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13452145-RR-48 | 311 | ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
w/ ESRD (HD MWF), CABG ( ), HTN, HLD, DM2, HFrEF (30%; sev
MR), PAF (coum), bioMVR c/b R empyema s/p decortication presents from
rehab w/ SOB, ADHF requiring BIPAP.// Evaluation of worsening pulmonary
opacities, fluid vs infection.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.5 s, 39.7 cm; CTDIvol = 15.8 mGy (Body) DLP = 628.2
mGy-cm.
Total DLP (Body) = 628 mGy-cm.
## FINDINGS:
Thyroid is unremarkable. Right subclavian line terminates in the SVC. No
pathologically enlarged lymph node is identified in the supraclavicular,
axillary, and mediastinal regions. Thoracic aorta is normal caliber. Main
pulmonary artery is top normal size. Severe coronary artery calcifications
are present. Prosthetic mitral valve is noted. Partially imaged
transesophageal tube enters the stomach.
Small loculated pleural effusion is identified bilaterally. Multiple small
pockets of air is present in the right posterior loculated pocket of pleural
effusion. Several small foci of air is also noted in the right lower lateral
aspect of pleural space. Mild pulmonary emphysema is present. Small dense
airspace opacities and larger area of ground-glass opacities in right middle
lobe and left upper lobe lingula are new.
Limited evaluation of the upper abdomen demonstrates right renal cyst,
partially imaged. Sternotomy wires are intact. No suspicious bone lesion is
identified. Nondisplaced right lateral 8th rib fracture is newly apparent
since .
## IMPRESSION:
1. Small loculated bilateral pleural effusions are demonstrated. Right
posterior lower pocket of pleural fluid contains multiple foci of air, may
reflect bronchopleural fistula in the absence of recent intervention into the
pleural space. Compared to , the right pleural air is new and the
left loculated pleural effusion is increased.
2. Small dense airspace opacities and larger area of ground-glass opacities in
right middle lobe and left upper lobe lingula are new and may reflect
pneumonia.
3. Mild pulmonary emphysema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13452145", "visit_id": "21151088", "time": "2186-06-05 21:14:00"} |
18548923-AR-15 | 107 | ## ADDENDUM:
1. The area of washout and peripheral rim enhancement in the liver adjacent
to the RFA site appears to have tubular, branching appearance and might
correspond to the tumor thrombus in the left hepatic or portal vein branches.
2. Further noted is oval filling defect adjacent to the interventricular
septum in the right ventricle (9:8) measuring approximately 1.9 x 2.9 cm.
This lesion appears to enhance on the post-contrast imaging and is concerning
for cardiac tumor deposit. Further evaluation can be performed by cardiac
echo or dedicated cardiac MRI.
These findings were discussed at the multidisciplinary liver tumor conference
on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18548923", "visit_id": "N/A", "time": "2182-05-12 11:46:00"} |
18769077-RR-27 | 179 | ## INDICATION:
female with left adnexal cyst seen on previous scan.
## FINDINGS:
Transabdominal and transvaginal ultrasound images of the pelvis
were obtained, the latter for further evaluation of the endometrium and
adnexa. The uterus measures 8.1 x 4.3 x 6.1 cm. There are multiple masses
consistent with fibroids. The largest fibroid is fundal, anterior and
intramural measuring 1.5 x 0.8 x 1.3 cm. There are scattered myometrial
cysts. The endometrium measures 4 mm, within normal limits. The right ovary
is normal in appearance. There is resolution of the simple left adnexal cyst.
Again seen is a 5.1 x 2.2 x 2.8 cm tubular left adnexal structure containing
low-level echoes. The differential for this lesion remains hematosalpinx or
an endometrioma. There is no free fluid in the posterior cul-de-sac.
## IMPRESSION:
1. A 5.1 x 2.2 x 2.8 cm tubular structure within the left adnexa, stable in
size when compared to the previous examination, and is likely hematosalpinx.
Endometrioma is also considered.
2. Fibroid uterus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18769077", "visit_id": "N/A", "time": "2150-12-11 07:02:00"} |
15947916-RR-83 | 93 | ## INDICATION:
woman with pancreatic cancer and now with abdominal
distention and vomiting.
## SUPINE AND ERECT ABDOMINAL RADIOGRAPHS:
The biliary drain and feeding tube
are unchanged in position from prior study. Mildly dilated loops of small
bowel within the pelvis are noted. There is gas within the colon. Cannot
exclude early mild partial small bowel obstruction. Followup is recommended.
## IMPRESSION:
Mildly dilated pelvic loops of small bowel with gas in the colon
raises the question of partial small bowel obstruction.
Dr. was notified of the results at 12:47 p.m. on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15947916", "visit_id": "22046967", "time": "2134-09-23 11:34:00"} |
11245423-RR-14 | 246 | ## INDICATION:
female with history of left sternoclavicular joint
effusion, presenting with neck pain for two days.
## FINDINGS:
There is apparent superior displacement of the medial left clavicle
without significant joint effusion. There is no evidence of inflammation or
abscess. There is a small subchondral cyst along the left clavicular head
near the sternoclavicular joint, likely related to degenerative change. The
right clavicle is superiorly displaced distally with evidence of remote
fracture and/or acromioclavicular separation with evidence of healing,
consistent with chronic injury. There is no abnormal fluid collection in this
region.
There is diffuse multilevel cervical spine degenerative disease with disc
space narrowing, spondylosis and endplate sclerosis. Multilevel discogenic
disease is present. Uncovertebral disease is present exacerbating multilevel
mild neural foraminal narrowing. There is no critical canal stenosis.
Intrathecal evaluation is better on MRI.
Paranasal sinuses and mastoid air cells are well aerated. There is severe
left TMJ degenerative change. Vascular calcifications are seen in the
cavernous carotid arteries and cervical carotid bifurcations. The
nasopharyngeal and oropharyngeal soft tissues are symmetric. The salivary
glands appear unremarkable. There is no lymphadenopathy by size criteria.
Vascular structures appear patent. There is no focal thyroid lesion. Lung
apices demonstrate severe right greater than left centrilobular emphysema.
## IMPRESSION:
1. No fluid collection about the sternoclavicular joints or evidence of
inflammation.
2. Remote right distal clavicular fracture/AC separation. Mild superior
displacement of left clavicular head.
3. Multilevel cervical degenerative disease.
4. Left TMJ degerative disease.
5. Emphysema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11245423", "visit_id": "22208859", "time": "2115-03-25 22:12:00"} |
13395801-DS-16 | 1,705 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Primary low transverse C-section, exploratory laparotomy,
packing of liver, exploratory laparotomy with secondary washout
and unpacking of liver laceration and complex abdominal closure
## HISTORY OF PRESENT ILLNESS:
Ms. is a yo G3P1 at 38w3d presenting as a transfer
from with HELLP syndrome. She reports
initially beginning to feel "off" this past , when she
noticed she was unusually fatigued. She continued to feel
fatigued over the next few days, and today began to note upper
abdominal pain that increased in severity throughout the day.
She also today began to notice regular contractions that have
increased in intensity throughout the day. She reported feeling
decreased fetal movement as well. She was therefore instructed
by her physician to come in for evaluation. At
, she was diagnosed with HELLP based on LFTs in the 200s
and platelets in the . She had a BPP done that was , but
initially had fetal tachycardia that improved with fluid
hydration. She was then transferred here for further evaluation
and management.
Patient denies chest pain, SOB, VB, LOF.
Of note, patient was noted to have proteinuria on urine
dipsticks during pregnancy, and had a 24 hour urine protein of
1017mg last week. She had normal PIH labs last week, and has had
normal blood pressures throughout pregnancy.
## PNC:
- by
- Labs Rh pos/Abs neg/Rub I/RPR NR/HBsAg neg/HIV neg/GBS neg
- FFS wnl
- GLT - + early gdm screening -> GDMA1
- U/S - U/S for monitoring for single uterine artery
notable
for 7lb1oz
- Issues
- gdma1
- followed for single umbilical artery
- uterine fibroid 2.5cmx2.4cm
- anemia on iron
- subchorionic hemorrhage trimester, now resolved
## GYNHX:
- Hx of abnormal paps, repeat negative
- no h/o Gyn surgery, STIs
## ABD:
soft, gravid, epigastric and RUQ TTP, no rebound/guarding
EFW 7 by
## SVE:
FT/L/P
Toco
FHT 160/moderate varability/+accels/-decels
(upon discharge)
## VS:
afebrile, HR 88, BP 103-132/76-88, RR
## ABD:
soft, nontender, FF 2cm below U. no RUQ tenderness
## PERTINENT RESULTS:
WBC-10.3 RBC-4.28 Hgb-12.5 Hct-36.0 MCV-84 Plt-80
WBC-8.9 RBC-4.19 Hgb-12.2 Hct-35.8 MCV-85 Plt-70
WBC-8.0 RBC-3.71 Hgb-10.9 Hct-32.0 MCV-86 Plt-53
WBC-10.0 RBC-3.53 Hgb-10.1 Hct-30.3 MCV-86 Plt-60
WBC-7.6 RBC-3.13 Hgb-9.2 Hct-26.6 MCV-85 Plt-48
WBC-8.6 RBC-2.84 Hgb-8.2 Hct-24.1 MCV-85 Plt-57
WBC-9.4 RBC-3.63 Hgb-10.6 Hct-31.0 MCV-85 Plt-57
WBC-9.1 RBC-4.04 Hgb-11.9 Hct-34.3 MCV-85 Plt-63
WBC-10.1 RBC-3.59 Hgb-11.1 Hct-30.6 MCV-85 Plt-70
WBC-9.6 RBC-3.51 Hgb-10.8 Hct-29.8 MCV-85 Plt-72
WBC-9.1 RBC-3.42 Hgb-10.4 Hct-29.2 MCV-85 Plt-67
WBC-9.4 RBC-3.17 Hgb-9.2 Hct-27.4 MCV-86 Plt-91
WBC-10.9 RBC-3.12 Hgb-9.1 Hct-27.2 MCV-87 Plt-103
WBC-10.2 RBC-3.28 Hgb-9.6 Hct-28.9 MCV-88 Plt-132
PTT-26.9 PTT-26.7 PTT-27.9 PTT-25.8 PTT-25.3 PTT-20.2 PTT-21.2 PTT-24.7 PTT-24.3 Glu-132 BUN-4 Cre-0.4 Na-134 K-4.4 Cl-101 HCO3-19
Glu-113 BUN-6 Cre-0.6 Na-135 K-4.8 Cl-99 HCO3-22
Glu-94 BUN-7 Cre-0.6 Na-134 K-4.3 Cl-101 HCO3-23
Glu-120 BUN-8 Cre-0.5 Na-133 K-4.4 Cl-100 HCO3-20
Glu-148 BUN-8 Cre-0.4 Na-132 K-4.2 Cl-100 HCO3-21
Glu-148 BUN-8 Cre-0.4 Na-132 K-4.2 Cl-100 HCO3-21
Glu-155 BUN-7 Cre-0.4 Na-133 K-4.0 Cl-99 HCO3-25
Glu-127 BUN-11 Cre-0.4 Na-131 K-4.2 Cl-98 HCO3-25
Glu-123 BUN-10 Cre-0.4 Na-132 K-3.9 Cl-96 HCO3-26
Glu-97 BUN-7 Cre-0.4 Na-135 K-3.8 Cl-102 HCO3-24
ALT-353 AST-324 LD(LDH)-386 Amylase-46
ALT-417 AST-385
ALT-471 AST-419
ALT-238 AST-218 LD( )-321 AlkPhos-101 Amylase-33
TBili-2.4
ALT-181 AST-151 AlkPhos-78 TotBili-7.4
ALT-163 AST-135 LDH-403 APhos-69 TBili-6.8 DBili-4.2
IBili-2.6
ALT-245 AST-210 AlkPhos-90 TotBili-4.4
ALT-252 AST-188 AlkPhos-98 TotBili-3.8
ALT-232 AST-146 AlkPhos-82 TotBili-3.1
ALT-225 AST-127 LD(LDH)-281 AlkPhos-84 TotBili-2.5
DirBili-1.4 IndBili-1.1
ALT-215 AST-113 LD(LDH)-268 AlkPhos-84 TotBili-2.1
ALT-194 AST-86 LD(LDH)-215 AlkPhos-79 TotBili-1.5
ALT-193 AST-95 AlkPhos-91 TotBili-1.2
UricAcd-6.1
Albumin-2.4 Calcium-7.3 Phos-3.9 Mg-4.2 Iron-238
Calcium-7.1 Phos-3.9 Mg-6.0
Calcium-6.5 Phos-5.0* Mg-5.5
Calcium-8.0 Phos-3.0 Mg-2.3
Calcium-7.8 Phos-3.4 Mg-2.1
Calcium-7.7
Calcium-7.9 Phos-3.4 Mg-1.9
calTIBC-270 Ferritn-355 TRF-208
01:50AM BLOOD Hapto-<10
12:49AM BLOOD Hapto-<10
11:28PM BLOOD Hapto-38
TSH-3.4 T4-6.1
BLOOD Type-ART pO2-99 pCO2-44 pH-7.24 calTCO2-20 Base
XS--8
BLOOD Type-ART pO2-374 pCO2-43 pH-7.34 calTCO2-24 Base
XS--2
BLOOD Type-ART pO2-181 pCO2-46 pH-7.33 calTCO2-25 Base
XS--1
BLOOD Type-ART pO2-165 pCO2-33 pH-7.45 calTCO2-24 Base
XS-0
BLOOD Type-ART pO2-118 pCO2-38 pH-7.41 calTCO2-25 Base
XS-0
BLOOD pH-7.36
BLOOD Type-ART pO2-72 pCO2-34 pH-7.38 calTCO2-21 Base
XS-- yo G3P1 transferred at 38w3d presenting as a transfer from
with preeclampsia/HELLP syndrome. On arrival,
her blood pressures were stable and fetal testing was
reassuring. Her transaminitis was worsening, platelets had
decreased to 80, and LDH/haptoglobin confirmed hemolysis. She
reported some RUQ discomfort which improved with Dilaudid.
Induction of labor was initiated and she was started on
Magnesium sulfate for seizure prophylaxis. Serial labs were
followed and she was closely monitored. During her induction,
she had a nonreassuring fetal tracing remote from delivery and
underwent a primary LTCS on and delivered a liveborn
female weighing 3235 grams with Agpars of 7 and 8.
Intra-operative, a 400-500cc hemoperitoneum was noted upon entry
into the abdomen. After delivery of the baby, inspection of the
RUQ revealed active bleeding with a large hematoma on the
surface of the liver. The RUQ as immediately packed, the massive
transfusion protocol was initiated, and trauma surgery was
consulted urgently. She was converted to general anesthesia as
well. The hysterotomy was closed and trauma surgery scrubbed in
to further evaluate the abdomen and liver. The liver hematoma
was stabilized and packed. Intraoperatively, she was transfused
4 units of PRBCs and 2 units of FFP. Her abdomen was left open
with 2 JP drains and she was transferred to the Trauma SICU.
Please see operative reports for details.
.
Ms underwent close hemodynamic monitoring in the
TSICU. Her coagulopathy improved. She received an additional 2
units of packed RBCs on POD#1. She was continued on Magnesium
for 24 hours postpartum and her blood pressures were stable. On
, she returned to the operating room for exploratory
laparotomy with washout, unpacking of liver laceration, and
complex abdominal closure. The procedure was uncomplicated with
only 100cc EBL. She returned to the TSICU for further
monitoring. On , she underwent a CTA of the
chest/abdomen/pelvis after she developed tachycardia and
hypoxia. No intra-abdominal extravasation or PE was identified.
CXR was concerning for pulmonary edema. She diuresed
appropriately after 40mg of Lasix. Echocardiogram on was
unremarkable with an EF 60%. She was extubated and transferred
to the postpartum floor. Her pain was controlled with a Dilaudid
PCA. She continued to have tachycardia to the 130s and was
closely monitored. Her blood pressures were well controlled on
po Labetolol 200mg bid. Her labs remained stable. On , her
foley was removed. She was tolerating a regular diet and
transitioned to po pain medication. Her Labetolol was
discontinued on . Also, a stitch was placed at the JP site
on the right due to a moderate amount of serosanguinous
drainage. Her incision was well approximated with staples
without any surrounding erythema. She was discharged to home in
stable condition on and will have close outpatient follow
up.
## DISCHARGE MEDICATIONS:
1. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice
a day Disp #*60 Capsule Refills:*1
2. Ibuprofen 600 mg PO Q6H:PRN Pain
RX *ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours
Disp #*40 Tablet Refills:*1
3. OxyCODONE (Immediate Release) mg PO Q4H:PRN Pain -
Severe
RX *oxycodone 5 mg tablet(s) by mouth every four (4) hours
Disp #*50 Tablet Refills:*0
## DISCHARGE DIAGNOSIS:
38 week gestation, HELLP syndrome, liver rupture
## DISCHARGE INSTRUCTIONS:
Nothing in the vagina for 6 weeks (No sex, douching, tampons)
No heavy lifting for 6 weeks
Do not drive while taking narcotics (i.e. Oxycodone, Percocet)
Do not take more than 4000mg acetaminophen (tylenol) in 24 hrs
Do not take more than 2400mg ibuprofen in 24 hrs
Please call the on-call doctor at if you develop
shortness of breath, dizziness, palpitations, fever of 101 or
above, abdominal pain, increased redness or drainage from your
incision, nausea/vomiting, heavy vaginal bleeding, or any other
concerns.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13395801", "visit_id": "25479837", "time": "2149-07-18 00:00:00"} |
17681159-RR-35 | 210 | ## MR RIGHT FEMUR:
Within the right proximal femoral diaphysis, there is abnormal signal within
the intramedullary cavity, spanning approximately 12 cm (CC). The abnormal
signal is isointense to muscle on T1-weighted images and hyperintense to
muscle on T2- and STIR-weighted images. Following the administration of
intravenous Gadovist, there is heterogeneous enhancement. There is mild
extension into the soft tissues medially, with the largest soft tissue
component measuring 18 (AP) x 6 (TV) mm (10:19). There is mild scalloping of
the cortex. No fracture line is identified. There is periosteal edema as
before.
Within the right ischium, there is an additional 2.0 (AP) x 2.0 (TV) cm
metastatic lesion with surrounding edema. Right inguinal lymph nodes measure
up to 7 mm.
There is faint, somewhat nodular enhancement within the right adductor magnus
muscle ( ) which may reflect vasculature as no abnormal FDG avidity was
noted within this region.
## IMPRESSION:
1. Metastatic lesion within the right proximal femur with small soft tissue
component and mild cortical thinning. Surrounding periosteal edema, but no
discrete fracture line appreciated.
2. Right ischial tuberosity lesion.
3. Faint foci of enhancement within the right adductor magnus muscle, which
could relate to vasculature, but to which attention can be paid on followup.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17681159", "visit_id": "N/A", "time": "2165-06-10 11:58:00"} |
16896683-RR-33 | 122 | ## HISTORY:
female with past medical history of sclerosing
cholangitis and primary biliary cirrhosis now presenting with right upper
quadrant/flank pain.
## CT PELVIS WITH INTRAVENOUS CONTRAST:
There are scattered sigmoid diverticuli,
though no signs of acute inflammation or obstruction. The bladder is mildly
distended and appears normal. The uterus and adnexa are not visualized,
likely secondary to prior surgical resection. There is no pelvic free fluid.
No pathologically enlarged mesenteric, retroperitoneal, pelvic, or inguinal
lymph nodes are identified.
## BONES AND SOFT TISSUES:
No bone destructive lesion or acute fracture is
identified.
## IMPRESSION:
1. Unchanged intra- and extrahepatic pneumobilia, likely related to prior
sphincterotomy.
2. Stable periampullary duodenal diverticulum.
3. Pectus excavatum deformity.
4. Sigmoid diverticulosis without signs of acute diverticulitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16896683", "visit_id": "N/A", "time": "2153-01-29 21:26:00"} |
12042461-DS-8 | 3,686 | ## ALLERGIES:
All allergies / adverse drug reactions previously recorded have
been deleted
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Paracentesis
Pigtail catheter placement in right thorax
Flexible Bronchoscopy
## HISTORY OF PRESENT ILLNESS:
Mr. is a year old male with history of MDS,
hypercalcemia, and complicated pneumonia admitted with abdominal
distention worsening oxygen demands at rehab. He was recently
discharged from . He was treated for pneumonia
and paraneumonic effusion. During admission he had
hypercalcemia, and definitive cause was not determined. Per
report from pt and family, he was at in
and was having worsening shortness of breath as well as an
increased O2 demand over the past several days and pt was sent
to ED for concern for recurrance of PNA.
.
Pt reports that he has been slightly short of breath but denies
any fever or chills, no night sweats, no cough. He also
complains of feeling very gassy and has had worsening abdominal
distention. He complains of occassional nausea, but no diarrhea
or constipation.
.
Of note, pt reports a 70 lb weight loss over the past year. His
wife reports that he has been bleeding easily as well but he has
not had any brbpr, melena.
.
In ED vitals were 98.4 81 131/71 18 98% 4L. Lactate was 4.5 and
he was given 2L fluid and improved to 3.0. Guaiac was negative,
no leukocytosis but noted to have monocytosis and abnormal
lymphocytes. CTA chest and abdomen revealed some cavitation in
RLL as well as large right sided effusion. Abdominal CT showed
diffuse ascites and splenomegaly. When taken off of O2 he was
desating to the low . Pt was given vanc and zosyn.
## PAST MEDICAL HISTORY:
BPH
Anemia
Dyspepsia
Weight Loss
Atrial flutter diagnosed in , s/p ablation in
Vitamin D Deficiency
DMII
MDS
Colonic adenomas
h/o Sigmoid diverticulitis.
h/o Basal cell carcinoma.
h/o Left hip fracture, status post ORIF in .
## FAMILY HISTORY:
Maternal aunt with diabetes. There is no family history of
premature coronary artery disease, arrhythmias, or sudden death.
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear
## NECK:
supple, JVP not elevated, no bruits, 2cm hard fixed
nontender lymph node on L upper anterior cervical chain
## LUNGS:
R side lung sounds < L scattered crackles on right. Dull
to percussion on right side up.
## CV:
Regular rate and rhythm, normal S1 + S2, systolic murmur
of RUSB
## ABDOMEN:
Soft, grossly distended, some spider angiomoas on
abdomen and chest. No hepatomegaly. dull to percussion
throughout. Nontender, no rebound or guarding.
## EXT:
warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## NEURO:
CNs2-12 intact, motor function grossly normal
## HEENT:
Sclera anicteric, oropharynx clear, dry MM with cracked
lips
## NECK:
no enlarged thyroid, enlarged lymph node no longer felt,
JVP not elevated, no bruits
## COR:
RRR, nl s1 and s2, no murmurs
## LUNGS:
CTAB with diminished breath sounds at bilateral bases
R>L, good air movement bilaterally
## ABD:
+BS, nontender, distended with + fluid wave and shifting
dullness that has increased, no hepatosplenomegaly felt
## SKIN:
right hip bed sore and right arm bed sore. patient has
many scabs and scratches from easy bleeding
## EXT:
warm, well-perfused, no edema
## HIV:
07:35PM BLOOD HIV Ab-NEGATIVE
## SPEP/UPEP:
06:09AM BLOOD PEP-POLYCLONAL b2micro-14.8* IgG-2394*
IgA-849* IgM-52 IFE-NO MONOCLO
07:30PM URINE U-PEP-MULTIPLE P IFE-NO MONOCLO
Infectious disease labs:
Test Result Reference
Range/Units
HISTOPLASMA ANTIGEN URINE <2.0 < 2.0 EIA
Units
Test Result Reference
Range/Units
QN 141 83-199 mg/dL
HISTOPLASMA ANTIBODY (BY CF AND ID)
Test Result Reference
Range/Units
YEAST PHASE ANTIBODY <1:8
MYCELIAL PHASE ANTIBODY <1:8 <1:8
## INTERPRETIVE CRITERIA:
<1:8 - Antibody Not Detected
> or = 1:8 - Antibody Detected
07:50 B-GLUCAN
Test
-----
Fungitell (tm) Assay for (1,3)-B-D-Glucans
Results Reference Ranges
-----
-----
56 pg/mL Negative Less than
60 pg/mL
Indeterminate 60 - 79
pg/mL
Positive Greater
than or equal to 80 pg/mL
HEPATITIS C - RIBA
Test Name In Range Out of Range
Reference Range
-----
-----
-----
-----
HCV AB, RIBA Negative
Negative
BAND PATTERN Nonreactive
Nonreactive
(p)/cl00 (p)
c33c Nonreactive
Nonreactive
c22p Nonreactive
Nonreactive
NS5 Nonreactive
Nonreactive
hSOD Nonreactive
Nonreactive
## HIT WORK-UP:
HEPARIN DEPENDENT ANTIBODIES NEGATIVE
## COMMENT:
NEGATIVE PF4 HEPARIN ANTIBODY BY
HEPARIN DEPENDENT ANTIBODIES Equivocal
## IMPRESSION:
1. Multifocal pneumonia with dense consolidation in the right
lower lobe
containing a central area of hypodensity and gas concerning for
necrotizing pneumonia/abscess. Loculated right parapneumonic
effusion without evidence of pleural enhancement to suggest
empyema.
2. No evidence of pulmonary embolism.
3. Increased ascites. Splenomegaly. Slight nodular contour of
the liver
raises the question of cirrhosis. Clinical correlation
recommended.
4. Known L1 fracture demonstrates no significant interval
healing with slight distraction of the fracture fragments,
however, no retropulsion into the spinal canal.
## IMPRESSION:
1. Multifocal pneumonia with dense consolidation in the right
lower lobe
containing a central area of hypodensity and gas concerning for
necrotizing pneumonia/abscess. Loculated right parapneumonic
effusion without evidence of pleural enhancement to suggest
empyema.
2. No evidence of pulmonary embolism.
3. Increased ascites. Splenomegaly. Slight nodular contour of
the liver
raises the question of cirrhosis. Clinical correlation
recommended.
4. Known L1 fracture demonstrates no significant interval
healing with slight distraction of the fracture fragments,
however, no retropulsion into the spinal canal.
## TTE :
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler. The estimated right atrial pressure
is mmHg. Left ventricular wall thickness, cavity size, and
global systolic function are normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic root is mildly dilated at the sinus level. The ascending
aorta is mildly dilated. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. Trace
aortic regurgitation is seen. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. Mild
(1+) mitral regurgitation is seen. There is mild pulmonary
artery systolic hypertension. There is no pericardial effusion.
## IMPRESSION:
Normal biventricular cavity sizes with preserved
global and regional biventricular systolic function. Mild mitral
regurgitation with normal valve morphology. Mild pulmonary
artery systolic hypertension. Dilated ascending aorta.
## IMPRESSION:
1. Worsening left upper lobe opacification anteriorly concerning
for
continued spread of infection.
2. Stable cavitary abscess in the short interval since
. A
radiograph performed concurrent with this CT is recommended as a
reference for future evaluation.
3. Centrilobular emphysema is severe in the upper lobes.
4. Axillary and mediastinal lymphadenopathy is stable in the
shorter term
from , though progressed since .
5. Slight increase moderate, layering, nonhemorrhagic right
pleural effusion, whether this is empyema or exudate can only be
reliably excluded by sampling.
## IMPRESSION:
1. Tiny right thyroid cyst; however, no new dominant nodule is
seen within
the thyroid gland.
2. Prominent lymph node with relatively normal morphology seen
at level III of the left neck. This lymph node may represent a
reactive process; while it has a fatty hilum it is somewhat
prominant. Correlate with location of symptoms.
## PERITONEAL FLUID :
NEGATIVE FOR MALIGNANT CELLS.
## PLEURAL FLUID :
ATYPICAL.
Rare atypical epithelioid cell.
## PLEURAL FLUID FLOW CYTOMETRY :
INTERPRETATION
Non-specific T cell dominant lymphoid profile; diagnostic
immunophenotypic features of involvement by leukemia/lymphoma
are not seen in specimen. Correlation with clinical findings
and morphology (see Cytology) is recommended. Flow cytometry
immunophenotyping may not detect all lymphomas due to
topography, sampling or artifacts of sample preparation.
## IMPRESSION:
1. Patent portal, hepatic, and caval venous systems with normal
hepatic
arterial waveforms.
2. Cholelithiasis without evidence of acute cholecystitis.
Gallbladder wall thickening likely relates to moderate ascites.
No biliary dilatation.
3. Massive splenomegaly.
## IMPRESSION:
1. FDG avidity corresponding to areas of known
pulmonary
opacification, likely infectious in etiology 2. No FDG-avid
lymphadenopathy or other concerning focus of FDG avidity 3.
Diffuse bony FDG uptake, likely related to know MDS 4. Moderate
right pleural effusion, large ascites and anasarca.
## MICRO:
Bronchoalveolar lavage, right lower lobe :
NEGATIVE FOR MALIGNANT CELLS.
Alveolar macrophages and neutrophils.
No fungal organisms or viral cytopathic effect identified.
Bronchial brushings, right lower lobe :
NEGATIVE FOR MALIGNANT CELLS.
4:00 pm SPUTUM Site: INDUCED Source: Induced.
GRAM STAIN (Final :
>25 PMNs and >10 epithelial cells/100X field.
Gram stain indicates extensive contamination with upper
respiratory
secretions. Bacterial culture results are invalid.
PLEASE SUBMIT ANOTHER SPECIMEN.
RESPIRATORY CULTURE (Final :
TEST CANCELLED, PATIENT CREDITED.
LEGIONELLA CULTURE (Final : NO LEGIONELLA
ISOLATED.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.
## ACID FAST CULTURE (PRELIMINARY):
NO MYCOBACTERIA ISOLATED.
2:13 pm PERITONEAL FLUID PERITONEAL FLUID.
GRAM STAIN (Final :
2+ per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
NO MICROORGANISMS SEEN.
This is a concentrated smear made by cytospin method,
please refer to
hematology for a quantitative white blood cell count..
FLUID CULTURE (Final : NO GROWTH.
ANAEROBIC CULTURE (Final : NO GROWTH.
FUNGAL CULTURE (Final : NO FUNGUS ISOLATED.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
## ACID FAST CULTURE (PRELIMINARY):
NO MYCOBACTERIA ISOLATED.
6:35 pm PLEURAL FLUID PLEURAL FLUID.
GRAM STAIN (Final :
NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.
FLUID CULTURE (Final : NO GROWTH.
ANAEROBIC CULTURE (Final : NO GROWTH.
## FUNGAL CULTURE (PRELIMINARY):
NO FUNGUS ISOLATED.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
## ACID FAST CULTURE (PRELIMINARY):
NO MYCOBACTERIA ISOLATED.
3:25 pm BRONCHOALVEOLAR LAVAGE RIGHT LOWER LOBE
BAL.
LCU,NCU ADDED ON AT .
GRAM STAIN (Final :
2+ per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
NO MICROORGANISMS SEEN.
RESPIRATORY CULTURE (Final :
Commensal Respiratory Flora Absent.
YEAST. 10,000-100,000 ORGANISMS/ML..
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.
## FUNGAL CULTURE (PRELIMINARY):
ALBICANS.
ID AND FLUCONAZOLE TESTING REQUESTED BY #
, ON
. Fluconazole SENSITIVE.
sensitivity testing performed by .
This test has not been FDA approved but has been
verified
following Clinical and Laboratory Standards Institute
guidelines
by Clinical
Laboratory..
POTASSIUM HYDROXIDE PREPARATION (Final :
Test cancelled by laboratory.
PATIENT CREDITED.
This is a low yield procedure based on our in-house
studies.
if pulmonary Histoplasmosis, Coccidioidomycosis,
Blastomycosis,
Aspergillosis or Mucormycosis is strongly suspected,
contact the
Microbiology Laboratory ( ).
LEGIONELLA CULTURE (Final : NO LEGIONELLA
ISOLATED.
## NOCARDIA CULTURE (PRELIMINARY):
NO NOCARDIA ISOLATED.
3:38 pm BRONCHIAL BRUSH RIGHT LOWER LOBE BRUSHING.
GRAM STAIN (Final :
NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.
RESPIRATORY CULTURE (Final : NO GROWTH, <100
CFU/ml.
ACID FAST SMEAR (Final :
NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.
## FUNGAL CULTURE (PRELIMINARY):
NO FUNGUS ISOLATED.
POTASSIUM HYDROXIDE PREPARATION (Final :
Test cancelled by laboratory.
PATIENT CREDITED.
if pulmonary Histoplasmosis, Coccidioidomycosis,
Blastomycosis,
Aspergillosis or Mucormycosis is strongly suspected,
contact the
Microbiology Laboratory ( ).
## PRIMARY REASON FOR ADMISSION:
Mr. is a year old male with MDS, hypercalcemia and recent
hospitalization for multifocal pneumonia, re-admitted with
worsening O2 requirement and abdominal distension, treated for
RLL necrotizing pneumonia and ascites, now with ascites and
transaminitis of unknown etiology.
## # MALIGNANCY WORK-UP:
Patient's history of 70-lb weight loss,
anemia, uptrending LFTs, lymphomatous-appearing nodularity of
liver, and overall clinical picture is concerning for
malignancy. All cytologies (pleural, ascites, bronchial) have
been negative for malignant cells, and flow cytometry if pleural
fluid was negative for malignant pattern as well. PET/CT showed
no evidnece of malignancy; again seen is bone marrow signal
likely related to underlying MDS or drug effect. Further
work-up of a malignancy would require tissue sampling, either an
ultrasound-guided biopsy of a cervical lymph node (considered
low yield because lymph node has fatty hilum and appears
reactive), a transbronchial biopsy of a mediastinal node
(considered high risk because patient bleeds disproportionally
to his plts and INR, raising concern of platelet dysfunction),
or a laparoscopic biopsy of a mesenteric node. A family meeting
was held to discuss goals of care and how aggressively dignosis
should be pursued, and it was concluded that even if a diagnosis
could be made, patient was unlikely to tolerate extensive
therapy, thus a focus should be made on providing comfort. The
patient was made DNR/DNI, trending towards CMO (but not yet
CMOO), and was discharged home with hospice.
## # MULTIFOCAL PNEUMONIA:
Patient was recently hospitalized with
complicated pneumonia with parapneumonic effusion with admission
from to . During his last admission, he was treated
with 9 days of vanc/zosyn/levo with clinical improvement. On
CT, effusion has reaccumulated and some evidence of cavitation
and enlarged mediastinal lymph nodes. Multifocal pneumonia is
still present, as well as evidence of emphysema. Patient is
afebrile with no leukocytosis. Differential dx includes
multifocal pneumonia with necrotizing pneumonia vs. TB vs.
malignant lesion. AFB cultures were negative. IP was consulted
and chest tube was inserted on to drain the effusion. A
bronchoscopy was also performed and BAL was sent for culture and
cytology, both of which returned negative. Repeat CT chest
shows worsening of RUL pneumonia and slight worsening of
effusions; could not definitively rule out empyema. Antibiotics
were broadened from zosyn to meropenem on as patient
clinically looked worse. Pleural fluid cultures were negative
for growth, cytology negative for malignant cells, and flow
cytometry of pleural fluid was negtive for malignancy. All ID
labs from have returned negative. Patient has completed a
14 day course of vancommycin, and a 12 day course of meropenem
(thus patient has exceeded the 8 day course previously planned).
He was continued on O2 by nasal cannula, eventually weaned from
to .
## # HISTORY OF HYPERCALCEMIA:
Patient was noted to be
hypercalcemic last admission and was given palendronate with
improvement. During that admission, no evidence of malignancy
was found on skeletal survey or PET scan. Patient did not
experience hypercalcemia until two weeks into this admission
when Calcium trended up to 10.5-11.2. He again shows no
evidence of thoracic malignancy on CT chest, and mediastinal
lymphadenopathy can be reactive from pneumonia. Most likely
cause of hypercalcemia is bone turnover, but no clear source
despite thorough workup. During last admission, PTH was
appropriately low, PTHrp was low, and VitD1,25 was low as well.
SPEP and UPEP again both negative for MM. IgG was again
measured this admission and is again polyclonal (as it was last
admission). Patient was given gentle IVF to bring down calcium,
but his ascites was monitored, as he tends to accumulate fluid
in his abdomen. He was encouraged to increase PO intake.
## # TRANSAMINITIS/ASCITES:
Patient has ascites, nodular liver on
imaging, and splenomegaly. He has transaminitis with AST>ALT,
elevated alk phos but normal Tbili. No SBP by tap, SAAG>1.1
with low protein. Does have some spiders on abdomen, but no
other signs of liver disease. Differential diagnosis includes
cirrhosis, portal vein thrombosis or other portal vein
obstruction, or malignancy. No evidence of portal vein
thrombosis seen on CTA. Spleen was also enlarged on abd US
and all portal vasculature were patent. Under the guidance of
a hepatology consult, labs were sent for hepatitis serologies,
disease, hemachromatosis (iron studies), autoimmune
hepatitis, all of which returned negative. TTG was negative.
IgG and IgA are elevated; IgM normal. AMA, and
antitrypsin negtive. Per liver, positive 1:80 Anti-smooth
muscle antibodies is not high enough of a titer to be
concerning. A week into his hospitalization, his LFTs began to
rise. There were no recent changes to his medications, and all
nonessential medications were discontinued. Pravastatin was
also discontinued. Per hepatology team, this clinical and
laboratory picture may be consistent with lymphomatous
infiltration of the liver, which can produce the type of
nodularity seen by imaging. Hepatology team would need
tranjugular liver biopsy for further workup, but as patient was
transitioning toward hospice care, further work-up was not
pursued.
# Afib: Patient was noted to be in afib on telemetry overnight
during first week of admission. Patient has no hx of afib,
although has hx of aflutter s/p ablation. He has had difficulty
with anticoagulation in the past with bleeding after a tooth
extraction. CHADS2 score is 2 (htn, DMII). Patient's heart
rate has been fine in the . Patient was initially
monitored on telemetry but preferred not to be on telemetry. As
he did not have a fast heart rate despite being intermittently
in afib, his telemetry was discontinued and he was maintaed on
q4h vital checks. He was not anticoagulated, given his current
clinical state and high risk for hemorrhage.
## # THROMBOCYTOPENIA:
Patient's platelets started trending down a
week into admission, from 218 to 99 over a course of five days.
Differential diagnosis for thrombocytopenia included decreased
production (known MDS, marrow suppression from vanc which has
been supratherapeutic and zosyn), increased destruction (HIT -
current T4 score is 5 intermediate risk, DIC because also
slightly more anemic, ITP) and splenic sequestration.
Peripheral smear shows no evidence of microangiopathic disease.
First heparin dependent antibody test was equivocal, but second
returned negative. However, patient may have had type 2 HIT.
Despite negative PF4, given patient's ease of bleeding, and the
uptrend of his plt count off of heparin, heparin sq was held for
the rest of his admission.
## # MDS:
His MDS has been followed by outpatient hematologist, who
has thought about his case extensively for years and is
uncertain why he has experienced such significant weight loss
and severe anemia. It appears that his MDS is not severe enough
to cause such severe anemia, and no evidence of GI bleeding was
ever discovered. Based on current labs and smears, patient
still does not have severe MDS and malignant transformation
seems very unlikely. Patient had a few premature myelocytes on
his diff, which can also be seen in the setting of infection.
Thus, his cell lines were monitored throughout hospitalization
and he received a total of 2 transfusions when his hct ws 22, to
help with his symptoms of fatigue/dyspnea.
## # HTN:
Patient's SBP was in the 100s on home lisinopril regimen,
but then began to trend down to when patient was becoming
more ill with pneumonia, so held lisinopril at that point and
remained held for the remainder of his hospitalization. His SBP
stayed in the 100s-110s throughout hospitalization.
## CODE:
DNR/DNI (GOING HOME WITH HOSPICE CARE)
## (DAUGHTER):
PCP be contact person for hospice.
## MEDICATIONS ON ADMISSION:
1. miconazole nitrate 2 % Powder Sig: One (1) application
Topical three times a day: Apply to buttocks.
2. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
3. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.
4. pravastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
6. cholecalciferol (vitamin D3) 1,000 unit Capsule Sig: One (1)
Capsule PO once a day.
7. dextromethorphan-guaifenesin mg/5 mL Syrup Sig: Five
(5) ml PO every six (6) hours as needed for cough or chest
congestion.
8. Fleet Enema gram/118 mL Enema Sig: One (1) enema Rectal
once a day as needed for constipation.
9. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection three times a day.
10. DuoNeb 0.5 mg-3 mg(2.5 mg base)/3 mL Solution for
## NEBULIZATION SIG:
One (1) neb Inhalation every four (4) hours as
needed for shortness of breath or wheezing.
11. Lidoderm 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) patch Topical once a day: Apply to L1-L2 area. 12 hours
on, 12 hours off.
12. pamidronate 60 mg/10 mL (6 mg/mL) Solution Sig: Sixty (60)
mg Intravenous once a month: Last given .
13. aluminum-magnesium hydroxide 200-200 mg/5 mL Suspension Sig:
Five (5) mL PO four times a day as needed for indigestion.
14. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every
four (4) hours as needed for pain.
## DISCHARGE MEDICATIONS:
1. hospice
Admit to hospice
2. sodium chloride 0.65 % Aerosol, Spray Sig: Sprays Nasal
QID (4 times a day) as needed for nasal dryness .
Disp:*1 bottle* Refills:*3*
3. oxycodone 10 mg Tablet Sig: One (1) Tablet PO every six (6)
hours.
Disp:*120 Tablet(s)* Refills:*2*
4. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
powder package PO DAILY (Daily).
Disp:*30 powder package* Refills:*2*
5. prochlorperazine maleate 5 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours) as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
6. ZOFRAN ODT 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every six (6) hours as needed for nausea.
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
Multifocal pneumonia/necrotizing pneumonia
Ascites
Anemia
Weight Loss
Myelodysplastic Syndrome
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you here at
. You were admitted with increasing
trouble breathing and a distended abdomen. While you were here,
we found you had a multifocal pneumonia with a necrotizing
cavitary lesion. You also had a pocket of fluid around your
lung, which we drained with a chest tube. We also found you had
some liver problems with elevated enzymes and your blood level
was low. We tried to find a unifying diagnosis for your
problems and you received a few CTs, ultrasounds, and PET CTs in
the process. Based on discussions with you and your family, we
agreed that you think it is more important for you to be at home
and with your family, than to find a definitive diagnosis for
your current disease. Therefore, we helped you control your
symptoms. We supported your breathing with oxygen and we gave
you pain medication for your chronic pain. In keeping with your
wishes to go home with a focus on comfort and symptom
management, we have arranged for home hospice services to
support you and your family.
Please note that the following are the medications you should
take:
- Sodium chloride 0.65% Nasal Spray Sprays 4 times a day as
needed for nasal dryness
- Oxycodone 10mg PO every six hours
- Polyethylene glycol 3350 17 gram/dose PO daily
- Prochlorperazine 5mg PO every 6 hours as needed for nausea
- Zofran ODT 8mg PO every six hours as needed for nausea
- Oxygen therapy up to 2L by nasal cannula as needed
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12042461", "visit_id": "27750880", "time": "2123-02-28 00:00:00"} |
10246643-RR-9 | 1,051 | ## :
Cardiology Staff: , MD
## GENDER:
Male Radiology Staff: , MD
## RACE:
Other Technologist: , RT
## STATUS:
Outpatient Nursing Support: , RN
## WEIGHT (LBS):
189 Injection Site: right hand vein
## RHYTHM:
Sinus rhythm Creatinine (mg/dl): 0.9
## CMR MEASUREMENTS:
Measurement Normal Range
Left Ventricle
LV End-Diastolic Dimension (mm) 57 <62
LV End-Diastolic Dimension Index (mm/m2) 28 <32
LV End-Systolic Dimension (mm) 36
LV End-Diastolic Volume (ml) 184 <196
LV End-Diastolic Volume Index (ml/m2) 91 <95
LV End-Systolic Volume (ml) 76
LV Stroke Volume (ml) 108
LV Stroke Volume Index (ml/m2) 53
LV Ejection Fraction (%) 59 >=54
LV Mass (g) 86
LV Mass Index (g/m2) 42 <80
Basal wall thickness (mm) 8 <12
Basal infero-lateral wall thickness (mm) 6 <11
Q-Flow Aortic Net Forward Stroke Volume (ml) 96
Q-Flow Aortic Total Stroke Volume (ml) 98
Q-Flow Aortic Cardiac Output (l/min) 4.1
Q-Flow Aortic Cardiac Index (l/min/m2) 2
LV Effective Forward Ejection Fraction (%) *52 >=54
Right Ventricle
RV End-Diastolic Volume (ml) 166
RV End-Diastolic Volume Index (ml/m2) 82 58-114
RV End-Systolic Volume (ml) 80
RV Stroke Volume (ml) 86
RV Stroke Volume Index (ml/m2) 42
RV Ejection Fraction (%) 52 >=46
Q-Flow Pulmonary Net Forward Stroke Volume (ml) 71
Q-Flow Pulmonary Total Stroke Volume (ml) 80
Qp/Qs 0.74 0.8-1.2
Atria
Left Atrial Dimension (Axial) (mm) 36 <40
Left Atrial Length (4-Chamber) (mm) **61 <52
Right Atrial Dimension (4-Chamber) (mm) 46 <50
Coronary Sinus Diameter (mm) 13 <15
Great Vessels
Ascending Aorta Diameter (mm) 30 <39
Ascending Aorta Diameter Index (mm/m2) 15 <20
Transverse Aorta Diameter (mm) 24
Transverse Aorta Diameter Index (mm/m2) 12
Descending Aorta Diameter (mm) 24 <28
Descending Aorta Index (mm/m2) 12 <14
Abdominal Aorta Diameter (mm) 24
Abdominal Aorta Diameter Index (mm/m2) 12
Main Pulmonary Artery Diameter (mm) 26 <29
Main Pulmonary Artery Diameter Index (mm/m2) 13 <15
Pulmonary Veins
Number of Left Pulmonary Veins 1
Number of Right Pulmonary Veins 2
Left Common PV Dimension (mm) 28 x 11
Left Common PV Cross-Sectional Area (mm2) 264
Left Common PV Late Gadolinium Enhancement Positive
Left Common PV Visual Apperance Normal
Right Upper PV Dimension (mm) 21 x 16
Right Upper PV Cross-Sectional Area (mm2) 255
Right Upper PV Late Gadolinium Enhancement Positive
Right Upper PV Visual Appearance Normal
Right Lower PV Dimension (mm) 20 x 18
Right Lower PV Cross-Sectional Area (mm2) 339
Right Lower PV Late Gadolinium Enhancement Positive
Right Lower PV Visual Appearance Normal
Valves
Aortic Valve Morphology Trileaflet
Aortic Valve Excursion Normal
Aortic Valve Area (cm2) 4.4 >=2
Aortic Valve Area Index (cm2/m2) 2.2
Aortic Valve Regurgitation (Visual) None present
Aortic Valve Regurgitant Volume (ml) 2
Aortic Valve Regurgitant Fraction (%) 2 <5
Mitral Valve Regurgitation (Visual) Present
Mitral Valve Regurgitant Volume (ml) 10
Mitral Valve Regurgitant Fraction (%) *9 <5
Pulmonary Valve Regurgitation (Visual) None present
Pulmonary Valve Regurgitant Volume (ml) 9
Pulmonary Valve Regurgitant Fraction (%) *11 <5
Tricuspid Valve Regurgitation (Visual) Present
Tricuspid Valve Regurgitant Volume (ml) 6
Tricuspid Valve Regurgitant Fraction (%) *7 <5
Pericardium
Pericardial Thickness (mm) 2 <4
Pericardial Effusion Trace
* Mildly abnormal | ** Moderately abnormal | *** Severely abnormal
## STRUCTURE
" T1-WEIGHTED (BLACK BLOOD):
Dual-inversion T1-weighted fast spin echo images
were acquired in 5-mm contiguous axial slices to evaluate cardiac and vascular
anatomy.
## FUNCTION
" CINE SSFP:
Breath-hold SSFP cine images were acquired in 8-mm slices in the
4-chamber, 3-chamber, 2-chamber, and short axis orientations.
" Cine SSFP (Additional Aortic Valve Views): A short-axis series was acquired
at the level of the aortic valve.
## FLOW
" AORTIC VALVE FLOW:
Phase-contrast cine images were acquired transverse to
the proximal ascending aorta to quantify through-plane flow.
" Pulmonary Valve Flow: Phase-contrast cine images were acquired transverse
to the main pulmonary artery to quantify through-plane flow.
Viability
" LGE of the Pulmonary Veins: Late gadolinium enhancement (LGE) images of the
left atrium and pulmonary veins were acquired using a navigator-gated 3D
ultrafast gradient echo inversion-recovery sequence with spectral fat
saturation pre-pulses 15 minutes after injection of a total of 0.1 mmol/kg (15
mL) Gd-BOPTA (Multihance).
MRA
" MRA of the Pulmonary Veins: First-pass magnetic resonance angiography (MRA)
images of the pulmonary veins were acquired after administration of a bolus of
0.1 mmol/kg (15 mL) Gd-BOPTA (Multihance). Multiplanar reconstructions of the
pulmonary arteries were generated and analyzed on a workstation.
## LEFT VENTRICLE
" LV CAVITY SIZE:
Normal
" LV ejection fraction: Normal
" LV mass: Normal
## RIGHT VENTRICLE
" RV CAVITY SIZE:
Normal
" RV ejection fraction: Normal
" Intra-cardiac shunt: None present
## ATRIA
" LA SIZE:
Moderately enlarged
" RA size: Normal
## GREAT VESSELS
" ASCENDING AORTIC DIAMETER:
Normal
" Main pulmonary artery diameter: Normal
Pulmonary Veins
" Number of Left Pulmonary Veins: 1
" Number of Right Pulmonary Veins: 2
" Late gadolinium enhancement of the left common pulmonary vein: Positive
" Late gadolinium enhancement of the right upper pulmonary vein: Positive
" Late gadolinium enhancement of the right lower pulmonary vein: Positive
## VALVES
" AORTIC VALVE MORPHOLOGY:
Trileaflet
" Aortic stenosis: No
" Aortic regurgitation jet: None present
" Mitral regurgitation jet: Present
" Mitral regurgitation: Mild
" Pulmonary regurgitation jet: None present
" Pulmonary regurgitation: Mild
" Tricuspid regurgitation jet: Present
" Tricuspid regurgitation: Mild
## PERICARDIUM
" PERICARDIAL THICKNESS:
Normal
" Pericardial effusion: Trace
## ADDITIONAL INFORMATION/FINDINGS:
None.
## NON-CARDIAC FINDINGS:
Bilateral axillary lymphadenopathy, as seen previously. Clinical correlation
is recommended, likely related to CLL.
## IMPRESSION:
Moderately enlarged left atrium. Normal right atrium. Normal left
ventricular wall thicknesses with normal cavity size and normal regional and
global left ventricular systolic function. Normal right ventricular size and
systolic function. Normal ascending aorta, descending aorta, and main
pulmonary artery diameters. Mild mitral regurgitation. Mild tricuspid
regurgitation. Normal size and orientation of the pulmonary veins (two right
sided and one common left sided) without evidence of anomalous pulmonary
venous return or pulmonary vein stenosis. Late gadolinium enhancement of the
posterior left atrial wall and ostia of all pulmonary veins, consistent with
prior ablation. Trace pericardial effusion.
Compared to prior study dated , the left ventricular cavity size is
now normal and there is evidence of mild tricuspid regurgitation. The
pulmonary veins are mildly reduced in size compared to the prior study in the
absence of focal stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10246643", "visit_id": "N/A", "time": "2170-07-16 15:51:00"} |
17287581-RR-43 | 89 | ## HISTORY:
female presenting with abdominal pain after recent
surgery. Assess for subdiaphragmatic free air.
## PA AND LATERAL CHEST RADIOGRAPH:
Linear opacities within the lung bases, left
greater than right, correspond with atelectasis seen on concurrent CT. No
confluent opacity is identified to suggest pneumonia. There is no pulmonary
edema or pleural effusions. No pneumothorax is evident. Mediastinal and
hilar contours are within normal limits. Mild enlargement of the cardiac
silhouette is unchanged. There is no subdiaphragmatic free air.
## IMPRESSION:
1. Minimal bibasilar atelectasis.
2. Unchanged mild cardiomegaly.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17287581", "visit_id": "N/A", "time": "2181-09-19 23:35:00"} |
16845903-RR-21 | 157 | ## HISTORY:
with IgG lambda monoclonal gammopathy and inflammatory
myopathy. Evaluation for bone lesions or plasmacytoma.
## SKULL:
Lateral view shows no abnormal lesions. Paranasal sinuses and mastoid
air cells are clear.
## CERVICAL SPINE:
No lytic or destructive bone lesions or pathologic fracture.
Paravertebral soft tissues are within normal limits.
## THORACIC SPINE:
AP and lateral views show no destructive bone lesion or
pathologic fracture.
## LUMBAR SPINE:
AP and lateral views demonstrates the destructive bone lesions
or pathologic fractures. Mild degenerative disease involving the lower lumbar
spine.
## LONG BONES:
The bilateral humeri, proximal aspects of the bilateral radius
and ulnar, bilateral femurs, and bilateral proximal tibia show no lytic
lesions or destructive bony mass.
## PELVIS:
There is scattered enthesopathy at tendinous insertions. No lytic
lesion seen, allowing for limitations of overlying bowel gas.
The visualized lungs and mediastinal structures are within normal limits.
Intra-abdominal structures are within normal limits.
## IMPRESSION:
No evidence of myelomatous lesions or fractures.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16845903", "visit_id": "N/A", "time": "2165-06-24 12:20:00"} |
10540520-RR-23 | 205 | ## INDICATION:
year old man s/p brain stem cavernoma resection, evaluate for
post-operative change
## FINDINGS:
The examination is markedly limited by motion.
The patient is status post right frontotemporal craniotomy and resection of
the mass in the midbrain. The small extra-axial hematoma, underlying the
craniotomy site in the right frontal lobe, and right frontotemporal scalp
edema as well as subcutaneous emphysema are similar in appearance to the CT
brain . There are small subdural fluid collections diffusely over
the hemispheres and along the falx. This is a common postoperative finding.
The pneumocephalus in the bilateral frontal lobes has decreased from the prior
examination.
There is hemorrhage and slow diffusion in the resection cavity.
Hyperintensity in the midbrain on the FLAIR images appears similar to, or
slightly decreased since, the brain MRI of No abnormal
enhancement is identified. Hemorrhage layers dependently in the occipital
horns of the bilateral ventricles. The prior ventriculostomy tract in the
right frontal lobe is unchanged. There is no evidence of infarction or
midline shift. The ventricles are unchanged in size.
## IMPRESSION:
Postsurgical changes status post right frontotemporal craniotomy and resection
of the mass in the inter pedicular midbrain with blood products at
thepostsurgical bed and no abnormal enhancement.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10540520", "visit_id": "29199993", "time": "2147-07-25 00:33:00"} |
13714286-RR-77 | 286 | ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
year old man with resp failure, PNA, pulm edema// pna pna
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.3 s, 36.2 cm; CTDIvol = 13.2 mGy (Body) DLP = 478.0
mGy-cm.
Total DLP (Body) = 478 mGy-cm.
## THORACIC INLET:
ET tube projects approximately 4 cm from the carina. NG tube
projects below the left hemidiaphragm. There is a right IJ line which
projects to the SVC. There is a right-sided PICC line with its tip in the
SVC.
## BREAST AND AXILLA:
There are no enlarged axillary lymph nodes
## MEDIASTINUM:
There are multiple enlarged mediastinal bilateral hilar lymph
nodes with evidence of wall calcification. There is moderate cardiomegaly.
There is moderate coronary artery calcification. There is no pericardial
effusion.
## PLEURA:
There are moderate bilateral pleural effusions right greater than
left.
## LUNG:
Consolidative opacity in the right lower lobe and left lower lobe is
unchanged there is diffuse bilateral ground-glass opacification superimposed
over emphysema and several scattered nodules which most likely represents
pulmonary edema. Evaluation of lung parenchyma is somewhat limited by
respiratory motion. There is a right upper lobe nodule measuring 15 mm.
## BONES AND CHEST WALL:
Review of bones shows degenerative changes involving
the thoracic spine.
## UPPER ABDOMEN:
Limited sections through the upper abdomen are unremarkable.
## IMPRESSION:
Moderate bilateral pleural effusions right greater than left. Consolidative
opacities in both lower lobes most likely represent atelectasis.
Pulmonary edema. Superimposed over emphysema.
Several scattered bilateral pulmonary nodules the largest in the right upper
lobe measuring 15 mm
ETT, NG tube, right IJ line and right PICC line in acceptable position.
Mediastinal bilateral hilar lymph nodes some of which are calcified, could be
related to sarcoidosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13714286", "visit_id": "25156580", "time": "2175-09-08 15:54:00"} |
10245522-RR-34 | 445 | ## EXAMINATION:
CT abdomen and pelvis with IV contrast.
## INDICATION:
with abdominal wall pus draining. eval for abscess. Chart
review notes that patient had a gastrostomy tube placed in in head and
anterior abdominal wall infection in seventeen which was treated with
antibiotics. Now presenting with several days of increasing redness,
swelling, and purulent drainage.
## LOWER CHEST:
There is mild dependent atelectasis in the bilateral lower lobes.
Linear opacity in the left lower lobe likely represents scarring is unchanged
from CT abdomen pelvis . There is a partially calcified right
posterior pleural plaque, unchanged from . Epicardial pacing wires
are again noted.
## HEPATOBILIARY:
The liver is grossly unremarkable aside from mild periportal
edema, unchanged from . There is no evidence of focal lesions.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
gallbladder is within normal limits. Small amount of pericholecystic fluid is
unchanged from .
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
Gastrostomy tube terminates within the stomach. The stomach
is unremarkable. Small bowel loops demonstrate normal caliber, wall
thickness, and enhancement throughout. The colon and rectum are within normal
limits. The appendix is not visualized but there are no secondary signs of
acute appendicitis.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The prostate is not enlarged.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Moderate degenerative changes the lumbar spine are noted.
## SOFT TISSUES:
In the anterior abdominal wall near the course of the epicardial
pacing wires and inferolateral to the course of the gastrostomy tube, there is
a hyperattenuating area measuring 3.0 x 1.4 cm (02:30), mildly decreased in
size from CTA . There is a lipoma in the anterior subcutaneous
tissues of the upper abdomen (02:20)
## IMPRESSION:
At the level of the left upper anterior abdomen inferolateral to the
percutaneous gastrostomy tube is a hyperattenuating focus measuring 3.0 x 1.4
cm with associated skin thickening. This is nonspecific and may represent a
phlegmon given the provided clinical history. No evidence of drainable fluid
collection.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10245522", "visit_id": "26710066", "time": "2169-12-09 10:43:00"} |
18032895-RR-45 | 269 | ## INDICATION:
woman with pancreatic cancer and liver metastases.
Evaluate for metastatic disease in the thorax.
## DOSE:
Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
## FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL:
5 mm calcified nodule is seen in
the right thyroid lobe, unchanged from previous study (2:4). Supraclavicular
and axillary nodes are not enlarged, largest node in the left axilla measuring
9 mm (302:61).
Specifically excluding the breasts which require mammography for evaluation,
there are no soft tissue abnormalities elsewhere in the chest wall concerning
for malignancy.
## UPPER ABDOMEN:
Findings below the diaphragm will be reported separately.
## MEDIASTINUM:
No mediastinal mass or lymphadenopathy.
## HILA:
No hilar mass or lymphadenopathy.
## HEART AND PERICARDIUM:
Tip of right anterior chest wall port is at the
cavoatrial junction. Heart is normal size. Coronary arteries are not
calcified. No pericardial effusion.
## PLEURA:
No pleural effusion or pneumothorax.
## 1. PARENCHYMA:
There is no consolidation. No suspicious pulmonary nodules.
## 2. AIRWAYS:
Tracheobronchial tree is patent to the subsegmental level.
## 3. VESSELS:
The aorta and pulmonary artery are normal caliber.
## CHEST CAGE:
No pathologic or compression fractures or destructive bone
lesions.
Although there are no bone lesions in the imaged chest cage suspicious for
malignancy or infection, it should be noted that radionuclide bone and FDG PET
scanning are more sensitive in detecting early osseous pathology than chest CT
scanning.
## IMPRESSION:
No evidence of metastatic disease in the chest.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18032895", "visit_id": "N/A", "time": "2138-12-07 09:45:00"} |
10705949-RR-43 | 112 | RADIOGRAPHS OF THE CERVICAL SPINE
## HISTORY:
Left-sided neck pain with one month of atraumatic radiculopathy.
## FINDINGS:
The C5-C6 interspace is mildly narrowed with moderate-sized anterior
osteophyte formation. The C6-C7 and C7-T1 levels are somewhat difficult to
visualize due to overlapping bony structures. On the left, the neural
foramina appear widely patent without clear evidence for substantial
degenerative change along facet joints. Minimal rightward convex curvature
makes the right-sided neural foramina difficult to assess, but there is
potentially moderate neural foraminal narrowing on the right at C4-C5 with
striking osteophytes.
## IMPRESSION:
Mild-to-moderate degenerative changes, particularly noting facet
joint degenerative changes at C4-C5.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10705949", "visit_id": "N/A", "time": "2131-09-29 15:05:00"} |
16625434-RR-79 | 157 | ## STUDY:
man with syndrome and has had prior renal
transplant, and right ankle pain.
## FINDINGS:
No prior studies of the ankle available for a direct comparison.
There is a sclerotic lesion in the distal tibia which has peripheral
calcification and is compatible with a bone infarct. There is no cortical
destruction or pathologic fracture at this location. Additionally, there is
an area of cystic change in the talar dome measuring 2.4 cm which extends to
the joint surface. This likely represents sequela from avascular necrosis.
There is no gross articular collapse at this time. However, imaging with MRI
may better characterize this abnormality. The ankle mortise is preserved.
There is no discrete fracture. There is some mild soft tissue swelling.
## IMPRESSION:
1. Cystic area within the talar dome, extending to the articular surface,
likely due to avascular necrosis. This could be further evaluated with MRI
imaging.
2. Bone infarct within the distal tibial metaphysis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16625434", "visit_id": "28760088", "time": "2135-10-28 18:02:00"} |
15370183-RR-47 | 374 | ## INDICATION:
Cirrhosis, status post antrectomy, Roux-en-Y gastrojejunostomy
for bleeding ulcer with duodenal stump leak, now concern for sepsis.
and
## CT ABDOMEN:
The visualized lung bases demonstrate mild bibasilar atelectasis.
There is no pleural or pericardial effusion.
Nodularity of the liver with left hepatic lobe and caudate hypertrophy are
consistent with known cirrhosis. A 9-mm hypodensity in the hepatic dome (2:7)
is too small to characterize but is unchanged from . No other focal
lesions are seen in the liver. The gallbladder is surgically absent.
Splenomegaly is unchanged with the spleen measuring 15.1 cm.
varices are unchanged. Bilateral adrenal glands are normal. The kidneys
enhance symmetrically and excrete contrast promptly without hydronephrosis.
A 1.3 x 2.3cm fluid collection anterior to right kidney is decreased from
, when it measured 1.9 x 2.7cm. Small perihepatic and perisplenic
ascites is stable, with a drain ending near the hepatic dome, unchanged in
position from . The patient is status post Roux-en-Y
gastrojejunostomy and oral contrast follows the expected post-surgical course.
There is no extravasation of oral contrast at the anastomotic site to suggest
a leak. The bowel is of normal caliber without obstruction. There is
pancolonic bowel wall thickening, most pronounced in the ascending and
transverse colons. A small amount of stranding surrounding the descending
colon is improved from .
Mild atherosclerotic calcifications are seen throughout the aorta without
aneurysmal dilation. The main portal vein, splenic vein, and SMV are patent.
No pathologically enlarged mesenteric or retroperitoneal lymph nodes are
present.
## CT PELVIS:
Minimal bowel wall thickening is noted in the rectum and sigmoid
colons. The bladder, and prostate are normal. There is no free fluid and no
pelvic or inguinal lymphadenopathy.
## BONE WINDOWS:
No bone finding suspicious for malignancy or infection is seen.
## IMPRESSION:
1. Status post Roux-en-Y gastrojejunostomy without evidence of leak.
2. Colonic wall thickening, predominantly in the ascending and transverse
colons, with a small amount of surrouding stranding in the descending colon.
Findings consistent with colitis of unknown acuity, but the CT appearance is
improved from .
3. Interval decrease in size of small fluid collection anterior to right
kidney.
Initial findings discussed with 10:42am .
Revised findings discussed with Dr. by phone .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15370183", "visit_id": "20543489", "time": "2149-06-03 09:38:00"} |
17509096-RR-57 | 146 | ## EXAMINATION:
COMPLETE GU U.S. (BLADDER AND RENAL)
## INDICATION:
year old man with hx gross hematuria, radiation for prostate
cancer and renal failure with diabetes // r/o masses, hydro, tumors
status post penile implant
## FINDINGS:
The right kidney measures 10.1 cm. The right renal cortex is thinned and
echogenic consistent with atrophy. Several simple cysts are evident. The
largest is in the upper pole measuring 11.4 x 8.3 x 12.5 cm.
The left kidney measures 11.8 cm. The left renal cortex appeared thinned and
echogenic consistent with atrophy. There are several simple cyst demonstrated
in the kidney. The largest measures 17 x 7 x 15 cm. There is no hydronephrosis
bilaterally.
The bladder remained empty during the exam. The penile implant reservoir was
identified.
## IMPRESSION:
1. Bilateral renal atrophy. Large simple cysts bilaterally.
2. Empty urinary bladder throughout exam.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17509096", "visit_id": "N/A", "time": "2140-09-30 13:00:00"} |
17784861-RR-75 | 287 | ## EXAMINATION:
MR KNEE W/O CONTRAST RIGHT
## INDICATION:
year old woman R knee pain and locking. Evaluation for
meniscal tear.
## MEDIAL MENISCUS:
There is redemonstration of a vertically oriented
longitudinal tear involving the anterior horn of the medial meniscus, similar
in appearance to prior study. There is medial extrusion of the meniscus
measuring up to 3 mm. A small parameniscal cyst is again noted (05:11).
Lateral meniscus: Intact.
## ANTERIOR CRUCIATE LIGAMENT:
Intact.
Posterior cruciate ligament: Intact.
## MEDIAL COLLATERAL LIGAMENT:
Intact. Increased edema located along the
posteromedial joint line, posterior to the MCL, which could be seen in the
setting of meniscocapsular separation. Mild tendinosis of semimembranosus
Lateral collateral ligamentous complex: Intact.
## EXTENSOR MECHANISM:
The quadriceps and patellar tendons are intact.
## CYST:
None.
Joint effusion: None.
Articular cartilage
## MEDIAL:
Few areas of partial and full-thickness cartilage loss involving the
medial femoral condyle and medial tibial plateau with associated subchondral
marrow edema, increased from prior study.
## BONE MARROW:
Increased subchondral marrow edema involving the anterior aspect
of the medial tibial plateau, with small subchondral cyst measuring up to 7 mm
(05:12).
## ADDITIONAL:
Small amount of edema noted surrounding the semimembranosus
muscle.
## IMPRESSION:
1. Overall similar appearance of a vertically oriented longitudinal tear
involving the anterior horn of the medial meniscus, with an adjacent
parameniscal cyst. There is mild medial extrusion of the meniscal body
2. Interval progression of degenerative change within the medial compartment,
including few areas of partial and full-thickness cartilage loss involving the
medial femoral condyle and medial tibial plateau with associated underlying
subchondral marrow edema and subchondral cyst formation.
3. Intact appearance of the MCL with increased edema located posteriorly,
which can be seen in the setting of meniscocapsular separation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17784861", "visit_id": "N/A", "time": "2195-05-21 12:57:00"} |
12612379-RR-119 | 102 | ## HISTORY:
Shortness of breath, hypoxia.
## FINDINGS:
The lungs are hyperinflated. The heart size is normal. Mediastinal and hilar
contours are unchanged. Small right pleural effusion has increased in size
compared to the prior study. Re- demonstrated is scarring with bronchiectasis
and ill-defined nodular small opacities in the right middle lobe with coarse
calcifications of the right breast. Right basilar patchy opacity likely
reflects atelectasis. Pulmonary vasculature is not engorged. There is no
pneumothorax.
## IMPRESSION:
Slight interval increase in size of small right pleural effusion with right
basilar atelectasis. Chronic bronchiectasis, scarring, and nodular opacities
in the right middle lobe.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12612379", "visit_id": "29670447", "time": "2195-10-10 11:42:00"} |
11685699-RR-35 | 125 | ## INDICATION:
Status post aortofemoral bypass with abdominal and
retroperitoneal abscess after drain fell out with spiking fevers.
## OSSEOUS STRUCTURES:
No suspicious intraosseous lesions are present. There is
multilevel degenerative disease and mild loss of vertebral body height at T12,
unchanged.
## IMPRESSION:
1. Interval increase in the size of multiloculated retroperitoneal abscess
with locules of air which could be due to gas forming organisms, however
fistulous communication with bowel is not excluded.
2. Unchanged mild right hydroureteronephrosis likely due to mass effect from
the retroperitoneal abscess.
3. Subcentimeter right renal cyst, too small to characterize, unchanged.
4. Mild pericholecystic fat stranding, acalculous cholecystitis is not
excluded, and clinical correlation is recommended. Discussed with
.
5. Bilateral pleural effusions, right greater than left, and bibasilar
atelectasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11685699", "visit_id": "26579183", "time": "2186-06-28 10:24:00"} |
16625180-RR-29 | 141 | ## EXAMINATION:
HAND (PA,LAT AND OBLIQUE) RIGHT
## INDICATION:
year old woman with right hand pain// right hand pain
## FINDINGS:
There is a mildly comminuted mildly displaced intra-articular fracture of the
fifth metacarpal base.
There are scattered mild interphalangeal joint degenerative changes. There is
moderate to severe first CMC joint osteoarthritis with joint space narrowing,
osteophytosis, subchondral sclerosis. Minimal degenerative changes are
present at the second and third MCP joints. There is minimal degenerative
change at the triscaphe joint. No chondrocalcinosis. No erosion. No
embedded radiopaque foreign body.
## IMPRESSION:
Mildly comminuted and displaced intra-articular fracture of the fifth
metacarpal base.
Degenerative changes, most marked at the first CMC joint.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 08:44 into the Department of Radiology critical
communications system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16625180", "visit_id": "N/A", "time": "2143-07-14 08:21:00"} |
15854896-RR-28 | 200 | ## HISTORY:
male with hepatitis C and elevated LFTs.
## COMPLETE ABDOMINAL ULTRASOUND:
The liver demonstrates homogeneous
echogenicity without suspicious focal lesion. The main portal vein is patent
with hepatopetal flow. Scattered subcentimeter hepatic cysts are identified,
however, there are no suspicious hepatic lesions. There is a small amount of
perihepatic ascites and a right pleural effusion. The gallbladder is filled
with stones, however, demonstrates no secondary signs of acute cholecystitis.
The common bile duct measures 3 mm and is not dilated. The right kidney
measures 10.1 cm and the left kidney measures 9.1 cm. There is no
hydronephrosis or suspicious renal mass. A 5-mm non-obstructing calculus is
identified in the mid pole of the left kidney. The pancreas is well
visualized and is normal in appearance. The spleen is normal measuring 7.6
cm. Evaluation of the distal aorta is limited due to overlying bowel gas;
however, the proximal and mid aorta are normal in caliber. The visualized
portions of the inferior vena cava are normal.
## IMPRESSION:
1. Normal echogenicity of the liver without suspicious focal lesion. Small
hepatic cysts.
2. Small right pleural effusion and perihepatic ascites.
3. Cholelithiasis without evidence of acute cholecystitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15854896", "visit_id": "26243099", "time": "2182-09-11 15:06:00"} |
14322627-RR-31 | 82 | ## EXAMINATION:
MRA NECK WANDW/O CONTRAST T9716 MR NECK
## INDICATION:
female with probable myeloproliferative neoplasm
incidentally found to have circumferential thickening of left common carotid
artery.// Evaluate left common carotid artery.
## FINDINGS:
The common, internal and external carotid arteries appear normal. There is no
evidence of stenosis by NASCET criteria. The origins of the great vessels,
subclavian, and vertebral arteries appear normal bilaterally. The common
carotid bifurcations appear normal.
## IMPRESSION:
1. Normal MRA neck. Specifically, no left common carotid narrowing.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14322627", "visit_id": "29780437", "time": "2136-09-27 12:24:00"} |
16877638-RR-40 | 529 | ## EXAMINATION:
CTA ABD AND PELVIS
## INDICATION:
year old woman with right breast cancer planning for flap
breast reconstruction. Has previous abdominal surgery. Please evaluate
vessels// Please evaluate vessels for planning reconstructive surgery
## ABDOMEN AND PELVIS CTA:
Non-contrast and multiphasic
post-contrCast images were acquired through the abdomen and pelvis.
Oral contrast was not administered.
MIP reconstructions were performed on independent workstation and reviewed on
PACS.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 8.8 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 11.9 s, 0.2 cm; CTDIvol = 189.6 mGy (Body) DLP =
37.9 mGy-cm.
3) Spiral Acquisition 8.1 s, 52.6 cm; CTDIvol = 6.0 mGy (Body) DLP = 309.3
mGy-cm.
Total DLP (Body) = 349 mGy-cm.
## FINDINGS:
The inferior epigastric arteries are patent bilaterally from the external
iliac artery to the perforator branches. There are 3 dominant perforators
identified:
## LEFT:
Branching pattern: Type 2
## PERFORATORS:
2.5 mm, 22 mm to the left at the level of the umbilicus (series 10, image 52)
2.1 mm, 66 mm to the left at the level of the umbilicus (series 10, image 52)
## RIGHT:
Branching pattern: Type 2
## PERFORATORS:
3.3 mm, 39 mm to the right and 31 mm below the umbilicus (series 10, image 57)
## VASCULAR:
There is no abdominal aortic aneurysm.
The right hepatic artery is replaced to the SMA. The left hepatic artery is
replaced to the left gastric artery. There is duplication of the IVC below
the level of the renal veins.
## LOWER CHEST:
The imaged lung bases are clear. There is no pleural or
pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is within normal limits,
without stones or gallbladder wall thickening.
## 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 adrenal gland appears normal. The left adrenal gland has
a solitary limb.
## URINARY:
The left kidney is congenitally absent. The right kidney is
malrotated but is normal in size with no evidence of stones, 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 colon and
rectum are within normal limits.
## RETROPERITONEUM:
There is no evidence of retroperitoneal lymphadenopathy.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
## REPRODUCTIVE ORGANS:
There is a bicornuate uterus. The adnexa are normal in
appearance.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Interpeduncular screws are noted at L3-L5.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. 3 dominant vessels as detailed above.
2. Incidental congenitally absent left kidney and bicornuate uterus,
duplication of the infrarenal IVC, left adrenal hypoplasia and replaced right
and left hepatic arteries.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16877638", "visit_id": "N/A", "time": "2125-05-11 07:49:00"} |
12117907-DS-24 | 2,222 | ## ALLERGIES:
Sulfa (Sulfonamide Antibiotics) / Tetracycline
## CHIEF COMPLAINT:
fall and right shoulder pain
## HISTORY OF PRESENT ILLNESS:
yo M with RML lung adenocarcinoma, right pleural effusion
(s/p chest tube and pleureX), and mets to brain, liver, bone,
with h/o malignant pleural effusion s/p pleurex removal
presents after a fall with right shoulder pain.
Note pt was recently admitted right
rib fracture noted. Pain regimen of oxycontin was increased and
lidocaine patch and gabapentin were added. He went home with
plan
to bridge to hospice. He also noted pain in the right shoulder
worse than before which was attributed to 6th rib fracture. His
course was complicated by chronic hyponatremia attributed to
SIADH which improved w/ fluid restriction. He was noted to have
a
right sided pleural effusion and a chest tube was placed
followed
by a pleurex.
Regarding his known malignant pleural effusion he is s/p R
tunneled pleural catheter placement (h/o loculated
empyema), with replacement of a second pleurX on the right
given further accumulation of fluid. Original right pleurex was
removed . He was seen in clinic on at which time
he
was feeling better from respiratory standpoint with decreased
cough and noted very minimal drainage from the pleurex.
Accordingly the pleurex was removed at that visit.
Today he states that he was getting a snack in the kitchen and
slipped. Note he recently fell which prompted his last admission
as above, however he states he is not using alcohol and he had a
purely mechanical slip. He did not feel dizzy. He hit the front
of his head but no pain in that area now and no LOC. Fall
witnessed by his girlfriend who wanted him to come to the
hospital last night but he finally came today due to worsening
pain in the right shoulder/scapular region which is where he
landed during the fall. He denies chest pain, shortness of
breath, cough, or fevers. Denies headaches, dizziness,
palpitations. Pain poorly controlled at home wiht his usual dose
of oxycontin/oxycodone so he came to the ED.
ED Course (labs, imaging, interventions, consults):
## - INITIAL VITALS/TRIGGER:
+ Triage 115 133/91 20
98%
- EKG: ST @105, NANI, no STE
- CT cspine showed unchanged T2 and T3 lytic metastatic lesions
with superior endplate compressions and focal lucency through
right pedicle of T2 (cortical erosion from tumor but fracture
not
excluded) all stable from prior.
- CXR showed removal of a chest tube, volume loss in right
hemithorax and oval opacity suggesting loculated pleural
collection, persistent infection not excluded but the only
change
from prior was slightly improved aeration in right mid lung.
Nondisplaced but recent right sided rib fractures of and 5th
ribs which appear unchanged.
- head CT: stable known mets with surrounding edema; no bleed
- new right posterior fourth rib fracture was seen on XR
and
again today.
On the floor he is comfortable but reports continued pain in the
right shoulder/scapula.
## PAST ONCOLOGIC HISTORY:
Right shoulder pain started after a fall
t showed RML mass
SOB started
ED visit for worsening SOB
Chest CT showed RML mass, LAD, right effusion, right 5th
rib fracture
Chest tube placement
## CYTOLOGY:
adenocarcinoma
Admission with fatigue, hyponatremia and ARF
Brain MRI showed many lesions
FDG-PET
Admission for SOB
- WBR-C2 5x4 Gy by Dr.
Pleurodesis
did not receive chemo due to complicated hospital
admission
Brain MRI stable
see HPI for recent hospital admission
## PAST MEDICAL HISTORY:
1. Lung mass, and brain lesions
2. Subdural bleed , craniotomy
3. Hypertension
4. Osteoporosis
5. Pancreatitis
6. Pancreatic duct stricture
7. H. pylori gastritis
8. Diverticular disease
9. Dyslipidemia
## FAMILY HISTORY:
Of his three brothers, one died at with complications of an
infection, and the others are healthy. His mother died in her
with complications of diabetes, and his father is alive. He
quit smoking years ago.
## GENERAL:
NAD resting in bed
## HEENT:
MMM, no OP lesions, no cervical, supraclavicular, or
axillary adenopathy, no thyromegaly
## CV:
RR, NL S1S2 no S3S4 MRG
## PULM:
coarse breath sounds throughout but dullness at right
base, no wheezing
## ABD:
BS+, soft, NTND, no masses or hepatosplenomegaly
## LIMBS:
No edema, clubbing, tremors, or asterixis; no inguinal
adenopathy
## SKIN:
No rashes, pt does have stage I decubitus ulcer over
sacrum/right buttock but only 1-2cm in diameter
## NEURO:
Cranial nerves II-XII are within normal limits excluding
visual acuity which was not assessed, no nystagmus; strength is
of the proximal and distal upper and lower extremities;
reflexes are 2+ of the biceps, triceps, patellar, and Achilles
tendons, toes are down bilaterally; intact coorindation. Fully
oriented x3
DISCHARGE PHYSICAL EXAM
## GENERAL:
Pleasant man lying in bed, AAOx3, in mild distress due
to pain
## HEENT:
MMM, no OP lesions
## CV:
RR, sinus tachycardia, normal S1/S2, no murmurs/rubs/gallps
## PULM:
Coarse breath sounds throughout but dullness at right
base, very coarse rumbling heard over all L lung fields, no
wheezing
## ABD:
BS+, soft, NTND, no masses or hepatosplenomegaly
## LIMBS:
Tender to palpation over R shoulder, back and lateral
chest, but has full ROM in both UEs bilaterally. No edema,
clubbing, tremors, or asterixis
## SKIN:
No rashes, pt does have stage I decubitus ulcer over
sacrum/right buttock but only 1-2cm in diameter
## NEURO:
CN exam grossly intact, some cognitive dysfunction noted
although AOx3
## SCAPULAR X-RAY:
No scapular fracture. Right rib fractures as seen on chest
x-ray.
## FINDINGS:
A chest tube was removed. There is similar volume
loss in the
right hemithorax with an oval opacity suggesting a loculated
pleural
collection as well as the possibility of a small more
free-flowing type of pleural effusion at the base of the right
chest as well as areas of scarring and atelectasis. Findings
associated with a known malignancy are not optimally assessed
with radiographs and persistent infection is not excluded;
however, the only change is slightly improved aeration in the
right mid lung since the more recent of the comparison studies.
Non-displaced but recent right-sided rib fractures involving the
fourth and fifth ribs appear unchanged.
## CT C-SPINE:
1. No cervical spine fracture or malalignment. Degenerative
changes as above.
2. Unchanged appearance of T2 and T3 with lytic metastatic
lesions with
superior endplate compressions, unchanged. Focal lucency
through the right pedicle of T2, potentially due to cortical
erosion from tumor although prior fracture is not entirely
excluded.
## CT HEAD:
1. No evidence of new intracranial hemorrhage. No evidence of
fracture.
2. Known intracranial metastases with surrounding edema are
again demonstrated and unchanged in appearance from .
## BRIEF HOSPITAL COURSE:
yo M with metastatic lung adenocarcinoma (to brain, liver,
bone), malignant right pleural effusion (s/p chest tube and
pleureX removed , presents after a fall with persistent
right shoulder pain.
# RIGHT SHOULDER PAIN AND RIB FX: Per shoulder and chest XR in
ED, pt has a right sided fourth rib fracture now in addition to
the known 6th rib fracture. However, that was present on XR
that he had done for clinic visit, which seems to predate the
fall, so likely this was a new pathologic fracture. He also may
have some irritation from loculated pleural effusion (see
below). Pt has full range of motion and no fevers, nothing to
suggest an infectious etiology or more serious trauma to the
joint in addition to the rib fractures. He recieved pamidronate
60mg x1 as this is helpful for pathologic fractures in
metastatic disease but also will help with pain in that setting,
doesn't appear pt has received this before. Per Palliative Care
recs, giving home oxycontin, increased to 60/60/60 (as of
due to increased pain requirements), home gabapentin increased
to , and home oxycodone and lidocaine patch. His pain
was better controlled and he was stable for discharge.
## # FALLS:
History not c/w syncope, seems clearly mechanical.
However pt has had two falls prompting hospital admission with
fractures in the last 2 weeks which raises concerns for
underlying pathology. Known brain lesions and last MRI showed
small cerebellar mets which could be progressing.
## # PLEURAL EFFUSION:
S/p pleurex removal . On CXR seems
loculated. No fevers or imaging to suggest infectious process.
Pt has h/o empyema. Will likely need a chest CT to characterize
loculated effusions however given clinical stability this is not
warranted urgently, will discuss with primary oncologist
## # BRAIN METS:
C/b seizure previously. No signs of progression on
CT, but last MRI showed small cerebellar mets. No changes in
neuro exam from last admission. We continued home keppra for
seizure prophylaxis, dexamethasone for cerebral edema, and
atovaquone/acyclovir ppx while on dexamethasone
## # METASTATIC LUNG ADENOCARCINOMA:
Pt has not received chemo yet.
His outpatietn oncologists were informed of his admission and he
has multidisipinary follow-up 2 days after discharge. Note pt
had been DCd with bridge to hospice so DNR/DNI discussion should
take place, however family deferring until one of his sons can
get here.
## # T2/T3 ENDPLATE COMPRESSIONS:
Apparently stable. No signs on
imaging or clinical exam of cord compression. Doesn't appear to
be causing much back pain.
## TRANSITIONAL ISSUES:
====================
- S/p a second mechanical fall in 2 weeks, seen on imaging to
have two pathologic fractures in and 6th ribs causing severe
R sided shoulder/chest wall pain
- Adjusted pain med regimen to oxycontin 60/60/60, oxycodone 15
prn, gabapentin . At f/u, should consider adding
fentanyl patch as pt sometimes gets behind on pain management
upon waking in the morning; may also require increase in
oxycontin schedule
- evaluation for repeat falls, recommended placement in
rehab after discharge, family amenable
- Put on lovenox injections for DVT prophylaxis while admitted,
which should be continued at rehab facility until pt is out of
bed and ambulating
- Has multidisciplinary oncology appt on w/ Dr. ,
has been made aware of this admission
- Pt and family have elected to defer changing code status from
"full" after pt's brother can get in from overseas on AM of
- Will likely need a chest CT to characterize loculated
effusions at some point in the future, however given clinical
stability this was not warranted urgently. Should f/u w/ primary
oncologist Dr.
- followed by Palliative Care , NP), has
previously been resistant to discussions about code
status/hospice care/goals of care/end of life issues but seemed
more open to these topics on this admission. Conversation on
these topics should be continued at f/u oncology appts
## CODE STATUS:
Full for now, addressed w/ pt and pt's
daughter/HCP, who would like to defer decision until her brother
gets here later this week.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. OxyCODONE SR (OxyconTIN) 40 mg PO Q8H
2. OxycoDONE (Immediate Release) 15 mg PO Q2H:PRN pain
3. LeVETiracetam 1500 mg PO BID
4. Atovaquone Suspension 1500 mg PO DAILY
5. Dexamethasone 4 mg PO DAILY
6. FoLIC Acid 1 mg PO DAILY
7. Gabapentin 100 mg PO TID
8. Lidocaine 5% Patch 1 PTCH TD QAM
9. Lorazepam 0.5 mg PO Q4H:PRN SOB/anxiety
10. Omeprazole 40 mg PO DAILY
11. Docusate Sodium 100 mg PO DAILY
12. Polyethylene Glycol 17 g PO DAILY:PRN constipation
## DISCHARGE MEDICATIONS:
1. Atovaquone Suspension 1500 mg PO DAILY
2. Dexamethasone 4 mg PO DAILY
3. Docusate Sodium 100 mg PO DAILY
4. FoLIC Acid 1 mg PO DAILY
5. Gabapentin 100 mg PO BID
RX *gabapentin 100 mg capsule(s) by mouth every 8 hours Disp
#*20 Capsule Refills:*0
6. Gabapentin 300 mg PO HS
Gabapentin 100 @ 8am
Gabapentin 100 @ 4pm
Gabapentin 300 @ 12am
7. LeVETiracetam 1500 mg PO BID
8. Lidocaine 5% Patch 2 PTCH TD QAM
RX *lidocaine [Lidoderm] 5 % (700 mg/patch) apply 2 patches to
skin over area of pain every morning Disp #*8 Patch Refills:*0
9. Lorazepam 0.5 mg PO Q4H:PRN SOB/anxiety
RX *lorazepam 0.5 mg 1 tablet by mouth every 4 hours Disp #*24
## TABLET REFILLS:
*0
10. Omeprazole 40 mg PO DAILY
11. OxycoDONE (Immediate Release) 15 mg PO Q2H:PRN pain
RX *oxycodone 15 mg 1 tablet(s) by mouth every 2 hours Disp #*48
## TABLET REFILLS:
*0
12. OxyCODONE SR (OxyconTIN) 60 mg PO TID
RX *oxycodone [OxyContin] 60 mg 1 tablet(s) by mouth every 8
hours Disp #*12 Tablet Refills:*0
13. Polyethylene Glycol 17 g PO DAILY:PRN constipation
14. Acetaminophen 1000 mg PO Q8H
15. Enoxaparin Sodium 40 mg SC Q12H
## TODAY - , FIRST DOSE:
Next Routine Administration
Time
Continue until pt OOB and ambulating.
RX *enoxaparin 40 mg/0.4 mL 1 syringe SC daily Disp #*4 Syringe
## DISCHARGE DIAGNOSIS:
Metastatic Lung Adenocarcinoma
Pathologic Rib Fractures
Chronic Pain
Repeated Falls
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of at .
came to us after suffered from an accidental fall, and
had an increase in your chronic right shoulder pain. Your pain
is likely from spread of your cancer into the bones of your
right shoulder and chest, so we gave a shot to help
strengthen your bones and worked with your pain medication
regimen to try to get your pain under better control. also
were evaluated by , who feels would do best after
discharge at a rehabilitation facility where could
consider getting more .
Please note the medication changes and follow-up appointments
scheduled for , as detailed below.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "12117907", "visit_id": "29427469", "time": "2151-10-30 00:00:00"} |
17326187-RR-22 | 870 | ## INDICATION:
year old man with atrial fibrillation for evaluation of
pulmonary veins prior to pulmonary vein isolation procedure.
## RHYTHM:
atrial fibrillation
CMR Measurements
Measurement Male Normal
Range
LV End-Diastolic Dimension (mm) 58 <62
LV End-Diastolic Dimension Index (mm/m2) 28 <32
LV End-Systolic Dimension (mm) 43
LV End-Diastolic Volume (ml) 135 <196
LV End-Diastolic Volume Index (ml/m2) 66 <95
LV End-Systolic Volume (ml) 58
LV Stroke Volume (ml) 77
LV Ejection Fraction (%) 57 >54
LV Anteroseptal Wall Thickness (mm) 7 <12
LV Inferolateral Wall Thickness (mm) 4 <11
LV Mass (g) 85
LV Mass Index (g/m2) 41 <80
RV End-Diastolic Volume (ml) 160
RV End-Diastolic Volume Index (ml/m2) 78 <114
RV End-Systolic Volume (ml) 83
RV Stroke Volume (ml) 77
RV Ejection Fraction (%) 48 >46
Aortic Valve Area (2-D) (cm2) 4.4 >3.0
Aortic Valve Area Index (cm2/m2) 2.1
Ascending Aorta diameter (mm) 33 <39
Ascending Aorta diameter Index (mm/m2) 16 <20
Transverse Aorta diameter (mm) 23 <31
Descending Aorta diameter (mm) 23 <28
Descending Aorta Index (mm/m2) 11 <14
Main Pulmonary Artery diameter (mm) 21 <29
Main Pulmonary Artery diameter Index (mm/m2) 10 <15
Left Atrium (Parasternal Long Axis) (mm) **52 <40
Left Atrium Length (4-Chamber) (mm) ***72 <52
Right Atrium (4-Chamber) (mm) ***72 <50
Pericardial Thickness (mm) 3 <4
Coronary Sinus diameter (mm) 9 <15
Pulmonary Vein
Left Common (mm) 41x9
Right Lower (mm) 21x14
Right Upper (mm) 34x25
PV Cross-Sectional Area
Left Common (mm2) 337
Right Lower (mm2) 248
Right Upper (mm2) 667
* = Mildly abnormal, ** =moderately abnormal, *** = severely abnormal
## EGFR:
>60 ml/min1.73m2 based on creatinine 0.76 mg/dl on
Total Gd-DTPA (Magnevist ) contrast: 35 ml (0.2 mmol/kg)
Injection site: Right cephalic vein
## 1) STRUCTURE:
Axial dual-inversion T1-weighted images of the myocardium were
obtained without spectral fat saturation pre-pulses in 5-mm contiguous slices.
2) Function: Breath-hold cine SSFP images were acquired in the left
ventricular 2-chamber, 4-chamber, horizontal long axis, short axis slices (8-
mm slices with 2-mm gaps), sagittal and coronal orientations of the left
ventricular outflow tract, and aortic valve short axis orientations. Breath-
hold real time SSFP images were acquired in the left ventricular 2-chamber, 4-
chamber, and mid-papillary short axis slices.
3) Pulmonary Vein MRA: First pass angiography of the pulmonary veins (PV) was
obtained after administration of a bolus of gadopentetate dimeglumine 0.2
mmol/kg (24 ml Magnevist solution). Multiplanar reconstructions of the
pulmonary veins were generated and assessed on a workstation.
4) : Late gadolinium enhancement (LGE) images were obtained using
a 3D free-breathing ECG-gated segmented inversion-recovery TFE acquisition in
the axial plane 20 minutes after injection of a total of 0.2 mmol/kg
gadopentetate dimeglumine (24 ml Magnevist solution) with spectral fat
saturation pre-pulses.
## FINDINGS:
Structure and Function
There was normal epicardial fat distribution. The pericardial thickness was
normal. There were no pericardial or pleural effusions. The origins of the
left main and right coronary arteries were identified in their customary
positions. The indexed diameters of the ascending and descending thoracic
aorta were normal. The main pulmonary artery diameter index was normal. The
left atrial AP dimension was moderately increased. The right and left atrial
lengths in the 4-chamber view were severely increased. The coronary sinus
diameter was normal.
The left ventricular end-diastolic dimension index was normal. The end-
diastolic volume index was normal. The calculated left ventricular ejection
fraction was normal at 57% with normal regional systolic function. The
anteroseptal and inferolateral wall thicknesses were normal. The left
ventricular mass index was normal. The right ventricular end-diastolic volume
index was normal. The calculated right ventricular ejection fraction was
normal at 48%, with normal free wall motion.
The aortic valve was tri-leaflet with normal valve area.
Pulmonary Vein MR
Two right-sided pulmonary veins and one (common) left-sided pulmonary vein
were identified, all entering the left atrium and free of focal stenoses
listed above). The multiplanar reconstructions confirmed the above
findings.
Left Atrial Fibrosis
High-resolution late gadolinium enhancement images of left atrium demonstrated
no focal enhancement of the atrial wall or ostia of the pulmonary veins.
Non-Cardiac Findings
There was a focus in the liver, which likely represents a cyst or hemangioma.
There were also anterior compression deformities in the mid to lower thoracic
spine and thoraco-lumbar junction and a small hiatal hernia.
## IMPRESSION:
1. Normal left ventricular cavity size with normal regional left ventricular
systolic function. The LVEF was normal at 57%.
2. Normal right ventricular cavity size and systolic function. The RVEF was
normal at 48%.
3. The indexed diameters of the ascending and descending thoracic aorta were
normal. The main pulmonary artery diameter index was normal.
4. Severe biatrial enlargement.
5. Normal size and orientation of the pulmonary veins without MR evidence of
anomalous pulmonary venous return or pulmonary vein stenosis.
6. Liver focus, which likely represents a cyst or hemangioma. Anterior
compression deformities in the mid to lower thoracic spine and thoraco-lumbar
junction. Small hiatal hernia.
The images were reviewed by Drs. , and
.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17326187", "visit_id": "N/A", "time": "2171-01-21 08:16:00"} |
11754710-RR-17 | 117 | ## FINDINGS:
Six radiographs in this series of both feet, and 3 radiographs of
each knee were obtained.
## RIGHT FOOT:
Joint spaces are preserved. There is no acute fracture. Mild
second DIP subluxation is noted.There is mild tibiotalar degerative osteophyte
formation. An os peroneum is incidentally noted.
## LEFT FOOT:
There is no acute fracture. Mild first MTP osteoarthritis is
noted. Alignment is satisfactory.
## RIGHT KNEE:
Minimal sharpening of the tibial spines and patellar osteophyte formation is
seen. No effusion, fracture or malalignment.
## LEFT KNEE:
Minimal sharpening of the tibial spines and mild patellar osteophyte
formation. No effusion, malalignment or fracture.
## IMPRESSION:
No erosions in either foot to suggest gouty arthropathy.
Early bilateral knee patelofemoral osetoarthritis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11754710", "visit_id": "N/A", "time": "2130-06-24 10:09:00"} |
13039821-RR-19 | 295 | ## INDICATION:
woman with necrotizing fasciitis and septic shock,
assess for infectious process.
## DOSE:
Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
## FINDINGS:
The study is somewhat limited due to motion artifact.
An ET tube is in place, terminating approximately 2 cm above the carina. An
enteric tube is in place, terminating below the diaphragm. A right IJ catheter
terminates in the mid SVC.
## NECK, THORACIC INLET, AXILLAE:
The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged. Soft tissue defect
and subcutaneous emphysema in the left supraclavicular soft tissues is
consistent with recent surgical intervention.
## MEDIASTINUM:
Mediastinal lymph nodes are not enlarged.
## HILA:
Hilar lymph nodes are not enlarged.
## HEART:
The heart is not enlarged and there is no coronary arterial
calcification. There is no pericardial effusion.
## VESSELS:
Vascular configuration is conventional. Aortic caliber is normal.
The main, right, and left pulmonary arteries are normal caliber.
## PULMONARY PARENCHYMA AND PLEURA:
There are bilateral basilar atelectasis with
associated small bilateral pleural effusions. There is no emphysema.
## AIRWAYS:
The airways are patent to the subsegmental level bilaterally.
## CHEST WALL AND BONES:
There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild.
## UPPER ABDOMEN:
Please see separately submitted Abdomen and Pelvis CT report
for subdiaphragmatic findings.
## IMPRESSION:
1. Bilateral compressive atelectasis with associated small bilateral pleural
effusions.
2. No intrathoracic infectious source is identified.
3. Subcutaneous emphysema in the left supraclavicular soft tissue is
consistent with recent surgical intervention.
4. Please refer to separate report of Abdomen and Pelvis CT performed same day
for subdiaphragmatic findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13039821", "visit_id": "22851533", "time": "2163-02-25 14:55:00"} |
11263908-RR-6 | 284 | ## INDICATION:
female with chest pain and tortuous aorta on chest
radiograph.
## CT THORAX:
The thyroid gland is within normal limits. The airways are patent
to the subsegmental level but show mild wall thickening, probably
inflammatory, also accompanied by mild mosaic appearance of lung attenuation.
There is no mediastinal, hilar, or axillary lymph node enlargement by CT size
criteria. The heart, pericardium and great vessels are within normal limits.
No esophageal abnormality is identified. No pleural effusion or pneumothorax
is present. There has been mastectomy with a saline implant on the left.
Within the inferior aspect of the left lower lobe, there is a 4 mm nodule
noted (5:158). An additional left lower lobe nodule measures 3 mm (3:199).
Lastly, a nodule at the left lung apex measures 2 mm in diameter (3:42).
## CTA THORAX:
The upper descending aorta is very mildly ectatic measuring up to
29 mm in diameter although doubtful in significance with slight unfolding.
The pulmonary arteries are opacified to the subsegmental level. There is no
filling defect to suggest pulmonary embolism.
The examination not tailored for evaluation of solid diaphragmatic officer,
limited evaluation demonstrates a 1.9 x 1.9 cm hypodensity within the left
hepatic lobe (2:96) consistent with a simple benign cyst.
There are no suspicious bone lesions.
## IMPRESSION:
1. Very mild ectasia of the proximal descending aorta (28 mm in diameter).
Minimally tortuous.
2. No evidence of pulmonary embolism.
3. Left hepatic cyst which appears simple and benign.
4. Few small left lung nodules measuring up to 5 mm. Although scattered
incidental nodules are common, but close follow-up is recommended in three
months with chest CT given history of known malignancy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11263908", "visit_id": "27979925", "time": "2160-07-20 21:35:00"} |
12432545-RR-36 | 184 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
man with Coronary artery disease and presenting with
cough. Evaluate for pneumonia or congestive heart failure.
## FINDINGS:
The lungs are well-expanded. The opacity in the region of the left upper
hemithorax is increased in size from the prior exam. No focal consolidation to
suggest pneumonia. No pleural effusion, pneumothorax, or pulmonary edema. The
cardiomediastinal silhouette is unchanged. Stable tortuosity of thoracic
aorta. The leftward deviation of the trachea with associated narrowing of the
lumen appears stable and is consistent with a thyroid goiter. Stable
appearance of the hila.
## IMPRESSION:
1. No acute cardiopulmonary process.
2. Interval increase in the left upper hemithorax opacity, which may be
intraparenchymal or a pleural plaque. Recommend further evaluation with a
chest CT.
3. Stable leftward deviation of the trachea, likely from thyroid goiter.
When the chest CT is performed for the left upper lung opacity, this could be
simultaneously evaluated.
## NOTIFICATION:
The findings were discussed by Dr. with Dr.
, the referring provider requesting wet read, on the telephone on
at 4:42 , 2 minutes after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12432545", "visit_id": "N/A", "time": "2117-08-26 15:15:00"} |
19634412-RR-40 | 170 | ## TYPE OF EXAMINATION:
Chest AP portable single view.
## INDICATION:
female patient with questionable pneumonia.
Evaluate.
## FINDINGS:
AP single view of the chest has been obtained with patient in
sitting upright position. Analysis is performed in direct comparison with the
next preceding PA and lateral chest examination of . On the
previous examination the findings were considerably within normal limits. On
the present single view examination the heart shadow is moderately larger. No
typical configurational abnormalities identified and the pulmonary vasculature
is not congested. There is crowded vasculature on the bases but no conclusive
evidence of acute parenchymal infiltrates can be identified and the lateral
pleural sinuses are free. No pneumothorax is present.
Comparison with the previous normal chest examination demonstrates the
limitations of this portable examination as the patient made a very shallow
inspirational effort with crowded pulmonary vasculature. To exclude a
possible local infiltrate is limited on this single examination and a routine
PA lateral chest examination is recommended considering the questionable
pneumonia as indicated on the requisition.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19634412", "visit_id": "20170715", "time": "2146-09-01 11:22:00"} |
16495075-RR-20 | 71 | ## HISTORY:
woman with left upper quadrant pain for two days. The
patient is status post laparoscopic band.
## IMPRESSION:
1. Laparoscopic band surrounding the cardia of the stomach, just below the
gastroesophageal junction. Oral contrast passes through the laparoscopic band
into the body of the stomach.
2. Bilateral ovarian cysts. Further evaluation with pelvic ultrasound in 6
weeks is recommended. This finding was emailed to the ED QA nurses on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16495075", "visit_id": "N/A", "time": "2122-08-12 22:35:00"} |
10581673-RR-45 | 118 | ## INDICATION:
year old woman with scoliosis // Please eval
scoliosis***PLEASE DO: AP/LAT VIEWS***
## FINDINGS:
Redemonstrated is a severe compression deformity at L1 with associated severe
kyphosis at the thoracolumbar junction. Posterior stabilization hardware is
unchanged in appearance when compared to the prior study. Kyphoplasty cement
at L1 and L2, unchanged from the prior. Again seen are superior endplate
irregularities of T11, T12 and L2.. There is dextroscoliosis at the
thoracolumbar junction similar to with mild positive coronal
imbalance seen. The visualized lung fields are clear.
## IMPRESSION:
Redemonstrated postsurgical changes of posterior stabilization at the
thoracolumbar junction, for L1 compression fracture, in unchanged alignment
and without further height loss seen.
Mild dextroscoliosis at the thoracolumbar junction .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10581673", "visit_id": "N/A", "time": "2131-10-30 14:05:00"} |
10433099-RR-135 | 115 | ## REASON FOR EXAMINATION:
Followup of the patient with respiratory failure
after pulseless electrical activity arrest.
Portable AP chest radiograph was compared to .
ET tube tip is approximately 6.5 cm above the carina. The right PICC line tip
is at the level of low SVC. The NG tube tip passes below the diaphragm, most
likely terminating in the stomach. Cardiomediastinal silhouette is stable.
Lungs are essentially clear. There is interval improvement of the right upper
lobe opacity seen on the prior study obtained yesterday at 05:10 a.m.
There is no evidence of failure. There is no increase in pleural effusion and
there is also no pneumothorax demonstrated on the current study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10433099", "visit_id": "28593361", "time": "2149-01-09 04:23:00"} |
17083316-RR-12 | 201 | ## EXAMINATION:
MRI of the left calf.
## INDICATION:
year old woman with history of repeat trauma to her left shin
with open wound and ultrasound showing fluid collection. Orthopedics
requesting MRI to better evaluate abscess vs. hematoma and extent of muscle
involvement// ? hematoma vs. abscess, question muscle involvement. Wound is
anterior shin/tibia
##
SOFT TISSUE:
There is a mildly T1 hyperintense STIR hyperintense rim enhancing
collection within the anterior aspect of the left leg measuring approximately
8.5 x 1.8 x 7.7 cm within its maximal dimension that could represent an
organized hematoma, however superimposed infection cannot be excluded. A skin
defect is noted within the anterior aspect of the midportion of the leg, which
is contiguous with the collection.
## MUSCLES:
Fatty atrophy of the medial gastrocnemius muscle is likely from old
injury. Otherwise, normal signal intensity.
## BONE MARROW:
No signal abnormality to suggest osteomyelitis. Mild subchondral
edema is noted within the bilateral tibial plateau secondary to degenerative
changes.
## IMPRESSION:
8.5 x 1.8 x 7 collection within the subcutaneous tissue of the anterior aspect
of the left leg could represent an organized hematoma, however superimposed
infection cannot be excluded. No evidence of muscle or bony involvement.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17083316", "visit_id": "20596397", "time": "2140-08-21 14:37:00"} |
12166185-RR-118 | 93 | ## EXAMINATION:
BILATERAL DIGITAL 2D AND 3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAM
INTERPRETED WITH CAD
## INDICATION:
woman with history of bilateral breast cancer status
post breast conservation therapy.
## TISSUE DENSITY:
C- The breast tissue is heterogeneously dense which may
obscure detection of small masses.
Stable postoperative changes are visualized within the bilateral breasts.
There is no suspicious dominant mass, unexplained architectural distortion, or
grouped microcalcifications in either breast.
## IMPRESSION:
No specific mammographic evidence of malignancy.
## RECOMMENDATION(S):
Age and risk appropriate screening.
## NOTIFICATION:
Findings reviewed with the patient at the completion of the
study.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12166185", "visit_id": "N/A", "time": "2200-02-27 09:12:00"} |
15447353-RR-41 | 393 | ## INDICATION:
year old woman with metastatic RCC, dyspnea, tachycardia and
signs of heart strain// eval for PE
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 9.2 mGy (Body) DLP = 1.8
mGy-cm.
2) Stationary Acquisition 2.1 s, 0.2 cm; CTDIvol = 34.6 mGy (Body) DLP =
6.9 mGy-cm.
3) Spiral Acquisition 4.9 s, 31.8 cm; CTDIvol = 6.9 mGy (Body) DLP = 206.2
mGy-cm.
Total DLP (Body) = 215 mGy-cm.
## FINDINGS:
Apparent hypodensity located at the junction of left atrium and posterior left
pulmonary vein (4:75). Otherwise, the aorta and its major branch vessels are
patent, with no evidence of stenosis, occlusion, dissection, or aneurysmal
formation.
Central filling defect within the right lower lobe subsegmental artery and
possibly within subsegmental lingular branches in the left lung. The
remainder of the pulmonary arteries are well opacified to the subsegmental
level.The main and right pulmonary arteries are normal in caliber, and there
is no evidence of right heart strain.
There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.
The thyroid gland appears unremarkable. Multiple enlarged paraesophageal
lymph nodes, the largest of which measures up to 14 mm (04:53)
Small to moderate left lower lobe of pleural effusion. Patchy left lower lobe
consolidation with air bronchograms, concerning for pneumonia in the
appropriate clinical setting. The airways are patent to the subsegmental
level.
Limited images of the upper abdomen demonstrates innumerable hepatic,
mesenteric and pelvic metastatic nodules in this patient with known history of
RCC. These have increased in size in number in comparison to the prior CT
chest dated , most notably throughout the liver.
No lytic or blastic osseous lesion suspicious for malignancy is identified.
## IMPRESSION:
1. Right lower lobe segmental pulmonary embolism. No central pulmonary
embolism or evidence of right heart strain.
2. Apparent hypodensity located at the junction of left atrium and posterior
left pulmonary vein. Correlation with echocardiogram is recommended to
exclude thrombus.
3. Patchy left lower lobe consolidation with air bronchograms, concerning for
pneumonia in the appropriate clinical setting.
4. Interval progression of widespread metastatic to the liver and mesentery,
increased since .
5. Paraesophageal lymphadenopathy measuring up to 14 mm.
## NOTIFICATION:
The findings were discussed with Dr. by Dr.
, . on the telephone on at 9:08 pm, 2 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15447353", "visit_id": "24378498", "time": "2122-08-16 21:27:00"} |
14729260-RR-68 | 170 | ## INDICATION:
A woman with lymphoma. New onset dizziness.
## FINDINGS:
There is no evidence of infarct. There is a 6-mm focus of
susceptibility artifact in the posterior right pons at the level of the middle
cerebellar peduncle; on T2 it is centrally bright with a rim of dark signal.
There is no associated FLAIR signal abnormality. There is possible minimal
associated linear enhancement after gadolinium. Review of CT neck from
demonstrates no calcifications in this location. There is
no mass effect or enhancing mass. There are nonspecific T2/FLAIR
hyperintensities in the periventricular and deep white matter, which are
nonenhancing. The signal within the bone marrow is within normal limits. The
paranasal sinuses are clear.
## IMPRESSION:
1. 6-mm focus of susceptibility artifact in the posterior right pons likely
represents a cavernoma; questionable associated developemental venous anomaly.
2. No evidence of enhancing mass or mass effect.
3. Nonspecific nonenhancing T2/FLAIR hyperintensities in the periventricular
white matter may reflect chronic small vessel ischemic disease in this age
group.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14729260", "visit_id": "N/A", "time": "2197-04-03 12:51:00"} |
19457519-DS-6 | 800 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Left medial knee mass resection and MCL reconstruction
## HISTORY OF PRESENT ILLNESS:
is a cooperative gentleman who complaints of
pain and stiffness, left knee since . He was apparently
alright before that time when he met with an accident in
. He was hit by a jeep and the bumper hit him
around the knee, left side. After that he was taken to the
emergency room at where he was diagnosed with
sprain in the knee and was discharged after painkillers and
x-ray. After that he developed a swelling in the left knee,
medial aspect. The swelling has been present there constantly
since then and has not increased in size as per patient. As per
patient, his knee swelling and pain is present since
after the trauma and he had no joint pain before that. The pain
is constantly present and about in intensity, but it
becomes more and more when the patient starts walking on it and
when the patient does activity. The pain becomes in
intensity after walking a couple of blocks and then he has to
sit and take rest and only after taking rest, he can walk
further distance. The
knee also gets stiff on prolonged sitting and he has to move
around the knee before he can even start walking. His range of
movement of the knee has also been affected slowly and gradually
since that time. His knee gave way in of this year when
he was taken to the BI Emergency where an x-ray was done. He
was then sent to under the care of Dr.
took an x-ray and an MRI and then the patient was referred
here to our service. The range of movement and stiffness of the
knee has been present there since , but has increased
presently in the past six months. He seems to be in
considerable distress and emotional trauma due to this pain and
stiffness. There is no history of any fever or discharge from
that site.
There is no history of patient being hospitalized for that
trauma. There is no history of any other joint pain. There is
no history of any surgery being done on the patient.
## FAMILY HISTORY:
There is history of cancer in both father and grandfather with
prostate cancer. There is history of heart disease and diabetes
in the family as well.
## LLE:
-Incision without drainage or erythema
-Hip flex, knee flex/ext, ankle DF/PF, intact
-New decreased sensation around the knee. Baseline decreased
sensation in the foot.
-Palpable pulse
## BRIEF HOSPITAL COURSE:
The patient was admitted following surgery. He worked with
POD 1 and performed very well. His block wore off over the
remainder of the day and he had increasing pain. The pain was
tolerable. He was seen by the Hospitalist service as advised by
anesthesia regarding his HTN. He was recommended to follow up
with his PCP for further blood pressure management control. POD
2 he worked once again with and his dressing was changed and
his drain removed. His incision was benign. POD 3 he was
deemed medically stable for DC to home and had cleared for a
safe discharge to home. He was provided a prescription for
outpatient and pain medications.
## MEDICATIONS ON ADMISSION:
Lisinopril 20mg once daily
Bupropion 100mg twice daily
## DISCHARGE MEDICATIONS:
1. Docusate Sodium 100 mg Capsule Sig: Capsules PO BID (2
times a day) as needed for constipation.
Disp:*40 Capsule(s)* Refills:*1*
2. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous
DAILY (Daily) for 2 weeks.
Disp:*14 * Refills:*0*
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Bupropion 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Hydromorphone 2 mg Tablet Sig: Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
6. Outpatient Physical Therapy
Please work on endurance, gait, and gaining extension. Patient
has baseline 20 degree knee flexion contracture. ROM for knee
should be degrees. He is weight bearing as tolerated.
7. Walker
## DISCHARGE INSTRUCTIONS:
You had a left medial knee mass resected and medial collateral
ligament reconstruction. You should keep your incision dry for
5 days. After that you may get it wet in the shower but you may
not soak it for 3 weeks. You should change your dressing daily
for the week following surgery with a dry sterile dressing.
Leave the steristrips in place (white pieces of tape).
Watch for signs of infection. These include increasing pain,
drainage and increasing redness surrounding your incision.
You are allowing to put all of your weight on your left leg but
do not bend you knee past 50 degrees.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19457519", "visit_id": "24492140", "time": "2130-04-14 00:00:00"} |
18841180-DS-19 | 752 | ## HISTORY OF PRESENT ILLNESS:
yo M with no significant PMH presents with worsening right
shin swelling and redness that started on . He does not
remember any trauma or insect bite to the area but noticed a
small area roughly the size of a pinhead that was red with black
center. Pt relates accompanying pain and notes that the initial
area of 'bite' increased as well as the erythema extending
around the focal area with streaking up his right leg to his
groin. Pt tried topical Bendryl and peroxide as well as manually
compressing the area to expel fluid or pus but none of the
methods were helpful. Pt denies any fever, chills, nausea, or
vomiting. He says that he has pain in his right shin with
ambulation and not with rest.
In the ED, initial VS were: 98.8 86 139/87 16 100. Patient was
given IV vancomycin. Pt experienced shortness of breath with
vancomycin administration and it was stopped. This AM,
lymphangitic streaking was still visible into right groin.
Remained afeb, VS on transfer 97.6 117/85 71 16 100% on RA.
On the floor, pt says that the area 'looks worse than it ever
has before'. He still related pain but did not feel it warranted
pain medication.
Review of sytems:
(+) 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.
## PAST MEDICAL HISTORY:
- Acid reflux
- Hemorrhoids
## FAMILY HISTORY:
- High cholesterol both sides of family
## HEENT:
Sclera anicteric, MMM, oropharynx clear
## NECK:
Supple, no JVD elevation
## LUNGS:
No wheezing, crackles, rales
## CV:
RRR, S1S2, no murmurs/rubs/gallops
## ABDOMEN:
soft, NT, ND, bowel sounds present
## EXT:
R leg +1 edema. Warm, well perfused, 2+ pulses
## SKIN:
R anterior shin ~1cm focal red blister with fluid inside.
Right erythematous with streaking of inner leg to groind.
Palpable lymph node at groin. R shin edematous and warm to
touch. No open lesions. Pulses b/l .
## NEURO:
CN II-XII intact. Protective sensations intact.
## BRIEF HOSPITAL COURSE:
# RLE Cellulitis - Pt received x2 doses of Linezolid while
in-house. Following abx administration, lymphangitic streaking
as well as erythema and edema of his right lower extremity began
to improve in appearance. Pt remained afebrile while in-house
and did not require any pain management during the duration of
his stay. On discharge from the hospital, pt denied any pain and
was given prescriptions for oral antibiotics (Keflex and
Bactrim) for a linical appearance of RLE
cellulitis was much improved from initial presentation. Blood
cultures and MRSA screening were pending on his discharge.
Pt was given x1 dose of Vancomycin in ED; he experienced
shortness of breath and itchiness following administration.
Allergy to Vancomycin has been documented in OMR and POE and
related to the pt.
# Acid reflux - Pt was asymptomatic while in-house. He continued
his home regimen of Omeprazole.
## DISCHARGE MEDICATIONS:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
2. Bactrim DS 800-160 mg Tablet Sig: Two (2) Tablet PO twice a
day for 7 days.
Disp:*28 Tablet(s)* Refills:*0*
## 3. KEFLEX MG CAPSULE SIG:
One (1) Capsule PO every six (6)
hours for 7 days.
Disp:*28 Capsule(s)* Refills:*0*
## PRIMARY:
Right lower extremity cellulitis
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital with right leg swelling and
pain. While you were at the hospital, you were given iv
antibiotics and the streaking up your right leg as well as the
infection in your right leg improved. You remained afebrile
while in-house.
You may have an allergy to Vancomycin. You should avoid using
this antibiotic in the future.
Changes in Medication:
- You should take 2 tabs Bactrim DS orally twice a day for 7
days total.
- You should take 1 tab orally Keflex every 6 hours for 7 days
total.
- Take can take Tylenol if you experience any pain.
- If the blister on your right leg deroofs, you should gently
wash the area with warm water and soap. Let the area air dry and
then cover with dry dressings.
If you develop any of the symptoms listed below or anything else
concerning to you contact your PCP or go to your nearest
emergency room.
Please keep all follow up appointments.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18841180", "visit_id": "25741502", "time": "2172-02-10 00:00:00"} |
18662708-RR-141 | 234 | ## REASON FOR EXAM:
Follow up pulmonary nodules seen in prior PET-CT.
PET-CT was performed on . and CT from
## FINDINGS:
A subpleural rounded opacity in the right upper lobe measures 5 mm (4, 51)
could be an area of atelectasis, new from prior study. There is diffuse mild
air trapping. A ground-glass nodular opacity in the left lower lobe measuring
12 mm (4, 185) is likely an area of atelectasis, but attention on followup
studies is recommended. 4-mm nodule in the left lower lobe (4, 113) is stable
since . Right lower lobe atelectasis is unchanged.
The airways are patent to the subsegmental level. There is no large
mediastinal, hilar, or axillary lymph node, though evaluation of a small hilar
lymphadenopathy is limited due to the lack of IV contrast. The main pulmonary
artery is dilated as before measuring 4 cm, suggesting pulmonary hypertension.
There is mild cardiomegaly. The aorta is normal in caliber. There is no
pleural or pericardial effusion.
This examination is not tailored for subdiaphragmatic evaluation. The patient
is status post cholecystectomy. The right hemidiaphragm is elevated as
before.
There are no bone findings of malignancy.
## IMPRESSION:
Stable left lower lobe lung nodule, no further followup is
recommended.
Peripheral opacity and ground-glass opacity in the right upper lobe and left
lower lobe are most likely atelectasis.
Small airways disease
Dilated main pulmonary artery suggesting pulmonary hypertension.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18662708", "visit_id": "N/A", "time": "2203-04-21 10:52:00"} |
14258949-RR-149 | 87 | ## INDICATION:
M with multiple myeloma, admitted s/p fall with L hip
fracture now s/p ORIF, admission CT with PNA, now with worsening hypoxia//
eval for interval change
## FINDINGS:
Lungs are well expanded. Small bilateral left greater than right pleural
effusions and atelectasis are re-demonstrated. No new consolidations are
identified. There is no pneumothorax. Cardiomediastinal silhouette appears
stable, accounting for patient rotation.
## IMPRESSION:
Small bilateral left greater than right pleural effusions, re-demonstrated.
Superimposed pneumonia at the right lung base cannot be excluded.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14258949", "visit_id": "21506603", "time": "2183-11-26 11:34:00"} |
19861402-RR-5 | 224 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## HISTORY:
with painless jaundice// eval for dilated common
bile duct
## LIVER:
The hepatic parenchyma appears coarsened. The contour of the liver is
smooth. There is no focal liver mass. The main portal vein is patent with
hepatopetal flow. There is trace ascites in the right lower quadrant.
## BILE DUCTS:
There is no intrahepatic biliary dilation. The distal common bile
duct is not visualized.
## GALLBLADDER:
The gallbladder is mildly distended with small amount of sludge,
but without evidence of wall edema or sonographic sign.
## PANCREAS:
The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
## KIDNEYS:
Limited views of the kidneys show no hydronephrosis.
Right kidney: 12.1 cm
Left kidney: 11.7 cm
## RETROPERITONEUM:
The visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
1. Dilated CBD up to 8 mm, with the distal portion is not well assessed.
Findings are new compared to prior CT abdomen pelvis performed
and further evaluation with dedicated MRCP is recommended.
2. Mildly distended gallbladder containing sludge without specific sonographic
findings to suggest acute cholecystitis.
3. Coarsened hepatic parenchyma without evidence of focal liver lesion. There
is probable underlying cirrhosis with evidence of portal hypertension
including trace ascites and splenomegaly.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19861402", "visit_id": "27840398", "time": "2163-09-20 21:41:00"} |
10606601-RR-12 | 141 | ## INDICATION:
One day of worsening right lower quadrant pain.
No comparison studies available.
## FINDINGS:
Included views of the lung bases are clear. There is no
pericardial or pleural effusion. The heart size is normal.
The liver, gallbladder, spleen, pancreas, adrenal glands, kidneys, stomach,
and intra-abdominal loops of small and large bowel are normal. There is no
mesenteric or retroperitoneal lymphadenopathy, and no free air or free fluid.
The appendix measures 6 mm in diameter, with a focus of air in the proximal
segment (104B:63), with no neighboring stranding. Intrapelvic loops of small
and large bowel are normal. There is no intrapelvic free fluid or
lymphadenopathy. The uterus, adnexa, and urinary bladder are normal.
## OSSEOUS STRUCTURES:
There is no acute fracture. No concerning blastic or
lytic lesions are identified.
## IMPRESSION:
No acute intra-abdominal or intra-pelvic process.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10606601", "visit_id": "N/A", "time": "2122-01-12 20:57:00"} |
13564061-RR-23 | 286 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## INDICATION:
Evidence of biliary obstruction vs infection, metastasis. Pl
## LIVER:
The liver echotexture is homogeneous. No focal suspicious liver
lesions are identified. There is no ascites. Multiple hypoechoic lesions are
seen adjacent to the porta hepatis and in the abdomen, which likely represent
enlarged lymph nodes, measuring up to 2.2 cm in short axis. Additional
hypoechoic structure in the mid abdomen noted, measuring 5.1 x 4.4 x 6.7 cm of
uncertain significance.
## BILE DUCTS:
There is no intrahepatic biliary dilatation. The CBD measures 3
mm.
## LIVER DOPPLER:
The main, right, and left portal veins are patent with normal
color Doppler and appropriate hepatopetal flow. The right, middle, and left
hepatic veins are patent with appropriate hepatofugal flow. The main hepatic
artery is patent with normal spectral Doppler waveforms.
The patient is status post splenectomy and left nephrectomy. Limited
evaluation of the right kidney shows multiple hypoechoic lesions, compatible
with cysts. A 1.6 x 1.7 x 1.6 cm heterogeneously hypoechoic lesion in the
right kidney shows internal echoes and is not consistent with a simple cyst.
## IMPRESSION:
Normal hepatic vasculature. Normal gallbladder.
Multiple hypoechoic lesions seen in the porta hepatis likely reflect
adenopathy. Additional indeterminate hypoechoic process in the mid abdomen
could reflect additional mass, less likely prominent bowel loop.
1.7 cm hypoechoic lesion in the midpole of the right kidney shows internal
echoes and is not consistent with a simple cyst. Consider contrast enhanced
CT for further evaluation when clinically appropriate.
## RECOMMENDATION:
CT Torso to assess for adenopathy.
When possible, a multi phase renal CT or MRI could also be performed to assess
the indeterminate interpolar right renal lesion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13564061", "visit_id": "26530519", "time": "2168-03-10 02:54:00"} |
19923383-RR-41 | 95 | ## CHEST:
Frontal and lateral views
## INDICATION:
History: with chest pain// Eval for ptx, pna
## FINDINGS:
The lungs remain relatively hyperinflated. There is bibasilar atelectasis.
Streaky bibasilar opacities are most likely due to atelectasis and overlapping
vascular structures, although developing pneumonia is difficult to exclude in
the appropriate clinical setting. Biapical pleural thickening again seen. No
pleural effusion or pneumothorax is seen. The cardiac and mediastinal
silhouettes are stable.
## IMPRESSION:
Streaky bibasilar opacities are most likely due to atelectasis and overlying
vascular structures, but pneumonia is difficult to exclude in the appropriate
clinical setting.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19923383", "visit_id": "26021355", "time": "2111-12-04 18:11:00"} |
10354034-RR-25 | 521 | MRI OF THE CERVICAL AND LUMBAR SPINES.
## HISTORY:
A male patient status post fall with ongoing back pain.
## MRI CERVICAL SPINE:
The cervical spine vertebral bodies are aligned. The
vertebral body height is maintained. The craniocervical junction appears to
be within normal limits. There is no cord signal abnormality seen.
There is a small amount of fluid seen in the prevertebral soft tissues from
approximately the C3 vertebral body to the level of the C5 vertebral body.
However, no definite evidence of ligamentous injury is identified.
At the C3/C4 level, there are disc osteophyte complexes eccentric to the right
side causing moderate right-sided neural foraminal stenosis. There is mild
left-sided neural foraminal stenosis. There is no high-grade spinal canal
stenosis.
At the C4/C5 level, there are also anterior and posterior spondylytic ridges
with uncovertebral joint hypertrophy bilaterally causing moderate bilateral
neural foraminal stenosis. There is no high-grade spinal canal stenosis.
At the C5/C6 level, there are also disc osteophyte complexes with anterior and
posterior spondylytic ridging more prominent anteriorly. There is no spinal
canal stenosis. There is, however, bilateral moderate neural foraminal
stenosis.
At the C6/C7 level, there are endplate degenerative changes with anterior-
posterior spondylytic ridges. There are disc osteophyte complexes. No high-
grade spinal canal stenosis is seen. There is moderate neural foraminal
stenosis.
At the C7/T1 level, there are very minimal posterior spondylytic ridges
without neural foraminal narrowing or spinal canal stenosis.
## IMPRESSION:
1. Small amount of prevertebral edema. However, no evidence of gross
ligamentous injury.
2. Degenerative changes throughout the cervical spine as described above. No
high-grade spinal canal stenosis. No cord signal abnormality.
## LUMBAR SPINE:
The lumbar spine vertebral bodies are aligned. The vertebral
body height is maintained. The conus terminates at the level of the L1
vertebral body.
At the T12/L1, L1/L2, and L2/L3 levels, there is no disc herniation, spinal
canal stenosis, or neural foraminal stenosis. There is a bright T1 and T2
lesion in the L2 vertebral body, which could represent a focal fatty change or
a fat-containing hemangioma.
At the L3/L4 level, there is mild disc bulging slightly eccentric to the left
side causing mild left-sided neural foraminal narrowing without deformity of
the exiting nerve root. There is no spinal canal stenosis. There is mild
disc desiccation.
At the L4/L5 level, there is minimal disc bulging. There is a small posterior
annular tear. There is no spinal canal stenosis or neural foraminal stenosis.
At the L5/S1 level, there is minimal central protrusion without spinal canal
stenosis or neural foraminal stenosis.
There is, however, a focal area of increased signal on the STIR images along
the S2 and S3 vertebral bodies without significant deformity, which is of
concern for a fracture of the sacrum.
There is a Tarlov cyst in the sacral spinal canal.
## IMPRESSION:
1. Abnormal STIR signal on the S2 and S3 vertebral bodies, which are of
concern for a non-displaced fracture of the sacrum. There is a small amount
of presacral edema.
2. Mild degenerative changes in the lumbar spine.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10354034", "visit_id": "22521066", "time": "2170-10-08 13:20:00"} |
18483037-RR-17 | 219 | ## INDICATION:
Metastatic prostate cancer, followup
## FINDINGS:
Diffuse enlargement of the thyroid gland is unchanged. Dilatation of the
distal portion of the aortic arch with extensive atherosclerotic disease is
unchanged. The rest of the descending aorta is distended but stable. Heart
size is enlarged particular left ventricle. Severe calcifications of the
aortic valve are re-demonstrated. There is no pericardial or pleural
effusion.
At the level of the hiatus there is continues presence of the extensive
thrombus with progression of penetrating ulcer, series 2, image 49, 50. A
adjacent low-density structure, series 2, image 49 measuring 28 Hounsfield
units in diameter is stable in appearance, 1.9 cm. Image portion of the upper
abdomen will be reviewed separately as part of the CT abdomen and pelvis in
corresponding report will be issued
Airways are patent to the subsegmental level bilaterally. Centrilobular
emphysema is moderate. Pleural calcifications are similar to previous
examinations consistent with prior asbestos exposure minimal atelectasis in
the lingula is present.
Extensive degenerative disease involving the thoracic spine. No definitive
lytic or sclerotic lesions within the thorax demonstrated.
## IMPRESSION:
Evidence of extensive atherosclerotic disease involving aorta including
progressing ulcerating plaque at the level of the aortic hiatus, coronary
calcifications and dilated heart.
Asbestos exposure seen as pleural calcified plaques
No evidence of intrathoracic metastatic disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18483037", "visit_id": "N/A", "time": "2169-10-15 09:15:00"} |
14288592-RR-25 | 153 | ## HISTORY:
Pain.
PA and lateral radiographs of the lumbar spine demonstrate multilevel
degenerative endplate change and marginal osteophyte formation. No
spondylolisthesis is evident. There is sclerosis along the superior endplate
of the L4 vertebral body and associated mild loss of height of the L4
vertebral body. The findings represent a subtle compression fracture
accounting for less than 25% of normal vertebral body height. There is
equivocal evidence of a small retropulsed fragment. There is densely
atherosclerotic calcification. Moderate-to-severe degenerative change
involves the bilateral hip joints, worse on the left than the right. The
sacroiliac joints are unremarkable as is the symphysis pubis. Surgical
staples are in the right upper quadrant.
## IMPRESSION:
Lumbar spondylosis.
L4 vertebral body compression fracture accounting for less than 25% of normal
vertebral body height. The finding is of uncertain chronicity.
Findings were entered into the critical results dashboard at the time of
initial image interpretation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14288592", "visit_id": "N/A", "time": "2200-02-17 10:37:00"} |
10833304-RR-36 | 263 | ## EXAMINATION:
BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD AND
LEFT BREAST ULTRASOUND
## INDICATION:
Palpable lump felt by the patient's physician in the left breast
at 12 o'clock near the areola is seen a mobile 2-3 cm mass. Patient does not
feel any lumps.
## TISSUE DENSITY:
C - The breast tissue is heterogeneously dense which may
obscure detection of small masses. There is a cluster of linear branching
microcalcifications spanning a 7 mm area in the right upper outer mid breast.
These warrant a biopsy. There are no spiculated masses or areas of
architectural distortion. A 9 mm asymmetry in the left upper breast appears
consistent with an intramammary lymph node is stable dating back to .
There are no spiculated masses or areas of architectural distortion.
## LEFT BREAST ULTRASOUND:
Targeted ultrasound of the left breast was
performed. The left breast was scanned from o'clock. A definite mass was
not identified in the left breast at 12 o'clock. In the left breast at 11
o'clock ; 5 cm from the nipple is a fairly well-circumscribed hypoechoic
lobulated mass measuring 0.8 x 0.7 x 0.5 cm, it shows some posterior acoustic
enhancement and no vascularity.
## IMPRESSION:
1) Suspicious microcalcifications in the right breast. Stereotactic core
biopsy of these recommended.
2) Lobulated mass in the left breast at the 11 o'clock. Though this could
present a fibroadenoma and ultrasound-guided core biopsies recommended for
definitive diagnosis.
## NOTIFICATION:
Findings reviewed with the patient at the completion of the
study.
## BI-RADS:
4B Suspicious - moderate suspicion for
malignancy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10833304", "visit_id": "N/A", "time": "2191-10-07 12:43:00"} |
14430186-DS-4 | 1,160 | ## MAJOR SURGICAL OR INVASIVE PROCEDURE:
: s/p Hemiarthroplasty, right hip.
## HISTORY OF PRESENT ILLNESS:
year old female s/p fall on resulting in a right hip
fracture requiring surgical management.
## FAMILY HISTORY:
several aunts and uncles with cancer, no history of DM or heart
disease
## HEENT:
Normocephalic, atraumatic
C-spine nontender to palpation and clinically clear
## CARDIOVASCULAR:
Regular Rate and Rhythm, Normal first and
second heart sounds
## EXTR/BACK:
Good peripheral pulses. Pain with any motion of
the right hip. System otherwise intact.
## NEURO:
Speech fluent, moves all 4 extremities though motion
of the right lower extremity limited secondary to pain. CSM
is otherwise intact.
## PSYCH:
Normal mood, Normal mentation
## BRIEF HOSPITAL COURSE:
Ms. was admitted to the Orthopedic service on for
a right hip fracture. On she underwent
hemiarthroplasty of the right hip without complication. On
she was started on Ciprofloxacin for an urinary tract
infection. On she developed hypoxia. A chest xray was
performed that showed pneumonia. She was started on Ceftriaxone
and Azithromycin. The medical service was consulted for
recommendations for antimicrobial therapy for the UTI and
pneumonia. The morning of AM patient triggered for desat
to 86% on 3L NC. This improved with repositioning, facemask
oxygen, and nebulization treatment. ABG was obtained and was
reassuring. Since then, saturations continued to improve.
On her antibiotic therapy was changed to Levaquin and
Cefpodoxime for treatment of her pneumonia and urinary tract
infection. Oxygen has been weaned to 2L NC. Patient is
discharged back to .
## MEDICATIONS ON ADMISSION:
1. Mirtazapine 15 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime).
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Tablets PO Q6H (every 6
hours) as needed for pain.
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
6. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO BID (2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
10. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
11. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
## DISCHARGE MEDICATIONS:
1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe
Subcutaneous Q HS () for 4 weeks.
4. amlodipine 5 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
5. furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
6. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. mirtazapine 15 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
10. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for anxiety.
11. tramadol 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
12. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical Q 12H (Every 12
Hours).
## 13. MULTIVITAMIN TABLET SIG:
One (1) Cap PO DAILY (Daily).
14. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
15. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
## NEBULIZATION SIG:
One (1) neb Inhalation Q4H (every 4 hours) as
needed for SOB.
16. ipratropium bromide 0.02 % Solution
## SIG:
One (1) neb
Inhalation Q4H (every 4 hours) as needed for SOB.
17. cefpodoxime 100 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 6 days: Stop date .
18. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 5 days: Stop date .
19. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours).
20. oxycodone 5 mg Tablet Sig: Tablets PO Q4H (every 4
hours) as needed for pain.
21. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
22. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
23. trazodone 50 mg Tablet Sig: 0.25 Tablet PO HS (at bedtime)
as needed for insomnia.
24. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
## SIG:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
25. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO BID (2 times a day) as needed for
indigestion.
26. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
27. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
dose PO DAILY (Daily).
## DISCHARGE DIAGNOSIS:
Right hip fracture.
Hypoxia.
Urinary Tract Infection.
Pneumonia.
Post operative hypokalemia.
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## WOUND CARE:
-Keep Incision dry.
-Do not soak the incision in a bath or pool.
## ACTIVITY:
-Continue to be full weight bearing on your right leg.
Other Instructions
- Resume your regular diet.
- Avoid nicotine products to optimize healing.
- Resume your home medications. Take all medications as
instructed.
- Continue taking the Lovenox to prevent blood clots.
-You have also been given Additional Medications to control your
pain. Please allow 72 hours for refill of narcotic
prescriptions, so plan ahead. You can either have them mailed
to your home or pick them up at the clinic located on 2.
We are not allowed to call in narcotic (oxycontin, oxycodone,
percocet) prescriptions to the pharmacy. In addition, we are
only allowed to write for pain medications for 90 days from the
date of surgery.
- Narcotic pain medication may cause drowsiness. Do not drink
alcohol while taking narcotic medications. Do not operate any
motor vehicle or machinery while taking narcotic pain
medications. Taking more than recommended may cause serious
breathing problems.
If you have questions, concerns or experience any of the below
danger signs then please call your doctor at or go
to your local emergency room
## ACTIVITY AS TOLERATED
RIGHT LOWER EXTREMITY:
Full weight bearing
Left lower extremity: Full weight bearing
Encourage turn, cough and deep breathe q2h when awake
## TREATMENTS FREQUENCY:
Remove staples 14 days from date of surgery.
Continue to wean oxygen therapy. Patient is not on oxygen at
baseline.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14430186", "visit_id": "25125176", "time": "2145-04-22 00:00:00"} |
13549117-RR-25 | 498 | ## INDICATION:
year old man with cirrhosis and psoas abscess with drain in
place, with persistent drainage evaluation of size of abscess // Evaluation
of known psoas abscess
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.7 s, 51.9 cm; CTDIvol = 16.5 mGy (Body) DLP = 855.4
mGy-cm.
Total DLP (Body) = 855 mGy-cm.
## LOWER CHEST:
Minimal dependent atelectasis within the lung bases. There is no
pleural or pericardial effusion. Moderate esophageal varices are noted.
## HEPATOBILIARY:
Cirrhotic liver. A hypodense lesion is appreciated in segment
6 measuring 1.5 cm, unchanged compared to previous. No intrahepatic or
extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of
cholecystitis.
## PANCREAS:
The pancreas is mildly atrophic diffusely. The main pancreatic duct
is not dilated.
## SPLEEN:
Splenomegaly measuring up to 18.3 cm unchanged. Large splenic varices
are noted.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
Nodular appearance of the adrenal glands is favored to be secondary to
adjacent varices.
## URINARY:
Normal appearance the right kidney. No renal calculi. No evidence
of hydronephrosis. Unremarkable appearance of the left kidney, with no
evidence of renal calculi or hydronephrosis. Mild perinephric stranding is
appreciated, reactive to the left retroperitoneal process. The bladder is
unremarkable. A few central prostatic calcifications are appreciated.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. The colon and rectum are within
normal limits. The appendix is normal. There is a left inguinal hernia,
containing fat and fluid.
## RETROPERITONEUM:
Appropriate position of the pigtail catheter is again
appreciated in the left posterior para renal space, anterior to the psoas
muscle. There is stable to minimally decreased size of the retroperitoneal
collection, currently measuring 2.5 x 6.2 x 22 cm, compared to prior
measurement of 1.9 x 6.9 x 22 cm. There is surrounding stranding, as well as
a few locules of air. There is extension of the retroperitoneal fluid through
the left inguinal hernia. No new collections are noted.
## LYMPH NODES:
There are multiple mildly enlarged retroperitoneal and pelvic
lymph nodes, likely reactive. There are bilateral mildly enlarged inguinal
lymph nodes. The largest lymph nodes measure up to 1.3 cm in the left
inguinal space.
## VASCULAR:
Moderate esophageal and gastric varices, as well as splenic varices
noted. IVC filter in situ. There is a background of moderate
atherosclerosis.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
There has been prior spinal instrumentation at L4-S1, with compression and
fragmentation of the L5 vertebral body, and mild retropulsion of the bony
fragments, unchanged compared to previous. Background moderate multilevel
degenerative changes within the spine. Old left healed rib fractures.
## IMPRESSION:
1. Stable to minimally decreased size of the left retroperitoneal collection,
which herniates through the right inguinal canal into the scrotum. The
pigtail catheter is in appropriate position.
2. Similar appearance of a hypodense lesion within hepatic segment 6,
incompletely characterized.
3. Cirrhotic liver. Splenomegaly. Multiple varices. No ascites.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13549117", "visit_id": "26853673", "time": "2117-03-08 13:35:00"} |
12030855-RR-17 | 140 | ## HISTORY:
woman with fall and head strike and loss of
consciousness.
## FINDINGS:
The alignment of the cervical spine is preserved. There is no
prevertebral soft tissue edema. The vertebral body height is preserved.
There are mild multilevel degenerative changes in the cervical spine with
small disk-osteophyte complexes indenting the thecal sac at C5/6 and C6/7
levels. Anterior and inferior to vertebral body of C5 there is a small
osseous fragment, 401B:20. Lung apices appear normal. Hypodensity in the
left thyroid lobe, 3:52, appears stable since .
## IMPRESSION:
1. Tiny osseous fragment anterior and inferior to vertebral body of C5, could
be a small osteophyte. Correlate with point tenderness and flexion-extension
views.
2. Small hypodensity in the left thyroid lobe, stable since . Thyroid
ultrasound can be done in a nonurgent setting to evaluate further.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12030855", "visit_id": "20269491", "time": "2181-11-10 04:24:00"} |
15574754-RR-93 | 442 | ## INDICATION:
year old man with heart failure now with ischemic bowel and
comfort focused care // Venting g-tube for symptomatic management of ischemic
bowel
## OPERATORS:
Dr. radiology fellow) and Dr.
radiology attending) performed the procedure. The
attending, Dr. was present and supervising throughout the procedure. Dr.
radiologist, personally supervised the trainee during the key
components of the procedure and reviewed and agreed with the trainee's
findings.
## ANESTHESIA:
Moderate sedation was provided by administrating divided doses of
1 mg of morphine and 0.5 mg of midazolam throughout the total intra-service
time of 55 minutes during which the patient's hemodynamic parameters were
continuously monitored by an independent trained radiology nurse. 1% lidocaine
was injected in the skin and subcutaneous tissues overlying the access site.
## CONTRAST:
20 ml of Optiray contrast.
## PROCEDURE:
1. Flouroscopically-placed gastrostomy tube.
## PROCEDURE DETAILS:
Following the discussion of the risks, benefits and
alternatives to the procedure, written informed consent was obtained from the
patient. The patient was then brought to the angiography suite and placed
supine on the exam table. A pre-procedure time-out was performed per
protocol. The abdomen was prepped and draped in the usual sterile fashion.
A scout image of the abdomen was obtained. A 5 Kumpe catheter was
advanced through the right nare and into the stomach to be used for
insufflation. The stomach was then insufflated through the Kumpe catheter.
Using a marker, the skin was marked using palpation to feel the costal margins
and the liver edge was marked using ultrasound. Permanent ultrasound images
were not stored.
Under fluoroscopic guidance, 3 T fastener buttons were sequentially deployed
in a triangular position elevating the stomach to the anterior abdominal wall.
Intra-gastric position was confirmed with aspiration of air and injection of
contrast. A 19 gauge needle was introduced under fluoroscopic guidance and
position confirmed using an injection of dilute contrast. A wire was
introduced into the stomach. A small skin incision was made along the needle
and the needle was removed.
After sequential dilation using 8, 10, and 12 dilators, a
gastrostomy catheter was advanced over the wire into position. The metal
stiffener and wire were removed. The catheter was secured by forming the
retaining loop in the stomach after confirming the position of the catheter
with a contrast injection. The catheter was then flushed, capped and secured
to the skin with 0-silk sutures. Sterile dressings were applied.
The patient tolerated the procedure well and there were no immediate
complications.
## FINDINGS:
1. Successful placement of a gastrostomy tube.
## IMPRESSION:
Successful placement of a 12 Wills gastrostomy tube. The
catheter should not be used for 24 hours.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15574754", "visit_id": "27546909", "time": "2153-08-19 10:13:00"} |
17181069-RR-69 | 161 | ## PREVIOUS SCAN DATE:
.
Transabdominal and transvaginal sonography were performed, the latter to
better evaluate the uterus, endometrium, and adnexa.
The uterus measures 10.5 x 5.7 x 6.5 cm. The uterus is heterogeneous in
echotexture consistent with fibroids. The largest fibroid measures 2 cm. The
endometrium measures 1.7 cm in thickness. No focal endometrial lesion is
seen. There are some mobile blood products seen within the endometrial
cavity. The ovaries are normal with a hemorrhagic left corpus luteal cyst.
There is small amount of free fluid, within physiologic range.
## IMPRESSION:
1) Slightly enlarged uterus with small fibroids. Ovaries within normal
limits with follicular activity.
2) 17 mm heterogeneous endometrium without focal lesion seen. Appearances
could be due to stage of menstrual cycle. If there is a continued concern for
endometrial pathology, follow up ultrasound in four to six weeks at the early
part of the patient's next menstrual cycle, and/or sonohysterography could be
considered.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17181069", "visit_id": "N/A", "time": "2168-01-10 14:39:00"} |
17208152-RR-68 | 90 | PA AND LATERAL CHEST, AT HOURS.
## FINDINGS:
The lungs are clear without consolidation or edema. A double
barrel port is again present from a right subclavian approach stable in course
and position. The mediastinum is otherwise unremarkable. The cardiac
silhouette is within normal limits for size. No effusion or pneumothorax is
seen. A slight levoconcave curvature of the thoracic spine is again
identified. Otherwise, the visualized osseous structures are unremarkable.
## IMPRESSION:
No acute pulmonary process. Please note the numerous pulmonary
nodules seen on recent chest CT remain radiographically occult.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17208152", "visit_id": "26343930", "time": "2141-08-22 19:33:00"} |
13834826-RR-5 | 188 | ## REASON FOR EXAM:
female with hypertension and right basal ganglia
hemorrhage.
## NON-CONTRAST CT OF THE HEAD:
Again seen, there is a 1.5 x 1.0 cm area of
hemorrhage likely in the pulvinar of the right thalamus extending to the
posterior limb of internal capsule with surrounding edema, grossly unchanged
since prior exam. There is no midline shift. Basal cisterns and suprasellar
cistern are patent. Mild prominence of the ventricles and cerebral sulci are
consistent with age-appropriate atrophy. A focal low-density area in the right
inferior basal ganglia, image #14, series 2, may represent a dilated Virchow-
space vs. lacunar infarct. Multiple periventricular and subcortical
areas of white matter hypodensity likely represent sequelae of chronic small
vessel ischemic disease. Atherosclerotic calcification of bilateral carotid
arteries, left middle cerebral artery is noted. There is no fracture. The
visualized mastoid air cells and paranasal sinuses are grossly unremarkable.
The visualized orbits are grossly unremarkable. The patient is likely status
post right cataract surgery.
## IMPRESSION:
1. Stable right Pulvinar hemorrhage.
2. Areas of subcortical and periventricular hypodensity likely representing
sequelae of small vessel ischemic disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13834826", "visit_id": "24324634", "time": "2135-05-07 11:23:00"} |
10786539-DS-19 | 1,668 | ## HISTORY OF PRESENT ILLNESS:
hx APLA syndrome with hx of multiple thromboembolic events,
CAD s/p STEMI and large area of LV hypokinesis with associated
thrombus, AICD.
He initially presented to earlier today with of
worsening L flank pain. It has been constant, worsening, and not
similar in character to his prior kidney stones. It started on
on the L, gradually worsened on that side, and then
progressed to the R. It became so severe that he could not
sleep, and then that he was vomiting. He presented to
for eval.
By report CTAP was obtained there showing suggestion of subtle
stranding in L perirenal space, which they postulated might
represent pancreatitis or pyelonephritis (has been over-read by
our radiologists -- see below). His labs were notable for plt
. He was given IVFs, IV Cipro, IV Morphine and Fentanlyl;
his VS on transfer were BP 198/104, HR 75, RR 20, Sa 98% on RA.
In the ED, initial vital signs were: 97.6 80 184/86 20 100% RA
- Exam was notable for: none recorded in dash.
- Labs were notable for: Na 146, K 4.6, glucose 119, plt 64.
Coags showed 16.8, PTT 69.6, INR 1.5. UA with large blood,
100 prot, >182 RBCs, 18 WBCs.
- Imaging:
Reviewed pt's LifeImage CT scan with ED Radiology PGY4 on call.
Per her read, there is no evidence of pancreatitis or
nephrolithiasis. There is an area of periadrenal abnormality
centered on the L adrenal gland that is suspicious for adrenal
hemorrhage; additionally, neither adrenal gland attenuates
appropriately relative to his prior CT in our system. She has
received our request for formal opinion and will over-read
the scan tonight.
- The patient was given:
01:40IVMorphine Sulfate 4 mg
01:40IVOndansetron 4 mg
01:41IVF1000 mL NS 1000 mL
02:11IVMorphine Sulfate 4 mg
02:14IVF1000 mL NS 1000 mL
02:47IVMorphine Sulfate 4 mg
03:35IVF1000 mL NS 1000 mL
03:35IVKetorolac 15
## VITALS PRIOR TO TRANSFER WERE:
98.4 85 177/102 22 98% RA
Given bilateral attenuation of the adrenal glands, coagulopathy
on labs, and plts 75K -> 64k, I was concerned for early onset of
catastrophic APLA syndrome and consulted Heme Onc prior to
patient arriving on the floor from the ED. Discussed with
on-call Heme Onc fellow - will get peripheral smear,
repeat labs, and tbw Heme Onc.
## REVIEW OF ATRIUS RECORDS:
patient frequently subtherapeutic on
INR. There are mentions of socioeconomic difficulties - lost
job, house, etc and being unable to obtain meds.
Upon arrival to the floor, patient continues to have severe
bilateral flank pain and associated nausea.
===========================
## REVIEW OF SYSTEMS:
Per HPI. Denies headache, visual changes,
pharyngitis, rhinorrhea, nasal congestion, cough, fevers,
chills, sweats, weight loss, dyspnea, chest pain, abdominal
pain, diarrhea, constipation, hematochezia, dysuria, rash,
paresthesias, and weakness.
## PAST MEDICAL HISTORY:
-stroke in with no residual deficits, possible TIA
years ago
-antiphospholipid antibody syndrome
-AICD placement
-MI in
-aborted STEMI in , LAD thrombus treated with bare metal
stent
-LV dysfunction
-large mural left ventricular apical thrombus on echo
-HTN
-hand surgery year ago work accident
## FAMILY HISTORY:
-- Mother with disease and hypothyroidism, maternal
cousin with lupus, grandmother with "heart problems from an
early age"
-- patient's wife does not recall the details. Father died of
kidney failure, patient's wife does not recall the cause of the
renal failure.
## PHYSICAL EXAM:
EXAM ON ADMISSION
=========================
## HEENT:
no icterus, PERRLA, MMM, no OP lesion. Superficial
quarter-sized lump on back of head, which is chronic per
patient. Scar on forehead
## NECK:
no JVP, no LAD
## COR:
tachycardic, regular rhythm, no NMRG
## PULM:
exam limited by pain with deep breathing, CTAB
## ABD:
soft, mildly tender in epigastric area, nondistended
## BACK:
Moderate-severe pain with palpation over kidneys
bilaterally. Diffuse erythematous, non pruritic papular rash.
## NEURO:
AOx3, no focal sensory or motor deficits in bilat
## MSK:
without edema, 2+ distal pulses
EXAM ON DISCHARGE
=========================
## GENL:
appears comfortable, laying in bed, NAD
## HEENT:
no icterus, PERRLA, MMM, no OP lesion. Superficial
quarter-sized lump on back of head, which is chronic per
patient. Scar on forehead
## COR:
RRR, normal S1,S2, no NMRG
## ABD:
soft, mild tenderness in left lower quadrant
## NEURO:
AOx3, no focal sensory or motor deficits in bilat
## MSK:
without edema, 2+ distal pulses
## IMAGING/STUDIES
===========================
CTA CHEST:
1. Left ventricular filling defect concerning for left
ventricular thrombus. Correlate with echocardiogram findings.
2. No pulmonary embolus or acute aortic abnormality.
OSH CT abdomen w/ contrast read at :
## IMPRESSION:
1. Uniform thickening associated with diffuse hypoenhancement
of the adrenal glands with surrounding stranding is suspicious
for adrenal infarcts. No hemorrhage or hematoma is visualized.
This examination was not protocoled for evaluation of adrenal
vein thrombosis.
2. Left ventricular wall calcification with thrombus is not
significantly changed from priorexam and may be monitored by
ECHO.
## TTE :
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is moderate regional left ventricular systolic
dysfunction with mid to distal anterior/anterospetal and apical
akinesis. A large thrombus is seen in the left ventricular apex.
There is no ventricular septal defect. The diameters of aorta at
the sinus, ascending and arch levels are normal. There is no
aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve appears structurally normal with trivial mitral
regurgitation. The pulmonary artery systolic pressure could not
be determined. There is no pericardial effusion.
Compared with the prior study (images reviewed) of ,
an apical LV thrombus is now seen.
## IMPRESSION:
No evidence of obstruction.
## BRIEF HOSPITAL COURSE:
Mr. is a year old man with APLA syndrome with hx of
multiple thromboembolic events, CAD s/p STEMI and large area of
LV hypokinesis with associated thrombus, AICD, who presented
with bilateral flank pain and imaging concerning for adrenal
infarcts.
## #APLP SYNDROME:
#ADRENAL THROMBI + ISCHEMIA:
Patient presented with adrenal
thrombi secondary to APLP syndrome and having not taken coumadin
for a week because he ran out of the prescription. Hematology
was consulted. Patient was systemically anticoagulated first
with a heparin gtt and then with lovenox. He was bridged back to
coumadin for a goal INR . He also had a CTA chest to rule out
PE, and it was negative. His AM cortisol was WNL while in the
hospital and one was pending on discharge. Pt should be
observed for signs of adrenal insufficiency on discharge. He
was discharged on oxycodone. Pt was advised on the risks of
narcotic use and notified of option for partial fill.
## #LV THROMBUS:
Pt has a history of an LV thrombus, and CT
abd/pelvis at outside hospital was concerning for one. A CTA
chest and TTE were done, confirming an LV thrombus. Of note, TTE
also showed an EF of 35-40% found on echo. Patient will have
cardiology follow up.
## #THOMBOCYTOPENIA:
Patient with thrombocytopenia upon
hospitalization, likely in setting of thrombosis. Platelets were
improved with systemic anticoagulation.
## # ALCOHOL USE:
Patient had reported vague alcohol use upon
admission, but would not give further details. He was initially
placed on CIWA and was minimally scoring.
## TRANSITIONAL ISSUES:
- Patient discharged on Coumadin 10 mg daily, goal INR
- F/u anticardiolipin and anti Beta-2-Glycoprotein 1 Antibodies,
cortisol
- Patient discharged with mirtazapine for appetite stimulation,
can consider discontinuing if appetite improves as pain resolves
- TTE with 35-40% EF and new LV thrombus which will be followed
up as an outpatient by cardiology
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Clopidogrel 75 mg PO DAILY
2. Warfarin 12.5 mg PO DAILY16
3. Cialis (tadalafil) 10 mg oral DAILY:PRN ED
4. Gabapentin 600 mg PO TID
## DISCHARGE MEDICATIONS:
1. Clopidogrel 75 mg PO DAILY
2. Warfarin 10 mg PO DAILY16
RX *warfarin [Coumadin] 10 mg 1 tablet(s) by mouth daily Disp
#*30
## TABLET REFILLS:
*0
3. Mirtazapine 15 mg PO QHS
RX *mirtazapine 15 mg 1 tablet(s) by mouth every night Disp #*30
Tablet
## REFILLS:
*0
4. FoLIC Acid 1 mg PO DAILY
RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
## REFILLS:
*0
5. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day
Disp #*60 Capsule Refills:*0
6. Multivitamins 1 TAB PO DAILY
RX *multivitamin 1 capsule(s) by mouth daily Disp #*30 Capsule
Refills:*0
7. OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN pain
RX *oxycodone 10 mg 1 tablet(s) by mouth q6h prn Disp #*25
## TABLET REFILLS:
*0
8. Polyethylene Glycol 17 g PO DAILY
RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by
mouth daily Disp #*30 Packet Refills:*0
9. Thiamine 100 mg PO DAILY
RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily
Disp #*30 Tablet Refills:*0
10. Cialis (tadalafil) 10 mg oral DAILY:PRN ED
11. Gabapentin 600 mg PO TID
## PRIMARY DIAGNOSES:
- Catastrophic antiphospholipid antibody syndrome
- Bilateral adrenal thrombosis
- Left ventricular thrombus
Secondary Diagnoses
- Previous stroke
- Previous MI with AICD placement
- Hypertension
- Alcohol withdrawal
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you during your hospitalization
at the . You were admitted
with back pain, which is from blood clots in your adrenal
glands, which are organs that sit on top of the kidney. You were
also found to have a blood clot in your heart. You were started
on a blood thinner, and started to get better. You have been
transitioned back to warfarin, and it is important that you get
your INR checked regularly. Your next appointment is
, and you should have your INR checked then.
As you know, it is very important to keep taking the blood
thinners at home. If you are having any difficulty with
obtaining these medications, please talk to your doctor about
finding alternative options.
Please see below for additional information about your
medications and followup appointments.
It was very nice to meet you and we wish you the very best!
Sincerely,
Your Care Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10786539", "visit_id": "23065569", "time": "2135-07-18 00:00:00"} |
16919532-RR-7 | 180 | ## EXAMINATION:
CT ORBITS, SELLA AND IAC W/ CONTRAST Q1215 CT HEADSUB
## INDICATION:
year old woman with right optic neuropathy, ? unable to obtain
MRI due to old surgical clips ? enhancement of the right optic nerve- please
perform thin, post-contrast, coronal cuts through the orbits.
## DOSE:
The doses with CT angiography.
## FINDINGS:
Postsurgical changes of bilateral lens replacement. Surgical material is seen
within the left medial orbit. The extraocular muscles are symmetric. The
retrobulbar fat is maintained. There is no evidence of intraconal or
extraconal hemorrhage or mass. The optic nerve sheaths are symmetric.
No fractures are identified. There is no evidence of facial swelling. There
is mild mucosal thickening of the paranasal sinuses. No air-fluid levels are
identified. There is no evidence of abnormal fluid collections.
There is moderate opacification of the visualized mastoid air cells..
Mild arthrosis of the left temporomandibular joint.
## IMPRESSION:
1. No evidence of abnormal enhancement of the optic pathway. No perineural
soft tissue abnormalities or enhancement seen.
2. Symmetric appearance of the optic nerve sheaths
3. Preserved intraconal and extraconal fat planes.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16919532", "visit_id": "N/A", "time": "2112-09-13 07:08:00"} |
11882807-RR-38 | 268 | ## CLINICAL HISTORY:
man with kidney and pancreas transplant.
Increased LFT and ongoing abdominal pain.
## LUNG BASES:
Lung bases are included and are clear. No suspicious pulmonary
nodules or pleural effusions are seen.
## ABDOMEN:
Numerous subcutaneous collaterals are identified in the anterior
abdominal wall, no significant change from the prior study. The liver and
spleen are normal in size. No focal hepatic lesions are identified on this
unenhanced CT study. The gallbladder and adrenals are unremarkable. The
pancreas is atrophic, unchanged from the prior study. Both kidneys are also
significantly decreased in size. No suspicious renal lesions are identified
on this unenhanced CT study. There are no enlarged retroperitoneal or
mesenteric lymph nodes.
## PELVIS:
The small and large bowel is unremarkable. A transplant kidney is
identified in the left iliac fossa. No focal renal lesions are seen. There
is no evidence of hydronephrosis. A pancreatic transplant is identified in
the right iliac fossa, also appearing unremarkable. There is no
peripancreatic fat stranding. The graft is normal in diameter.
There is no pelvic or inguinal lymphadenopathy. The urinary bladder is
decompressed. The seminal vesicles and prostate are normal in size for the
age of the patient.
Review of images on bone window does not show any suspicious bony lesions.
## IMPRESSION:
1. Status post pancreas and renal transplant. The grafts appear
unremarkable.
2. The liver appears normal. The absence of intravenous contrast
administration limits the evaluation of focal hepatic lesions, but no lesions
are identified on the unenhanced images.
3. Atrophic native pancreas and kidneys bilaterally.
## DOSE REPORT:
The total DLP of the exam is 1678.80 mGy-cm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11882807", "visit_id": "N/A", "time": "2131-03-11 09:49:00"} |
17708119-RR-54 | 139 | ## DOSE:
DLP: given in abdominal CT report.
## FINDINGS:
No incidental thyroid findings. No supraclavicular, infraclavicular or
axillary lymphadenopathy. All visible lymph nodes in the mediastinum (2, 13)
Are normal in size. No abnormalities are noted in the mediastinum. Mild
cardiomegaly. No substantial coronary or valvular calcifications. No
pericardial effusion. Moderate tortuosity of the descending aorta. Small
hiatal hernia. The upper abdomen is reported in detail in the dedicated
abdominal CT report, including the left renal cyst and the calcified gallstone
(304, 114). No osteolytic lesions at the level of the ribs, the sternum, and
the vertebral bodies. Moderate degenerative vertebral disease. No vertebral
compression fractures.
Mild respiratory motion. No pleural thickening, no pleural effusions. No
diffuse lung disease. No suspicious pulmonary nodules or masses. The airways
are patent.
## IMPRESSION:
No evidence of metastatic disease to the thorax.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17708119", "visit_id": "N/A", "time": "2189-05-27 17:07:00"} |
13823519-DS-10 | 1,434 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Exploratory laparotomy, total abdominal hysterectomy, bilateral
salpingo-oophorectomy, resection right-sided pelvic mass,
infracolic omentectomy, bilateral pelvic and para-aortic lymph
node dissection, cystoscopy.
## HISTORY OF PRESENT ILLNESS:
Ms. is a female who presented with
worsening back pain. An MRI on incidentally noted a
pelvic mass. Patient complained of worsening abdominal pain and
distention and was admitted to . During that
admission she underwent a paracentesis confirming
adenocarcinoma, with staining suggestive of gynecological
origin. A CT scan was done which revealed small bilateral
pleural effusions, moderate to large hiatal hernia and a large
amount of ascites throughout the abdomen and pelvis. There was
a large 10.4 cm irregular mass within the right adnexa, and
CA-125 was 297. She presented to the gynecology-oncology
service for surgical management.
## PAST MEDICAL HISTORY:
lupus, new onset dementia, back pain,
spinal stenosis, osteoporosis
## OBGYN HISTORY:
G2P2, SVD x 2, metastatic ovarian cancer
## FAMILY HISTORY:
Mother who was diagnosed with breast cancer in her . No other
GYN related malignancies.
## PHYSICAL EXAM:
On the day of discharge:
Afebrile, vital signs stable
## GEN:
well-appearing, no acute distress
## CV:
regular rate and rhythm
## PULM:
clear to auscultation bilaterally
## ABD:
soft, non-distended, minimal tenderness to palpation, no
rebound or guarding; incision with staples clean/dry/intact; no
erythema or drainage; normoactive bowel sounds
## EXT:
warm and well perfused, no edema, no calf tenderness
## GU:
no spotting on pad
## PATHOLOGIC DIAGNOSIS:
1. and fallopian tube, right (1A-1FS1):
Ovarian carcinosarcoma, see synoptic report.
2. Uterus, cervix, left fallopian tube and (2A-2J):
Uterine serosa and left involved by metastatic
carcinosarcoma.
Uterine leiomyoma (3.6 cm), atrophic endometrium.
3. Omentum (3A-3G):
Metastatic carcinosarcoma in adipose tissue (macroscopic nodule
<2 cm,
Block 3B).Metastatic carcinosarcoma in 1 of 1 lymph node.
4. Lymph ndes, right pelvic (4A-4H):
Metastatic carcinosarcoma in 1 of 11 lymph nodes ( ).
5. Lymph nodes, left pelvic (5A-5G):
Metastatic carcinosarcoma in 1 of 10 lymph nodes ( ).
6. "Fat nodule", sigmoid (6A-6B):
No malignancy identified, fibroadipose tissue.
7. Lymph node, right paraortic (7A-7C):
Metastatic carcinosarcoma in 1 of 2 lymph nodes ( ).
8. Lymph node, left paraortic (8A-8B)
Metastatic carcinosarcoma in 4 of 4 lymph nodes ( ).
## NOTE:
The tumor is poorly differentiated with foci consistent
with
high-grade Mullerian/serous carcinoma. The less differentiated
component likely represents carcinosarcoma. Nodal metastases are
composed of the carcinoma component.
Synopsis
Staging according to Joint Committee on Cancer Staging
Manual
-- Edition,
Macroscopic
## SPECIMEN TYPE:
Right salpingo-oophorectomyLeft
salpingo-oophorectomyHysterectomy
Tumor Site
## RIGHT:
not applicable (distal tube not separately identified)
## OMENTUM:
Implant (<2 cm)
Extent of Invasion
## PT3B (IIIB):
Macroscopic
peritoneal metastasis beyond pelvis 2 cm or less in greatest
dimension
## PN1:
Regional lymph node
metastasis
## BRIEF HOSPITAL COURSE:
Ms. was admitted to the gynecology oncology service
after undergoing exploratory laparotomy, total abdominal
hysterectomy, bilateral salpingo-oophorectomy, resection of
right-sided pelvic mass, infracolic omentectomy, bilateral
pelvic and para-aortic lymph node dissection, and cystoscopy.
Please see the operative report for full details.
Her immediate post-operative course was complicated by
hypotension, likely secondary to her epidural anesthesia in
addition to a low baseline and exacerbated by pre-operative
bowel prep. She required phenylephrine in the OR and immediately
post-operatively in the PACU. She remained asymptomatic in the
PACU. She was found to be anemic with a hematocrit of 26.1,
attributed to intra-operative blood loss. She received 1 unit
of packed red blood cells in the PACU. Her blood pressure
stabilized but remained low after IV fluid resuscitation and
albumin transfusion. On the evening of post-operative day #0,
her epidural came out unintentionally as she was getting out of
bed without assistance. Subsequently, her blood pressure
gradually improved and remained normal with systolic ranges
100-120s for the remainder of her hospitalization.
For pain management, she was started on a Dilaudid PCA and IV
Acetaminophen once her epidural came out. On post-operative day
#2, she was transitioned to oral pain medications (Percocet,
Motrin). An adjustable abdominal binder was provided for
support.
On post-operative day #1, she was noted to have intermittent
borderline low urine output. She also was noted to be fluid
positive after extensive IVF resuscitation secondary to
hypotension immediately post-operatively. Her sodium level
demonstrated hyponatremia to 129, likely secondary to the above.
Her urine output and fluid balance improved after being given
one dose of IV lasix. Her IVF were minimized and she was given
a low maintenance dose of normal saline of 50 cc/hr until she
was tolerating a regular diet. Her sodium level gradually
increased and was noted to be 133 on the day of discharge. On
post-operative day #3, her urine output was adequate and she was
ambulating independently, so her Foley catheter was removed and
she voided spontaneously.
Her blood counts continued to be monitored post-operatively and
remained low to a nadir of 26, felt to reflect equilibration
after acute blood loss anemia secondary to surgery. She received
a total transfusion of 3 units of packed red blood cells,
including one immediately post-operatively in the PACU. She
remained asymptomatic from an anemia standpoint.
Her post-operative course was also notable for intermittent
confusion and forgetfulness notable during interactions, which
was consistent with her baseline status of recently diagnosed
new onset dementia, likely exacerbated by post-anesthesia and
medication side effects as well as disorientation while being
hospitalized. Her mental status improved and returned to
baseline by post-operative day #2.
On post-operative day #2, her diet was gradually advanced and by
day 3 she was tolerating a regular diet.
She was continued on her home medications: baclofen for lupus
and back pain, clonazepam as needed for insomnia, colace and
senna for constipation, and pantoprazole for GERD. She received
kefzol for infectious prophylaxis and lovenox for DVT
prophylaxis post-operatively.
By post-operative day #3, she was meeting discharge milestones
-- tolerating a regular diet, voiding spontaneously, ambulating
independently, and pain was controlled with oral medications.
She was then discharged home in stable condition with outpatient
follow-up scheduled.
## MEDICATIONS ON ADMISSION:
-Clonazepam 0.5mg, one tablet at bedtime
-Magnesium oxide 400mg tablet, once a day
-Pantoprazole 40mg, once daily
-Senna 8.6mg PO twice daily
-Baclofen 20mg, once daily
-Alendronate 70mg weekly
-Methotrexate 2.5mg 5 pills weekly
-Leucovorin 5mg biweekly
-Multivitamin
-Oxycodone, as needed for pain
## DISCHARGE MEDICATIONS:
1. Baclofen 20 mg PO DAILY
2. ClonazePAM 0.5 mg PO QHS:PRN insomnia, anxiety
3. Docusate Sodium 100 mg PO BID
Hold for loose stools.
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily
Disp #*60 Capsule Refills:*2
4. Ibuprofen 600 mg PO Q8H:PRN pain
Take with food to avoid GI upset.
RX *ibuprofen 600 mg 1 tablet(s) by mouth up to every 8 hours.
Disp #*60 Tablet Refills:*0
5. Lidocaine 5% Patch 1 PTCH TD DAILY:PRN back pain
6. Oxycodone-Acetaminophen (5mg-325mg) TAB PO Q4H:PRN pain
Do not drive or combine with alcohol. Do not take >4000mg
acetaminophen in 24hrs.
RX *oxycodone-acetaminophen 5 mg-325 mg tablet(s) by mouth
every hours Disp #*50 Tablet Refills:*0
7. Pantoprazole 40 mg PO Q24H
8. Senna 8.6 mg PO BID
RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice daily Disp
#*60 Tablet Refills:*2
9. Methotrexate 2.5 mg PO 5X/WEEK ( )
10. Leucovorin Calcium 5 mg PO 2X/WEEK (WE,SA)
11. Alendronate Sodium 70 mg PO QWEEK
12. Magnesium Oxide 400 mg PO DAILY
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the gynecologic oncology service after
undergoing the procedures listed below. You have recovered well
after your operation, and the team feels that you are safe to be
discharged home. Please follow these instructions:
.
* Take your medications as prescribed.
* Do not drive while taking narcotics.
* Do not combine narcotic and sedative medications or alcohol.
* Do not take more than 4000mg acetaminophen (APAP) in 24 hrs.
* No strenuous activity until your post-op appointment.
* Nothing in the vagina (no tampons, no douching, no sex) for 12
weeks.
* No heavy lifting of objects >10 lbs for 6 weeks.
* You may eat a regular diet.
* It is safe to walk up stairs.
.
Incision care:
* You may shower and allow soapy water to run over incision; no
scrubbing of incision. No bath tubs for 6 weeks.
* Your staples will be removed at your follow-up visit on
.
.
To reach medical records to get the records from this
hospitalization sent to your doctor at home, call .
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "13823519", "visit_id": "27251670", "time": "2127-01-02 00:00:00"} |
13777050-RR-226 | 64 | ## FINDINGS:
Contrast is seen traversing a left upper quadrant tube into the
left upper quadrant with borders most representative of stomach rugae in the
gastric fundus. The tip of the catheter is likely within the stomach.
Degenerative changes of the spine are severe. There is no evidence of bowel
obstruction.
## IMPRESSION:
Tip of tube likely within the stomach, level of the fundus.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13777050", "visit_id": "28694742", "time": "2142-12-15 17:56:00"} |
15775667-RR-24 | 113 | ## INDICATION:
History of foot pain and mild shortness of breath. Please
evaluate for pneumonia. Please evaluate for pleural effusions or pneumonia.
## FINDINGS:
The heart size is top normal. The hilar and mediastinal contours
are normal. The lung volumes are low. Interval increase in diffuse
opacification throughout the lungs bilaterally, compared to the exam from
, is likely secondary to mild pulmonary edema. There is no large
pleural effusion or pneumothorax. Partially visualized is a gastrostomy tube
in place. The visualized osseous structures are unremakable.
## IMPRESSION:
Mild diffuse opacification throughout the lungs bilaterally is likely
secondary to pulmonary edema.
Updated findings were d/w Dr. by Dr. by phone at 8:30a on
.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15775667", "visit_id": "28197635", "time": "2114-12-05 02:11:00"} |
10946421-RR-20 | 334 | ## INDICATION:
with PMH hypothyroidism, hypertension, compression fracture,
who presented with abdominal pain, lipase > 7000, and CT consistent with acute
pancreatitis. Also with new onset iron deficiency anemia, please eval for
evidence of ampullary mass or evidence of ductal abnormality
## FINDINGS:
Limited examination secondary to non breath hold technique.
## LOWER THORAX:
There is moderate bibasilar atelectasis with associated pleural
effusions.
## LIVER:
The liver is normal in morphology and signal intensity. No focal liver
lesions are seen. There is small volume ascites.
## BILIARY:
Gallbladder is unremarkable without evidence of stones. No intra or
extrahepatic biliary duct dilation is seen.
## PANCREAS:
The pancreas is enlarged and edematous with surrounding
peripancreatic and fluid. No focal pancreatic mass is seen. There are
multiple acute peripancreatic collections with the largest located inferior to
the distal pancreatic body measuring 2.8 x 3.1 x 2.1 cm. Additional acute
peripancreatic collection is noted adjacent to the pancreatic tail measuring
2.4 x 3.9 x 2.3 cm. Pancreatic parenchyma demonstrates diffuse low T1 signal
but enhances normally. There is no evidence of pancreatic necrosis. Note is
made of pancreas divisum.
## SPLEEN:
The spleen is normal in size and signal intensity.
## ADRENAL GLANDS:
The right and left adrenal glands are thickened but without
discrete nodularity.
## KIDNEYS:
The kidneys are mildly atrophic. There are bilateral peripelvic
renal cysts. No suspicious focal renal lesion is seen.
## GASTROINTESTINAL TRACT:
There is a moderate hiatal hernia. Note is made of a
small duodenal diverticulum.
## LYMPH NODES:
There are no enlarged mesenteric or retroperitoneal lymph nodes.
## VASCULATURE:
There is no abdominal aortic aneurysm. There is no gross
vascular abnormality within the limitations of a non breath hold examination.
## OSSEOUS AND SOFT TISSUE STRUCTURES:
There are no suspicious bony lesions.
There is no superficial soft tissue abnormality.
## IMPRESSION:
1. Acute interstitial pancreatitis with multiple small acute peripancreatic
fluid collections. No evidence of necrosis.
2. Limited study due to non breath hold technique, with no underlying mass
identified.
3. Bilateral pleural effusions with associated atelectasis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10946421", "visit_id": "24266393", "time": "2196-07-17 09:59:00"} |
17924864-RR-35 | 406 | ## INDICATION:
with PO intolerance, diffuse abdominal tenderness.+PO
contrast // obstruction? abscess? diverticulitis?
## 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 not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## LOWER CHEST:
Subpleural reticular markings suggesting fibrosis again noted at
the lung bases. There is no pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. 5 mm
hypodensity within the inferior most aspect of the right hepatic lobe (02:30)
is too small to characterize, unchanged, likely a hepatic cyst or biliary
hamartoma. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
Multiple bilateral renal cortical hypodensities are present and are too small
to characterize. A 1.3 cm cortical hypodensity within the inferior pole of
the left kidney (02:31) reflects a simple cyst. There is no hydronephrosis or
perinephric abnormality. Several areas of renal cortical scarring identified
bilaterally as well.
## GASTROINTESTINAL:
There is a small hiatal hernia. The stomach is otherwise
unremarkable. Small bowel loops demonstrate normal caliber, wall thickness,
and enhancement throughout. Duodenum diverticulum is noted. Again noted in
the descending colon is mural thickening with minimal surrounding stranding of
the fat (02:46). The colon is otherwise unremarkable. The appendix is
normal.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
Uterus and adnexae are unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
The abdominal and pelvic wall is within normal limits.
## IMPRESSION:
1. No acute intra-abdominal or pelvic abnormality. Normal appendix.
2. Re- demonstration of mural thickening with in the descending colon with
equivocal surrounding stranding of the fat for which colonoscopy for further
evaluation is again advised given concern for underlying mass lesion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17924864", "visit_id": "25258318", "time": "2143-08-27 17:29:00"} |
15170418-DS-6 | 1,366 | ## HISTORY OF PRESENT ILLNESS:
Mr. is with history of DM1 on insulin, Addison's
disease on prednisone, bipolar disorder, seizure disorder who
initially presented with nausea and vomit, and found to be in
DKA on . He was initially in the MICU, and then
transferred to the floor. During this recent admission, the
patient had been on an insulin drip until his gap closed, and
then was restarted on him home dose of Lantus. It was unclear
what precipitated his DKA, but it was thought that it could be
secondary to a viral gastroenteritis versus noncompliance with
his fludrocortisone, in the setting of an undetecable cortisol
level.
While in house, had been following him. Of note, while on
the floor, the patient was also found to have some mild
hematemesis thought to be secondary to a tear.
This had resolved while on the floor.
The patient was then transferred to on with
suicidal and homicidal ideation. While on Deac 4, the patient
was continued on his lantus and and HISS. continued to
follow him while on Deac 4, and increased his Lantus to 45 units
qhs. He was continued on his home prednisone and florinef, as
well.
The patient had initially been doing well on Deac 4, but then
early this morning, he started developing nausea and vomiting.
As per report, there was also blood in the vomitus. The patient
has been unresponsive to Zofran.
The patient reports that this morning at 5AM he developed nausea
and vomiting. He also reports that since this morning, he has
had three episodes of diarrhea. He also reports that he has not
been able to take PO today since the nausea started. Of note,
the patient refused his insulin and prednisone/fluronef this AM
because of his nausea.
Exam notable for tachycardia, abdominal tenderness. Sugars have
been ranging from 39-393, with AM FSG today 191.
The patient is being transferred to medicine given concern for
norovirus. Norovirus stool PCR needs to be sent.
Currently, the patient reports that he feels a little better. No
current nausea. Reports only episodes of non-bloody emesis
with last this morning. He states he has had plus episodes
of non-blood not black diarrhea. No abdominal pain. States has
been all over the place with feeling hot and cold, but no fevers
or chills.
## ROS:
per HPI and below
-reports feeling sore all over
-denies fever, chills, night sweats, headache, vision changes,
rhinorrhea, congestion, sore throat, cough, shortness of breath,
chest pain, abdominal pain, constipation, BRBPR, melena,
hematochezia, dysuria, hematuria.
## PAST MEDICAL HISTORY:
-Type I DM - dx at age
-Addison's Disease
-Possible seizure disorder- Uncertain whether epileptic vs
hypoglycemic vs other.
-Bipolar Disorder
-Depression with prior hospitalizations for SI
## FAMILY HISTORY:
Denies history of diabetes, Addison's, or autoimmune diseases.
Denies psychiatric history as well.
## GENERAL:
NAD, lying in bed
## HEENT:
no scleral icterus, OP clear, dry mucous membranes.
## NECK:
supple, no cervical .
## CV:
RRR, nl S1 S2, no r/m/g appreciated.
## ABDOMEN:
soft, ND, mild diffuse tenderness to palpation, No
organomegaly. +BS.
## EXT:
WWP, +2 pulses. No pedal edema.
## GENERAL:
NAD, lying in bed
## HEENT:
no scleral icterus, OP clear, moist mucous membranes.
## NECK:
supple, no cervical .
## CV:
RRR, nl S1 S2, no r/m/g appreciated.
## ABDOMEN:
soft, ND, no TTP, No organomegaly. +BS.
## EXT:
WWP, +2 pulses. No pedal edema.
## BRIEF HOSPITAL COURSE:
BRIEF HOSPITAL COURSE
======================
Mr. is a year old gentleman with history of
ketosis-prone T1DM, Addison's disease, bipolar d/o, and seizure
disorder who presented initially presented to the hospital with
3 days of nausea and vomiting on found to be in DKA, have
low levels of cortisol, and with bloody emesis. He was treated
in the ICU for DKA which resolved and transferred to the floor.
Given SI/HI the patient was transferred to Deac 4 on and
was transferred back to medicine for nausea, vomiting, and
diarrhea due to concern for norovirus. His symptoms improved and
he was approved by Infection Control to return to Deac 4.
Norovirus PCR was still pending on discharge.
ACTIVE ISSUES
==============
# Nausea, vomiting, diarrhea with concern for norovirus or viral
gastroenteritis: On admission had low grade fevers, significant
nausea greater than usually experienced, ongoing diarrhea,
myalgias. Likely viral gastroenteritis (with concern for
norovirus given the season and circumstances). Other ddx are
gastroparesis, DKA, bacterial gastroenteritis. Norovirus PCR was
sent to state lab, however patient improved within around 24
hours and was cleared by infection control to return to Deac 4.
Diet advanced to regular diet (carb consistent).
# Type 1 diabetes with recent episode of DKA: Blood sugar
ranged in 200s while on the floor. He was hypoglycemic in the
setting of receiving meal time doses of humalog while NPO on
Deac 4, otherwise no other episodes of hypoglycemia during this
admission
- He will be followed by when transferred to
(inpatient psych unit). He can continue on his Lantus and
humalog sliding scale with fingersticks QACHS (meals and
bedtime).
- If patient NPO for any reason, use night time sliding scale
for humalog insulin.
## # HEMATEMESIS:
Resolved. Consistent with tear,
blood only started after persistent retching. Hematocrit stable,
and patient had no further emesis or bleeding. be some
component of gastroparesis causing nausea / vomiting, vs
gastroenteritis, hypocortisolism. He was discharged on PO PPI.
## CHRONIC ISSUES
===============
# ADDISON'S DISEASE:
Recent admission with undetectable cortisol
levels. onsider re-checking as outpatient. Continued home
prednisone and florinef.
#Depression and ?bipolar disorder: Patient endorsed active SI /
HI on recent medicine admission, was transferred to Deac 4, but
once developed acute diarrhea and nausea, was transferred back.
He was maintained on a 1:1 sitter during admission and was
transferred back to 4. Was continued on home meds and
abilify which was started on Deac 4.
## # LIKELY SEIZURE DISORDER:
Had complex partial seizures with
secondary generalization, previously seen in house by Neurology,
in the setting of DKA, but AED levels were normal. Has not yet
had a chance to f/u with Neurology as an outpatient. Continued
depakote.
## TRANSITIONAL ISSUES
===================
- CODE STATUS:
Full code.
- Emergency contact: ONLY TO BE USED IN EXTREME MEDICAL
## CIRCUMSTANCES:
Aunt , .
- Studies pending on discharge: Norovirus PCR, blood cultures x2
from .
- Consider rechecking a cortisol level at follow up appointment.
- Consider uptitrating lantus as outpatient.
- If patient appears markedly altered, consider checking stat
labs to look for DKA (previously somnolent when in DKA).
- Please help patient to make and PCP appointments at
discharge from Deac4.
- He will be followed by when transferred to
(inpatient psych unit). He can continue on his lantus (42 units
at bedtime currently) and humalog sliding scale (QACHS) with
fingersticks QACHS (ie, meals and bedtime).
*** IF PATIENT IS NPO FOR ANY REASON, PLEASE USE THE NIGHT TIME
HUMALOG SLIDING SCALE WHEN DOING FINGERSTICKS TO AVOID
HYPOGLYCEMIA. ***
- Please consult social work for assistance - patient has issues
with housing.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Divalproex (DELayed Release) 1000 mg PO BID
2. Fludrocortisone Acetate 0.2 mg PO DAILY
3. Glargine 40 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
4. Pantoprazole 40 mg PO Q24H
5. PredniSONE 10 mg PO QAM
6. Sodium Chloride 1 gm PO TID
7. Acetaminophen mg PO Q6H:PRN pain, fever
8. Nicotine Polacrilex 2 mg PO Q1H:PRN nicotine cravings
9. Aripiprazole 5 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Divalproex (DELayed Release) 1000 mg PO BID
2. Fludrocortisone Acetate 0.2 mg PO DAILY
3. Glargine 42 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
4. Pantoprazole 40 mg PO Q24H
5. PredniSONE 10 mg PO DAILY
6. Sodium Chloride 1 gm PO TID
7. Aripiprazole 5 mg PO QHS
8. Nicotine Polacrilex 2 mg PO Q2H:PRN nicotine craving
9. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol
10. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol
11. Glucose Gel 15 g PO PRN hypoglycemia protocol
## DISCHARGE DIAGNOSIS:
Hypoglycemia
Viral gastroenteritis
Type 1 diabetes
tear
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking part in your care at ! You were
admitted to the hospital for nausea, vomiting, and diarrhea. You
improved and were medically stable for transfer back to Deac 4.
We wish you the best of luck!
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15170418", "visit_id": "22510431", "time": "2188-05-30 00:00:00"} |
15392674-RR-34 | 218 | ## ULTRASOUND-GUIDED CORE BIOPSY, LEFT BREAST:
The patient was referred for
biopsy of a nodule in the left breast at 2 o'clock, 8 cm from the nipple. The
procedure, risks, and benefits were explained to the patient, and written
informed consent was obtained. A preprocedure timeout was performed using two
patient identifiers and laterality was confirmed.
Using standard aseptic technique and 1% lidocaine for local anesthesia, a
13-gauge coaxial guide was advanced to the margin of the lesion. Following
this, three passes were made with a 14-gauge biopsy device. The lesion
resolved after the first pass.
## PERCUTANEOUS CLIP PLACEMENT:
Following the biopsy, an INRAD ribbon clip was
deployed at the biopsy site.
UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM, LEFT BREAST:
CC and 90-degree views
of the left breast were obtained. These views demonstrate a new INRAD ribbon
clip in the lateral left breast corresponding to the site of mammographic
abnormality; however, the abnormality is no longer visualized on the
mammogram.
The patient tolerated the procedure well without complications.
, NP, and , M.D., performed the procedure.
## IMPRESSION:
Successful biopsy in the left breast. Pathology is pending. The
patient was instructed to follow up with her referring provider in three to
five business days for pathology results and post-care instructions were
provided to the patient.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15392674", "visit_id": "N/A", "time": "2151-06-16 13:32:00"} |
13999829-RR-98 | 231 | ## INDICATION:
Patient with stage IV lung cancer and known DVT, now with
increasing shortness of breath and low oxygen saturation. Evaluate for
evidence of PE.
## FINDINGS:
After the scout images were obtained, 100 mL of contrast was
injected, but there was no contrast seen within the blood vessels in
subsequent SmartPrep images. At that point in time, assessment of the venous
access was made and it was noted that the patient had lost venous access and
the injected contrast had infiltrated into the subcutaneous tissues. I (Dr.
, was called to assess the patient clinically. The patient
had no pain in the area and had a normal radial pulse. The forearm and hands
were warm and the patient retained sensation and strength. The skin was tense
on exam but the patient had arrived to the CT suite with asymmetric swelling
of the left arm as per the ED physician . At that time, the study was
canceled and the patient was sent back to the emergency department for
replacement of the venous access and monitoring.
I personally communicated the events to Dr agreed with
observation, elevation of the extremity and warm and cold compresses for
relief of symptoms.
The scout images obtained show bibasilar ill defined opacities compatible with
known history of lung neoplasm with probable superimposed infectious process.
These findings were better assessed on the CT of the chest from .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13999829", "visit_id": "21351013", "time": "2139-11-22 17:34:00"} |
15050317-DS-21 | 932 | ## CHIEF COMPLAINT:
abdominal pain, nausea, vomiting
## HISTORY OF PRESENT ILLNESS:
M s/p FEVAR, bilateral renal stent graft, SMA stent on
now with nausea and vomiting since the morning. The
patient states he has been feeling weak since discharge. Has not
had a BM since and he normally has a BM every days.
Additionally, when he got up to go to the bathroom, slipped and
fell on his back, no loc, no residual pain or obvious injuries
from the fall. Denies fever, chills, dysuria. Pt has not been
taking any narcotic pain medications.
## PSH:
Bilateral cataract surgery
B/L guinal hernia repairs (remote)
Coil embolization of the right internal iliac artery in prep for
FEVAR.
## PULM:
Clear to auscultation b/l
## ABD:
Soft, distended, mildly TTP in LLQ. Suprapubic ecchymosis.
Feet warm, well perfused.
## BRIEF HOSPITAL COURSE:
Mr. was evaluated in the ED for complaints of nausea,
vomiting, and constipation. He was admitted to the vascular
surgery team for continued evaluation. He was started on IV
fluids and a bowel regimen. His constipation improved after
receiving the bowel medication. His labs were trended
throughout his stay. It was noted that his WBC was elevated on
admission. This trended down by day of discharge.
## NEURO:
The patient was alert and oriented throughout
hospitalization; pain was initially managed with oral medication
alone.
## CV:
The patient remained stable from a cardiovascular
standpoint; vital signs were routinely monitored.
## PULMONARY:
The patient remained stable from a pulmonary
standpoint; vital signs were routinely monitored.
## GI/GU/FEN:
The patient was initially stared on IV fluids.
Patient's intake and output were closely monitored.
## ID:
The patient's fever curves were closely watched for signs of
infection, of which there were none. The patients WBC was
elevated on admission but trended down by discharge with no
further intervention needed.
## HEME:
The patient's blood counts were closely watched for signs
of bleeding, of which there were none.
At the time of discharge, the patient was doing well, afebrile
with stable vital signs. The patient was tolerating a normal
diet, ambulating, voiding without assistance, and pain was well
controlled. The patient received discharge teaching and
follow-up instructions with understanding verbalized and
agreement with the discharge plan.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. Calcium Carbonate 500 mg PO QID:PRN indigeston
3. Lisinopril 10 mg PO DAILY
4. Simvastatin 10 mg PO QPM
5. Terazosin 2 mg PO QHS
6. Vitamin D UNIT PO DAILY
7. Acetaminophen 650 mg PO TID
8. Clopidogrel 75 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Clopidogrel 75 mg PO DAILY
3. Simvastatin 10 mg PO QPM
4. Terazosin 2 mg PO QHS
5. Acetaminophen 650 mg PO TID
6. Calcium Carbonate 500 mg PO QID:PRN indigeston
7. Lisinopril 10 mg PO DAILY
8. Vitamin D UNIT PO DAILY
9. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice per day
Disp #*30 Capsule Refills:*0
## DISCHARGE INSTRUCTIONS:
Mr. ,
You were admitted to on with complaints of
nausea, vomiting, and abdominal pain. You were evaluated by the
vascular team and no intervention was needed. You were started
on medications to help with bowel movement. Your condition
improved significantly after a bowel movement. You are now ready
for discharge with the following instructions.
## MEDICATIONS:
Take Aspirin 325mg (enteric coated) once daily
Do not stop Aspirin unless your Vascular Surgeon instructs you
to do so.
Continue all other medications you were taking before surgery,
unless otherwise directed
You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort
To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication
## WHAT TO EXPECT AT HOME:
It is normal to have slight swelling of the legs:
Elevate your leg above the level of your heart (use
pillows or a recliner) every hours throughout the day and at
night
Avoid prolonged periods of standing or sitting without your
legs elevated
It is normal to feel tired and have a decreased appetite, your
appetite will return with time
Drink plenty of fluids and eat small frequent meals
It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication
## ACTIVITIES:
When you go home, you may walk and go up and down stairs
You may shower (let the soapy water run over groin incision,
rinse and pat dry)
Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal)
Gradually increase your activities and distance walked as you
can tolerate
No driving until you are no longer taking pain medications
## CALL THE OFFICE FOR:
Numbness, coldness or pain in lower extremities
Temperature greater than 101.5F for 24 hours
New or increased drainage from incision or white, yellow or
green drainage from incisions
Bleeding from groin puncture site
FOR SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site or
incision)
Lie down, keep leg straight and have someone apply firm
pressure to area for 10 minutes. If bleeding stops, call
vascular office. If bleeding does not stop, call for
transfer to closest Emergency Room.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15050317", "visit_id": "24068623", "time": "2185-03-17 00:00:00"} |
18370680-RR-15 | 170 | ## INDICATION:
A female with toxic nodular goiter, left lobe nodule
on physical exam.
## FINDINGS:
The right lobe of the thyroid measures 2.3 x 1.7 x 5.0 cm. The
right lobe is heterogeneous with innumerable tiny confluent hypoechoic
nodules, which appear to measure about 2-5 mm. No dominant right lobe nodule
is identified.
The left lobe measures 1.9 x 2.1 x 4.4 cm. The left lobe is also
heterogeneous with numerous small nodules. A spongy nodule is seen at the
upper pole measuring 1.0 x 0.9 x 1.8 cm. A similar-appearing nodule is seen
at the lower pole measuring 1.5 x 1.3 x 1.7 cm. No dominant left lobe nodule
is identified.
A spongy nodule is also seen in the left portion of the isthmus measuring 1.8
x 1.2 x 1.6 cm.
## IMPRESSION:
Multinodular thyroid gland. No dominant nodule is identified and
the nodules seen do not demonstrate any intrinsically worrisome features.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18370680", "visit_id": "N/A", "time": "2166-01-23 09:17:00"} |
10846330-RR-9 | 159 | ## HISTORY:
Low back pain extending to the right lower extremity.
## FINDINGS:
On the sagittal images, there is no malalignment or loss of
vertebral body height. No suspect marrow lesions are noted. There are
Schmorl's nodes at L4. Degenerative endplate changes are seen at L5-S1.
There is disc desiccation in the lower lumbar spine. The conus is
unremarkable.
Axial images at L3-L4 demonstrate diffuse disc bulge and moderate right
foraminal narrowing and mild left foraminal narrowing. No significant central
stenosis. Mild bilateral lateral recess narrowing.
At L4-L5, there is a diffuse disc bulge and mild bilateral lateral recess
narrowing. There is bilateral ligamentum flavum and facet hypertrophy. There
is moderate left and right foraminal narrowing with abutment of the exiting
nerve roots.
At L5-S1, there is a mild diffuse disc bulge. There is abutment of bilateral
S1 nerve roots. No significant central stenosis. Foramina are patent.
## IMPRESSION:
Mild degenerative changes as detailed above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10846330", "visit_id": "N/A", "time": "2122-08-18 14:15:00"} |
16950272-DS-23 | 1,893 | ## ALLERGIES:
Prilosec / Bactrim DS / Percocet / Sulfa (Sulfonamide
Antibiotics) / Vitamin D / Nifedipine / Atrovent HFA / Maxair
Autohaler
## HISTORY OF PRESENT ILLNESS:
Ms. is a year old woman with a history asthma,
paroxysmal afib on coumadin, HTN who presents to the ED this
morning complaining of palpitations and shortness of breath.
Patient noticed palpitations yesterday and took her pulse
throughout the day, noting ranges from 50's to 120's. She awoke
this morning with similar symptoms associated with dizziness.
She noted pulse down to the 30's and called an ambulance. Per
EMT HR was in the 160's with normal blood pressure. when she
decided to come into the ED.
.
Patient endorses a history of asthma requiring daily Atrovent
and Xopenex. She states she uses the Xopenex daily despite poor
efficacy. Yesterday she estimated 4 or 5 uses of Xopenex. She
denies recent URI, allergen exposure, diarrhea or vomitting. She
endorses PND and 3 pillow orthopnea with a chronic nighttime
cough. She develops SOB after block of walking.
.
In the ED, initial vitals were T 97.8, HR 122, BP 117/79 RR 18,
satting 99% on 2L. Per ED's note, her heart rate was noted to be
in the 140's and patient was in SVT or AFib with RVR. She
recieved 10 mg of IV diltiazam.
.
On transfer to the floor, initial vital signs T 98.1, P , RR
25, satting 96% on Ra. Pt continued to complain of racing heart
and mild difficulty breathing.
.
On review of systems, she endorses calf claudication on walking.
She denies any prior history of stroke, TIA, deep venous
thrombosis, pulmonary embolism, bleeding at the time of surgery,
myalgias, joint pains, hemoptysis, black stools or red stools.
She denies recent fevers, chills or rigors. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
ankle edema, syncope or presyncope.
## PAST MEDICAL HISTORY:
1. Atrial fibrillation on disopyramide and coumadin
2. Obstructive airway disease (FEV 1 0.81L (47%) on
3. Hypertension
4. H/o breast cancer, s/p lumpectomy, chemo and XRT in
5. Osteopenia
6. Cardiomyopathy (EF 20% in but much improved with control
of tachyarrhythmia, most recently 50%)
7. Possible amiodarone-induced lung toxicity
8. H/o lung nodules
9. H/o trigeminal neuralgia
10. H/o migraine headaches, usually right-sided, retroorbital.
11. History of TAH/BSO for post-menopausal bleeding
12. S/p laprascopic cholecystectomy
## FAMILY HISTORY:
-Significant for heart disease in multiple siblings including
valvular disease and pacing in her sisters and 2 brothers who
died of 'heart disease'; Father died of lung cancer.
## GENERAL:
yo 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.
## NECK:
Supple, no thyromegaly or LAD noted..
## CARDIAC:
PMI nondisplaced. Tachy, 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, some use of accessory muscles. Crackles noted at
both bases, no wheezes or rhonchi.
## ABDOMEN:
Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominal bruits. Normoactive BS
## SKIN:
No stasis dermatitis, ulcers, scars, or xanthomas.
## LEFT:
Radial 2+ DP 2+ 1+
FEX on Discharge
## GENERAL:
Pleasant woman appears stated age laying in bed in no
acute distress. Oriented x3. Mood, affect appropriate.
## HEENT:
Sclera anicteric. PERRL,EOMI. Palate clear and
symetrical.
## NECK:
Supple, no JVP, LAD or thyromegaly.
## CARDIAC:
Slightly tachy with regular rhythm. S1, S2. No murmurs,
rubs or gallops noted.
## LUNGS:
Resp were unlabored, with mild accessory muscle use.
Crackles noted over left lung. Somewhat poor air movement.
## ABDOMEN:
normal BS. Soft, NTND.
## EXTREMITIES:
Well perfused, no CCE.
## PERTINENT RESULTS:
ADMISSION LABS
10:20AM cTropnT-<0.01
10:20AM proBNP-145
10:20AM WBC-6.3 RBC-4.83 HGB-13.7 HCT-38.7 MCV-80*
MCH-28.3 MCHC-35.3* RDW-14.4
10:20AM NEUTS-58.2 MONOS-7.2 EOS-3.2
BASOS-0.9
10:20AM PLT COUNT-254
10:20AM PTT-26.1
10:20AM GLUCOSE-92 UREA N-12 CREAT-0.9 SODIUM-137
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-21* ANION GAP-15
10:50AM URINE RBC-1 WBC-3 BACTERIA-FEW YEAST-NONE
EPI-1
10:50AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-MOD
10:50AM URINE COLOR-Straw APPEAR-Clear SP
DISCHARGE LABS
06:25AM BLOOD WBC-4.7 RBC-4.86 Hgb-14.0 Hct-39.9 MCV-82
MCH-28.8 MCHC-35.1* RDW-14.6 Plt
06:25AM BLOOD Plt
06:25AM BLOOD
06:25AM BLOOD Glucose-91 UreaN-10 Creat-0.8 Na-134
K-3.7 Cl-99 HCO3-25 AnGap-14
06:25AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.3
06:25AM BLOOD TSH-2.4
01:25PM URINE Color-Straw Appear-Clear Sp
REPORTS
1. CXR
The lungs are well expanded and clear. The cardiac silhouette
and hilar
contours are normal. No pleural effusions or pneumothorax is
present. The
aorta is diffusely enlarged and tortuous.
## IMPRESSION:
No acute intrathoracic process.
2.Cardiology Report ECG Study Date of 12:53:22
Sinus tachycardia. Left anterior fascicular block. Poor R wave
progression.
Compared to tracing #2 the premature atrial contractions are
absent.
TRACING #3
3.Cardiology Report ECG Study Date of 11:11:48 AM
Sinus tachycardia with premature atrial contractions. Left
anterior fascicular
block. Poor R wave progression. Compared to tracing #1 the
ventricular
premature beat is absent.
TRACING #2
Read by: .
Intervals Axes
Rate PR QRS QT/QTc P QRS T
106 184 96
4.Cardiology Report ECG Study Date of 10:01:42 AM
Sinus tachycardia with premature atrial contractions and
probable ventricular premature beats. Left anterior fascicular
block. Poor R wave progression could be due to left anterior
fascicular block. Compared to the previous tracing of the
ventricular premature beat is new.
TRACING #1
Read by: .
Intervals Axes
Rate PR QRS QT/QTc P QRS T
126 160 98 year old woman with history of paroxysmal AFib and asthma
presents with tachycardia, palpitations, and self reported
bradycardia.
##
ACTIVE PROBLEMS
1.TACHYARRHYTHMIA:
Patient was treated with 10 mg IV diltiazem
in the ED for suspected Afib with RVR. Upon admission to floor,
EKG noted sinus tachycardia with frequent PAC and LAFB. Patient
was monitored on telemetry overnight, and maintained this rhythm
around 100 bpm except for one brief conversion into Afib. Of
note, patients normal heart rate is approximately 100 per clinic
notes, and patient felt back to her baseline at this rate. EP
was consulted and offered PVI, which she declined at this time.
She was discharged with short acting diltiazem to take prn for
tachycardia along with her long acting cardiazem. Additionally,
disopyramide was increased to total of 450mg daily.
##
2. ASTHMA:
Patient has history of difficult to control asthma,
and reports taking frequent doses of xopenex. During her stay,
patient was treated with ipratropium nebs, as we held b-agonists
due to her tacchycardia. Patient was informed to use her
inhalers only as prescribed, and noted that b-agonists may be
contributing to her increased heart rate. Patient is to follow
up closely as outpatient for her difficult to control asthma.
Additional control of her anxiety may also help control her
chronic dyspnea.
##
CHRONIC PROBLEMS
1.HYPERTENSION:
Stable during admission, continued on home
valsartan 40 and diltiazem XL 360.
##
2.GERD:
Stable during stay, patient maintained on pantoprozole
40mg daily.
OUTSTANDING LABS
None
TRANSITIONAL ISSUES
Patient may benefit from discussion regarding PVI in the future
to control her heart rhythm better. Additionally, tight control
of her asthma with less frequent use of xopenex, along with
decrease of anxiety may decrease her dyspnea.
## MEDICATIONS:
confirmed
CLONAZEPAM - 0.5 mg Tablet - Tablet(s) by mouth twice a day
DILTIAZEM HCL - 360 mg Capsule, Extended Release - 1 (One)
Capsule, Sustained Release(s) by mouth once a day per cardiology
DISOPYRAMIDE - 150 mg Capsule - 1 Capsule(s) by mouth twice a
day
per cardiology
IPRATROPIUM BROMIDE [ATROVENT] - 21 mcg Spray, Non-Aerosol -
sprays each nostril at bedtime
LEVALBUTEROL TARTRATE [XOPENEX HFA] - 45 mcg/Actuation HFA
Aerosol Inhaler - 2 (Two) puffs(s) inhaled every six (6) hours
as
needed for dyspnea
PANTOPRAZOLE [PROTONIX] - 40 mg Tablet, Delayed Release (E.C.) -
1 Tablet, Delayed Release (E.C.)(s) by mouth once a day Brand
name only necessary - No Substitution
POLYETHYLENE GLYCOL 3350 - 17 gram/dose Powder - 1 capful
Powder(s) by mouth once a day in juice or water
POTASSIUM CHLORIDE - 10 mEq Capsule, Extended Release - 1
Capsule(s) by mouth three times a day
VALSARTAN [DIOVAN] - 40 mg Tablet - 1 Tablet(s) by mouth twice a
day
WARFARIN - 5 mg Tablet - 5mg MWSat, 7.5 other days
LORATADINE - 10 mg Tablet - 1 Tablet(s) by mouth once a day
## DISCHARGE MEDICATIONS:
1. clonazepam 0.5 mg Tablet
## SIG:
0.5 Tablet PO BID (2 times a
day) as needed for anxiety.
2. diltiazem HCl 360 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO once a day.
3. disopyramide 150 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO three times a day.
Disp:*90 Capsule, Extended Release(s)* Refills:*3*
4. Atrovent Nasal
5. levalbuterol tartrate 45 mcg/Actuation HFA Aerosol Inhaler
## SIG:
Two (2) PUFFS Inhalation every six (6) hours as needed for
shortness of breath or wheezing.
6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1)
CAPFUL PO DAILY (Daily) as needed for constipation: IN JUICE OR
WATER.
8. potassium chloride 10 mEq Tablet Extended Release Sig: One
(1) Tablet Extended Release PO three times a day.
9. valsartan 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. warfarin 5 mg Tablet Sig: One (1) Tablet PO DAYS (MO,WE,SA).
11. warfarin 5 mg Tablet Sig: 1.5 Tablets PO
.
12. loratadine 10 mg Tablet Sig: One (1) Tablet PO once a day.
13. diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO AS NEEDED
as needed for TACHYCARDIA: PLEASE TAKE ONE TAB AT ONSET OF
TACHYCARDIA.
Disp:*30 Tablet(s)* Refills:*2*
## DISCHARGE DIAGNOSIS:
Atrial tachycardia
Atrial fibrillation
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
You were admitted to the hospital due to a very rapid heart rate
and dizziness. You have had many similar episodes previously,
and your cardiac monitoring showed abnormal rhythms called
atrial fibrillation. You were seen by the electrophysiology
team, who recommended an ablation procedure. You preferred to
manage this problem with medicine, and so your dosages were
adjusted accordingly.
Please avoid caffeine and use your xoponex only if needed, as
these substances can stimulate your abnormal rhythms and
symptoms.
The following changes were made to your medications:
1. INCREASE DISOPYRAMIDE to 150mg in THREE TIMES A DAY
2. START DILTIAZEM (short acting) 60mg at the onset of your
tachycardia. You should still continue taking the normal 360mg
long-acting version of this drug every day.
Please continue all other medications as previously prescribed.
It was a pleasure taking care of you, Ms. .
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16950272", "visit_id": "25532388", "time": "2165-02-09 00:00:00"} |
16378154-RR-48 | 300 | LEFT DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD AND LEFT BREAST ULTRASOUND
## CLINICAL INDICATION:
Left breast nodular densities on recent screening.
Comparison is made to the patient's previous studies dated ,
and .
Spot compression CC and MLO and straight lateral views of the left breast were
obtained to further evaluate a vague area of nodularity in the central left
breast on the CC view and in the upper mid to posterior left breast on the MLO
view of the prior study dated . On these additional views, the MLO
asymmetry does not persist and is felt to correspond to superimposed breast
tissue. However, there is a persistent well-circumscribed partially obscured
mass in the upper central left breast. This area was further evaluated with
ultrasound.
This study was interpreted with the aid of the ICAD computer-aided detection
system.
Ultrasound of the left breast at 12 o'clock, 10 cm from the nipple in the area
of concern on mammography identifies a 0.8 x 0.8 x 0.5 cm solid hypoechoic
mass with somewhat heterogeneous internal echotexture. Although possibly
benign, ultrasound-guided biopsy to confirm the benign etiology of this
finding would be advised at this time. At the time of discussion with the
patient, the patient would prefer that an attempt to also be made at
percutaneously excising the lesion at the time of biopsy. Dr. ,
the covering physician for Dr. , was notified by phone of this
recommendation on at 2:25pm.
## IMPRESSION:
1. Indeterminate solid 0.8 x 0.8 x 0.5 cm mass in the left breast at 12
o'clock corresponding to the nodular asymmetry seen on the recent mammogram of
. Ultrasound-guided core biopsy using a vacuum assisted device would
be advised at this time.
BI-RADS 4A - suspicious abnormality, biopsy should be considered.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16378154", "visit_id": "N/A", "time": "2155-12-07 12:38:00"} |
11009741-DS-10 | 1,574 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
draining L foot ulcer
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Left foot debridement s/p wound vac placement
R PICC placement
Left foot debridement
## HISTORY OF PRESENT ILLNESS:
with PMH significant CAD, HTN, PVD s/p Rt BKA and Lt met
head resections who was referred to the ED from podiatry for an
infected ulcer on the bottom of his left foot. The ulcer has
been present for years, however it recently started draining
purulent material. He denies any pain, but has neuropathy at
baseline. The patient had a fever to yesterday with chills.
No cough, chest pain, shortness of breath, abdominal pain, and
dysuria. Podiatry would like to admit for scheduled debridement,
tentatively . Previous wound cultures grew GBS and MSSA.
the ED, initial VS were 99.7 60 133/65 16 98%
Exam significant for left foot s/p met head resection, 2x2cm
ulcer, foul smelling. Probes to bone. Extremities warm and dry.
Labs significant for Na 129, BUN/CR 38/2.2, Glucose 237, WBC
16.7, H/H 12.1/37.7. Blood Cx pending.
Received 1 L NS, vancomycin 1g x 1, zosyn 4.5 g x 1.
On arrival to the floor, patient reports no other complaints
other than his left foot ulcer. He reports noticing elevated
blood sugars over the last few days. He does report a one day
history of loose, small volume, bowel movements, approximately
six the last hours, without blood.
## PAST MEDICAL HISTORY:
CKD
Type I DM
History of Endocarditis
History of R BKA for PVD
HTN
CAD
GERD
PVD
Anemia
## PAST SURGICAL HISTORY:
R BKA
cholecystectomy
appendectomy
L toe amputation
Left metatarsal head resections
CABG
## FAMILY HISTORY:
Father with CAD, DM
Mother with non-alcoholic cirrhosis
## HEENT:
AT/NC, EOMI, PERRL, anicteric sclerae, pink conjunctivae,
patent nares, MMM, nontender supple neck, no LAD, no JVD
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## LUNG:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## ABDOMEN:
nondistended, +BS, nontender all quadrants, no
rebound/guarding, no hepatosplenomegaly
## EXTREMITIES:
+ right BKA without sign of infection, L foot
wrapped ACE and gauze, 2-3 cm lesion on the plantar surface
leaking serosanguinous fluid, moving all extremities well, no
cyanosis, clubbing or edema
## NEURO:
A&O x 3, CN II-XII intact
## SKIN:
warm and well perfused, no excoriations or lesions, no
rashes
## HEENT:
AT/NC, EOMI, PERRL, anicteric sclerae, pink conjunctivae,
patent nares, MMM, nontender supple neck, no LAD, no JVD
## CARDIAC:
RRR, S1/S2, no murmurs, gallops, or rubs
## LUNG:
CTAB, no wheezes, rales, rhonchi, breathing comfortably
without use of accessory muscles
## ABDOMEN:
nondistended, +BS, nontender all quadrants, no
rebound/guarding, no hepatosplenomegaly
## BACK:
no midline tenderness, no CVA tenderness
## EXTREMITIES:
+ right BKA without sign of infection, L foot with
bandage that is c/d/i, moving all extremities well, no cyanosis,
clubbing or edema
## NEURO:
A&O x 3, CN II-XII intact
## SKIN:
warm and well perfused, no rashes
## 9:52 AM SWAB SOURCE:
Rectal swab.
**FINAL REPORT
R/O VANCOMYCIN RESISTANT ENTEROCOCCUS (Final :
No VRE isolated.
9:33 am TISSUE LEFT SECOND METATARSAL HEAD.
**FINAL REPORT
GRAM STAIN (Final :
2+ per 1000X FIELD): POLYMORPHONUCLEAR
LEUKOCYTES.
2+ per 1000X FIELD): GRAM POSITIVE COCCI.
PAIRS.
2+ per 1000X FIELD): GRAM NEGATIVE ROD(S).
1+ (<1 per 1000X FIELD): GRAM POSITIVE ROD(S).
SMEAR REVIEWED; RESULTS CONFIRMED.
TISSUE (Final :
MIXED BACTERIAL FLORA.
This culture contains mixed bacterial types (>=3) so an
abbreviated workup is performed. Any growth of
P.aeruginosa,
S.aureus and beta hemolytic streptococci will be
reported. IF
THESE BACTERIA ARE NOT REPORTED BELOW, THEY ARE NOT
PRESENT
this culture..
Work-up of organism(s) listed below discontinued
(excepted
screened organisms) due to the presence of mixed
bacterial flora
detected after further incubation.
STAPH AUREUS COAG +. RARE GROWTH.
Staphylococcus species may develop resistance during
prolonged
therapy with quinolones. Therefore, isolates that are
initially
susceptible may become resistant within three to four
days after
initiation of therapy. Testing of repeat isolates may
be
warranted.
## SENSITIVITIES:
MIC expressed
MCG/ML
STAPH AUREUS COAG +
|
CLINDAMYCIN
-----
<=0.25 S
ERYTHROMYCIN
-----
<=0.25 S
GENTAMICIN
-----
<=0.5 S
LEVOFLOXACIN
-----
0.25 S
OXACILLIN
-----
0.5 S
TETRACYCLINE
-----
<=1 S
TRIMETHOPRIM/SULFA
-----
<=0.5 S
ANAEROBIC CULTURE (Final :
MIXED BACTERIAL FLORA.
Mixed bacteria are present, which may include anaerobes
and/or
facultative anaerobes. Bacterial growth was screened
for the
presence of B.fragilis, C.perfringenes, and C.septicum.
None of
these species was found.
## 4:51 AM STOOL CONSISTENCY:
LOOSE Source:
Stool.
**FINAL REPORT
C. difficile DNA amplification assay (Final :
Negative for toxigenic C. difficile by the Illumigene DNA
amplification assay.
(Reference Range-Negative).
and BLOOD CULTURES NEGATIVE.
## BRIEF HOSPITAL COURSE:
with PMH significant for peripheral vascular disease s/p
Rt BKA and Lt met head resections who was referred to the ED
from clinic for an infected ulcer on the bottom of his
left foot, with hospital course complicated by hyponatremia and
acute kidney injury, both of which resolved with fluids.
## TRANSITIONAL ISSUES:
- Please continue ceftriaxone 2gm IV daily and flagyl 500mg PO
every 8 hrs for a planned six week course (last day
unless advised otherwise by infectious disease department at
- Laboratory studies: WEEKLY: CBC with differential, BUN, Cr,
AST, ALT, TB, ALK PHOS, ESR, CRP. Next draw on then
weekly afterwards. Please fax results to: ATTN:
CLINIC - FAX:
- Please apply wound vac on day of arrival to rehab facility and
exchange wound vac every three days.
- Patient should be nonweight bearing on left forefoot, can do
small transfers with his heel if necessary.
- All questions regarding outpatient parenteral antibiotics
after discharge should be directed to the
R.N.s at or to the on-call ID fellow when the
clinic is closed.
## # L FOOT OSTEOMYELITIS:
Patient with infected L foot ulcer,
draining serosanguinous fluids, reported fevers, with a WBC on
admission of 16. He was initiated on broad spectum antibiotics
with vanc/zosyn (day . On , he underwent
debridement with podiatry with a wound vac place. On , he
was transitioned from vancomycin/ciprofloxacin/flagyl to
ceftriaxone/flagyl given wound biopsy grew MSSA. PICC placed
right arm on . He was discharged to rehab with plan to
continue ceftriaxone and flagyl to complete 6-week course of
antibiotics (last day and to initiate wound wound vac. He
will follow up with podiatry and infectious disease for further
management as an outpatient.
## # HYPONATREMIA:
Resolved. Patient with an admission sodium of
129, without changes mental status. Urinary lytes consistent
with pre-renal losses likely from hypovolemic hyponatremia
the setting of infection. His sodium improved and normalized
with fluid resuscitation.
## # DIARRHEA:
Improving. C diff negative. Patient was treated with
supportive care and loperamide prn.
## # :
Resolved. Patient with Cr of 2.2 on admission, up from
last known baseline of 1.4-1.6. Urinary lytes consistent with
prerenal etiology, possible hypovolemia given diarrhea and
infection described above. Cr returned to baseline (1.5-1.7)
with fluid resuscitation and improved PO intake. Discharge Cr
was 1.6.
## # HTN:
Continued home metoprolol. Furosemide was initially held
and restarted on once had resolved.
## # CAD:
Continued aspirin and simvastatin.
## # ANXIETY:
Continued clonazepam and setraline.
## # TYPE I DM:
Increased lantus to 22U/22U and continued ISS.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Gabapentin 200 mg PO BID
2. Metoprolol Succinate XL 25 mg PO BID
3. Furosemide 40 mg PO DAILY
4. Aspirin 81 mg PO DAILY
5. Sertraline 150 mg PO DAILY
6. Omeprazole 20 mg PO DAILY
7. Simvastatin 40 mg PO DAILY
8. ClonazePAM 0.5 mg PO BID
9. Glargine 20 Units Breakfast
Glargine 20 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. ClonazePAM 0.5 mg PO BID
RX *clonazepam 0.5 mg 1 tablet(s) by mouth twice a day Disp #*14
## TABLET REFILLS:
*0
3. Gabapentin 200 mg PO BID
4. Metoprolol Succinate XL 25 mg PO BID
5. Omeprazole 20 mg PO DAILY
6. Sertraline 150 mg PO DAILY
7. Simvastatin 40 mg PO DAILY
8. Heparin 5000 UNIT SC TID
9. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain
RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp
#*28 Tablet Refills:*0
10. Furosemide 40 mg PO DAILY
11. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H
12. CeftriaXONE 2 gm IV Q24H
13. Glargine 22 Units Breakfast
Glargine 22 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
## PRIMARY:
Left foot osteomyelitis
Acute kidney injury
Hyponatremia
## SECONDARY:
Peripheral vascular disease
Diabetes Mellitus
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you while you were the
hospital.
You were admitted to the hospital because of a left foot ulcer
infection. You were given IV antibiotics and taken to the
operating room on for debridement (cleaning out of the
infection) by our podiatrists. They also did this again on
. Since the infection is your bone, you will need to
be on antibiotics for 6 weeks. You will be on ceftriaxone and
flagyl. You will follow up with the infectious disease doctors
who help determine if this antibiotic course needs to
change at all.
Please seek medical attention if you develop fevers, shaking
chills, severe and persistent pain, persistent nausea and
vomiting, or drainage from your wound.
It was a pleasure taking care of you,
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11009741", "visit_id": "20197047", "time": "2171-10-24 00:00:00"} |
18067737-RR-60 | 116 | ## HISTORY:
man with history of small cell carcinoma.
## CT CHEST:
There are stable post-radiation changes with left perihilar opacity
and traction bronchiectasis. No new soft tissue density or pulmonary nodules
are identified. There is no axillary, mediastinal, or hilar lymphadenopathy.
The heart size is at upper limits of normal. The moderate-to-large
pericardial effusion may be slightly increased in size. There is no pleural
effusion. Right adrenal calcification and small adjacent hyperdense focus are
unchanged. Imaged portions of the upper abdomen are otherwise unremarkable.
There are no bone lesions suspicious for malignancy.
## IMPRESSION:
No evidence of recurrent or new intrathoracic malignancy,
following left hilar radiation. Slight increase in size of pericardial
effusion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18067737", "visit_id": "N/A", "time": "2172-03-15 10:18:00"} |
14552465-RR-34 | 85 | ## FINDINGS:
A pacemaker device appears unchanged. The cardiac, mediastinal and
hilar contours appear unchanged. There is no definite pleural effusion or
pneumothorax. There is patchy left basilar density, as seen previously. but
possibly due to normal bronchovascular structures or minor atelectasis.
Pneumonia is doubtful.
## IMPRESSION:
No definite acute cardiopulmonary disease. If pulmonary symptoms
are present and were to persist, or if there were to continue to be an
unexplained potential source for fever, radiographs could be considered with
standard PA and lateral technique.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14552465", "visit_id": "24709451", "time": "2179-05-19 16:24:00"} |
11629252-DS-6 | 1,556 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
CABG X4 (LIMA to LAD, SVG to Diag, SVG to OM, SVG to
PDA)
## HISTORY OF PRESENT ILLNESS:
year-old M with CAD (s/p
subendocardial MI , frequent anginal symptoms, HTN, HLD,
hx
of A fib s/p successful cardioversion years ago (not on
coumadin), severe PVD with recent left femoropopliteal bypass
for
a thrombosed left popliteal artery aneurysm causing left foot
ischemia on (hospital course c/b bleed into left knee
when anticoagulation was started for thrombosed l pop artery)
who
presents with chief complaints of fever, rigors, and nausea. Pt.
was at and was found to be febrile to 102.8.
EMS was called to bring patient to the hospital. Prior to EMS'
arrival, the patient reported a very mild episode of pressure
located in abdominal area without radiation, relieved by a
single
SLN, lasting for approximately ten minutes.
Initial EKG documented by EMS was NSR, but en route to the
hospital, the patient began to demonstrate some ectopy with
wide complexes noted on the monitor. He was admitted under the
vascular service for L thigh infection/possible abcess
formation.
He has a new LBBB and underwent cardiac cath today which
revealed
triple vessel coronary artery disease. Cardiac surgery was
consulted for possible CABG.
## PAST MEDICAL HISTORY:
Peripheral Artery Disease
CAD c/b subendocardial MI ( )
Intermittent angina (about 3X per year)
Hypertension
Dyslipidemia
Hx of A fib s/p successful cardioversion (not on coumadin)
GOUT (last attack yrs ago)
Psoriasis
Osteoarthritis in B/L knees
BPH
H. Pylori c/b duodenal/gastric ulcers s/p treatment
Diverticulitis s/p surgery X 2
Cholecystectomy
## PAST SURGICAL HISTORY:
s/p colostomy due to duverticulitis and s/p reversal of
colostomy
s/p L fem-pop bypass
s/p choley
s/p shrapnel injury to L arm
## FAMILY HISTORY:
No significant history of CAD. Father had a leg
amputated in (hx of injury to leg).
## HEENT:
PERRLA [x] EOMI [x] edentulous
## NECK:
Supple [x] Full ROM [x]
## CHEST:
Lungs clear bilaterally [x]
## HEART:
RRR [x] Irregular [] Murmur
## ABDOMEN:
Soft [x] non-distended [x] non-tender [x] bowel sounds
+ [x]well healed surgerical scars
## EXTREMITIES:
Warm [x] well-perfused [x] Edema Varicosities:
None
[x] left mid calf saphenectomy wound healing well, left groin
packed with VAC dressing. Left foot has 2+ edema
Left arm: old schrapnel wound, well healed.
## FEMORAL RIGHT:
2+ Left: cath site
## PRE CPB:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium or left atrial appendage.
No atrial septal defect is seen by 2D or color Doppler.
There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta,
there is no atheroma in the ascending aorta which was evaluated
with epiaortic ultrasound. The IABP was positioned aproximately
2 cm below the takeoff of the left subclavian.
There are three aortic valve leaflets. There is no aortic valve
stenosis. No aortic regurgitation is seen.
There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen.
Dr. was notified in person of the results.
## POST CPB:
The patient is AV-Paced, on low dose phenylephrine.
Preserved biventricular systolic fxn. No AI, trace MR.
remains in good position. Aorta intact.
I certify that I was present for this procedure in compliance
with regulations.
Electronically signed by , MD, Interpreting
physician 22: dmitted to the vascular service from rehab for thigh
incision infection. Started on triple abx therapy. Seen by
cardiology for new LBBB.Ruled in for NSTEMI and underwent
cardiac cath which showed severe LM and 3VD. Referred for CABG.
Left carotid dz on US noted during pre-op workup. Plavix washout
done as well as CT of thigh. Fluid collection noted by no I&D
necessary per vasc. VAC placed. Underwent surgery with Dr.
on . Transferred to the CVICU in stable condition
on IABP. Extubated on POD #1. Transferred to the floor on POD #2
to begin increasing his activity level. Gently diuresed toward
his preop weight. Beta blockade titrated. Amiodarone started for
recurrent A Fib. Chest tubes and pacing wires removed per
protocol. Creatinine peaked at 2.3 and was 2.1 at discharge.
PICC placed for continued abx through . Cleared for
discharge to rehab on POD #6. All floowup appts
were advised, including f/u with vasc. surg.
## MEDICATIONS ON ADMISSION:
AMLODIPINE 10 mg Tablet - 1
Tablet(s) by mouth once a day
BUDESONIDE-FORMOTEROL [SYMBICORT] 160 mcg-4.5 mcg/Actuation HFA
Aerosol Inhaler - 1 once a day
CEPHALEXIN 500 mg 1 Capsule(s) by mouth three times a day
COLCHICINE 0.6 mg 1 Tablet(s) by mouth daily
DICLOFENAC SODIUM 100 mg Tablet Sustained Release 24 hr - 1
Tablet(s) by mouth daily
FOLIC ACID 1 mg - 1 Tablet(s) by mouth daily
FUROSEMIDE 40 mg 1 Tablet(s) by mouth daily
ISOSORBIDE DINITRATE 30 mg 1 Tablet(s) by mouth daily
METOPROLOL TARTRATE 50 mg 1 Tablet(s) by mouth daily
SIMVASTATIN 40 mg 1 Tablet(s) by mouth daily
TAMSULOSIN 0.4 mg Sust. Release 24 hr - 1 Capsule(s) by mouth
daily
TIOTROPIUM BROMIDE 18 mcg Capsule, w/Inhalation Device - 1 once
a
day
ASPIRIN 81 mg 1 Tablet by mouth daily
CALCIUM GLUBIONATE Dosage uncertain
CYANOCOBALAMIN (VITAMIN B-12) 500 mcg 1 Tablet(s) by mouth daily
NIACIN [ENDUR-ACIN] 500 mg 1 Tablet(s) by mouth daily
OMEPRAZOLE 20 mg Delayed Release (E.C.) - 1 Tablet(s) by mouth
daily
Plavix 75 mg PO daily
## DISCHARGE MEDICATIONS:
1. docusate sodium 100 mg Capsule
## SIG:
One (1) Capsule PO BID (2
times a day) for 1 months.
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation BID (2 times a day).
4. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
5. niacin 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO BID (2 times a day).
6. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
7. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 3 days: 400 mg BID through , then 400 mg daily
then 200 mg daily ongoing.
8. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
9. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
11. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. metolazone 2.5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
13. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO TID
(3 times a day) as needed for thrush.
14. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
15. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
## SIG:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
16. Furosemide 40 mg IV DAILY
17. Zosyn 2.25 gram Recon Soln Sig: 2.25 grams IV Intravenous
every six (6) hours for 5 days: through for a . metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day): hold for HR <55 and SBP <90.
## DISCHARGE DIAGNOSIS:
CAD s/p CABG x4
Peripheral Artery Disease
CAD c/b subendocardial MI ( )
Intermittent angina (about 3X per year)
Hypertension
Dyslipidemia
Hx of A fib s/p successful cardioversion (not on coumadin)
GOUT (last attack yrs ago)
Psoriasis
Osteoarthritis in B/L knees
BPH
H. Pylori c/b duodenal/gastric ulcers s/p treatment
left carotid dz.
NSTEMI
left thigh abscess
## PAST SURGICAL HISTORY:
s/p colostomy due to duverticulitis and s/p reversal of
colostomy
s/p L fem-pop bypass
s/p choley
s/p shrapnel injury to L arm
## DISCHARGE CONDITION:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
## INCISIONS:
Sternal - healing well, no erythema or drainage
Leg Right - healing well, no erythema or drainage.
left thigh wound (fem-pop) VAC drsg
## 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": "11629252", "visit_id": "25565252", "time": "2193-12-03 00:00:00"} |
18305480-DS-19 | 1,116 | ## CHIEF COMPLAINT:
Amaurosis fugax in the setting of known carotid stenosis
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Right carotid exploration and right carotid
stenting.
## HISTORY OF PRESENT ILLNESS:
gentleman, known to have a right carotid stenosis
followed by duplex over several years, recently developed
symptoms with 2 episodes of amaurosis. He was therefore
admitted to the hospital and heparinized with surgery planned
for this admission.
## PMH:
Esophageal cancer, GERD, BPH, asthma, stage II melanoma
, inguinal hernia, SBO diaphragmatic hernia
## PSH:
esophagectomy , Left total knee replacement .
Right total knee replacement , excision of melanoma, right
forearm , Tonsillectomy, Mucoepidermoid carcinoma, right
submaxillary gland excised , Surgical repair of
diaphragmatic hernia in .
## FAMILY HISTORY:
Father and 2 half sisters with CAD
## PHYSICAL EXAM:
Alert and oriented x 3
## PULSES:
Left Femoral palp, DP palp , palp
Right Femoral palp, DP palp , palp
Left neck incision soft, no hematoma or ecchymosis.
## BRIEF HOSPITAL COURSE:
The patient was admitted to the hospital on after 2
episodes of amaurosis fugax in the setting of known right
carotid artery stenosis. He was brought to the operating room
on and underwent a right carotid artery cutdown and
stenting. The procedure was without complications. He was
closely monitored in the PACU and then transferred to the floor
in stable condition. On POD 1, he developed R eye diplopia,
for which he was evaluated by the neurology service. A CTA
showed a large thrombus within the petrous segment of the right
internal carotid and narrow flow channel in the ICA stent with
possible thrombus. The right anterior circulation is likely
receiving blood from collateralflow from the left anterior
circulation. He was started on heparin and transitioned to
coumadin. He did develop a small right neck hematoma which was
managed conservatively. The diplopia has since resolved and he
is neurologically intact. Other issues that required attention
while in the hospital included:
1.Aspiration
Significant signs of aspiration became evidence as po intake was
increased on POD #3. Speech and swallow was consulted.
Aspiration and pharyngeal residue was noted with all
consistencies trialed during evaluation. He was made NPO. A
video swallow performed showed moderate oral and
pharyngeal dysphagia. His dysphagia is likely acute on chronic
with components associated both with his post-esophageal ca
dysphagia (documented in as well as swelling from his
right carotid endarterectomy. Repeat study on showed
improvement but there was continued mild aspiration. He was
discharge to home on nectar thick liquids and moist, ground
solids. We have done diet teaching and set him up for home
suction for oral care. He is scheduled for an outpatient repeat
video swallow study on .
2.Vocal Cord Paralysis
Worsening hoarseness was noted on POD #4 and ENT was consulted.
Exam showed evidence of moderate supraglottic and laryngeal
edema, likely associated with the hematoma, as well as right
true vocal cord paralysis. He was started on decadron 10mg
three times daily with taper which was completed by . His
voice has improved and is nearly back to baseline. Follow up
with ENT has been arranged.
3.Pneumonia
Chest Xray on POD 3 showed evidence of infiltrate in left lower
lobe and right base with fever to 101.6 felt to be secondary to
aspiration. He was started on vanco and cefepime and received
an 8 day course. He is now afebrile with a normal white blood
cell count and breath sounds.
4. Carotid Thrombus
The plan is for anticoagulation with coumadin with goal INR .
As his INR was subtheraputic today, he will be discharged on a
lovenox bridge until INR is checked on . Anticoagulation
is being followed by his PCP, . Follow-up has been
arranged with Dr. in one month with surveillance
carotid duplex.
He was discharged to home on POD # 11 in stable condition with
home services.
## DISCHARGE MEDICATIONS:
1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours) as needed for SOB.
3. fluticasone 110 mcg/actuation Aerosol Sig: Two (2) Puff
Inhalation BID (2 times a day).
4. mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).
5. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
7. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. vitD3 1000mg daily
9. melatonin 6mg nightly
10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
## DISCHARGE DIAGNOSIS:
Carotid Artery Stenosis - Symptomatic
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital after surgery to address a
blockage in your carotid artery.
You have begun coumadin (a blood thinner), and need a lab test
done every days to adjust your dose as necessary. We also
started you on lovenox injections which you should continue
twice daily until your coumadin is in range. Dr. is
responsibile for further directions on the coumadin and lovenox
dosing.
Division of Vascular and Endovascular Surgery
Carotid Stent Discharge Instructions
## MEDICATIONS:
Take Aspirin 325mg (enteric coated), Plavix (Clopidogrel) 75mg
and Coumadin (as directed by your PCP) once daily
Continue all other medications you were taking before surgery,
unless otherwise directed
You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort
What activities you can and cannot do:
When you go home, you may walk and go up and down stairs
You may shower (no direct spray on incision, let the soapy
water run over incision, rinse and pat dry)
Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week
After 1 week, you may resume sexual activity
After 1 week, gradually increase your activities and distance
walked as you can tolerate
No driving until you are no longer taking pain medications
You should not have an MRI scan within the first 4 weeks after
carotid stenting
What to report to office:
Changes in vision (loss of vision, blurring, double vision,
half vision)
Slurring of speech or difficulty finding correct words to use
Severe headache or worsening headache not controlled by pain
medication
A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
Trouble swallowing, breathing, or talking
Numbness, coldness or pain in lower extremities
Temperature greater than 101.5F for 24 hours
New or increased drainage from incision or white, yellow or
green drainage from incisions.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18305480", "visit_id": "28119297", "time": "2172-04-08 00:00:00"} |
18088662-RR-16 | 53 | ## INDICATION:
woman with right-sided UVJ stone two days ago, now
with elevated WBC, worsening abdominal pain, vomiting, tenderness. Evaluate
for stone.
## OSSEOUS STRUCTURES:
There are no suspicious lytic or sclerotic osseous
lesions.
## IMPRESSION:
Obstructive 3 mm right UVJ calculus with hydrouretronephrois and
worsening perinephric fluid collection suggesting further forniceal rupture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18088662", "visit_id": "N/A", "time": "2112-01-16 23:20:00"} |
10994152-RR-49 | 337 | BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD AND RIGHT BREAST ULTRASOUND
## CLINICAL INDICATION:
Intermittent discomfort in the upper-outer right breast,
history of interval fluctuating weight loss over the past several years, late
childbearing, history of menorrhagia over the past few years.
Comparison is made to the patient's previous studies dated and
.
The breast tissues are predominantly fatty with minimal residual
fibroglandular tissue. Overall, there is an asymmetry in the upper-outer
right breast corresponding to the area of discomfort as indicated by the
patient which does not appear to be significantly changed since but
appears more prominent than in . Given the patient's clinical history and
her age, this most likely represents a benign process, probably
pseudoangiomatous stromal hyperplasia. The option of biopsy of the asymmetry
under stereotactic guidance was discussed with the patient, and if there is a
need for more immediate diagnostic certainty, this could be attempted.
However, the patient is comfortable with follow-up imaging in six months which
does represent a reasonable option given stability since . No clusters of
suspicious microcalcifications or areas of architectural distortion are
appreciated.
This study was interpreted with the aid of the ICAD computer-aided detection
system.
Ultrasound of the right breast from o'clock, 5-14 cm from the nipple, in
the area of discomfort as indicated by the patient was performed.
Fibroglandular tissue is seen with no suspicious solid lesion or cystic area.
Benign-appearing axillary lymph node was seen with no pathologic
lymphadenopathy appreciated. Further management of the patient's symptoms at
this time should be based on the clinical assessment.
## IMPRESSION:
Probable benign asymmetry in the upper-outer right breast corresponding to the
area of concern as indicated by the patient but favoring a benign process,
possibly . Followup mammography in six months to re-evaluate this area
seems the most reasonable approach at this time. Further management of the
patient's symptoms at this time should be based on the clinical assessment.
BI-RADS 3 - probable benign finding, short-interval followup suggested.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10994152", "visit_id": "N/A", "time": "2146-07-31 08:34:00"} |
12310370-RR-15 | 502 | ## EXAMINATION:
MR CERVICAL SPINE W/O CONTRAST MR SPINE
## HISTORY:
with cervical spine injuryIV contrast to be given at
radiologist discretion as clinically needed// ? Cord compression
## FINDINGS:
The known right C7 lamina, facet comminuted fracture and right C6-C7 facet
subluxation is better seen on prior. There is fluid in the left C6-C7 facet
joint. 3 mm anterolisthesis of C6 on C7 is unchanged.
Trace edema or epidural hematoma at C7 level right side. No cord compression
is seen.
A small amount of fluid signal intensity in the superior aspect of the C6 and
C7 vertebral bodies, which may reflect a minimal anterior compression fracture
versus degenerative changes. Otherwise, the remainder of the vertebral body
heights are grossly maintained.
Tiny T2 signal well-circumscribed hyperintensity in the central cord,
measuring 2 mm across and 4 mm in length at C6 level likely represents small
syrinx, may be incidental finding, unlikely configuration is not supportive of
cord contusion.
Remainder of the cord is normal.
There is no frank posterior longitudinal ligament disruption. There is no
frank anterior longitudinal ligament disruption, though fluid does undercut
the anterior longitudinal ligament extending from approximately C6-T1. There
is also a small amount of prevertebral soft tissue edema anterior to the
anterior longitudinal ligament at these levels, without ligament disruption
There is fluid signal within the interspinous ligaments between C3-C7,
suggesting interspinous ligament injury.
The cervical spinal canal appears congenitally narrowed, measuring
approximately 10 mm in diameter at the level of C4. In addition, there are
superimposed background degenerative changes as follows:
## C2-C3, C3-C4:
There is no significant spinal canal stenosis or neural
foraminal narrowing.
## C4-C5:
A posterior disc bulge with annular tear indents the ventral thecal sac
with moderate canal stenosis, combining with uncovertebral joint hypertrophy
to result in mild-to-moderate bilateral foraminal narrowing.
## C5-C6:
Posterior disc bulging indents the ventral thecal sac and contacts the
ventral spinal cord with moderate canal stenosis, combining with uncovertebral
joint hypertrophy result in no left but moderate severe right neural foraminal
narrowing.
## C6-C7:
A posterior disc bulge with annular fissure, tiny central disc
protrusion indents the ventral thecal sac mildly contacting the ventral cord
with mild-to-moderate canal narrowing. This combines with vertebral joint
hypertrophy to result in mild right neural foraminal narrowing.
## C7-T1:
There is no definite spinal canal stenosis or neural foraminal
narrowing.
Preserved vascular flow voids, including right vertebral artery.
## IMPRESSION:
1. Known fracture right C7 lamina, upper facet, subluxation of the facet
joint, some fluid in the left facet joint at this level, 3 mm C6-C7
anterolisthesis, as seen before.
2. Trace epidural fluid, possibly epidural hematoma, laterally at the fracture
site, not contributing significantly to canal narrowing.
3. Mild degenerative changes versus subtle compression fractures C6 and C7.
4. Small central cord abnormality at C6 level may represent small focal
syrinx, less likely cord contusion.
5. Posterior ligamentous complex injury C3-C7
6. Congenitally narrow cervical spinal canal with background spondylosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12310370", "visit_id": "N/A", "time": "2165-01-21 08:13:00"} |
15639789-RR-22 | 164 | ## INDICATION:
female with IVDA and bacteremia, foreign body seen on
recent x-ray.
## FINDINGS:
Transverse and sagittal images of the soft tissues at the left
antecubital fossa were obtained. There is a linear echogenic foreign body
seen deep within the soft tissues, the location of which is concordant with
the recent x-ray. This foreign body measures 1.4 cm in length and is located
within the muscle plane that is deep to the left brachial artery. The foreign
body appears to be about 7 mm deep to the left brachial artery and is about 7
mm anterior to the distal humerus. Appropriate arterial flow is seen within
the left brachial artery.
## IMPRESSION:
Linear foreign body. The appearance and location of which is
concordant with a needle fragment seen on the recent left elbow x-ray. This
foreign body is deep to the left brachial artery and does not appear to be in
a position to threaten the vasculature at this time.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15639789", "visit_id": "23657218", "time": "2120-01-16 12:50:00"} |
15479046-RR-24 | 323 | CT HEAD WITHOUT CONTRAST DATED
## HISTORY:
woman with new-onset delirium;? hemorrhage.
## FINDINGS:
There are no comparison studies on record. There is no intra- or
extra-axial hemorrhage, and the midline structures are in the midline. There
is relatively slight, proportionate prominence of the cortical sulci and
fissures representing mild atrophy. There is ill-defined, patchy low-
attenuation in the centrum semiovale and corona radiata, left more than right;
given the presence of a chronic-appearing lacune in the right caudate nucleus,
this likely reflects chronic microvascular infarction.
There is no focal soft tissue abnormality and no underlying skull fracture is
seen. There is minimal mucosal thickening involving the right more than left
fronto-ethmoidal recess and anterior ethmoid air cells, with the remainder of
the paranasal sinuses, as well as the mastoid air cells and middle ear
cavities clear. Noted is apparent relatively acute vitreous hemorrhage in the
left globe (56-62 , with an overall morphology suggestive of acute retinal
detachment with hemorrhagic subretinal effusion; there is chronic phthisis
bulbi on the right, which may relate to a similar event in the past. The
remainder of the orbits is unremarkable in appearance.
## IMPRESSION:
1. No acute intracranial abnormality; continued concern regarding a meningeal
process should be addressed directly by lumbar puncture.
2. Mild atrophy and chronic microvascular infarction in the left centrum
semiovale/corona radiata.
3. Acute-appearing vitreous hemorrhage in the left globe, with morphology
suggestive of acute hemorrhagic retinal detachment, with phthisis bulbi on the
right.
## COMMENT:
Findings posted to the ED dashboard at the time of the study. The
constellation of findings (if there is no history of diabetic proliferative
retinopathy, for example) in the clinical setting of "meningitis" brings up
the rare entity of syndrome. Consideration should be
given to MRI with orbital protocol, both to further characterize the
intraocular process, and to exclude associated CNS lesions.
Posted to the Radiology Dept. "Critical Results Communication" dashboard, on
.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15479046", "visit_id": "23899008", "time": "2167-06-08 08:13:00"} |
12314312-RR-25 | 177 | ## INDICATION:
male with pain, rule out rotator cuff tear.
## FINDINGS:
There is mild bursal surface fraying of the anterior leading edge
of the supraspinatus tendon. Intrasubstance signal consistent with tendinosis
is seen. There is no full-thickness tear. Muscle bulk of the supraspinatus
is maintained. There are small degenerative resorptive cysts at the distal
insertion on the greater tuberosity. There is trace amount of fluid in the
subacromial/subdeltoid bursa. The infraspinatus, subscapularis, and teres
minor tendons are intact. Biceps tendon is seated in the bicipital groove.
The bicipital anchor is intact.
The anterior superior labrum is irregular and most likely torn.
Marrow signal in the glenoid and humeral head is otherwise unremarkable and
there is no fracture. There is degenerative change with edema at the distal
clavicle and proximal acromion. No subacromial spur is present.
## IMPRESSION:
1. Articular surface fraying at the anterior leading edge of the
supraspinatus tendon. Tendinosis also noted. No full-thickness tear.
2. Findings suggestive of a tear of the anterosuperior labrum.
3. Mild glenohumeral joint and acromioclavicular joint osteoarthritis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12314312", "visit_id": "N/A", "time": "2189-08-12 06:54:00"} |
18816954-RR-7 | 195 | ## HISTORY:
Bilateral lower extremity pain.
## CERVICAL SPINE:
C1 through C7 are demonstrated on the lateral view. There is
mild straightening of the normal cervical lordosis. There are no fractures or
dislocation. There are multilevel degenerative changes with loss of vertebral
body height at C5 and C6 with disc space narrowing at C5-C6 and C6-C7 levels.
There are multilevel anterior osteophytes. No soft tissue swelling is noted.
## THORACIC SPINE:
There are multilevel degenerative changes with multilevel
disc space narrowing and mild loss of vertebral body heights. No acute
fracture or dislocation is noted. There are prominent diffuse idiopathic
skeletal hyperostosis (DISH) changes with fusion of multilevel lateral large
associated 'osteophytes'.
## LUMBAR SPINE:
Multilevel degenerative changes with extensive osteophyte
formation with lateral or anterior fusion an many levels and decrease of disc
space narrowing. The SI joints are asymmetric, partially fused on the right
inferior portion (bridging osteophye). There is enthesopathy at both iliac
wings laterally. Minimal supero medial joint space narrowing right hip. No
fracture or dislocation.
## IMPRESSION:
Extensive DISH. I doubt associated spondyloarthropathy altho
appearances right hip and right SI joint are noteworthy in this regard. No
fracture or bone destruction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18816954", "visit_id": "24068123", "time": "2178-05-20 16:10:00"} |
13782412-RR-95 | 198 | ## EXAMINATION:
BILATERAL DIGITAL SCREENING MAMMOGRAM INTERPRETED WITH CAD
## INDICATION:
Screening. History of right breast cancer status post lumpectomy
and radiation. Previous left breast biopsy.
## TISSUE DENSITY:
B - There are scattered areas of fibroglandular density.
There are post treatment changes in the right upper breast posteriorly
including postsurgical density with distortion, dystrophic calcifications and
skin retraction. There are no suspicious findings in either breast.
There are no suspicious microcalcifications on the left. There is however a
possible developing asymmetry or mass measuring approximately 3 mm in the deep
central left breast on the MLO view just above the nipple line for which
additional imaging is recommended. A definitive correlate is not identified
on the CC view but it could be in the outer breast given the distribution of
tissues.
## IMPRESSION:
No specific evidence of malignancy in the right breast, status post lumpectomy
and radiation.
Possible developing asymmetry or mass in the deep central slightly upper left
breast on the MLO view only for which additional imaging is recommended.
## BI-RADS:
0 Incomplete - Need Additional Imaging
Evaluation.
## NOTIFICATION:
A summary letter will be sent to the patient with this result.
## BI-RADS:
0 Incomplete - Need Additional Imaging
Evaluation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13782412", "visit_id": "N/A", "time": "2150-09-14 08:56:00"} |
10262096-RR-20 | 81 | ## FINDINGS:
There is no intracranial hemorrhage, mass effect, shift of normally
midline structures or edema. Gray-white matter differentiation is preserved.
Prominence of the cerebral sulci is consistent with age-related involutional
changes. Extensive regions of periventricular hypoattenuation are compatible
with small vessel ischemic change. Bilateral basal ganglia calcifications are
unchanged.
The cavernous portion of the internal carotid arteries is calcified. The
paranasal sinuses and mastoid air cells are well aerated. No fracture is
identified.
## IMPRESSION:
No intracranial hemorrhage.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10262096", "visit_id": "23639696", "time": "2167-03-09 15:22:00"} |
16038816-RR-26 | 106 | ## EXAMINATION:
MRI IAC WANDW/O CONTRAST T9132 MR HEAD
## INDICATION:
year old man with sudden left hearing loss for 5 days.// r/o
AN
## FINDINGS:
Study is mildly degraded by motion.
Images through the internal auditory canal demonstrates grossly symmetric
appearance of the seventh eighth nerve complexes. There is no definite
evidence of abnormal enhancement or mass lesion within the internal auditory
canals, cerebellopontine angles or membranous labyrinth. No other mass lesions
are seen within the visualized posterior fossa.
## IMPRESSION:
1. Study is mildly degraded by motion.
2. Within limits of study, no evidence of IAC or cerebellopontine angle mass.
3. Probable Thornwaldt cyst.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16038816", "visit_id": "N/A", "time": "2113-10-18 17:10:00"} |
13420572-RR-46 | 109 | ## INDICATION:
Evaluation of patient with lymphoma and tachycardia and bilateral
lower extremity swelling.
## FINDINGS:
Single AP portable chest radiograph is obtained. There is mild
prominence of the interstitial markings consistent with previously visualized
pattern of noncardiogenic edema. Otherwise, the cardiomediastinal silhouette
is within normal limits. A left subclavian PICC line is visualized with the
catheter tip at the superior cavoatrial junction. Lungs are without evidence
of consolidation. There are small bilateral pleural effusions. The osseous
structures are within normal limits.
## IMPRESSION:
There is prominence of the interstitial markings with a normal heart size
which is representative of the previously visualized pattern of mild
non-cardiogenic pulmonary edema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13420572", "visit_id": "26791903", "time": "2179-08-20 16:25:00"} |
15842393-RR-76 | 108 | ## INDICATION:
woman with history of non-Hodgkin's lymphoma status
post Rituxan therapy. Evaluate disease status.
CT OF THE TORSO WITHOUT IV CONTRAST
## IMPRESSION:
1. Stable retroperitoneal and mesenteric lymphadenopathy.
2. Stable pulmonary nodules and small right pleural effusion.
3. Stable renal cysts and liver lesions that too small to characterize but
likely also represent cysts.
4. Enlarged uterus not changed compared to but a new finding compared
to . This is not well evaluated on this non-contrast enhanced study
and needs to be further evaluated with a pelvic ultrasound or MRI as it is
concerning for endometrial or cervical carcinoma or may represent cervical
stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15842393", "visit_id": "N/A", "time": "2133-04-28 09:22:00"} |
17594158-RR-117 | 169 | ## INDICATION:
Follow-up evaluation of left frontal and falcine meningiomas.
## FINDINGS:
There is a lesion noted in the left frontal region with central hypointensity
and minimal rim hyperintensity and demonstrating heterogeneous enhancement and
measures 1.4 x 1.5 x 1.3 cm; there is no significant change compared to the
prior of 1.3 x 1.4 x 1.3 cm. The homogeneously enhancing lesionright
parafalcine measures 0.9 x 0.5 x 0.5 cm in the CC, AP and transverse
and is increased compared to when it measured 0.9 x 0.3 x
0.3 cm.
No obvious new lesions are noted. The ventricles and the extra-axial CSF
spaces are normal.
Retention cysts are noted in the maxillary sinuses on both sides.
## IMPRESSION:
No significant change in the left frontal ossified meningioma,
measuring 1.3 x 1.3 x 1.4 cm; mild increase in the size of the right
parafalcine homogeneously enhancing lesion (likely representing meningioma),
compared to . Close follow up.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17594158", "visit_id": "N/A", "time": "2138-09-13 08:15:00"} |
11152220-RR-26 | 153 | ## EXAMINATION:
Portable AP chest x-ray.
## INDICATION:
year old woman with picc repo // picc repo Contact
name: :
## FINDINGS:
There is again seen and left-sided PICC line with a tortuous course, with
distal portion coursing superiorly and with tip seen projecting over the lower
right brachiocephalic vein. There has been no significant interval change in
position of catheter. The right brachiocephalic stent is again seen in stable
position.
The cardiac and mediastinal silhouettes are unchanged. No interval change is
seen in the lungs.
There is no evidence of pneumothorax or effusion.
## IMPRESSION:
No significant interval change in position of left-sided PICC line. Distal
tip projects over the lower right brachiocephalic vein, and will require
repositioning. No other significant interval changes.
## NOTIFICATION:
The above findings regarding the left-sided PICC line position
were discussed over the phone with IV nurse by Dr. on at
11:27, approximately 30 minutes after discovery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11152220", "visit_id": "24147617", "time": "2139-04-18 10:00:00"} |
17056073-RR-37 | 129 | ## EXAMINATION:
KNEE (2 VIEWS) RIGHT PORT
## INDICATION:
year old man with 1) s/p wide resection right distal femur
chondrosarcoma and reconstruction with distal femur replacement prosthesis on
2) s/p Irrigation and debridement of right knee wound dehiscence and
cellulitis on // interval xrays, patient c/o swelling Please include
all hardware
## FINDINGS:
The patient has extended hinged total knee arthroplasty is unchanged in
positioning and alignment compared to the radiograph dated . No
acute fracture or dislocation is seen. There are no significant degenerative
changes. There is no knee joint effusion. Diffuse osseous demineralization.
Osseous proliferation around the femoral component, which may be related to
interval healing from prior cellulitis/osteomyelitis.
## IMPRESSION:
No hardware related complications seen. Unchanged alignment and positioning
of the extended total knee arthroplasty.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17056073", "visit_id": "N/A", "time": "2154-05-22 09:50:00"} |
13397413-RR-17 | 232 | ## HISTORY:
male with new hepatic failure.
## RIGHT UPPER QUADRANT ULTRASOUND:
The liver echotexture is somewhat difficult
to evaluate given the presence of bowel gas. The hepatic echogenicity is not
definitely increased, but the liver echotexture may be slightly coarsened.
There is no focal liver lesion. There is no intrahepatic biliary ductal
dilatation, and the common bile duct measures 5 mm. The main portal vein is
patent, with antegrade flow. The pancreatic head is unremarkable, and the
distal pancreas is obscured by bowel gas. There is no peripancreatic fluid or
ascites.
The gallbladder wall is thickened, measuring 10 mm. However, no
pericholecystic fluid is identified, and the gallbladder is not distended.
Although there was pain over the site, these findings could represent
hepatitis or liver disease, given lack of other findings for cholecystitis.
Doppler ultrasound of the abdomen was performed, and the hepatic veins and
portal veins demonstrate appropriate waveforms and are patent. Limited
waveforms of the hepatic arteries appear normal.
The right kidney measures 12.7 cm, and the left kidney measures 12.6 cm. There
is no evidence of stones, mass or hydronephrosis. The spleen measures 12.6
cm, and appears normal.
## IMPRESSION:
1. Possibly coarsened liver echotexture, although this assessment is
difficult given presence of bowel gas. No focal liver lesion.
2. Appropriate vascular waveforms.
3. Thickened gallbladder wall may be secondary to hepatitis or chronic liver
disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13397413", "visit_id": "24489365", "time": "2149-11-20 09:18:00"} |
10256269-RR-42 | 269 | ## INDICATION:
female with Pauci immune glomerulonephritis and
worsening renal function. Requiring exchange transfusion today. Potentially
also requiring hemodialysis.
## OPERATORS:
Drs. , and , attending
interventional radiologist. Dr. was present and supervising the
procedure.
## PROCEDURE:
After the risks and benefits of the procedure were explained to
the patient, informed consent was obtained. The patient was brought to the
angiography suite and laid in supine position. The right neck was prepped and
draped in standard sterile fashion. A preprocedure timeout and huddle were
performed. The patient's right neck was examined with ultrasound,
demonstrating a patent and compressible right internal jugular vein. This
vein was cannulated with a micropuncture needle just above the clavicles. Pre-
and post-cannulation images were obtained and printed. A guidewire was
advanced into the SVC through the needle. The needle was exchanged for a
micropuncture sheath. The inner dilator and wire were removed and exchanged
for wire, which was extended down into the upper right atrium. The
sheath was exchanged for a 14 dilator. Following dilation, the 15 cm
triple lumen dialysis/pheresis catheter including VIP port was advanced over
the wire with tip terminating in the high right atrium. The wire was removed,
the catheter flushed. A post- procedure fluoroscopic image of the tip
confirms the tip location in the high right atrium. The catheter was secured
to the skin with silk suture and dressed appropriately. There were no
immediate complications.
## IMPRESSION:
Successful placement of a 15 cm triple-lumen dialysis catheter
(including VIP port) via the right internal jugular vein with tip terminating
in the high right atrium. The line is ready to use.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10256269", "visit_id": "23558397", "time": "2168-07-26 14:08:00"} |
10156295-RR-30 | 197 | ## STUDY:
MRI of the left knee without intravenous or intra-articular contrast
performed on .
## HISTORY:
Patient slipped on ice, suspect left meniscal tear.
## FINDINGS:
Comparison is made to radiograph from .
There is increased signal in the posterior horn of the medial meniscus exiting
the inferior articular surface consistent with a meniscal tear. This is best
seen on series 4 images 19 through 21. The rest of the medial meniscus is
intact. The lateral meniscus is unremarkable.
The ACL and PCL are intact.
There is a partial tear involving the anterior fibers of the medial collateral
ligament, this is best seen on series 3 image 12 and on series 6 image 14. The
more posterior fibers are intact but demonstrate some increased signal. There
is edema surrounding the medial collateral ligament.
The lateral collateral ligamentous complex is normal.
The extensor mechanism is intact. There is no cyst or significant
joint effusion. The articular cartilage within the patellofemoral, medial,
and lateral compartments are preserved. No abnormal subchondral marrow edema
is identified to indicate fracture.
## IMPRESSION:
1. Tear involving the posterior horn of the medial meniscus.
2. Partial tear involving the anterior fibers of the medial collateral
ligament.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10156295", "visit_id": "N/A", "time": "2163-09-29 15:55:00"} |
Subsets and Splits