. Nystatin Oral Suspension 5 ml PO QID
10. Sulfameth/Trimethoprim SS 1 TAB PO DAILY
11. ValGANCIclovir 450 mg PO 2X/WEEK (WE,SA)
This dose will be adjusted as kidney function improves
12. Cyanocobalamin 1000 mcg PO DAILY
13. Sodium Polystyrene Sulfonate 30 gm PO 1X/WEEK (MO)
14. Nephrocaps 1 CAP PO BID
15. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
RX *oxycodone 5 mg 1 tablet(s) by mouth q 4 hours Disp #*30
## TABLET REFILLS:
*0
16. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY
17. LaMIVudine 25 mg PO DAILY
RX *lamivudine [Epivir] 10 mg/mL 2.5 ml by mouth once a day Disp
Milliliter Refills:*12
18. Glargine 10 Units Dinner
Insulin SC Sliding Scale using HUM Insulin
19. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day
Disp #*60 Capsule Refills:*3
20. Senna 8.6 mg PO BID
RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*60
## TABLET REFILLS:
*3
21. Metoprolol Succinate XL 50 mg PO DAILY
22. Tacrolimus 3 mg PO Q12H
23. Furosemide 80 mg PO ONCE Duration: 1 Dose
take once on . Outpatient Lab Work
25. Outpatient Lab Work
## DISCHARGE DIAGNOSIS:
ESRD s/p kidney transplant
Delayed graft function
Hepatitis B core Antibody positive
## DISCHARGE INSTRUCTIONS:
Please call the transplant clinic at for fever
(temperature of 101 or greater, chills, nausea, vomiting,
diarrhea, constipation, inability to tolerate food, fluids or
medications, increased abdominal pain, incisional redness,
drainage or bleeding, dizziness or weakness, decreased urine
output or dark, cloudy urine, swelling of abdomen or ankles, or
any other concerning symptoms.
You will have labwork drawn twice weekly as arranged by the
transplant clinic at floor,
, 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
Tacrolimus until your labs are drawn. Bring your Tacrolimus with
you so you may take your medication as soon as your labwork has
been drawn.
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. The
staples are removed approximately 3 weeks following your
transplant.
No tub baths or swimming
No driving if taking narcotic pain medications
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 Glucerna nutritional supplement.
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": "14550633", "visit_id": "21250797", "time": "2183-06-12 00:00:00"} |
19919017-RR-11 | 114 | ## CLINICAL HISTORY:
Left ovarian cyst. Evaluate for change or resolution.
## PELVIC ULTRASOUND:
Comparison is made with the prior ultrasounds of and .
Both transabdominal and transvaginal ultrasound were performed. A clear
walled left ovarian cyst is again seen. No septations or projections are
noted. The overall size is currently 7.9 x 8 x 3.7 cm, which probably comes
to roughly the same volume as it was on the prior ultrasound, but is
definitely larger than it was in .
No other changes are seen since the prior ultrasound. There is a small amount
of fluid in the cul-de-sac, probably less than it was in .
## IMPRESSION:
Persistence of left ovarian cyst.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19919017", "visit_id": "N/A", "time": "2184-11-25 12:27:00"} |
13546197-RR-20 | 104 | ## INDICATION:
year old man with history of right arm swelling // ?
destructive arthritis
## IMPRESSION:
There is no significant joint effusion. No acute fractures or dislocations are
seen. There is a large spur off of the olecranon at the expected attachment of
the triceps tendon. Prominent soft tissue swelling seen suggestive of bursitis
or hematoma. The spur demonstrates a fracture of the distal tip, age
indeterminate. On the oblique view, there is a corticated density adjacent to
the medial epicondyle which may represent a loose body or sequela of prior
avulsion type injury. Spurring about the coronoid process is seen and
consistent with osteoarthritis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13546197", "visit_id": "N/A", "time": "2130-11-24 08:30:00"} |
18092188-RR-74 | 240 | ## INDICATION:
Status post wide excision for left breast papillary carcinoma,
. The patient's daughter reports that Dr. a left breast
mass.
## LEFT BREAST ULTRASOUND:
Targeted ultrasound of the left outer breast at 3
o'clock demonstrates a dilated duct in the retroareolar region measuring 1.3
cm in length x 0.6 cm in diameter. This is without internal debris. The duct
continues to be mildly dilated at least 6 cm from the nipple laterally. Other
ducts are noted to be dilated at this location also. In addition, at 3
o'clock, 6 cm from the nipple, there is some intraductal echogenicity with a
small fleck of calcification. This may represent internal debris
however, a small solid lesion is not entirely excluded.
In the more proximal duct, a few other calcifications are noted (3 o'clock, 2
cm from the nipple).
## IMPRESSION:
The area of palpable concern corresponds to the area of dilated
ducts at 3 o'clock. There is probable debris in the duct at 3 o'clock 6 cm
from the nipple.
In addition, the patient and her daughter and I discussed the possibility of a
six month follow-up vs. an ultrasound- guided core biopsy. However, the
patient will be seen by Dr. in the next few weeks, and the daughter,
the patient and Dr. will decide future management.
BI-RADS 3 - probably benign. Six-month followup mammogram and ultrasound is
recommended at this time.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18092188", "visit_id": "N/A", "time": "2176-02-03 15:39:00"} |
16492132-RR-12 | 147 | ## HISTORY:
male with large right-sided intracranial hemorrhage who
is intubated not moving the left side, with abrasions on the left upper arm.
## STUDY:
Two views of the left shoulder, two views of the left elbow.
## FINDINGS:
Limited views of the shoulder showed no evidence of fracture.
Dislocation cannot be definitively ruled out to the lack of an axillary or Y
view. Degenerative changes are seen at the AC joint. Visualized portion of
the left chest wall and lung appear unremarkable.
The left elbow shows no fracture or dislocation. Two round well-corticated
ossific densities are noted at the medial epicondyle, possibly the sequela of
prior injury. A supracondylar process is incidentally noted within the distal
humerus.
## IMPRESSION:
No fracture of the elbow or shoulder, although limited assessment
for shoulder dislocation. An axillary or Y view would be recommended to
definitively exclude a shoulder dislocation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16492132", "visit_id": "23590130", "time": "2147-08-31 11:38:00"} |
14994273-DS-5 | 486 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HISTORY OF PRESENT ILLNESS:
y/o male with 6 prostate cancer. He had a 26 core
prostate needle biopsy this afternoon with Dr. . He had
rectal bleeding shortly after going home from the clinic this
afternoon, and was brought to the ED by ambulance after feeling
lightheaded with continuous rectal bleeding. He had a syncopal
episode on admission to the ED. He denies nausea, vomiting,
fevers, chills, chest pain, dyspnea, hematuria, urinary urgency,
frequency. The patient had discontinued his aspirin one week
prior to the biopsy as instructed.
## PAST MEDICAL HISTORY:
HTN
Hyperlipidemia
Mild COPD/Asthma
Colonic polyps
## FAMILY HISTORY:
Father, mother: colon cancer
## VS:
Afebrile, HR 65, BP 139/49, R 16, 100%RA
NAD, A&Ox3, lying in Trendelenburg
RRR, No respiratory distress
## GU:
No active rectal bleeding on initial exam. On DRE, pressure
and surgicel were applied to the prostate, and there was no
active bleeding or clots after pressure applied.
## BRIEF HOSPITAL COURSE:
On , the patient was admitted to Dr.
service/SICU from the ED with rectal bleeding and syncope after
prostate needle biopsy. In the ED, surgicel and pressure were
applied to the prostate and the acute bleeding stopped. The
patient was placed in and serial Hct's were
checked. GI consult was requested by the ICU team, and they
recommended Vit K for elevated INR 1.5. Cardiac enzymes were
negative. On HD 2, the patient had several bloody bowel
movements and remained in the ICU for monitoring. Hematocrits
were stable at without transfusion on HD 2. On HD 3, the
patient was seen by general surgery, who performed an anoscope.
The anoscopy showed old clot, no active bleeding. Also on HD 3,
the patient was transferred to the floor from the ICU in stable
condition. Serial Hct's were monitored, which continued to be
stable at . He received antibiotic
prophylaxis, and he remained afebrile throughout his hospital
stay. At discharge, patient denied pain, was tolerating a
regular diet, ambulating without assistance, and voiding without
difficulty. He denied chest pain, dyspnea, abdominal pain at
discharge. He was given explicit instructions to call Dr.
office to schedule follow-up appointment.
## DISCHARGE MEDICATIONS:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*2*
## DISCHARGE DIAGNOSIS:
Rectal bleeding status post ultrasound guided prostate needle
biopsy
## DISCHARGE INSTRUCTIONS:
-Call Dr. ( ) to schedule follow up
appointment.
-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication,
discontinue if loose stool or diarrhea develops.
-If you have fevers > 101.5 F, abdominal pain, nausea or
vomitting, bright red blood per rectum, call your doctor or go
to the nearest emergency room.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14994273", "visit_id": "28784363", "time": "2141-04-17 00:00:00"} |
12839027-RR-27 | 100 | ## HISTORY:
female with removal of right chest tube. Assess for
pneumothorax.
Portable AP upright chest radiograph is compared to earlier the same day
performed at 9:10 a.m. A minimal right apical pneumothorax is evident.
Extremely tiny left apical pneumothorax is unchanged. Left chest tube remains
in position. Right chest tube has been removed. The right IJ central venous
catheter tip projects over the upper SVC, unchanged. Cardiomediastinal
contours are stable. Lungs remain clear aside from minimal bibasilar
atelectasis.
## IMPRESSION:
Status post removal of right chest tube with tiny right apical
pneumothorax. Unchanged tiny left apical pneumothorax.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12839027", "visit_id": "27532902", "time": "2116-11-02 12:01:00"} |
16864785-DS-12 | 1,179 | ## CHIEF COMPLAINT:
advanced dementia with aggressive behavior
## HISTORY OF PRESENT ILLNESS:
w/ history of dementia with aggressive behavior, frequent
falls, neuropathy, hearing loss presenting from House
for evaluation of aggressive behavior and possible psych
placement. Patient with long history of severe dementia. Was
admitted to in for dementia, aggressive
behavior found to have positive UA though negative Urine
culture, treated with 7 day abx course. Patient was seen by
psych as inpatient and started on for assistance in
managing aggressive behavior.
Since returning to house last month, patient has
continued to be aggressive while still on . Last night,
patient hit private aid in the head x2 causing the private aid
company to discontinue services. Patient also with intermittent
incontinence of urine and stool recently which is new for her.
In setting of ongoing violent/aggressive behavior, patient sent
to ED for evaluation and possible psych placement as she
can no longer be managed at house.
In the ED, initial vs were: 0 98 72 125/61 18 100% ra Labs were
remarkable for WBC 4.8 47%N, Hct 29.4 (bl , INR 1.1. UA
with large 2 WBCs, no bacteria, with 5 Epis. CT Head showed
hygroma/chronic Subdural hematoma. Patient was seen by
neurosurgery who stated that this was chronic, no need for
neurosurgical internvetion and that it was ok to continue ASA
325mg. CXR negative. Patient was given bactrim and risperidone.
Urine culture sent. Seen by Psych who recommended UTI rx and
restarting of depakote. Vitals on Transfer: 99.2 74 109/51 17
97% RA.
On the floor patient reports she feels fine and is without
complaints. Just wants to rest for the night. Per the nurse,
earlier she had been up and walking around the floor, very calm
and appreciative of others help.
Review of sytems: not reliable due to patient's dementia
## PAST MEDICAL HISTORY:
B12 deficiency, GERD, decreased hearing, hypercholesterolemia,
hypertension, monoclonal gammopathy, thalassemia, osteopenia,
neuropathy, advanced dementia, HLD, iron deficiency
## FAMILY HISTORY:
Reviewed, not pertinent to this hospitalization
## ADMISSION:
Vitals- 98.6, 139/60, 74, 18, 100%RA
General- Alert, orientedx1-2, in no acute distress, pleasant and
cooperative
- Sclera anicteric, MMM, oropharynx clear
Neck- supple, JVP not elevated, no LAD
Lungs- Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV- Regular rate and rhythm, normal S1, S2, no murmurs, rubs,
gallops
Abdomen- soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU- no foley
Ext- warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro- CNs2-12 intact, motor function grossly normal
## GEN:
NAD, alert, not oriented (only knows first name)
## :
anicteric sclera, EOMI, moist mucous membranes, clear
oropharynx
## NECK:
supple, JVP not elevated, no LAD
## CARDS:
RRR, normal S1/S2, no murmurs, rubs or gallops
## PULM:
CTAB; no wheezes, crackles, or increased work of breathing
## ABDOMEN:
soft, NT/ND, +BS, no rebound/guarding
## EXT:
warm and well perfused; 2+ pulses, no clubbing, cyanosis or
edema
## NEURO:
CN2-12 grossly intact, symmetrical muscle strength and
sensation, no focal neurologic deficits.
## TECHNIQUE:
Contiguous axial MDCT images were obtained through
the brain without contrast. Axial images were reviewed in
conjunction with coronal and sagittal reformats.
## FINDINGS:
A predominantly hypodense subdural hemorrhage with a
small hyperdense component is seen along the right parietal
convexity, maximally measuring 1 cm from the inner table. There
is no shift of normally midline structures. There is no evidence
of edema or acute vascular territorial infarction. Prominent
ventricles and sulci are compatible with age-related atrophy
with dilated temporal horns of the lateral ventricles also
suggesting medial temporal atrophy. Periventricular white matter
hypodensities are nonspecific but likely reflect sequelae of
chronic small vessel ischemic disease. The basilar cisterns are
patent. Gray-white matter differentiation is preserved. No
fracture is identified. Partially imaged paranasal sinuses,
mastoid air cells, and middle ear cavities are clear. Globes are
unremarkable.
## IMPRESSION:
Chronic subdural hematoma along the right parietal convexity
with a small acute component.
## BRIEF HOSPITAL COURSE:
The patient is an year old female with advanced dementia with
aggressive features, frequent falls, who was sent to from
House with increased aggression.
## # DEMENTIA WITH AGGRESSIVE FEATURES:
unclear eitology.
Differential diagnoses include medication effect (reccent d/c of
depakote), occult infection, pain/discomfort, head trauma, or
progression of severe dementia. Chest x-ray and urine analysis
were negative. Head CT does not show acute process, only
chronic subdural hematoma, which is resolving. Most likely due
to progression of dementia. The patient was re-started on
depakote (125 mg TID; LFTs WNL). Memantine was d/c'd since there
is no evidence that it increases the efficacy of donepezil and
may cause GI symptoms. Tethers and lines were avoided and the
patient was frequently re-oriented. She was treated with zyprexa
for acute episodes of agitation and qhs. She was also calmed by
. She was discharged to for further
evaluation and management.
## # CHRONIC ANEMIA:
likely due to a combination of B12 deficiency,
iron deficiency, and thalassemia. HCT was at patient's baseline
during admission.
# B12 deficiency: the patient's B12 level was elevated compared
with normal limits, so her B12 supplementation was decreased
from 1000 to 750 mg QD.
# Fe deficiency: continued home iron supplementation.
# Hyperlipidemia: continued home statin.
## # CODE:
Full code per
# CONTACT: daughter,
# HCP: (confirmed)
# PENDING STUDIES AT TIME OF DISCHARGE: none
# ISSUES TO DISCUSS AT FOLLOW UP: dementia
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list may be inaccurate and requires
futher investigation.
1. Aspirin 325 mg PO DAILY
2. Calcium Carbonate 500 mg PO DAILY
3. Cetirizine 10 mg Oral daily
4. Citalopram 20 mg PO DAILY
5. Donepezil 10 mg PO DAILY
6. Ferrous Sulfate 325 mg PO DAILY
7. Multivitamins 1 TAB PO DAILY
8. Memantine 5 mg PO DAILY
9. Simvastatin 20 mg PO DAILY
10. Cyanocobalamin 1000 mcg PO DAILY
11. Mirtazapine 15 mg PO HS
12. RISperidone 0.5 mg PO HS
13. RISperidone 0.25 mg PO DAILY
14. TraZODone 50 mg PO HS
15. TraZODone 25 mg PO Q6H:PRN agitation
## DISCHARGE MEDICATIONS:
1. Aspirin 325 mg PO DAILY
2. Calcium Carbonate 500 mg PO DAILY
3. Citalopram 20 mg PO DAILY
4. TraZODone 50 mg PO HS
5. Simvastatin 20 mg PO DAILY
6. RISperidone 0.25 mg PO DAILY
7. RISperidone 0.5 mg PO HS
8. Multivitamins 1 TAB PO DAILY
9. Mirtazapine 15 mg PO HS
10. Ferrous Sulfate 325 mg PO DAILY
11. Donepezil 10 mg PO DAILY
12. Cetirizine 10 mg Oral daily
13. TraZODone 25 mg PO Q6H:PRN agitation
14. Cyanocobalamin 750 mcg PO DAILY
15. Divalproex Sod. Sprinkles 125 mg PO TID
16. OLANZapine (Disintegrating Tablet) 5 mg PO QHS
## PRIMARY DIAGNOSIS:
advanced demention with aggressive behavior
Secondary diagnosis: neuropathy, hearing loss, B12 deficiency,
anemia, hyperlipidemia
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
It was a pleasure taking care of you during your recent
admission to . You were admitted
for aggression. You did not have any infections. You are being
discharged to a facility for further
care.
Best wishes!
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16864785", "visit_id": "24087345", "time": "2178-10-11 00:00:00"} |
17418657-RR-17 | 189 | ## INDICATION:
woman with abnormal uterine bleeding and fibroids;
assess reasons for uterine bleeding and size, number, and location of
fibroids.
## FINDINGS:
The uterus is anteverted and measures 11 x 6.1 x 7.5 cm. Multiple uterine
fibroids (at least 10 discrete) are demonstrated with submucosal, subserosal,
and intramural components:
The dominant fibroid on the left measures 3.4 x 3.3 x 4 cm.
A dominant fibroid in the right uterine fundus has a submucosal component and
measures approximately 2.7 x 2.5 x 2.7 cm (se 1b, im 72; se 1e, im 75).
The endometrium is distorted by fibroids and slightly heterogenous. The
endometrium measures up to 9 mm.
An intrauterine device is malpositioned, low-lying in the cervix.
The ovaries are normal. There is a small amount of simple-appearing free
fluid.
## IMPRESSION:
1. Multiple uterine fibroids with one dominant 2.7-cm right fundal fibroid
with submucosal component.
2. Malpositioned IUD, low-lying in the cervix.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 4:18 , 15 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17418657", "visit_id": "N/A", "time": "2133-01-15 13:54:00"} |
17725368-RR-10 | 845 | ## EXAMINATION:
CT CHEST/ABD/PELVIS W/ CONTRAST
## INDICATION:
with triple pressor sepsis, transferred, unclear source //
eval PNA, eval cholangitis, abdominal source. Additional clinical history was
provided, which includes at the patient is severely neutropenic and has
history of multiple prior bone marrow biopsies.
## HEART AND VASCULATURE:
Pulmonary vasculature is well opacified to the
segmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. Mild cardiomegaly is noted. Otherwise, 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.
## PLEURAL SPACES:
No pneumothorax. Small pleural effusions are noted
bilaterally.
## LUNGS/AIRWAYS:
There are small bilateral pleural effusions and subjacent
dependent atelectasis, although superimposed aspiration cannot be excluded.
Additionally, the interlobular septae are diffusely thickened and there are
diffuse regions of slight ground-glass opacity, concerning for mild pulmonary
edema. The airways are patent to the level of the segmental bronchi
bilaterally. An endotracheal tube is positioned with tip at the level of the
carina, and oriented towards the right main bronchus. Retraction by
approximately 2 cm would result in more optimal positioning.
## BASE OF NECK:
Visualized portions of the base of the neck show no abnormality.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There are 3 hypodense foci within the left lobe of the liver, the largest of
which measures up to 7 mm (2:103, 108), which may represent hepatic cysts or
biliary hamartomas. There is no evidence of intrahepatic or extrahepatic
biliary dilatation. There is moderate periportal edema and pericholecystic
fluid which likely reflects aggressive hydration. The gallbladder is
distended with probable mild wall thickening. No radiopaque gallstones.
## PANCREAS:
The pancreas is atrophic and 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. There are 2 rounded
cystic structures within the spleen, the larger of which measures up to 6.0 cm
in diameter (601:85). Of note, the spleen appears malrotated.
## 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 an 8 mm hypodensity at the lower left renal pole (2:155), too small
to characterize but likely representing a renal cyst. There is no evidence of
solid renal lesions or hydronephrosis. There is no perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. An enteric catheter is in
place, with tip in the distal stomach. Small bowel loops demonstrate no signs
of ileus or obstruction. There is mild thickening of the distal/terminal
ileum. There is significant abnormality involving cecum with mural
thickening, and extensive focal cecal pneumatosis (2:187). Additionally,
there is poor definition of the medial wall of the cecum best seen on series
601, image 38, and there are several small foci of extraluminal gas within the
mesentery. Findings raise concern for micro perforation. There is no portal
venous gas or gas within branches of the superior mesenteric vein. The
appendix is not visualized. There is no free intraperitoneal air. There is a
small amount of intra-abdominal free fluid.
## PELVIS:
The urinary bladder is decompressed with a Foley catheter and grossly
unremarkable. There is a small amount of pelvic free fluid.
## REPRODUCTIVE ORGANS:
There are several coarse calcifications within the
uterus, which may represent degenerated, calcified fibroids. The bilateral
adnexae are grossly within normal limits.
## LYMPH NODES:
There is enlarged mesenteric lymph node in the right lower
quadrant, measuring up to 1.1 cm in the short axis (601:46) and several
additional smaller lymph nodes not meeting CT size criteria for pathologic
enlargement. There is no retroperitoneal lymphadenopathy. There is no pelvic
or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. The celiac artery, superior mesenteric artery, superior mesenteric
vein, portal vein are patent. There is no portal venous gas.
## BONES AND SOFT TISSUES:
Within the right buttock deep to the right gluteus
medius muscle there is a pocket of soft tissue gas which tracks along the
fascial planes raising potential concern for necrotizing fasciitis (2:85).
There is no evidence of worrisome osseous lesions or acute fracture. Mild
anterolisthesis of L4 on L5.
## IMPRESSION:
1. Cecal thickening with pneumatosis may represent complications of typhlitis
given history of severe neutropenia. Micro perforation is suspected.
2. Multiple foci of gas seen in tracking along the fascia between the right
gluteus minimus and medius muscles. While necrotizing fasciitis is difficult
to exclude, clinical correlation is advised given history of multiple prior
intervention/bone marrow biopsies which may contribute to this appearance.
3. Mild pulmonary edema, small pleural effusions, small volume ascites,
periportal edema may reflect aggressive hydration and fluid overload state.
4. Suboptimal position of the ET tube terminating at the carina requires
retraction by 2-3 cm for more optimal positioning.
5. Significant lower lobe atelectasis, difficult to exclude a component of
aspiration.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17725368", "visit_id": "25311297", "time": "2138-07-23 19:20:00"} |
13899364-RR-132 | 363 | CT ABDOMEN AND PELVIS
## INDICATION:
History of ovarian CA, abdominal pain.
## CT ABDOMEN:
There is atelectasis noted within the inferior segment of the lingula. There
are multiple small bilateral pulmonary nodules stable in size and number since
prior imaging, consistent with known pulmonary metastatic disease. Small
right basal pleural effusion, little bigger when compared to prior CT. No
pericardial effusion noted.
Again there are multiple ill-defined low-attenuation lesions noted within the
liver consistent with diffuse hepatic metastases. The portal vein and
visualized hepatic veins are patent. Gallbladder is normal. There are two
low-density lesions identified within the spleen (series 2, image 19 and 14)
stable. Incidental note is made of a gastric diverticulum (series 2, image
14). Both adrenal glands and kidneys are unremarkable. The pancreas is
atrophic with no focal solid mass or cystic lesion identified.
Again there is an aortocaval lymphadenopathy measuring 1.1 x 2.5 cm,
previously 1.0 x 2.6 cm (series 2, image 26) and an aortocaval lymph node
measuring 10 x 13 mm, previously 9 x 9 mm (series 2, image 35) unchanged when
compared to prior imaging. No abnormally dilated or thickened small or large
bowel loops in the visualized upper abdomen and no evidence for free fluid or
omental deposits.
## CT PELVIS:
No pelvic adenopathy or free fluid. There has been prior hysterectomy and
bilateral salpingo-oophorectomy. Ileoanal anastomosis is noted which is
unremarkable. The visualized bladder is unremarkable.
## CT OSSEOUS SKELETON:
Again extensive sclerosis is noted in the L5 vertebral body and in the sacrum
in the midline (series 3, image 43), stable and unchanged when compared to
prior imaging. There is a convex scoliosis of the lumbar spine to the right
with decreased intervertebral disc space height noted at the lower three
lumbar vertebral levels. Unfused apophysis noted off the superior endplate of
the L3 vertebral body. They are stable and unchanged when compared to prior
CT.
## IMPRESSION:
1. Diffuse pulmonary, hepatic, and osseous metastases consistent with known
primary ovarian neoplasm.
2. No cause for acute abdominal pain identified on CT. No abnormally dilated
or thickened small or large bowel loop. No evidence for intra-abdominal
collection.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13899364", "visit_id": "26548983", "time": "2171-05-02 16:33:00"} |
19402233-RR-107 | 198 | ## INDICATION:
Fall after turn of the head. R/O carotid stenosis // Syncope
## RIGHT:
The right carotid vasculature has no atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 57 cm/sec.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 54, 49, and 46 cm/sec, respectively. The peak end
diastolic velocity in the right internal carotid artery is 20 cm/sec.
The ICA/CCA ratio is 0.9.
The external carotid artery has peak systolic velocity of 56 cm/sec.
The vertebral artery is patent with antegrade flow.
## LEFT:
The left carotid vasculature has no atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 88 cm/sec.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 46, 49, and 29 cm/sec, respectively. The peak end
diastolic velocity in the left internal carotid artery is 21 cm/sec.
The ICA/CCA ratio is 0.5.
The external carotid artery has peak systolic velocity of 62 cm/sec.
The vertebral artery is patent with antegrade flow.
## IMPRESSION:
Less than 40% stenosis bilaterally. No significant plaque noted.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19402233", "visit_id": "N/A", "time": "2142-08-22 11:07:00"} |
13100428-RR-6 | 384 | ## EXAMINATION:
CT abdomen and pelvis
## INDICATION:
with history of remote bariatric surgery, HF, afib, COPD
presents with 6 months severe LUQ and left flank pain// evaluate for
obstruction, abscess, etiology of LUQ and L flank pain
## 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:
Multiple calcified granulomas are noted in the left lower lobe.
There is mild scarring and atelectasis noted also in the lower lungs. The
imaged portion of the heart is unremarkable. There is a small hiatal hernia.
There is atelectasis bilaterally at the bases. There is no evidence of
pleural or pericardial effusion.
## HEPATOBILIARY:
The liver enhances normally. No focal liver lesion. Main
portal vein and central branches are patent. Notable intrahepatic and
extrahepatic biliary ductal dilation may in part reflect prior cholecystectomy
though clinical correlation is advised. No definite cause of obstruction is
identified on CT.
## PANCREAS:
Pancreas is atrophic though without focal lesion of concern or
ductal dilation.
## SPLEEN:
The spleen is normal.
## ADRENALS:
Adrenals are slightly atrophic in appearance bilaterally.
## URINARY:
The kidneys appear somewhat atrophic though enhance symmetrically and
demonstrate prompt excretion. A nonspecific hypodensity in the lower pole
left kidney is too small to characterize.
## GASTROINTESTINAL:
Patient is status post gastric bypass surgery. Contrast is
seen within the excluded stomach, compatible with a gastro-gastric fistula.
Small large bowel loops demonstrate no signs of ileus or obstruction. The
appendix is not visualized though there are no secondary signs of
appendicitis.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
Uterus is surgically absent. No adnexal mass is seen.
## 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:
No worrisome bony lesion.
## SOFT TISSUES:
Postsurgical changes are noted in the anterior body wall without
frank hernia.
## IMPRESSION:
1. Status post gastric bypass surgery with probable gastrogastric fistula.
2. Slightly atrophic appearance of the kidneys. Please correlate clinically.
3. Status post cholecystectomy with prominent intrahepatic and extrahepatic
biliary tree for which clinical correlation is advised.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13100428", "visit_id": "N/A", "time": "2136-03-09 15:32:00"} |
15188050-DS-17 | 1,310 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
. Mitral valve repair with a resection of the middle
scallop of the posterior leaflet, P2; and a mitral valve
annuloplasty with a 28 annuloplasty band.
2. Coronary artery bypass grafting x1 with reverse
saphenous vein graft to the right coronary artery.
## HISTORY OF PRESENT ILLNESS:
This is a year old male with known coronary artery
disease s/p LAD and DI stents and mitral regurgitation. He
recently underwent TEE in which revealed posterior
mitral valve prolapse with torn chordae and flail leaflet. Today
he underwent a cardiac cath that demonstrated 60% RCA and patent
stents.
Currently he admits to mild dyspnea on exertion. He denies chest
discomfort, lower extremity edema, orthopnea, PND, syncope,
pre-syncope, and palpitations.
## PAST MEDICAL HISTORY:
Coronary Artery Disease
Diabetes Mellitus
Hyperlipidemia
Hypertension
Mitral Regurgitation
Right Bundle Branch Block
Herpes Zoster
## PAST SURGICAL HISTORY:
s/p Knee surgery
s/p Back surgery
s/p Vasectomy
## FAMILY HISTORY:
Denies premature coronary artery disease
## PHYSICAL EXAM:
Vital Signs sheet entries for :
## GENERAL:
Well-developed male in no acute distress
## HEENT:
NCAT [X] PERRLA [X] EOMI [X] Sclera Anicteric [X] OP
Benign [X]
## NECK:
Supple [X] Full ROM [X] JVD []
## CHEST:
Lungs clear bilaterally [x]
## HEART:
RRR [X] Irregular [] Nl S1-S2 [X] Murmur [X] grade
holosystolic
## ABDOMEN:
Soft [X] non-distended [X] non-tender [X] bowel sounds
+[X]
## CAROTID BRUIT - RIGHT:
- Left: -
Discharge vital signs:
Temp 98.6 HR 70, BP , resp 16 RA 06%
## PERTINENT RESULTS:
04:40AM BLOOD WBC-4.5 RBC-2.56* Hgb-7.4* Hct-23.3*
MCV-91 MCH-28.9 MCHC-31.8* RDW-14.6 RDWSD-49.1* Plt Ct-89*
05:50AM BLOOD
04:40AM BLOOD Glucose-117* UreaN-23* Creat-1.3* Na-136
K-3.9 Cl-101 HCO3-26 AnGap-13
CXR
Medications - Prescription
AZELASTINE [ASTEPRO] - Astepro 0.15 % (205.5 mcg) nasal spray.
as needed - (Prescribed by Other Provider)
LISINOPRIL - lisinopril 2.5 mg tablet. tablet(s) by mouth daily
-
(Prescribed by Other Provider)
METFORMIN [FORTAMET] - Fortamet 500 mg tablet,extended release.
tablet(s) by mouth daily - (Prescribed by Other Provider)
METOPROLOL SUCCINATE - metoprolol succinate ER 25 mg
tablet,extended release 24 hr. tablet(s) by mouth daily -
(Prescribed by Other Provider)
NITROGLYCERIN - nitroglycerin 0.4 mg sublingual tablet.
tablet(s)
sublingually every 5 mins as needed chest pain - (Prescribed by
Other Provider)
ROSUVASTATIN [CRESTOR] - Crestor 40 mg tablet. tablet(s) by
mouth
- (Prescribed by Other Provider)
TADALAFIL [CIALIS] - Cialis 10 mg tablet. tablet(s) by mouth
daily as needed - (Prescribed by Other Provider)
Medications - OTC
ASPIRIN [ADULT LOW DOSE ASPIRIN] - Adult Low Dose Aspirin 81 mg
tablet,delayed release. tablet(s) by mouth daily - (Prescribed
by Other Provider)
LACTOBACILLUS COMBINATION NO.4 [PROBIOTIC] - Dosage uncertain -
(Prescribed by Other Provider)
MULTIVITAMIN [DAILY MULTIPLE] - Daily Multiple tablet. tablet(s)
by mouth daily - (Prescribed by Other Provider)
VIT D3-FOLIC ACID-B2-B6-B12 [ ] - Folgard 2,000 unit-800
mcg-0.32 mg tablet. tablet(s) by mouth dialy - (Prescribed by
Other Provider)
VITAMIN B COMPLEX [B COMPLEX 1] - Dosage uncertain -
(Prescribed
by Other Provider)
## BRIEF HOSPITAL COURSE:
The patient was admitted to the hospital and brought to the
operating room on where the patient underwent MVrepair
and CABG x1. Overall the patient tolerated the procedure well
and post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring. POD#1 found the
patient extubated, alert and oriented and breathing comfortably.
The patient was neurologically intact and hemodynamically
stable on vasopressor support. He was weaned off neo by POD1. SB
required initial pacing, returned to . Low dose Beta blocker
was initiated and the patient was gently diuresed toward the
preoperative weight. His creatinine peaked at 1.5. Currently
downtrending but not yet at baseline. Continue gentle diuresis.
Thrombocytopenic 77, platelets slowly recovering. The patient
was transferred to the telemetry floor for further recovery.
Chest tubes and pacing wires were discontinued without
complication. The patient was evaluated by the physical therapy
service for assistance with strength and mobility. By the time
of discharge on POD4 the patient was ambulating freely, his
wounds were healing and pain was controlled with oral
analgesics. The patient was discharged to home in good
condition with appropriate follow up instructions. to draw
pLTs and chem 7 in .
## MEDICATIONS ON ADMISSION:
Medications - Prescription
AZELASTINE [ASTEPRO] - Astepro 0.15 % (205.5 mcg) nasal spray.
as needed - (Prescribed by Other Provider)
LISINOPRIL - lisinopril 2.5 mg tablet. tablet(s) by mouth daily
-
(Prescribed by Other Provider)
METFORMIN [FORTAMET] - Fortamet 500 mg tablet,extended release.
tablet(s) by mouth daily - (Prescribed by Other Provider)
METOPROLOL SUCCINATE - metoprolol succinate ER 25 mg
tablet,extended release 24 hr. tablet(s) by mouth daily -
(Prescribed by Other Provider)
NITROGLYCERIN - nitroglycerin 0.4 mg sublingual tablet.
tablet(s)
sublingually every 5 mins as needed chest pain - (Prescribed by
Other Provider)
ROSUVASTATIN [CRESTOR] - Crestor 40 mg tablet. tablet(s) by
mouth
- (Prescribed by Other Provider)
TADALAFIL [CIALIS] - Cialis 10 mg tablet. tablet(s) by mouth
daily as needed - (Prescribed by Other Provider)
Medications - OTC
ASPIRIN [ADULT LOW DOSE ASPIRIN] - Adult Low Dose Aspirin 81 mg
tablet,delayed release. tablet(s) by mouth daily - (Prescribed
by Other Provider)
LACTOBACILLUS COMBINATION NO.4 [PROBIOTIC] - Dosage uncertain -
(Prescribed by Other Provider)
MULTIVITAMIN [DAILY MULTIPLE] - Daily Multiple tablet. tablet(s)
by mouth daily - (Prescribed by Other Provider)
VIT D3-FOLIC ACID-B2-B6-B12 [FOLGARD] - Folgard 2,000 unit-800
mcg-0.32 mg tablet. tablet(s) by mouth dialy - (Prescribed by
Other Provider)
VITAMIN B COMPLEX [B COMPLEX 1] - Dosage uncertain -
(Prescribed
by Other Provider)
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild
2. Docusate Sodium 100 mg PO BID
3. Furosemide 20 mg PO DAILY Duration: 5 Days
RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*5 Tablet
## REFILLS:
*0
4. Lactulose 30 mL PO DAILY
RX *lactulose 20 gram/30 mL 30 ML by mouth daily Refills:*0
5. Metoprolol Tartrate 12.5 mg PO BID
RX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth
twice a day Disp #*60 Tablet Refills:*1
6. Milk of Magnesia 30 mL PO DAILY
7. Potassium Chloride 20 mEq PO DAILY
RX *potassium chloride 20 mEq 1 tablet(s) by mouth daily Disp
#*5 Tablet Refills:*0
8. Senna 8.6 mg PO BID constipation
9. Tamsulosin 0.4 mg PO QHS
RX *tamsulosin [Flomax] 0.4 mg 1 capsule(s) by mouth q hs Disp
#*30 Capsule Refills:*1
10. TraMADol 50 mg PO Q6H:PRN Pain - Moderate
RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp
#*60 Tablet Refills:*0
11. Aspirin EC 81 mg PO DAILY
12. Rosuvastatin Calcium 40 mg PO QPM
## DISCHARGE DIAGNOSIS:
Mitral valve regurgitation, coronary
artery disease.
## DISCHARGE CONDITION:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
## INCISIONS:
Sternal - healing well, no erythema or drainage
Leg Right- healing well, no erythema or drainage. Edema trace
## DISCHARGE INSTRUCTIONS:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns
## FEMALES:
Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns . Answering service will contact on call
person during off hours**
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15188050", "visit_id": "27214447", "time": "2156-12-06 00:00:00"} |
16771333-RR-72 | 120 | ## FINDINGS:
There is incompletely characterized leftward convex curvature along
the lumbar spine with moderate degenerative changes. There is status post
interval right hip replacement surgery. The acetabular cup has a relatively
vertical configuration, but there is no evidence for hardware loosening; the
appearance is unchanged since at least . There is a cemented femoral stem
in position, again without loosening. The bones appear demineralized. There
is no evidence for fracture, dislocation, or bone destruction. The left hip
joint space is mild to moderately narrowed, as seen on the remote prior
examination. There is no evidence for fracture, dislocation, or bone
destruction. Patchy vascular calcifications are present.
## IMPRESSION:
Status post right total hip replacement. Bony demineralization.
No evidence for fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16771333", "visit_id": "25707385", "time": "2133-07-25 17:02:00"} |
11307047-RR-22 | 133 | ## EXAMINATION:
CHEST PORT. LINE PLACEMENT
## INDICATION:
year old man with s/p CABG // cardiac surgery fast track.
eval for ptx, effusions. call house officer at if there is any
concern with findings Contact name: house officer, :
cardiac surgery fast track. eval for ptx, effusions. call house officer
at if there is any concern with findings
## IMPRESSION:
Small left pleural effusion is new. No pneumothorax. Minimal pulmonary
edema. Normal postoperative cardiomediastinal silhouette.
A right transjugular central venous catheter follows an unexpected course. It
could be entirely in the right ventricle. Lateral view would be necessary for
precise localization.
ET tube, esophageal drainage tube, midline and bilateral pleural drains are in
standard placements.
## NOTIFICATION:
Dr. reported the findings to R , by telephone on
at 4:37 , 1 minutes after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11307047", "visit_id": "28638896", "time": "2121-09-02 15:23:00"} |
19120523-RR-18 | 663 | ## INDICATION:
Difficulty in walking, to evaluate for occlusion.
## C-MINUS:
No acute hemorrhage. Previously noted
hypodensity at right parietal cortex (series 2, image 23) is unchanged and age
indeterminate. MRA would be more sensitive to evaluate for acute ischemia.
## C-PLUS:
The vertebral arteries are diminutive and the left P2 is essentially
occluded; however, the basilar artery and PCAs are opacified. There are
bilateral carotid calcifications at the bifurcations; however, no major
intracranial vessel occlusion or evidence of dissection is seen. . .
## NON-CONTRAST CT HEAD:
There is no acute intracranial hemorrhage, mass effect,
or shift of normally midline structures. There are a few smalls cattered
hypodense areas adjacent to the cortex in the right cerebral hemisphere-
parietal lobe- better assessed on subsequent MRI. There are hypodense areas in
the periventricular and subcortical locations, related to small vessel
ischemic changes. There is mild dilation of the lateral ventricles along with
prominent sulci, related to volume loss.
No suspicious osseous lesions are noted. There is mild mucosal thickening in
the ethmoid air cells and frontal sinus. Sphenoid sinus septations insert on
the carotid grooves on either side.
Soft tissues of the scalp are unremarkable.
CT ANGIOGRAM OF THE HEAD AND NECK:
The origins of the arch vessels are patent. Minimal calcifications are noted
at the aortic arch and the origin of the subclavian artery on the right side.
Common carotid arteries are tortuous in course, right more tortuous than the
left. Marked calcifications are noted at the common carotid bifurcations on
both sides, right more than left, with eccentric plaque on both sides.( over a
segment of 1.8cm on the right side )
On the right side, there is a large eccentric calcified plaque medially
causing severe narrowing of the lumen with the residual lumen measuring 2.2
mm. Assessment of the extent of stenosis is limited due to eccentric location
of plaque. No flow limitation is noted distally.
The right vertebral artery is diminutive in size with marked narrowing and
smalls egment sof dilation (?post-stenotic). The V3 and V4 segments of right
vertebral artery are not seen.
The left vertebral artery is markedy diminutive in size and is not seen for
the majority except for a short segment at C2 and C5-6 level.
The distal cervical internal carotid artery measures 4.3mm on right and 4.7mm
on the left.
## CT ANGIOGRAM OF THE HEAD:
The distal vertebral arteries are seen. The
formation of the basilar artery is faintly seen; however, the Basilar artery
is better seen on the 3D MIP ref. and appears patent. There is narrowing of
the P1 segment of the posterior cerebral artery on the right side.
There is mild contour irregularity of the cavernous carotid segments on both
sides, with tiny outpouchings laterally (series 3, image 229).
The anterior and middle cerebral arteries are patent.
The ophthalmic arteries are patent. The ocular lenses are not seen.
## CT NECK:
Areas of scarring are noted in the lung apices on both sides. The
thyroid is small in size and unremarkable. A few small scattered nodes are
noted, not enlarged by CT size criteria.
Calcifications are noted in the right palatine tonsil and also in the left
palatine tonsil.
No obvious mass-like lesions are noted.
Multilevel degenerative changes are noted in the cervical spine with
moderate-to-severe foraminal narrowing at multiple levels. Mild canal
stenosis from posterior osteophytes and disc osteophyte complexes and
multilevel degenerative changes.
## IMPRESSION:
1. No acute intracranial hemorrhage or mass effect. Pl. see subsequent MR for
details reg. acute infarcts.
2. Markedly diminutive size of vertebral arteries on both sides related to
marked narrowing with intermittent visualization of left vertebral artery. (?
atherosclerotic disease/dissection) Marked calcifications of common carotid
bifurcations extending into proximal cervical internal carotid, right more
than left, as above-correlate with carotid doppler given the eccentric
location of plaques.
3. Multilevel degenerative changes in the cervical spine as described above
with moderate-to-severe foraminal and mild canal stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19120523", "visit_id": "29019651", "time": "2189-07-01 16:55:00"} |
14660983-DS-8 | 1,632 | ## CHIEF COMPLAINT:
anemia of unclear etiology/ Dyspnea
## HISTORY OF PRESENT ILLNESS:
The patient is a year old female with a history of severe
aortic stenosis 0.9 cm2), peripheral vascular disease with
stasis dermatitis of the lower extremities, and recent diagnosis
of iron deficiency anemia.
In , she reportedly had a GI workup for anemia at
with an EGD and colonoscopy that did not show a source of
bleeding. She was recently admitted again to from to
, were she was found to have Hct 18 per the patient and
her family. At that time, she was experiencing dyspnea on
exertion and tachycardia. She was admitted overnight and given 2
units of PRBCs, but did not have any further GI workup. Pt was
discharged home with services, and at discharge the
patient's hematocrit was around 23 per PCP .
.
Since then, she has felt fairly well, with occasional
tachycardia and dyspnea on exertion. She feels much better than
prior to her recent admission and denies any fatigue, chest
pain, or SOB. She does have some brief lightheadedness when
standing, but has nevere come close to syncope. She saw her PCP
today for followup and was found to have Hct 23 in the office.
Her PCP felt that she should be admitted for expedited GI
workup and transfusion.
Initial vitals in ED triage were T 98.8, HR 89, BP 138/57, RR
18, and SpO2 100% on RA. Exam was notable for pale sclera,
guaiac positive brown stool, and severe venous stasis changes in
the lower legs. EKG showed NSR at 80 bpm with NANI and no STEMI.
Her CBC showed Hct 28.6 and her chemistry panel was
unremarkable.
Given her guaiac positive stool and recent medical history, she
was admitted to medicine for further management of her anemia
and slow GI bleeding. Vitals prior to floor transfer were HR 84,
BP 145/62, RR 18, and SpO2 99% on RA. On reaching the floor, she
reported feeling well with no current complaints. Of note she
denied any shortness of breath, dyspnea on exertion, or light
headedness since her presentation with hematocrit of 17 to PCP.
## REVIEW OF SYSTEMS:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea, or
congestion. Denies cough, shortness of breath, or DOE. Denies
chest pain, pressure, tightness, or palpitations. Denies nausea,
vomiting, diarrhea, constipation, or abdominal pain. No recent
change in bowel or bladder habits. No dysuria or hematuria. No
new rashes or skin lesions. Denies arthralgias or myalgias.
Review of systems was otherwise negative.
## PAST MEDICAL HISTORY:
# Severe aortic stenosis -- 0.9 cm2
# Peripheral Vascular Disease
# Chronic Venous Insufficiency
# Stasis Dermatitis -- lower extremities
# Iron Deficiency Anemia
# Hyperuricemia
## # MOTHER:
cancer in her
# Maternal Aunt: Type 2, ovarian cancer in her
# Maternal Grandmother: Type 2
## VS:
T 98.0, BP 144/72, HR 95, RR 18, SpO2 95% on RA, Wt 59.6 kg
## GEN:
Elderly female in NAD. Oriented x3. Pleasant.
## HEENT:
NCAT. Arcus senilis. Sclera anicteric but pale. PERRL,
EOMI. MMM, OP benign.
## NECK:
JVP not elevated. No cervical lymphadenopathy.
## CV:
RRR with normal S1, soft S2. Harsh systolic murmur heard
throughout precordium.
## CHEST:
Respiration unlabored, no accessory muscle use. CTAB
without crackles, wheezes or rhonchi.
## ABD:
Normal bowel sounds. Soft, NT, ND. No organomegaly or
masses. Bruit versus transmitted AS murmur heard thoughout
abdomen.
## EXT:
edema 3+ bilaterally, symmetric. Unable to palpate pedal
pulses due to swelling.
## SKIN:
Severe venous stasis changes.
## NEURO:
CN II-XII grossly intact. Strength in all
extremities. No pronator drift. No cerebellar signs. Normal
speech.
## GEN:
Elderly female in NAD. Oriented x3. Pleasant.
## HEENT:
NCAT. Arcus senilis. Sclera anicteric but pale. PERRL,
EOMI. MMM, OP benign.
## NECK:
JVP not elevated. No cervical lymphadenopathy.
## CV:
RRR with normal S1, soft S2. Harsh systolic murmur heard
throughout precordium.
## CHEST:
Respiration unlabored, no accessory muscle use. CTAB
without crackles, wheezes or rhonchi.
## ABD:
Normal bowel sounds. Soft, NT, ND. No organomegaly or
masses. Bruit versus transmitted AS murmur heard thoughout
abdomen.
## EXT:
edema 3+ bilaterally, symmetric. Unable to palpate pedal
pulses due to swelling.
## SKIN:
Severe venous stasis changes.
## NEURO:
CN II-XII grossly intact. Strength in all
extremities. No pronator drift. No cerebellar signs. Normal
speech.
## MICRO:
6:00 am SEROLOGY/BLOOD CHEM# .
## BRIEF HOSPITAL COURSE:
The patient is a year old female with a history of severe
aortic stenosis 0.9 cm2), peripheral vascular disease with
stasis dermatitis of the lower extremities, and recent diagnosis
of iron deficiency anemia who presents with ongoing anemia from
an apparent slow GI bleed.
# normocytic anemia, guaiac positive stool: Upon presentation
concern patient had continued to bleed from recent hematocrit of
25 to 23 and continuing to have blood loss. Nevertheless, at
presentation to Hct was 27 with weakly guiac positive
stool and this hematocrit stayed stable for nearly 48 hours in
the hospital. Further, patient denied any recent symptoms of
light-headedness or shortness of breath, endorsing that she had
these prior to recent hospitalization (when Hct was ) but that
they had resolved. Given colonoscopy within the last year with
diverticuli and history of presumed diverticular bleeding this
was felt a possible etiology versus slow or intermittent upper
GI source such as gastritis or AVM. Given stability, however,
and patient's stated ambivalence about further procedures it was
felt further work up for upper GI source (as patient's has not
had EGD) could occur as outpatient presumably with EGD and then
possibly capsule study. Previous colonoscopy report implies
reasonable prep and repeat colonoscopy with diverticula very
unlikely to show intervenable source of bleeding. Patient was
started on PPI in the hospital to help slow bleeding from upper
GI AVM's or help with hemostasis. Her reticulocyte index
implied appropriate marrow response to anemia and her iron was
increased to TID with ascorbic acid to help rebuild blood
volume. She was also started on senna bid to prevent
constipation. She will follow up with her PCP and GI.
# Severe Aortic Stenosis: She reportedly has moderate to severe
AS with no echo in our system, but consistent murmur on exam.
She had no CHF symptoms during her admission and denied recent
or current chest pain.
# Venous Stasis / PVD: Chronic per patient and family. She has
recently completed a course of Ciprofloxacin for a possible GNR
soft tissue infection in the foot. Her aspirin 81 mg daily was
continued without issue. Wound care nurse made the following
recommendations regarding chronic leg rash:
Elevate legs while sitting, moisturize legs and feet twice
daily, wash legs with warm soapy water, including between the
toes and dry carefully but well. Apply ammonium lactate (Lac
Hydrin) lotion (rub into skin) daily.
## # HAND BURN:
Pt reports small burns on hand from touching oven
recently. No current sign of infection, wound care consult
recommended conservative management.
## # LOW ANION GAP:
Anion gap was normal when she was first
admitted at , but then lowered to 2 by discharge. Would
consider sending SPEP/UPEP if anion gap remains low.
## TRANSITIONAL ISSUES:
-continued outpatient GI bleed workup with possible EGC and
small bowel capsule study
-H pylori antibody test still pending
-consider SPEP/UPEP if anion gap remains low
## MEDICATIONS ON ADMISSION:
Ciprofloxacin 500 mg PO BID for 10 days (started by derm
Mupirocin 2% Ointment TP DAILY for 10 days (started
-- Applied to top of foot
Aspirin 81 mg PO DAILY
Folic Acid 1 mg PO DAILY
Horse Chestnut 300 mg PO BID
## DISCHARGE MEDICATIONS:
1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. horse chestnut 300 mg Capsule Sig: One (1) Capsule PO twice a
day.
4. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1)
Tablet PO TID (3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
5. ascorbic acid mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day: hold
for loose stool
.
Disp:*60 Tablet(s)* Refills:*2*
7. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
8. ammonium lactate 12 % Lotion Sig: One (1) Appl Topical ASDIR
(AS DIRECTED).
Disp:*qs one month tube* Refills:*2*
## PRIMARY:
normocytic anemia
gastrointestinal bleed
iron deficiency
## SECONDARY:
chronic venous stasis rash on lower extremities
severe aortic stenosis
peripheral vascular disease
hyperuricemia
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Ms. ,
You were sent to the hospital because your doctor was worried
about your low red blood cell count. Your blood was tested, and
your red blood cell count was stable during this
hospitalization. You may need more tests as an outpatient, which
will be arranged by your primary care physician.
Our physical therapists felt that you would benefit from home
physical therapy, which we have arranged for you.
We have made the following changes to your medications:
-START omeprazole 40mg tablets, 1 tab by mouth twice daily
-START iron sulfate 325mg tablets, 1 tab by mouth three times
daily, together with ascorbic acid mg tabs, 1 tab by mouth
three times daily
-START senna 8.6mg tabs, 1 tab twice daily
Our wound care nurse made the following recommendations
regarding your chronic leg rash:
-Elevate your legs while sitting.
-Moisturize your legs and feet twice daily.
-wash your legs with warm soapy water, including between the
toes and dry carefully but well.
-apply ammonium lactate (Lac Hydrin) lotion (we have prescribed
this for you). You will need to rub this into your skin daily.
Please continue to take your other medications as previously
prescribed.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14660983", "visit_id": "20092614", "time": "2136-01-31 00:00:00"} |
19395052-RR-55 | 327 | ## INDICATION:
History of disease on the right, now with symptoms on the
left. Evaluate for spinal stenosis, foraminal narrowing.
## FINDINGS:
There is stable grade 1 retrolisthesis of C3 on C4. Alignment is
otherwise maintained. Increased T2 signal in the inferior endplate of C3 and
the superior endplate of C4 is consistent with degenerative
changes. The prevertebral and paravertebral soft tissues are within normal
limits. The craniocervical junction is unremarkable.
The patient is status post laminectomies of the upper cervical spine from
C3-C6. There are multilevel degenerative changes, not appreciably changed
since , as detailed below.
## C2-C3:
There is mild central posterior disc bulge, but no significant central
canal or neural foraminal stenosis.
## C3-C4:
Posterior disc bulge is most severe at this level and broad-based with
associated posterior osteophytes resulting in moderate central canal
narrowing. Uncovertebral and bilateral facet joint hypertrophy results in
severe neural foraminal narrowing, left greater than right. Increased T2
signal in the cord at this level (2:8) compatible with myelomalacia persists
but is less conspicuous.
## C4-C5:
There is minimal central posterior disc bulge without significant
central canal narrowing. Uncovertebral and facet joint hypertrophy results in
minimal right and severe left neural foraminal narrowing.
## C5-C6:
There is minimal posterior disc bulge without significant central
canal narrowing. Uncovertebral and facet joint hypertrophy result in
mild-to-moderate bilateral neural foraminal narrowing, right greater than
left.
## C6-C7:
There is mild uncovertebral and facet joint hypertrophy, but no
significant spinal canal or neural foraminal narrowing.
## C7-T1:
There is no significant spinal canal or neural foraminal narrowing.
## IMPRESSION:
1. Overall, no significant change in multilevel degenerative changes as
detailed above. As on the prior study, disc bulges, most severe at C3-C4,
with moderate central canal narrowing and severe, left greater than right,
neural foraminal narrowing.
2. Increased T2 signal in the spinal cord at C3-C4 compatible with chronic
myelomalacia is less conspicuous than on the prior study,
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19395052", "visit_id": "N/A", "time": "2170-10-07 19:15:00"} |
14705136-RR-14 | 86 | ## INDICATION:
year old man with left middle finger pain // ?pain
## FINDINGS:
Patient is status post percutaneous fixation of a fracture through the distal
phalanx of the long finger with 2 percutaneous pins extending across the
distal interphalangeal joint. Alignment is unchanged when compared to the
prior study. A bony defect along the radial aspect of the head of the middle
phalanx is unchanged. No new fracture seen. Prior amputation of the ring
finger at the level of the proximal interphalangeal joint is again noted.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14705136", "visit_id": "N/A", "time": "2157-04-29 11:52:00"} |
10043956-RR-11 | 61 | ## LMP:
.
There is a single live intrauterine gestation, the fetus is in variable
position. The placenta is posterior. There is no evidence of previa. There
is a normal amount of amniotic fluid. No fetal morphologic abnormalities are
detected. The uterus and ovaries are normal. The following biometric data
were obtained:
## IMPRESSION:
Single live intrauterine gestation, size equals to dates.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10043956", "visit_id": "N/A", "time": "2163-05-29 15:18:00"} |
19209223-RR-61 | 282 | ## EXAMINATION:
CT HEAD W/O CONTRAST
## INDICATION:
History: with fall, eye brow lac // sdh? c spine fx? rib fx?
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 18.2 cm; CTDIvol = 49.7 mGy (Head) DLP =
903.1 mGy-cm.
2) Sequenced Acquisition 2.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
## FINDINGS:
There is no evidence of acute territorial infarction, hemorrhage, edema, or
large mass. Prominence of the ventricles and sulci is suggestive of
involutional changes.
Hyperdense lesion anterior to the globe measuring approximately 1.7 x 0.7 cm
which appears to exert mild mass effect on the right globe (series 2 a, image
9 ; series 602b, image 27)). The right globe appears grossly intact. There
is no evidence of post septal hematoma. There is mild mucosal thickening of
the bilateral maxillary sinuses with mild hyperostosis of the sinus walls
compatible with history of chronic sinusitis. Otherwise, the remainder the
visualized paranasal sinuses are essentially clear. The mastoid air cells
middle ear cavities are well pneumatized and clear. Soft tissue debris in the
bilateral external auditory canals are noted, likely representing cerumen.
There is a 3 mm thick left occipital subgaleal hematoma without underlying
skull fracture.
## IMPRESSION:
1. No acute intracranial abnormality on noncontrast head. Specifically no
intracranial hemorrhage.
2. Prominent right preseptal periorbital swelling and 1.7 cm soft tissue
hyperdense lesion which appears to exert mild mass effect on the right globe.
No postseptal hematoma is identified. The right globe itself appears intact.
The 1.7 cm hyperdense soft tissue lesion is known to clinicians at the time of
this dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19209223", "visit_id": "N/A", "time": "2194-10-12 09:37:00"} |
19474436-DS-10 | 692 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
: ORIF left femur fracture
## HISTORY OF PRESENT ILLNESS:
Ms. is a year old female who sustained a fall out of
the shower. She had left knee pain and the inability to
ambulate. She was taken to the for further evaluation and
care.
## PAST MEDICAL HISTORY:
COPD
anemia
OA
HTN
colitis
CHF
s/p R TKA ( )
s/p L TKA ( )
## PHYSICAL EXAM:
Upon admission
Alert and oriented
## EXTREMITIES:
LLE, +sensation/movement, + pulses, skin grossly
intact
## CT C-SPINE:
1. No acute fracture.
2. 3 mm of anterolisthesis at the C3-4 level is likely
degenerative. However, in the setting of trauma, ligamentous
injury cannot be excluded and MRI of the cervical spine is
recommended if clinically warranted.
3. Calcified thyroid lobe nodule for which nonemergent
ultrasound and
correlation with thyroid function tests is recommended.
Left femur films:
Acute oblique fracture of the distal femoral shaft. No evidence
of hardware loosening of the left total knee prosthesis.
## BRIEF HOSPITAL COURSE:
Ms. presented to the on . She was
evaluated by the orthopaedic surgery department and found to
have a left periprosthetic distal femur fracture. She was
evaluated, consented, and prepped for surgery. On she
was taken to the operating room and underwent an ORIF of her
left femur fracture. She tolerated the procedure well, was
extubated, transferred to the recovery room, and then to the
floor. She was transfused with 3 units of packed red blood
cells due to acute blood loss anemia. She was seen by physical
therapy to improve her strength and mobility. On she
was transfused with 2 units of packed red blood cells due to
acute blood loss anemia. Her hct before discharge was 26.
The rest of her hospital stay was uneventful with her lab data
and vital signs within normal limits and her pain controlled.
She is being discharged today in stable condition. She will
need close follow up with her PCP and needs to schedule an
thyroid U/S to workup her thyroid calcification noted on CT
neck.
## MEDICATIONS ON ADMISSION:
duonebs tid
simacourt bid
diovan 160qd
hydralazine 50mg qid
sulfasalazine (6pills qd)
MVI
iron
lasix 80mg qd
## DISCHARGE MEDICATIONS:
1. Hydralazine 25 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours).
2. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
## 4. THERAPEUTIC MULTIVITAMIN LIQUID SIG:
One (1) Tablet PO
DAILY (Daily).
5. Sulfasalazine 500 mg Tablet Sig: Three (3) Tablet PO Q 12H
(Every 12 Hours).
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.25 Tablet PO BID (2
times a day).
7. Oxycodone 5 mg Tablet Sig: Tablets PO Q4-6H () as needed.
8. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous
DAILY (Daily) for 2 weeks: 2 weeks following surgery.
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
11. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
12. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
13. Furosemide 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
14. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
## DISCHARGE DIAGNOSIS:
s/p fall
Left femur fracture
Acute blood loss anemia
## DISCHARGE INSTRUCTIONS:
Continue to be partial weight bearing on your left leg
Continue your lovenox injections as instructed
Please take all medication as prescribed
If you have any increased redness, swelling, or drainage, or if
you have a temperature greater than 101.5 please call the office
or come to the emergency department.
## AS TOLERATED
LEFT LOWER EXTREMITY:
Partial weight bearing
P/AROM L hip and knee as tolerated.
brace unlocked, ROM as tolerated
## TREATMENTS FREQUENCY:
Staples/sutures out 14 days after surgery
Dry sterile dressing daily or as needed for drainge or comfort
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19474436", "visit_id": "27647989", "time": "2151-09-20 00:00:00"} |
17441977-RR-34 | 225 | ## EXAMINATION:
CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST Q116 CT HEADSINUS
## INDICATION:
year old female with DLBCL/CNS involvement with febrile
neutropenia and persistent fevers despite being on broad spectrum
antibiotics// Please evaluate for acute sinusitis and/or other sources of
infection
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.7 s, 17.2 cm; CTDIvol = 29.9 mGy (Head) DLP = 495.3
mGy-cm.
Total DLP (Head) = 495 mGy-cm.
## FINDINGS:
No fractures are identified.
There is no evidence of facial swelling.
There is mild-to-moderate left maxillary sinus mucosal thickening with a
mucous retention cyst. Mild right maxillary sinus mucosal thickening. No
adjacent osseous changes to suggest invasive sinusitis. Trace sphenoid sinus
mucosal thickening on the left. The remaining visualized paranasal sinuses
are well aerated.
There is no evidence of abnormal fluid collections.
Bilateral mastoids appear normal.
The globes, extraocular muscles, optic nerves, and retrobulbar fat appear
normal.
The visualized upper aerodigestive tract appears normal.
The mandible and temporomandibular joints appear normal.
Stable 8 mm hyperdense focus in the right frontal lobe with mild surrounding
edema appears grossly unchanged since prior head CTs in and
(04:59, 58).
## IMPRESSION:
1. Moderate left maxillary, mild right maxillary, and trace sphenoid sinus
mucosal thickening without evidence of invasive sinusitis or abscess.
2. Stable right frontal lobe hyperdense lesion with mild surrounding edema
since .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17441977", "visit_id": "22140830", "time": "2175-02-03 17:38:00"} |
19799506-RR-41 | 167 | ## EXAMINATION:
HIP (UNILAT 2 VIEW) W/PELVIS (1 VIEW) RIGHT
## INDICATION:
year old man with hx of lumbar radiculopathy p/w chronic right
hip pain to r/o right hip pathology in x ray // year old man with hx of
lumbar radiculopathy p/w chronic right hip pain to r/o right hip pathology in
x ray
## FINDINGS:
No fracture, dislocation or gross degenerative change is detected about the
right hip. The joint space is grossly preserved. Incidental note is made of
a small os acetabuli and a bone island in the femoral head. Otherwise, no
periarticular calcification or ossification.
Limited assessment of the left hip is similar in appearance, with note made of
an enthesophyte at the lesser tuberosity.
The pelvic girdle is grossly congruent. The sacrum is obscured by overlying
bowel gas. Suspect normal variant spina bifida occulta at S1.
Compared with the trauma AP pelvic radiograph, I doubt
significant interval change.
## IMPRESSION:
X-ray examination of the right hip within normal limits.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19799506", "visit_id": "N/A", "time": "2134-06-20 10:08:00"} |
10157454-RR-32 | 100 | ## INDICATION:
year old man s/p corpectomy, intubated with chest tube in
place s/p bronch// eval for interval change, ptx
## FINDINGS:
The tip of the endotracheal tube projects 6 cm from the carina. The tip of a
right internal jugular central venous catheter projects over the distal SVC.
A left apically directed chest tube is present. There is an unchanged
moderate right pleural effusion with overlying atelectasis/consolidation. No
pneumothorax is identified. The size of the cardiac silhouette is unchanged.
Thoracic spinal hardware is again seen but incompletely evaluated.
## IMPRESSION:
No pneumothorax identified. No significant interval change.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10157454", "visit_id": "27113196", "time": "2182-02-28 16:41:00"} |
11382484-RR-50 | 327 | ## INDICATION:
man with oligometastatic high-grade sarcoma of the
peripheral nerve sheath (left ankle primary), with isolated metastasis to the
lung status post resection and new diagnosis of stage B non-small cell lung
carcinoma status post resection.
## PROCEDURE:
Ultrasound-guided core biopsy of a left gluteal nodule.
After discussion of risks, the benefits, and the alternatives of the proposed
procedure, written informed consent was obtained from the patient. A
preprocedure timeout was performed, using three patient identifiers, and
confirmed the procedure to be performed.
Preliminary targeted scanning demonstrates a 2.0 x 1.7 x 1.5 cm hypoechoic
nodule in the proximal aspect of the left gluteus medius muscle, corresponding
to an enhancing nodule seen on the MRI.
Using sonographic guidance, a suitable approach was selected and skin marked.
The skin was then prepped and draped in usual sterile fashion. A preprocedure
timeout was performed, using three patient identifiers, and confirmed the
procedure to be performed, the site and the side of the procedure.
1% lidocaine was used to anesthetize the skin and subcutaneous tissues.
Subsequently, under continuous sonographic guidance, a 15-gauge coaxial needle
was advanced to the edge of the lesion. Under continuous sonographic
guidance, a 16-gauge Achieve biopsy device was advanced into the lesion, and
five 16-gauge core samples were obtained. Subsequently, with the 18-gauge
spinal needle, one fine needle aspiration pass was performed.
The needles were then removed, hemostasis achieved, and a dry sterile dressing
applied.
The patient tolerated the procedure well, there were no immediate
complications.
Dr. , the attending radiologist, was present and supervised the
entire procedure.
Moderate sedation was provided by using divided doses of 3.5 mg of Versed and
150 mcg of fentanyl throughout the total intraprocedural time of 60 minutes
during which the patient's hemodynamic parameters were continuously monitored.
## IMPRESSION:
Status post core biopsy and fine-needle aspiration of a left
gluteal nodule. Samples were sent to pathology and cytology.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11382484", "visit_id": "N/A", "time": "2179-09-05 10:58:00"} |
10982295-RR-8 | 317 | ## INDICATION:
year old man with prostate cancer, please r/o mets.// year
old man with prostate cancer, please r/o mets.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.6 s, 36.5 cm; CTDIvol = 8.6 mGy (Body) DLP = 312.9
mGy-cm.
Total DLP (Body) = 313 mGy-cm.
## FINDINGS:
NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
The thyroid is unremarkable. No enlarged lymph nodes in either axilla or
thoracic inlet. No abnormalities on the chest wall. Moderate atherosclerotic
calcifications in the head and neck arteries. There is a small nodular
projection of the left cord close to the anterior commissure, 4:24, 25, that
could be a normal variant, but warrants direct visualization.
## MEDIASTINUM AND HILA:
The esophagus is unremarkable. Small mediastinal lymph nodes, none
pathologically enlarged by CT size criteria. No hilar lymphadenopathy.
## HEART AND VASCULATURE:
The heart is normal in size and shape. No pericardial effusion. Mild
atherosclerotic calcifications in the coronary arteries, none in the cardiac
valves or aorta. The aorta and pulmonary arteries are normal in caliber
throughout.
## LUNGS AND PLEURA:
The airways are patent to the subsegmental levels. Lungs are well expanded and
clear, with no bronchial wall thickening, bronchiectasis or mucus plugging. No
suspicious lung nodules or masses. No pleural effusions. Mild bilateral apical
scarring. Mild posterior dependent atelectasis.
## CHEST CAGE:
No acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic
lesions.
## UPPER ABDOMEN:
Small right posterior Bochdalek hernia is unchanged from prior study,
otherwise, the limited sections of the upper abdomen show no significant
abnormal findings.
## IMPRESSION:
No evidence of intrathoracic malignancy.
Left vocal cord asymmetry projecting into the anterior commissure warrants
direct visualization.
## RECOMMENDATION(S):
Left vocal cord asymmetry projecting into the anterior
commissure warrants direct visualization.
## NOTIFICATION:
Pertinent critical findings were posted by Dr. on
at 09:35 to the Department of Radiology online critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10982295", "visit_id": "N/A", "time": "2153-08-18 07:22:00"} |
14306557-RR-282 | 198 | ## HISTORY:
AML, multifocal pneumonia, pulmonary edema, effusions, worsening
hypoxia and shortness of breath.
## FINDINGS:
Right IJ central venous catheter terminates in right atrium. An abandoned
left-sided subclavian catheter is in stable position. Small catheter fragment
in the right brachiocephalic vein is stable. The main pulmonary artery
measures 3.1 cm, suggestive of pulmonary arterial hypertension. The great
vessels are otherwise normal caliber. The imaged portion of the thyroid is
unremarkable. The heart size is normal. Trace pericardial effusion is
stable. Multiple mediastinal lymph nodes are present, similar to prior, none
of which are pathologically enlarged.
The central airways are patent. Widespread peribronchial and consolidative
opacities have increased in all pulmonary lobes. Moderate to large bilateral
pleural effusions persist. No pneumothorax. Right lower lobe suture material
is unchanged.
The esophagus and visualized upper abdominal organs are unremarkable. The
patient is status post bilateral mastectomy.
## OSSEOUS STRUCTURES:
Heterogeneous appearance of the osseous structures is
similar to prior and likely related to underlying lymphoproliferative disease.
No focal lytic or sclerotic lesion concerning for malignancy.
## IMPRESSION:
1. Interval increase in widespread peribronchial consolidations involving all
pulmonary lobes, consistent with worsening infection.
2. Stable moderate to large bilateral pleural effusions.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14306557", "visit_id": "24850284", "time": "2196-12-30 13:57:00"} |
18643193-RR-38 | 325 | ## INDICATION:
year old woman with resected colon cancer s/p advuvant
chemotherapy// r/o recurrence
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP =
14.4 mGy-cm.
2) Spiral Acquisition 7.3 s, 57.1 cm; CTDIvol = 24.9 mGy (Body) DLP =
1,420.2 mGy-cm.
3) Spiral Acquisition 3.6 s, 28.6 cm; CTDIvol = 27.2 mGy (Body) DLP = 778.5
mGy-cm.
Total DLP (Body) = 2,213 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS WITH CONTRAST)
## THORACIC INLET:
The thyroid is unremarkable. There are no enlarged
supraclavicular lymph nodes.
## BREAST AND AXILLA:
There are no enlarged axillary lymph nodes. There is a
left-sided pacemaker with leads projected right atrium and right ventricle.
## MEDIASTINUM:
There are no enlarged mediastinal hilar lymph nodes. There is
moderate cardiomegaly. Prosthetic aortic valve is in place. There is
atherosclerotic calcification involving the mitral annulus. There is no
pericardial effusion
## PLEURA:
There is no pleural effusion
## LUNG:
Evidence of kyphos is. The right lower lobe nodular opacity (3, 91)
Measuring 11 mm is new since the prior study. The left lower lobe subpleural
opacity (3, 34) is unchanged. There is diffuse bilateral peribronchial
thickening which is also unchanged. A 4 mm left lower lobe pulmonary nodule
(3, 40) is new.
## BONES AND CHEST WALL:
Review of bones shows evidence of kyphosis. Bones are
osteopenic. There are extensive degenerative changes involving the thoracic
spine.
## UPPER ABDOMEN:
Limited sections through the upper abdomen shows mild
intrahepatic biliary ductal dilatation
## IMPRESSION:
New pulmonary nodules in the right lower and left lower lobe as described
above are indeterminate but could represent metastasis. Attention to these on
follow-up imaging is recommended.
Mosaic attenuation bilaterally with diffuse peribronchial thickening could be
related to bronchitis.
Kyphosis and degenerative changes involving the thoracic spine.
Cardiomegaly, prosthetic aortic valve in place. Mitral valve calcification.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18643193", "visit_id": "N/A", "time": "2176-08-10 13:48:00"} |
15055839-RR-34 | 138 | ## REASON FOR EXAMINATION:
Respiratory distress.
Portable AP chest radiograph was compared to prior study obtained on .
The ET tube tip is approximately 3 cm above the carina still impinging the
right tracheal wall and should be repositioned as previously suggested.
The NG tube tip has been advanced and is currently in the stomach. The heart
size is mildly enlarged but stable. The retrocardiac consolidations are
unchanged. There are no new areas of consolidation as well as there is no
interval development of pulmonary edema, pleural effusions or pneumothorax.
The left internal jugular line tip is at the level of superior SVC. The kink
that appears to be just above the first left rib might be external although
its internal location cannot be entirely excluded and it should be correlated
with the functioning of the central line.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15055839", "visit_id": "25660999", "time": "2137-07-22 03:16:00"} |
14032596-RR-4 | 234 | ## INDICATION:
woman, weeks pregnant, with known nephrolithiasis.
Assess right stone, hydronephrosis.
Comparison is made to prior ultrasound, .
## FINDINGS:
The right kidney measures 10.9 cm. The left kidney measures 11.7
cm.
There is persistent hydronephrosis involving the right kidney. On initial
scanning, the degree of hydronephrosis was less than on the prior study;
however, it increased to a similar level as previously following filling of
the bladder. There is a 0.5-cm non-obstructing calculus at the lower pole of
the right kidney.
The previously demonstrated calculus at the right VUJ is not demonstrated on
the current study, however a right ureteric jet is noted within the bladder.
A left ureteric jet is seen.
There is no hydronephrosis on the left. Corticomedullary differentiation is
within normal limits bilaterally. No renal masses.
## IMPRESSION:
Persistent hydronephrosis of the right kidney. The previously
demonstrated calculus at the right VUJ is no longer demonstrated, and a right
ureteric jet is now present. The appearances are consistent with either
passage of the previously demonstrated calculus with hydronephrosis secondary
to inflammation/spasm at the VUJ, hydonephrosis due to advanced gestation or
it could relate to migration of the calculus superiorly back into the distal
ureter causing partial obstruction.
Urologic consultation is advised. The patient was advised to discuss this
result with her obstetrician and to seek medical advice if she develops pain
or symptoms of sepsis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14032596", "visit_id": "N/A", "time": "2154-05-06 09:30:00"} |
17889152-DS-17 | 2,150 | ## CHIEF COMPLAINT:
Fever, tachycardia, tachypnea, diarrhea
## HISTORY OF PRESENT ILLNESS:
year old male with h/o HTN, hypercholesterolemia,
hypothyroidism with recent, prolonged admission to for
fall and subdural hematomas who now presents from rehab for
progressive tachycardia and tachypnea with lethargy; referred to
ED for r/o PE.
.
Of note, he was recently admitted to for b/l
SDHs after trauma from a fall. His subdurals were evacuated by
neurosurgery at that time. His hospitalization was complicated
by a tension pneumothorax during his initial intubation for
surgery which required chest tube placement. His post op course
s/p subdural evacuation was complicated by agitation which was
treated with haldol, seroquel, ativan, midazolam, fentanyl. He
was febrile thoughout his admission and sputum cultures grew
MRSA and acinetobacter. He was initially treated for VAP with
vancomycin and aztreonam which was then changed to linezolid and
aztreonam and subsequently changed to linezolid and merepenem
(course was to have been completed at rehab on , but it
appears that and vanco have been restarted as outlined
below). He was also undergoing rx with vanco and IV flagyl
for c. diff at the time of d/c to be completed . During his
last stay, he was also noted to have a small subsegmental
pulmonary embolism but given his subdural hematomas, was not
anticoagulated. His mental status waxed and waned during his
MICU stay. Neurology was consulted about whether he was having
seizures; he had an EEG that showed severe encephalopathy
affecting both cortical and subcortical structures, but no focal
abnormalities. He underwent trach for prolonged intubation
(underwent take down just yesterday).
.
In the ED, initial VS were T: 100.6 BP: 115/69 HR: 82 RR: 16
O2sat100%RA. He received levofloxacin 750mg IV x1, Flagyl 500mg
IV x1, Vancomycin 1g IV x1, Tylenol 1g PR x1, and Haldol 5mg IV
x1 for agitation.
.
On the floor, patient reports he does not know exactly why he is
back at , "they just sent me here." He denies subjective
fevers/chills. Reports mild cough, but not productive. No
CP/palps. No N/V/abdominal pain/diarrhea/blood in stools. Has
apparently had chronic foley since having been discharged from
, but denies buring/pain. He denies changes in
vision/headache, no neck stiffness.
.
## ROS:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies shortness of breath, chest pain or tightness,
palpitations. Denies nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits.
Denies arthralgias or myalgias.
## GEN:
NAD. Sleeping however easily arousable.
## HEENT:
EOMI, PERRL. Sclerae anicteric, no conjunctival pallor.
OP clear, MMM.
## NECK:
Recent trach site dressed, inside incision appears to be
healthy granulation tissue with fibrinous exudate, does not
appear grossly purulent.
## ABD:
Soft +BS, NT/ND. No rebound/guarding. Mildly erythematous
skin without increased warmth right lateral to umbilicus, NT.
## EXTREM:
no c/c/e, 2+ pulses.
## NEURO:
CN II-XII intact. Strength is biceps/triceps b/l.
Sensation intact to soft touch grossly throughout. right hip
flexor, left hip flexor, dorsi-/plantar flexion b/l. No
tremor/asterixis. Oriented to person, place and date as
. Gait deferred.
## CT TRACHEA:
1. Mild-to-moderate diffuse
tracheobronchomalacia.
2. Mild-to-moderate subglottic stenosis, probably the sequela of
previous
tracheostomy. 3. Linear web-like density in anterior trachea
just below site of stenosis, with small defect communicating
with a small anterior air collection, possibly representing a
small diverticulum/iatrogenic outpouching. It is also possible
that the linear band represents secretions rather than a fixed
anatomical abnormality. Direct correlation with bronchoscopy may
be helpful in this regard if warranted clinically.
4. Improving bibasilar atelectasis. 5. Overall improvement in
mediastinal lymphadenopathy. 6. Emphysema.
.
## CXR:
Right-sided PICC line tip is not well visualized but
likely lies at the cavoatrial junction. Dedicated PA and lateral
chest radiograph is recommended for definitive assessment.
.
## CT ABD:
1. No evidence of central or segmetal pulmonary
embolus. Respiratory motion precludes evaluation of the
subsegmental pulmonary arteries for small PE. 2. Collapse of the
airways on expiratory images, which is suggestive of underlying
tracheobronchiomalacia. 3. Mildly enlarged mediastinal and
pelvic lymph nodes, which is non-specific
finding. Diagnostic considerations include systemic infection,
idiopathic,
or, less likely, malignancy. Given short interval since prior, a
more remote follow up is likely indicated to further evaluate.
.
## CT HEAD:
1. No new intracranial hemorrhage. 2. Slight
decrease in size of bilateral frontal subdural fluid
collections. 3. Chronic opacification of bilateral mastoid air
cells.
## A/P:
year old man with h/o HTN, hypothyroidism, recent
admission following fall and traumatic SDHs complicated by VAP,
CDiff, and acenetobacter UTI, now readmitted with fever,
tachycardia, tachypnea, and diarrhea. Bandemia at 21%. CT chest
unrevealing. Mental status at post-injury baseline. Pt w
baseline multifocal atrial tachycardia to 130s - controlled with
diltiazem. Now w confirmed tracheobronchomalacia. Per
bronchoscopy, no tx needed for TBM as long as pt continues to be
asymptomatic.
.
# Fever on presentation, resolved: Afebrile for past 72 hours.
Met criteria for SIRS on presentation given fever, bandemia,
tachycardia and tachypnea and with presumed infection, sepsis.
Most likely CDiff as pt had loose stool, recent CDiff. In
setting of prolonged hospitalization at and then to rehab
so clearly at risk for health care associated infections. Was
treated for VAP during admission and upon d/c with MRSA and
acinetobacter in sputum having completed course . It
appears, however more recent sputum again grew MRSA (pt
currently denies significant cough) and he was restarted on
vanco at rehab presumably for pneumonia. Additionally, recent
urine cx from rehab showed acinetobacter and he was started on
meropenem as above. Thus he has multiple potential causes
including pneumonia and UTI. WBC count normal, but 21% bandemia
certainly concerning. CT abd/pelvis without clear source of
infection. CXR showed no PNA. Mental status is as post-injury
baseline. Urine Cx neg.
- Cont vanc and IV flagyl until . Taper Vanc.
- Foley changed to reduce UTI.
- f/u blood cultures.
.
# Bandemia on presentation, resolved: No abs leukocytosis, but
very significant bandemia in the setting of fever and clearly
concerning for infectious process as above.
- plan as per above
- continue to monitor cbc/diff
.
# Hypotension on presentation, resolved: BP prior to tx appear
to be high 100s. His recent baseline BPs are unknown
however he carries past dx of htn and SBPs were 150s on last
presentation (albeit in setting of SDHs). Clearly concerning in
setting of infection as above. SBPs currently stable in
100s-110s range. MAT on tele.
- IVFs
- Diltiazem, metoprolol restarted as pt's BP has been normal for
past 72 hours - used to control pt's MAT.
- continue to monitor closely
.
# Tachypnea/tachycardia on presentation, resolved: No longer
tachypneic since arrival to the floor. Despite no clear
infiltrate called on report, aspiration event possible (prelim
report commented on possible basilar opacity and pt failed
recent swallow study). CTA neg for PE. Both may also have been
in the setting of fever and increased metabolic demand and in
the setting of SIRS/sepsis. Pt has MAT per EKG. This was present
throughout his recent admission as well - treated with CCBs,
BBlks with varying success.
- continue to monitor
- cont metoprolol and diltiazem for rate control with clear
holding parameters.
- pt's tachypnea may be related to tracheobronchomalacia: IP
consult & CT airway.
.
# Tracheobronchomalacia: Pt had a prolonged intubation followed
by a trach placement during his previous hospital admission.
Noted to have TBM on CT.
- IP consult
- Bronch : Mild to moderate TBM noted on CT and bronch.
No stent placed. F/u in 2 months.
.
# Immature cell forms on peripheral diff: In review of labs,
abnormal diff was present during recent admission as well. ?
revved up bone marrow in the setting of infection vs. other BM
process.
- continue to monitor cell diff
.
# Mental status/agitation: Was an ongoing issue during last
admission (see last d/c summary) and appears it has been ongoing
while at rehab based on med list. At least in part d/t delirium
in setting of prolonged hospitalization, sdhs, and now
infection. He is currently alert, oriented and cooperative,
though is tangential and confused at times. Neck supple and
denies photophobia and think more likely waxing/waning in
setting of systemic infection as opposed to CNS infection. CT
head in ED stable from d/c.
- seroquel prn
- haldol prn
- monitor ekg
- treating with abx as above
- LP if pt's MS deteriorates, spikes.
.
# Subdural hematomas: CT head stable on this presentation. He is
on lower dose of keppra than upon d/c and valproic acid has been
added for seizure prophylaxis.
- clarify with rehab/neurosurg change to antiepileptic regimen
- valproic acid level
.
# Anemia: From previously normal baseline prior to ,
admission. Likely multifactorial in setting of SDHs, prolonged
illness and possible GI losses given at risk for stress
ulcers/gastritis in setting of his CNS process. also be some
bone marrow suppression in setting of possible
bacteremia/infection. Normal MCV with elevated RDW.
- continue to monitor
- guaiac stools
.
# FEN: TFs. Had Sp & Swallow eval . Pt placed on ground
solid / nectar thick liq.
- Follow nutrition recs.
- Follow blood glucose, as intake changing.
.
# PPx: subq heparin.
.
# Access: PIV.
.
# Code: FULL.
.
# Communication: (partner) .
## MEDICATIONS ON ADMISSION:
1. Nystatin 100,000 unit/mL Suspension 5ml qid prn
2. Heparin SC tid
3. Levothyroxine 100 mcg
4. Levetiracetam solution 500 mg NG bid
5. Ipratropium Bromide MDI 2 puffs qid prn
6. Acetaminophen 325-650 mg Q6H prn
7. Omeprazole bid
8. Vancomycin 125 mg Q6H (Last day planned per d/c
summary but rehab med list includes it through .
9. Levalbuterol nebs q6h prn
10. Miconazole Nitrate 2 % Powder topically
11. Diltiazem HCl 90 mg qid
12. Propranolol 80mg q6h
13. (off) Metronidazole 500mg IV q8h (Last day per d/c
## DISCHARGE MEDICATIONS:
1. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML QID
(4 times a day) as needed.
2. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet
( ).
3. Levetiracetam 100 mg/mL Solution Sig: Five (5) mL BID (2
times a day).
4. Ipratropium Bromide 0.02 % Solution Sig: Two (2) puffs
Inhalation Q6H (every 6 hours) as needed.
5. Acetaminophen 325 mg Tablet Sig: Tablets Q6H (every 6
hours) as needed.
6. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed.
7. Amantadine 50 mg/5 mL Syrup Sig: Fifty (50) mg BID (2
times a day).
8. Valproic Acid (as Sodium salt) 250 mg/5 mL Syrup Sig: Seven
Hundred Fifty (750) mg Q12H (every 12 hours).
9. Quetiapine 25 mg Tablet Sig: 0.5 Tablet Q6H PRN ().
10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) qs
Injection TID (3 times a day):
Please dose per SQ heparin
nomogram.
11. Diltiazem HCl 90 mg Tablet Sig: One (1) Tablet QID (4
times a day).
12. Quetiapine 25 mg Tablet Sig: Three (3) Tablet HS (at
bedtime).
13. Mirtazapine 15 mg Tablet Sig: 0.5 Tablet HS (at bedtime).
14. Vancomycin 125 mg Capsule Sig: One (1) Capsule Q6H (every
6 hours) for 1 weeks.
Disp:*28 Capsule(s)* Refills:*0*
15. Vancomycin 125 mg Capsule Sig: One (1) Capsule twice a
day for 1 weeks: Please dose on post-discharge day .
Disp:*14 Capsule(s)* Refills:*0*
16. Vancomycin 125 mg Capsule Sig: One (1) Capsule once a day
for 1 weeks: Please dose on post-discharge days .
Disp:*7 Capsule(s)* Refills:*0*
17. Lansoprazole 30 mg Tablet,Rapid Dissolve, Sig: One (1)
Tablet,Rapid Dissolve, .
Disp:*30 Tablet,Rapid Dissolve, Refills:*2*
18. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
19. Flagyl 500 mg Tablet Sig: One (1) Tablet three times a
day for 1 weeks.
Disp:*21 Tablet(s)* Refills:*0*
## PRIMARY DIAGNOSES:
- C Difficile Diarrhea
- Tracheobronchomalacia
- Multifocal atrial tachycardia
.
## SECONDARY DIAGNOSES:
- s/p bilateral subdural hematomas
- hypothyroidism
## DISCHARGE INSTRUCTIONS:
You have been evaluated and treated in the hospital for your
fever, rapid heart rate, and diarrhea. This was most likely
caused by Clostridium Difficile, a bacteria that causes
diarrhea. You were treated with antibiotics and IV fluids, which
led to the resolution of your symptoms. You were also quite
confused when you came to the hospital. This has also resolved
with the treatment of your infection.
.
You were evaluated for airway floppiness, which is a common
reaction to prolonged intubation. A CT showed that you have mild
to moderate tracheobronchomalacia, which was confirmed on
bronchoscopy. This level of TBM does not require any specific
treatment.
.
You were also evaluated for difficulty with swallowing. Your
swallowing improved - your recommended diet is Regular;
## CONSISTENCY:
Ground; Nectar prethickened liquids.Crush pills.
.
Please continue your home medications. Take any new medications
as prescribed.
.
Please call your primary care doctor or return to the ED if you
have:
- Fever >
- Difficulty breathing
- Chest pain
- Confusion
- Diarrhea
- Lightheadedness
- Anything concerning
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17889152", "visit_id": "29022830", "time": "2118-02-25 00:00:00"} |
19030887-RR-33 | 111 | ## INDICATION:
year old man with subcutaneous air// evaluate for chest tube
placement, PTX
## IMPRESSION:
Again seen is diffuse upper body soft tissue emphysema which appears slightly
progressed from prior exam.
Subtle curvilinear lucency along the expected right mediastinal border may
represent small amount of pneumomediastinum which appears relatively similar
to prior exam.
Right-sided chest tube may be slightly retracted from prior exam and is likely
retracted from . Side-hole appears to be within the intrathoracic
cavity, however clinical correlation is recommended.
Likely similar right pneumothorax. No prominent right pleural effusion. Right
lung opacity appears similar to mildly more prominent. Left lung appears
relatively clear.
Cardiomediastinal silhouette appears unchanged.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19030887", "visit_id": "25464745", "time": "2154-11-15 11:28:00"} |
17984169-RR-91 | 123 | ## HISTORY:
woman with AMS. Rule out ICH.
## FINDINGS:
There is no hemorrhage, major vascular territory infarction, edema,
mass or shift of normally midline structures. Prominence of ventricles and
sulci is consistent with age related parenchymal loss. There is
redemonstration of a hypodensity in the left subinsular region which is
consistent with chronic small vessel ischemic changes and appears stable since
prior examination. The basal cisterns appear patent and there is preservation
of gray-white matter differentiation.
No fracture is identified. There is opacification of some of the mastoid air
cells bilaterally, which may be chronic. The visualized paranasal sinuses are
clear. Some cerumen is again seen in the left external auditory canal. The
globes are unremarkable.
## IMPRESSION:
No acute intracranial process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17984169", "visit_id": "28362695", "time": "2145-08-07 07:55:00"} |
Subsets and Splits