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10085948-DS-17 | 1,111 | ## ALLERGIES:
Penicillins / amoxicillin / tramadol
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
EXAM UNDER ANESTHESIA, TOTAL LAPAROSCOPIC HYSTERECTOMY,
BILATERAL SALPINGOOPHORECTOMY, CYSTOSCOPY WITH REMOVAL OF
BLADDER POLYP; REDUCTION AND OPEN REPAIR OF INCARCERATED
UMBILICAL HERNIA
## HISTORY OF PRESENT ILLNESS:
gravida 0, transgender man who presents for gender
confirming surgery. states that he has been thinking
about
this procedure for quite some time. He has been married to his
wife for the past years and she is very supportive of his
transition. He is not interested in future pregnancy nor
harvesting eggs. He started testosterone over years ago and
he
has had no vaginal bleeding since that time. He is interested
in
having his female reproductive organs removed e.g. uterus,
fallopian tubes and ovaries bilaterally.
On an ultrasound which showed an anteverted uterus
that
measured 7.4 x 3.4 x 3.1 cm. The endometrium was homogenous and
measured 2 mm. The right ovary was not visualized. The left
ovary was seen and appeared normal. There was no free pelvic
fluid. These findings on this normal pelvic ultrasound were
discussed and his questions were answered.
## PSH:
-right knee lateral release years ago
- Right hand/arm cyst removal and tendon repair years ago
- fistulous track removed from right buttock cheek years ago
OB/GYN history:
Menarche he is not sure, he has had no bleeding for 2+ years.
His last Pap smear was and was normal. He denies any
history of abnormal Pap smears. He is currently sexually active
with his wife of years.
Contraception-not needed.
He does have a history of ovarian cyst.
He has never had a sexually transmitted infection.
He has never had a pregnancy.
## FAMILY HISTORY:
Mother-diabetes, COPD, hypertension, bipolar melanoma, alcohol
abuse and status post MI
Maternal grandmother-status post MI, alcohol abuse
Maternal grandfather-alcohol abuse
## INPUT/OUTPUT:
IVF- 1747 mL of LR in OR/PACU
Urine Output - 533 from OR to current, UOP 325 cc/ 1.5 hr
PE
## GEN:
Stable, in no apparent distress
## RRR
ABDOMINAL EXAM:
Bowel sounds present; abdomen soft,
non-distended, no rebound tenderness or guarding. Tenderness to
palpation in the umbilicus, but no tenderness in LLQ.
## INCISION:
Dressing clean, dry, intact. Closed with suture.
## GU:
Minimal staining of vaginal pad, Foley in place draining
concentrated yellow urine
## EXT:
Pneumoboots in place bilaterally, BLE nontender,
nonedematous
DISCHARGE EXAM
==============
## ABDOMEN:
soft, non-distended, appropriately tender to palpation
without rebound or guarding,
incisions clean/dry/intact
## GU:
no spotting in pad
## EXTREMITIES:
no TTP, pneumoboots in place bilaterally
## BRIEF HOSPITAL COURSE:
On , Mr. was admitted to the gynecology
service after undergoing TLH, BSO, cysto, bladder polyp
biopsy/removal, reduction and open repair of incarcerated
umbilical hernia for gender affirmation. Please see the
operative report for full details.
*) Post-op
His post-operative course was uncomplicated. Immediately
post-op, his pain was controlled with IV Dilaudid/Toradol. On
post-operative day 1, his urine output was adequate so his foley
was removed and he voided spontaneously. His diet was advanced
without difficulty and he was transitioned to PO
oxycodone/ibuprofen/acetaminophen
By post-operative day 2, he was tolerating a regular diet,
voiding spontaneously, ambulating independently, and pain was
controlled with oral medications. He was then discharged home
in stable condition with outpatient follow-up scheduled.
## =====================
CHRONIC ISSUES
=====================
*) H/O BIPOLAR, ANXIETY:
continue home meds
*) asthma: albuterol prn
## MEDICATIONS ON ADMISSION:
ALBUTEROL SULFATE [VENTOLIN HFA] - Dosage uncertain -
(Prescribed by Other Provider)
BUPROPION HCL [WELLBUTRIN XL] - Dosage uncertain - (Prescribed
by Other Provider)
CLONAZEPAM - Dosage uncertain - (Prescribed by Other Provider)
CLONIDINE HCL [CATAPRES] - Dosage uncertain - (Prescribed by
Other Provider)
OXCARBAZEPINE - Dosage uncertain - (Prescribed by Other
Provider)
TESTOSTERONE CYPIONATE - Dosage uncertain - (Prescribed by
Other
Provider)
## DISCHARGE MEDICATIONS:
1. Acetaminophen mg PO Q6H:PRN Pain - Mild
Reason for PRN duplicate override: Alternating agents for
similar severity
Do not exceed 4000 mg in a day
RX *acetaminophen 500 mg tablet(s) by mouth Q6HR Disp #*50
## TABLET REFILLS:
*1
2. Docusate Sodium 100 mg PO BID
Hold for loose stools
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day
Disp #*15 Capsule
## REFILLS:
*1
3. Ibuprofen 600 mg PO Q6H:PRN Pain
Do not exceed 2400 mg in a day. Take with food
RX *ibuprofen 600 mg 1 tablet(s) by mouth Q6HR Disp #*50 Tablet
## REFILLS:
*1
4. OxyCODONE (Immediate Release) mg PO Q4H:PRN Pain -
Severe
Do not drink and drive. cause sedation. Partial fill upon
request
RX *oxycodone 5 mg tablet(s) by mouth Q4HR Disp #*40 Tablet
Refills:*0
5. Albuterol Inhaler PUFF IH Q4H:PRN shortness of breath or
wheezing
6. BuPROPion XL (Once Daily) 300 mg PO DAILY
7. ClonazePAM 1 mg PO QHS:PRN anxiety
8. OXcarbazepine 600 mg PO BID
## DISCHARGE DIAGNOSIS:
DESIRES GENDER AFFIRMATION SURGERY & INCARCERATED UMBILICAL
HERNIA
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted to the gynecology service after your
procedure. You have recovered well and the team believes you are
ready to be discharged home. Please call Dr.
office with any questions or concerns. Please follow the
instructions below.
General instructions:
* Take your medications as prescribed.
* Do not drive while taking narcotics.
* Take a stool softener such as colace while taking narcotics to
prevent constipation.
* 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 3
months.
* No heavy lifting of objects >10 lbs for 6 weeks.
* You may eat a regular diet.
* You may walk up and down stairs.
Incision care:
* You may shower and allow soapy water to run over incision; no
scrubbing of incision. No tub baths for 6 weeks.
* If you have steri-strips, leave them on. They will fall off on
their own or be removed during your followup visit.
Call your doctor for:
* fever > 100.4F
* severe abdominal pain
* difficulty urinating
* vaginal bleeding requiring >1 pad/hr
* abnormal vaginal discharge
* redness or drainage from incision
* nausea/vomiting where you are unable to keep down fluids/food
or your medication
## CONSTIPATION:
* Drink liters of water every day.
* Incorporate 20 to 35 grams of fiber into your daily diet to
maintain normal bowel function. Examples of high fiber foods
include:
Whole grain breads, Bran cereal, Prune juice, Fresh fruits and
vegetables, Dried fruits such as dried apricots and prunes,
Legumes, Nuts/seeds.
* Take Colace stool softener times daily.
* Use Dulcolax suppository daily as needed.
* Take Miralax laxative powder daily as needed.
* Stop constipation medications if you are having loose stools
or diarrhea.
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": "10085948", "visit_id": "28355680", "time": "2157-04-06 00:00:00"} |
18492933-RR-18 | 108 | ## HISTORY:
man with motor vehicle collision.
## FINDINGS:
There is no acute intracranial hemorrhage, edema, mass effect, or
major vascular territorial infarct. The ventricles and sulci are normal in
size and symmetric in configuration. There is no shift of normally midline
structures. The gray-white matter differentiation is well preserved. There
is a large mucus retention cyst in the right maxillary sinus. Scattered
ethmoidal opacification is also noted. The left maxillary sinus and the
frontal sinus and mastoid air cells are clear.
There is no acute fracture.
## IMPRESSION:
1. No acute intracranial traumatic injury.
2. NG tube coiling in the oropharynx.
3. Sinus disease as described above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18492933", "visit_id": "23675123", "time": "2167-12-03 03:36:00"} |
13526039-RR-15 | 86 | ## EXAMINATION:
ELBOW (AP, LAT AND OBLIQUE) LEFT
## INDICATION:
year old woman with l elbow injury // l elbow fx l
elbow fx
## FINDINGS:
Again seen is the radial head prosthesis and anchors in the lateral
epicondyle, unchanged in appearance compared to prior study. Well corticated
osseous fragments are seen along the anterior medial aspect of the proximal
ulna. No acute fracture dislocation. There is a persistent joint effusion.
## IMPRESSION:
Unchanged appearance of radial head prosthesis suture anchors within the
lateral epicondyle. Small persistent joint effusion.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13526039", "visit_id": "N/A", "time": "2184-01-06 07:43:00"} |
17285008-DS-21 | 2,026 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## HISTORY OF PRESENT ILLNESS:
Patient is a with a PMHx of diverticulitis s/p sigmoid
colectomy who presents with LLQ abdominal pain and nausea x5- s fatigue for several weeks. Patient states that
pain was initially dull and continuous with intermittent
stabbing sensation. He tried oxycodone without effect. He has
also had fatigue and general malaise for several weeks.
Of note, patient was seen in ED about one week ago for
fever. Workup was negative at that time. He was not having
abdominal pain at that time. He was prescribed ampicillin by his
PCP for possible ear infection. He has no recurrent fevers. PCP
also stopped lisinopril 40 and nifedipine during recent visit
because he had been having lightheadedness and BP was 120s. He
states that the LH has significantly improved.
In the ED, initial vitals:
97.9 59 135/82 16 99% RA
- Exam notable for: LLQ tenderness
- Labs notable for: normal Chem 7, normal LFTs, normal WBC.
Lactate 2.0.
- Imaging notable for: CT A/P with two fat density lesions
along the L abdomen, likely represent fat necrosis or omental
infarct. Also with possible splenic infarct
Surgery was consulted who felt that presentation was consistent
with primary omental infarction and recommended symptomatic
treatment with NSAIDS.
- Patient given: 1L NS, 30mg IV ketorolac, simvastatin 10mg
- Vitals prior to transfer:
50 142/86 18 99% RA
On arrival to the floor, pt reports that pain in minimal now.
It is less severe and less frequent. No vomiting. mild nausea
that is improved. He has not had any diarrhea.
Patient has been told once before that his HR was low. He
thinks that this might have been during his most recent
admission for hernia repair this past . He denies any
history of cardiac issues.
He states that his most significant complaint at this time is
profound fatigue that has been going on for the past several
weeks. States that he has "slept enough for a year".
## REVIEW OF SYSTEMS:
No fevers, chills, night sweats, or weight
changes. No changes in vision or hearing, no changes in balance.
No cough, no shortness of breath, no dyspnea on exertion. No
chest pain or palpitations. No nausea or vomiting. No diarrhea
or constipation. No dysuria or hematuria. No hematochezia, no
melena. No numbness or weakness, no focal deficits.
## PAST MEDICAL HISTORY:
hemochromatosis c/b calcium pyrophosphate
deposition, osteoarthritis, HTN, HLD, GERD, diverticulitis
## PAST SURGICAL HISTORY:
B/L THR, R shoulder arthroplasty, lap
sigmoid colectomy
## FAMILY HISTORY:
No family history of IBD. Father died gastric cancer.
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear, neck supple, JVP
not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## CV:
regular rhythm, bradycardic, normal S1 + S2, no murmurs,
rubs, gallops
## ABDOMEN:
soft, mild discomfort to palpation in LLQ,
non-distended, bowel sounds present, no rebound tenderness or
guarding
## EXT:
Warm, well perfused, no cyanosis or edema
## SKIN:
Without rashes or lesions
## GENERAL:
Alert, oriented, no acute distress
## HEENT:
Sclera anicteric, MMM, oropharynx clear, neck supple, JVP
not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
## CV:
Bradycardic, normal S1 + S2, no murmurs, rubs, gallops
## EXT:
Warm, well perfused, no swelling/edema, no rashes
## SKIN:
Without rashes or lesions
## CTA TORSO ( ):
1. No significant interval change in appearance of two fat
density lesions
within the left abdomen, most compatible with fat necrosis or
omental infarct.
2. Previously described wedge-shaped peripheral splenic
hypodensities are less conspicuous on this study due to the
timing of the phase of contrast.
3. Mild intimal thickening at the origin of the celiac trunk and
common
hepatic artery, which may represent sequela of arteritis.
4. No evidence of pulmonary embolism or acute aortic syndrome.
5. Subtle wedge-shaped cortical hypodensity in the interpolar
region of the left kidney is unchanged from , and
may represent an additional area of infarct.
6. No embolic source identified on the basis of the study. If
there is
concern for cardiac source of embolus, recommend further
evaluation with ECHO.
7. Emphysema.
8. Pulmonary nodules measuring up to 4 mm.
The pulmonary nodule recommendations are
intended as
guidelines for follow-up and management of newly incidentally
detected
pulmonary nodules smaller than 8 mm, in patients years of age
or older. Low risk patients have minimal or absent history of
smoking or other known risk factors for primary lung neoplasm.
High risk patients have a history of smoking or other known risk
factors for primary lung neoplasm.
In the case of nodule size <= 4 mm: No follow-up needed in
low-risk patients. For high risk patients, recommend follow-up
at 12 months and if no change, no further imaging needed.
## TEE :
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium or left atrial appendage. No spontaneous echo
contrast is seen in the body of the right atrium. No atrial
septal defect or patent foramen ovale is seen by 2D, color
Doppler or saline contrast with maneuvers. 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 aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion. No masses or vegetations are seen on the aortic
valve. There are filamentous strands on the aortic leaflets
consistent with Lambl's excresences (normal variant). Trace
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. No mass or vegetation is seen on the mitral
valve. Mild to moderate ( ) mitral regurgitation is seen.
## IMPRESSION:
No patent foramen ovale or atrial septal defect. No
intracardiac source of emboli identified. Mild to moderate
mitral regurgitation.
TTE with Bubble :
The left atrial volume index is moderately increased. No atrial
septal defect or patent foramen ovale is seen by 2D, color
Doppler or saline contrast with maneuvers. The estimated right
atrial pressure is mmHg. There is mild symmetric left
ventricular hypertrophy with normal cavity size. Regional left
ventricular wall motion is normal. Left ventricular systolic
function is hyperdynamic (EF>75%). There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. The diameters of aorta at the sinus,
ascending and arch levels are normal. The aortic valve leaflets
(3) appear structurally normal with good leaflet excursion and
no aortic stenosis or aortic regurgitation. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is no mitral valve prolapse. There is no systolic anterior
motion of the mitral valve leaflets. The estimated pulmonary
artery systolic pressure is normal. There is no pericardial
effusion.
## IMPRESSION:
Suboptimal image quality. Mild symmetric left
ventricular hypertrophy with preserved regional andhyperdynamic
global biventricular systolic function. No valvular pathology or
pathologic flow identified.
## CT A/P W/C :
1. Two fat density lesions along the left abdomen, the larger
measuring up to 8.2 cm, likely represent fat necrosis or omental
infarct.
2. Two subcentimeter peripheral wedge shaped hypodensities in
the posterior spleen are concerning for splenic infarcts.
3. Thickening of the bladder wall may be secondary to
underdistention, however
infection cannot be excluded. Recommend correlation with
urinalysis.
Pertinent results:
04:40AM BLOOD PEP-NO SPECIFI
04:40AM BLOOD AFP-3.0
01:50PM BLOOD TSH-0.97
05:35AM BLOOD CARDIOLIPIN ANTIBODIES (IGG, IGM)-PND
04:40AM BLOOD BETA-2-GLYCOPROTEIN 1 ANTIBODIES (IGA,
IGM, IGG)-PND
05:35AM BLOOD Ret Aut-2.4* Abs Ret-0.11*
## BRIEF HOSPITAL COURSE:
with a PMHx of diverticulitis s/p sigmoid colectomy who
presents with LLQ abdominal pain and nausea x5- s
fatigue for several weeks, found to have bradycardia concerning
for heart block and new splenic and omental infarcts of unknown
etiology
##
# OMENTAL AND SPLENIC INFARCT:
Presented with LLQ pain and found
on imaging to have new omental, renal, and splenic infarct. ACS
consulted and recommended no intervention, and instead pain
control with NSAIDS. His abdominal pain resolved on hospital day
2. Unclear of the etiology of these infarcts. Initially there
was concern for endocarditis, but TTE bubble and TEE were
negative. Blood cultures negative to date. Further, CTA was
negative for thrombus. Hypercoagualability workup was initiated
with lupus anticoagulant (negative), beta-2-glycoprotein, and
cardiolipin antibodies, which are pending at the time of
discharge. UPEP and SPEP pending to assess for hyperviscosity.
Other etiologies stasis to bradycardia and junctional escape
rhythm. While underlying HHC may predispose for HCC, which would
cause hypercoagulability, AFP was within normal limits at 3. In
summary, no concern for active thrombus and all workup has been
unrevealing. These infarcts are most likely related to his
recent abdominal procedure ( ), secondary to omental
torsion. He is asymptomatic at discharge and will follow-up with
Hematology.
## # FATIGUE:
Endorses fatigue for several months, characterized by
very low energy levels. As above, no concern for endocarditis.
Likely related to sinus bradycardia or hemochromatosis (given
elevated iron, ferritin and transferrin saturation).
## # BRADYCARDIA:
Endorses fatigue since after his
colectomy. On OMR review, his prior HR from have been 60+.
EP was consulted and evaluated rhythm to be sinus bradycardia
alternating with "sinus arrest and junctional escape rhythm
competing with sinus at 50 bpm." He also had several episodes of
sinus pause ( ) at night, during which he was asymptomatic.
Untreated hemochromatosis and iron overload may potentially
damage cardiac conduction system, and possibly explain impaired
sinus node or atrial conduction, which may ultimately contribute
to junctional escape beats. Outpatient cardiac MRI may be useful
to evaluate further. Per EP recommendations, no need for
pacemaker now as per EP, but patient will go home with of
Hearts monitor. He will see Dr. follow-up in clinic.
## # HEMOCHROMATOSIS:
Elevated ferritin, iron, and transferrin
saturation. Seen by hematology as an inpatient. Outpatient
appointment scheduled with Dr. in Hematology on .
need to restart phlebotomy.
# Pulmonary nodules on CT scan: Patient with 30 pack year
smoking history. Will need year follow up CT scan.
## # CPPD:
Held hydroxychloroquine as patient reported not taking
it.
# HLD: Continued simvastatin 20 mg qpm
# BPH: Continued tamsulosin
Transitional issues:
- monitor on discharge, to be followed by Dr.
EP
- Follow-up appointments: PCP,
- F/up SPEP, UPEP
- F/up cardiolipin, beta-2-glycoprotein
- Consider outpatient phlebotomy for treatment of
hemochromatosis, to be seen by Hematology
- Consider outpatient JAK2 testing given elevated reticulocyte
count
- Consider cardiac MRI to evaluate for infiltrative heart
disease causing conduction abnormalities
- Pulmonary nodules measuring up to 4mm found on CTA Torso. Per
, recommend follow-up at 12 months given his 30 pack
year smoking history. If no change, no further follow-up needed
## # CODE STATUS:
Full confirmed
# CONTACT: (brother) is HCP. Neighbor,
on Admission:
The Preadmission Medication list is accurate and complete.
1. Aspirin 81 mg PO DAILY
2. Simvastatin 20 mg PO QPM
3. Tamsulosin 0.4 mg PO QHS
4. Hydroxychloroquine Sulfate 200 mg PO DAILY
5. Methotrexate 0.8 mL IM WEEKLY
6. Lisinopril 5 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Aspirin 81 mg PO DAILY
2. Hydroxychloroquine Sulfate 200 mg PO DAILY
3. Lisinopril 5 mg PO DAILY
4. Methotrexate 0.8 mL IM WEEKLY
5. Simvastatin 20 mg PO QPM
6. Tamsulosin 0.4 mg PO QHS
## DISCHARGE DIAGNOSIS:
Primary diagnosis:
Omental infarct
Sinus bradycardia
Sinus arrest with junctional escape rhythm
Secondary diagnosis:
Hemochromatosis
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted to for abdominal pain. You were found to
have small areas of infarction in your abdomen. We performed
extensive imaging of your heart and upper body to evaluate for
the presence of blood clots, which we did not find. We also
noticed your heart rate to be low (in the for much of the
day, which may be a cause of your fatigue. You also have
elevated iron levels concerning for a worsening of your
hemochromatosis. Once you leave, we have arranged for you to
follow-up with our cardiologists and hematologists for
evaluation and treatment of your low heart rate and
hemochromatosis, respectively. You will wear a of Hearts"
monitor in the meantime, which will record your heart rhythm.
It was a pleasure to participate in your care.
Sincerely,
Your team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17285008", "visit_id": "27137021", "time": "2136-12-28 00:00:00"} |
10253104-RR-7 | 117 | ## HISTORY:
Right lower quadrant pain with recent negative CT scan.
## FINDINGS:
Transabdominal scans of the pelvis reveal a small uterus measuring 5.3 x 3.9 x
6.5 cm. No focal uterine masses are seen. Limited views of the endometrium
are within normal limits. A normal-sized right ovary is visualized measuring
3.8 x 2.1 x 2.8 cm and demonstrating a 7mm cyst. The left ovary could not be
visualized. There were no adnexal masses nor any free fluid seen in the
pelvis.
Attempts were made at transvaginal scanning for better detail, but the patient
was unable to tolerate the probe.
## IMPRESSION:
Limited pelvic ultrasound shows no masses or fluid collections.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10253104", "visit_id": "23817143", "time": "2118-08-01 09:51:00"} |
16915955-RR-21 | 344 | ## HISTORY:
Known infrarenal aortic dissection. Possible new right
brachiocephalic artery dissection.
## CTA TORSO:
There is a focal intraluminal linear soft tissue density at the
origin of the right brachiocephalic artery (3:45). This does not extend
distally or more proximally into the thoracic aorta. The caliber of the
ascending aorta and arch are normal. There is mild mural thrombus in the
aortic arch and descending aorta. Origins of the celiac, SMA, paired right
and single left renal arteries are normal. Infrarenal aortic dissection
begins just above the origin of the patent SMA and passes just below this
vessel. The from the true lumen. There is a tiny focal
dissection of the proximal common iliac (3: 325). There is a partially
thrombosed right common iliac aneurysm (3: 3 and 42).
## CT CHEST:
The thyroid gland is homogeneous. There is no subclavicular,
mediastinal, or axillary adenopathy. Right hilar lymph nodes are small.
There is a calcified granuloma in the right lower lobe. There is no nodule,
mass, effusion, or pneumothorax. Cardiomegaly is mild. There is no
pericardial effusion. Coronary artery calcifications are diffuse.
## ABDOMEN:
There are no focal liver lesions. The gallbladder is thin walled,
nondistended, and free of stones. The pancreas and spleen are homogeneous.
The adrenal glands are normal. The largest hypodensities in both kidneys have
a simple cystic attenuation. Smaller hypodensities are too small to
characterize. The kidneys enhance symmetrically and excrete contrast
promptly. There is no abdominal ascites or adenopathy. There is a small
intramuscular lipoma in the left posterior abdominal wall (3: 333).
Visualized loops of bowel are not dilated or thickened.
There are no concerning lytic or sclerotic bone lesions.
## IMPRESSION:
1. Several small localized dissections of the infrarenal abdominal aorta and
left common iliac artery. Per verbal report, the infrarenal dissection is
known. No prior comparison imaging is available.
2. An intraluminal linear density within the proximal right brachiocephalic
artery may represent a very tiny, limited dissection without extension into
the thoracic aorta or distal brachiocephalic artery.
Findings were discussed with Dr. in person at approximately 0630
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16915955", "visit_id": "29825252", "time": "2186-06-18 05:59:00"} |
17222334-RR-5 | 355 | ## EXAMINATION:
CTA CHEST WITH CONTRAST
## INDICATION:
year old man with 2 days acute sob, pleuritic chest pain and
02 stat 89%. Recent RLL effusion/nodular change and Bx. Now presents with
different symptoms described as above.// R/O PE
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 15.0 mGy (Body) DLP =
7.5 mGy-cm.
2) Spiral Acquisition 4.4 s, 33.0 cm; CTDIvol = 9.2 mGy (Body) DLP = 304.3
mGy-cm.
Total DLP (Body) = 312 mGy-cm.
## HEART AND VASCULATURE:
Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber without evidence of dissection or
intramural hematoma. The cardiac size is not enlarged. There is no
pericardial effusion seen. The main pulmonary artery is not enlarged,
measuring 2.4 cm.
## AXILLA, HILA, AND MEDIASTINUM:
No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
## PLEURAL SPACES:
There is interval development of a right moderate to large non
serous pleural effusion since the prior exam in , likely sequela of
recent ultrasound-guided biopsy. There may be at least a small to moderate
loculated component. No pneumothorax.
## LUNGS/AIRWAYS:
There is right lower lobe volume loss adjacent to the new
pleural effusion. A previously seen right upper lobe 4 mm pulmonary nodule is
better seen on the dedicated CT low-dose screening exam from . There is
mild volume loss in the right middle lobe. A 2 mm pulmonary nodule in the
right middle lobe appears unchanged (2:80). The airways are patent to the
level of the segmental bronchi bilaterally.
## BASE OF NECK:
Visualized portions of the base of the neck show no abnormality.
## ABDOMEN:
Included portion of the upper abdomen is unremarkable.
## BONES:
No suspicious osseous abnormality is seen.? There is no acute fracture.
There are changes with anterior bridging osteophytes are seen along the
thoracic spine.
## IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Large and possibly loculated, non serous right pleural effusion responsible
for right lower lobe collapse, new since , following recent
ultrasound-guided biopsy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17222334", "visit_id": "22792142", "time": "2127-02-13 11:13:00"} |
14672547-RR-57 | 128 | ## INDICATION:
year old woman with right PICC // right PICC 39 cm Contact
name: , :
## FINDINGS:
Compared to chest radiographs from , right PIC line terminates
at the cavoatrial junction. Moderate left anterior hydropneumothorax is
unchanged. Right lung is clear. Upon review of chest radiographs from , left pigtail catheter tip traverses the major fissure and does
not communicate with the anterior hydropneumothorax. Otherwise, no relevant
change.
## IMPRESSION:
1. Right PIC line tip terminates at the cavoatrial junction.
2. Stable moderate left anterior hydropneumothorax. It should be noted that
left pigtail catheter tip does not communicate with the anterior
hydropneumothorax and should be appropriately repositioned.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 12:11 , 2 minutes after
discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14672547", "visit_id": "23322439", "time": "2203-12-30 09:01:00"} |
14117829-RR-9 | 92 | ## INDICATION:
year old man s/p AVR// eval for pleural effusions
## FINDINGS:
The tip of the endotracheal tube projects over the mid thoracic trachea. A
gastric tube extends into the stomach. The tip of the right Swan-Ganz
catheter projects over the pulmonary outflow tract. Bilateral chest tubes and
mediastinal drains are present. Status post median sternotomy and aortic
valve replacement.
Increased bilateral pleural effusions and new pulmonary edema. No
pneumothorax is identified. The size of the cardiac silhouette is enlarged.
## IMPRESSION:
New pulmonary edema with layering bilateral pleural effusions.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14117829", "visit_id": "20236200", "time": "2125-09-13 18:27:00"} |
12452675-RR-25 | 201 | ## EXAMINATION:
CT C-SPINE W/O CONTRAST Q311 CT SPINE
## INDICATION:
year old woman with resolved sepsis. Fell in bathroom with
head strike, no LOC. Evaluate for fracture.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 18.0 s, 20.8 cm; CTDIvol = 43.5 mGy (Head) DLP =
903.1 mGy-cm.
2) Spiral Acquisition 5.5 s, 21.8 cm; CTDIvol = 32.3 mGy (Body) DLP = 704.3
mGy-cm.
Total DLP (Body) = 704 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
## FINDINGS:
There is no traumatic malalignment. No fractures are identified.Multilevel
degenerative changes of the cervical spine are most prominent at C5-C6, where
there is moderate spinal canal narrowing and bilateral neural foraminal
narrowing. Large osteophytes are identified from C4- C7. There is no
prevertebral soft tissue swelling. Small foci of nuchal ligament ossification
are unchanged since the prior CT pure
Imaged thyroid and lung apices are unremarkable. The esophagus is patulous.
## IMPRESSION:
1. No cervical spinal fracture or traumatic malalignment detected.
2. Please refer to the MRI cervical spine from for full
characterization of degenerative changes.
## NOTIFICATION:
The above findings were communicated via telephone by Dr.
to Dr. at 14:28 on , 5 min after
discovery.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12452675", "visit_id": "20652838", "time": "2163-06-06 13:44:00"} |
10901772-DS-53 | 2,540 | ## ALLERGIES:
absorbable surgical gauze / ephedrine
## CHIEF COMPLAINT:
Pain and drainage from right thigh wound
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
Incision and drainage of right thigh abscess with
irrigation
## HISTORY OF PRESENT ILLNESS:
Ms. is a woman with a history of severe
peripheral arterial disease presented to the vascular surgery
clinic for urgent evaluation on , referred by her rehab
facility.
## :
drainage of right thigh abscess, wound VAC application
## :
left upper extremity cutdown, abscess drainage,
excision of right lower extremity infected graft
## :
Completion graft explant & sartorius flap
## :
right lower extremity below knee amputation & wound vac
exchange
She was discharged to rehab on . Since that time, she
has been working with and was scheduled to go home early next
week. About 2 days ago, she noticed purulent drainage from her
open thigh wound with increased warmth, redness and tenderness
to her medial thigh. She denies fever or chills. The rehab
started her on oral antibiotics.
In clinic, she was found to have new erythema, warmth
and tenderness in the medial right thigh. She had drainage of an
abscess in the area about 6 weeks ago as well as removal of her
bypass graft. She is now being admitted to the vascular surgery
service for broad spectrum antibiotics and further evaluation.
## PAST MEDICAL HISTORY:
PAST MEDICAL HISTORY
- CAD with the following interventions:
A. - 2.5 x 18 Cypher to LAD
B. - inferior STEMI with overlapping Endeavor stents to
the distal RCA
C. - ISR RCA stent status post POBA
D. - Progression of left main disease resulting in CABG
(free LIMA to LAD, SVG to RCA, SVG to OM). LIMA and SVG to RCA
are known to be occluded with SVG to OM patent ( ).
E. - Admission with congestive heart failure and non-ST
elevation MI in , transferred to . Angiography
showed 90% in-stent restenosis distal RCA stent, status post
2.75x20mm PROMUS DES.
F. There is residual 40% of LMCA and a tighter distal LAD
stenosis in a small vessel.
- Ischemic Cardiomyopathy (EF , last ECHO CI 2.8)
- ICD for primary prevention
- Peripheral arterial disease (PAD) s/p multiple surgeries, s/p
L TMA for ulcer disease (c/b post-operative hypotension)
- Osteomyelitis of Right great toe. s/p amputation in ,
required long course of IV antibiotics.
- DM2 with last A1c 7.9% , macroalbuminuria, diabetic
neuropathy
- HLD
- Tobacco use
- Sleep Apnea
- History of polysubstance abuse
- hepatitis C
- COPD
PAST SURGICAL HISTORY
- Right Fem-Pop PTFE
- L TMA
- Redo left femoral to above knee popliteal bypass with 6mm
ringed PTFE
- Debridement left toe, including partial metatarsal head
resection
- left first ray amputation
- aorto-bifem w dacron & L fem-pop bypass w PTFE
- Diagnostic angiogram
- L CFA endarterectomy, bovine pericardial patch angioplasty
from mid CFA into mid profunda femoral artery
- Aortogram bilateral lower extremity runoff
- Irrigation and closure of left neck wound
- Incision and drainage of left neck wound
- Left common carotid artery to left subclavian artery bypass
with 6-mm PTFE graft
- CABG x 3vessels, Mitral valve repair, closure of patent
foramen ovale
## CAD/MI, DM, CANCER:
esophageal, brain, lung
No family history of breast or lung cancer, melanoma or
lymphoma.
## PE:
Looks comfortable; non-toxicNAD
BP 98/50; HR 74; R; T98.2; RA 02 sat:95 %
## SKIN:
no generalized rash
Oropharynx; no thrush or mucositis
## COR:
normal S1S2; I/VI sys murmur at LSB;no or rub
appreciated
Lungs; clear to A&P
## ABDOMEN:
BSA; no masses appreciated. Non-tender to palpation. No
organomegaly appreciated
## RT UPPER EXT:
icc line: no induration
Rt thigh; anterior thigh area: erythema; induration; warmth;
tender to palpation along Rt groin incision; no crepitus; some
possible fluctuance in mid thigh
Inferior incision: has some seropurulent drainage
RT BKA stump eschar; no purulence expressed
DISCHARGE EXAM
===============
## GENERAL:
Well appearing woman w/ R BKA and wound vac
## HENT:
EOMI, MMM, missing teeth
## RESP:
CTAB, no wheezes or crackles
## EXT:
R BKA w/ clean staples at surgical site, minimal
surrounding erythema, wound vac w/ dressing from groin to distal
end of amputated limb, clean with minimal drainage
## ABCSESS CULTURE ( ):
- ALBICANS, PRESUMPTIVE IDENTIFICATION. SPARSE GROWTH
## TISSUE ( ):
-BETA STREPTOCOCCUS GROUP A. SPARSE GROWTH.
-STAPH AUREUS COAG +. SPARSE GROWTH
## WOUND CULTURE ( ):
Mixed bacterial flora
-Staph Aureus coag+ (pan sensitive)
-Beta Strep A
-Pseudomonas aeruginosa (pan sensitive)
IMAGING
========
Right lower extremity CT with contrast
## IMPRESSION:
Interval below-knee amputation. Two fluid
collections, one of which is predominantly in the anterior
subcutaneous tissues overlying the right hip just deep to a
surgical scar likely representing a postoperative seroma. The
second fluid collection measuring 3.1 x 3.1 x 14.4 cm, is in the
distal right thigh adjacent the femoral vessels with a few foci
of gas and wall enhancement consistent with abscess.
## BRIEF HOSPITAL COURSE:
Ms. is a woman with a history of severe
peripheral arterial disease more who was admitted to
on with new erythema, warmth
and tenderness in the medial right thigh where she recently
underwent drainage of an abscess ( ) as well as removal
of her femoral-popliteal bypass graft ( ) with Sartorius
flap ( ). The infectious disease service was consulted
and recommended starting her on oral linezolid and ciprofloxacin
due to inability to obtain intravenous access. A PICC line was
placed on , and she was switched to IV vancomycin and
cefepime per infectious disease. A right lower extremity CT with
contrast was performed, which demonstrated a large fluid
collection measuring 3.1 x 3.1 x 14.4 cm in the distal right
thigh adjacent the femoral vessels with a few foci of gas and
wall enhancement consistent with abscess. A second fluid
collection was also seen in the anterior
subcutaneous tissues overlying the right hip just deep to a
surgical scar, likely representing a postoperative seroma.
The patient was taken to the operating room on for
incision, drainage, and irrigation of her right thigh abscess
under moderate sedation. Wound cultures were sent, and the
abscess cavity was tightly packed with betadine soaked kerlex.
For details of the procedure, please see the surgeon's operative
note. At the end of the case, the patient became tachycardic to
the 140s and hypotensive to systolic after receiving
ephedrine. She returned to normal sinus rhythm with medical
intervention, and her pressures were sustained in the
systolic on a low dose phenylephrine infusion. She was taken to
the PACU in stable condition. The patient was weaned off
pressors within 4 hours of surgery and was transferred to the
vascular surgery floor. On the vascular floor, she developed
and was transferred to the medicine service for management of
her and hyperglycemia.
ACUTE PROBLEMS
===============
#R thigh abscess
Patient presented with right thigh abscess after complicated
recent hospitalization for fem-pop graft infection. She had an
incision and drainage procedure on complicated by acute
blood loss w/ hgb of 5.7 req 2u PRBC as well as SVT c/b
hypotension requiring norepi & esmolol. Cultures of the infected
site from the OR produced growth of mixed flora including MSSA,
P. aeruginosa, B strep, group A and C. albicans. Infectious
disease was consulted and recommended the pt initiate a
prolonged course of IV cefepime and IV micafungin. Vascular
surgery managed her wound with regular re-dressings and cavity
packing with saline kerlex and a wound vac. Pain was managed
with oxycodone PRN. She demonstrated clinical improvement
throughout her admission and was afebrile w/ normal white count.
She was discharged with wound vac in place and plans for several
weeks of IV antibiotics through .
#Acute Renal Failure
Pt had acute renal failure secondary to ATN from hypotension
during I&D. Contrast induced nephropathy as well as vancomycin
toxicity may have also been contributing factors. She was
oliguric w/ increased Cr after original injury so was given
NaHCO3 for academia and sevelamer carbonate as temporary
measures. A renal US was normal. Kidney function recovered after
several days as she began to have adequate urine output Cr
dropped back to near baseline by day of discharge.
#PVD
Patient has a complicated vascular surgery history including
bilateral lower extremity bypass s/p R femoral-popliteal graft
thrombectomy and stent. It was later also complicated by graft
infection s/p R thigh abscess drainage s/p graft explant and
Sartorius flap below the knee amputation. Vasucular surgery
continued to manage patient while admitted. She was started on a
heparin drip for graft thrombosis prophylaxis, which
transitioned to lovenox as a bridge to warfarin.
#HFrEF
The pt's heart failure is secondary to ischemic cardiomyopathy.
She was not volume overloaded during this admission and disease
appeared to be stable. Her torsemide and lisinopril were held in
the setting of hypotension. Her torsemide was restarted on
discharge. She has an ICD for primary prevention.
#SVT
Patient had an episode of SVT in OR on period during I&D.
There were no recorded events on interrogation of ICD and a CXR
demonstrated appropriate ICD lead placement in R ventricle. She
was not tachycardic and denied palpitations or chest pain during
this admission.
CHRONIC PROBLEMS
=================
#CAD s/p PCI, CABG
Continued on home Plavix.
#DM
Pt was given insulin sliding scale with 16u lantus QHS which was
uptitrated as her PO intake improved. She was discharged on 24u
lantus (from 32u lantus on admission).
#Polysubstance abuse
The patient was continued on methadone maintenance 45mg daily.
Her oxycodone dose was decreased as tolerated. QTc was
monitored.
#HLD
Continued home atorvastatin.
#COPD
Continued home budesonide as fluticasone and albuterol as
needed.
TRANSITIONAL ISSUES
====================
[] START lovenox 60mg BID tonight. Pt is being bridged to
warfarin and will need daily lovenox until INR is therapeutic
(2.5-3.5 for left lower extremity graft patency).
[] Wound vac management: Medium setting, pressure at 125, change
every 4 days, use bridging sponge, and please medicate the pt
for pain.
[] Pt is being discharged with 15mg oxycodone Q6 hrs. Please
taper dose as tolerated.
[] Lisinopril was held during admission and on discharge, please
restart pending repeat creatinine.
[] Recommend re-checking Cr and Mg in days.
[] Please monitor FSBG and titrate lantus as indicated.
[] Per ID recommendations, please check CBC/diff, BUN, Cr, LFT,
chemistry weekly and fax results to clinic:
.
[] The pt was on a beta blocker that was discontinued in .
Due to her cardiac history, it is recommended that she should be
on a beta blocker and there is no clear contra-indication noted
in her chart. Consider starting patient on a beta blocker if
appropriate.
- Pt's home torsemide was re-started on discharge.
- Pt will continue to use dynamic splint.
- Pt's maintenance methadone is 45mg daily
- She is being discharged on IV cefepime and micafungin via PICC
to complete a 4 week course ( ). She will follow up with
OPAT for further management.
## NEW MEDS:
cefepime 1gm IV q day as per clinic, micafungin
100mg IV q day, enoxaparin 60mg SC BID until INR >2.5
## CHANGED MEDS:
glargine 24 units qpm, oxycodone 15mg qid prn,
warfarin 2mg q day
## HELD MEDS:
lisinopril 2.5mg q day
## # CODE STATUS:
Full Code
# Emergency Contact:
Name of health care proxy:
## HUSBAND
PHONE NUMBER:
Cell phone:
>30 minutes spent on discharge planning and care coordination
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen 1000 mg PO Q8H
2. Gabapentin 300 mg PO TID
3. Lactobacillus acidophilus 1 billion cell oral DAILY
4. Prochlorperazine 5 mg PO Q6H:PRN nausea
5. Bisacodyl 10 mg PR QHS:PRN constipation
6. Docusate Sodium 100 mg PO BID:PRN constipation
7. Polyethylene Glycol 17 g PO DAILY:PRN constipation
8. Senna 8.6 mg PO DAILY:PRN constipation
9. Tizanidine 1 mg PO QAM
10. Tizanidine 2 mg PO QPM
11. Atorvastatin 80 mg PO QPM
12. Torsemide 20 mg PO DAILY
13. Multivitamins 1 TAB PO DAILY
14. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain
15. Methadone 45 mg PO DAILY
16. OxyCODONE (Immediate Release) 20 mg PO Q6H:PRN Pain -
Moderate
17. naloxone 4 mg/actuation nasal DAILY:PRN
18. Clopidogrel 75 mg PO DAILY
19. Pantoprazole 40 mg PO Q24H
20. Zinc Sulfate 220 mg PO DAILY
21. TraZODone 50 mg PO QHS:PRN insomnia
22. Ascorbic Acid mg PO BID
23. Vitamin D 1000 UNIT PO DAILY
24. Lisinopril 2.5 mg PO DAILY
25. Albuterol Inhaler PUFF IH Q6H:PRN SOB
26. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation
inhalation BID
27. Glargine 32 Units Bedtime
28. Warfarin 1 mg PO DAILY16
## DISCHARGE MEDICATIONS:
1. CefePIME 1 g IV Q24H
2. Enoxaparin Sodium 60 mg SC BID
## TODAY - , FIRST DOSE:
Next Routine Administration
Time
3. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line
flush
4. Micafungin 100 mg IV Q24H
5. Warfarin 2 mg PO DAILY16
6. Glargine 24 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
7. OxyCODONE (Immediate Release) 15 mg PO Q6H:PRN Pain -
Moderate
hold for sedation, RR<12
RX *oxycodone 15 mg 1 tablet(s) by mouth every six (6) hours
Disp #*28 Tablet Refills:*0
8. Acetaminophen 1000 mg PO Q8H
9. Albuterol Inhaler PUFF IH Q6H:PRN SOB
10. Ascorbic Acid mg PO BID
11. Atorvastatin 80 mg PO QPM
12. Bisacodyl 10 mg PR QHS:PRN constipation
13. Clopidogrel 75 mg PO DAILY
14. Docusate Sodium 100 mg PO BID:PRN constipation
15. Gabapentin 300 mg PO TID
16. Lactobacillus acidophilus 1 billion cell oral DAILY
17. Methadone 45 mg PO DAILY
18. Multivitamins 1 TAB PO DAILY
19. naloxone 4 mg/actuation nasal DAILY:PRN
20. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain
21. Pantoprazole 40 mg PO Q24H
22. Polyethylene Glycol 17 g PO DAILY:PRN constipation
23. Prochlorperazine 5 mg PO Q6H:PRN nausea
24. Senna 8.6 mg PO DAILY:PRN constipation
25. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation
inhalation BID
26. Tizanidine 1 mg PO QAM
27. Tizanidine 2 mg PO QPM
28. Torsemide 20 mg PO DAILY
29. TraZODone 50 mg PO QHS:PRN insomnia
30. Vitamin D 1000 UNIT PO DAILY
31. Zinc Sulfate 220 mg PO DAILY
32. HELD- Lisinopril 2.5 mg PO DAILY This medication was held.
Do not restart Lisinopril until Cr normalizes
## DISCHARGE DIAGNOSIS:
Right thigh abscess
Acute kidney injury
## DISCHARGE INSTRUCTIONS:
Dear ,
was a pleasure taking care of you at
.
Why was I admitted to the hospital?
- You were admitted to on
with a right thigh infection.
What was done while I was in the hospital?
- You were started in IV antibiotics and underwent a CT scan,
which showed a large abscess in your right thigh.
- You were taken to the operating room on for
incision, drainage, and irrigation of your right thigh abscess
with packing.
- You had temporary kidney problems after your surgery so you
were given some medications to keep your electrolytes balanced
while your kidneys recovered.
What should I do after I leave the hospital?
- You will need to continue taking IV antibiotics. An infectious
disease doctor help manage your antibiotics.
- You will need to continue taking Coumadin daily and check your
INR regularly to be sure that it is 2.5-3.5.
- You will receive assistance with managing your wound at rehab.
- Please follow up with vascular surgery on (see below).
- Please follow up with infectious disease on ***.
Thank you for allowing us to participation in your care!
Sincerely,
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10901772", "visit_id": "28761829", "time": "2153-07-30 00:00:00"} |
11239107-RR-34 | 119 | ## INDICATION:
Hypoxic respiratory failure in an intubated patient with a
history of HIV.
## SEMI-UPRIGHT AP CHEST RADIOGRAPH:
A double-lumen endotracheal tube is stable,
with one lumen ending 1.8 cm above the carina and the other 6cm into the left
mainstem bronchus. A nasogastric tube courses into the stomach and beyond the
field of view. The right subclavian central venous line ends in the superior
vena cava. Lung volumes are low. The patient is status post right lower
lobectomy with an open window thoracostomy. Cardiac and mediastinal contours
are stable. Increased ground-glass reticular markings throughout the left
lung have progressed from the previous study.
## IMPRESSION:
Worsened left lung opacities likely due to progressive
pneumonia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11239107", "visit_id": "25883588", "time": "2113-01-19 03:04:00"} |
16392858-RR-64 | 126 | ## INDICATION:
Status post single chamber permanent pacemaker implantation, here
to evaluate for pneumothorax and appropriate lead placement.
## FINDINGS:
A left pectoral single-chamber pacemaker is in place with a single
lead terminating in the right ventricle. The cardiac silhouette is moderately
enlarged but stable. The mediastinal contours are within normal limits with
mild tortuosity of the aorta. The hilar contours are within normal limits and
stable. The lungs are clear without focal consolidation, pleural effusion or
pneumothorax. The pulmonary vasculature is not engorged. Two screws are
noted in the left humeral head. Moderate degenerative changes are noted in
the bilateral acromioclavicular joints. Moderate degenerative changes are
noted in the lower thoracic spine. There is kyphotic curvature.
## IMPRESSION:
Appropriate pacemaker lead placement with clear lungs.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16392858", "visit_id": "27393206", "time": "2202-11-26 08:18:00"} |
17387047-DS-15 | 1,521 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
right total hip arthroplasty
## NOTE - DR. :
He is a
very healthy and active man with advanced and
symptomatic osteoarthritis of the right hip. He does do gym and
cardio workout. He is in great shape, quite muscular. He likes
to get out and hike mountains year round both in
and I believe in as well. Back in , started
to notice stiffness in the right hip while hiking, the pain had
been waxing and waning, but now is becoming more constant.
Longer hikes are very tough for him. He is still able to do day
hikes with a pound pack. For the past four months, the
pain has been quite intense. Back in of last year, he
did three consecutive hikes and he has been terrible since that
time. He is awoken by nighttime pain. He can perhaps walk a
half a mile. He still works out at the gym seven days per week.
He finds his hip getting stiff, difficult to get his shoes and
socks on.
hip survey right native hip entered into database. To
summarize, he has constant hip pain. He says he severely has to
downgrade his physical activities and severely lacks confidence
in the hip. No activity causes extreme pain, but he does have
severe pain with flexion, ambulation, getting in and out of a
car, shoes and socks, heavy domestic chores, walking on any type
of surface, at night while in bed. He says he is always in
pain,
and stiffness is moderate throughout the day. Severe pain with
attempts to abduct the hip.
## IMAGING STUDIES:
Weightbearing views from two months ago show
severe osteoarthritis, right hip with only 1 mm articular
cartilage, at most in the superior weightbearing zone with some
lateral uncovering and low-grade DDH and relative lateralization
of the femoral head versus the left side. On the left, he still
has over 5 mm of cartilage in the weightbearing zone.
Otherwise,
the osteology of the pelvis is normal.
## PAIN:
He rates his pain at rest, VAS, with activity
.
## PHYSICAL EXAMINATION:
A very healthy man, 5 feet 7 inches, 172
pounds, fit appearing. Muscular. Blood pressure 143/91, heart
rate 69. He has a 5-mm leg length discrepancy. On the affected
right hip, he has a 10-degree fixed external rotation deficit.
He can only flex to 100 degrees versus 120 on the left. Only 5
degrees internal rotation right versus 15 left, 15 degrees
external rotation right versus 25 degrees of left and 30 degrees
abduction right versus 45 degrees left.
## PAST MEDICAL HISTORY:
Hypertension and osteoarthritis, right
hip, ED.
## MEDICATIONS:
Lisinopril 10 mg daily and Viagra 100 mg p.r.n.
## FAMILY HISTORY:
Hypertension, prostate cancer, colon cancer and
pacemaker.
## REVIEW OF SYSTEMS:
feels he is in good health, certainly
appears so, wears corrective lenses. Everything else negative.
## IMPRESSION AND PLAN:
We have discussed that for his myriad of
symptoms and advanced arthritis, only a total hip replacement
can
provide lasting relief. I have given him all the information
related to THR, and he has read the risks and benefits and was
surgically consented today for that operation. We will have him
in touch with our orthopedic scheduling office to get him on the
surgical schedule at his earliest convenient time. Risks of
infection, DVT, fracture, neurovascular injury, heterotopic
ossification, instability, loosening over time, leg length
discrepancy, etc., have been reviewed with him, and he realizes
these are infrequent occurrences, but are potential risks. He
can donate blood on a p.r.n. basis at his own choice.
## PHYSICAL EXAM:
Well appearing in no acute distress
Afebrile with stable vital signs
Pain well-controlled
## NEUROLOGIC:
Intact with no focal deficits
## MUSCULOSKELETAL LOWER EXTREMITY:
* Incision well-approximated
* Scant serosanguinous drainage
* Thigh full but soft
* No calf tenderness
* Fires , TA,
* SILT, NVI distally
* Toes warm
## BRIEF HOSPITAL COURSE:
The patient was admitted to the Orthopaedic Arthroplasty
surgical service on and taken to the OR for right total hip
arthroplasty. Please see separately dictated operative note by
Dr. details of this procedure. Postoperatively, pt
was extubated and transferred to the PACU, and remained afebrile
and hemodynamically stable. The patient was transferred to the
floor later that day, and underwent an unremarkable
postoperative course.
## N:
Pain appropriately controlled, initially with IV and then
transition to PO pain medications.
## CV:
Vital signs were routinely monitored; the patient remained
hemodynamically stable.
## P:
There were no pulmonary issues.
## GI:
The patient tolerated a regular diet postoperatively
## GU:
Foley catheter was removed POD1, and the patient voided
without issues postoperatively. Lisinopril resumed POD2.
## ID:
The patient received perioperative antibiotics and remained
afebrile.
## HEME:
The patient received lovenox for DVT prophylaxis starting
POD1, and will complete a 4 week course postoperatively.
## MSK:
The patient was made weight-bearing as tolerated on the
operative extremity with posterior precautions. The overlying
surgical dressing was changed on POD#2 and wound was found to be
clean and well-approximated without erythema or abnormal
drainage.The patient worked with Physical Therapy daily
postoperatively, with recommendations for discharge to home c
home .
At the time of discharge, the patient was afebrile with stable
vital signs and good pain control; the operative extremity was
neurovascularly intact. The patient will follow-up in
clinic.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Lisinopril 10 mg PO DAILY
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO Q8H
RX *acetaminophen 500 mg tablet(s) by mouth q8hr Disp #*60
## TABLET REFILLS:
*2
2. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day
Disp #*60 Capsule Refills:*2
3. Enoxaparin Sodium 40 mg SC DAILY Duration: 28 Days
## , FIRST DOSE:
Next Routine Administration Time
continue for 28 days after discharge
RX *enoxaparin 40 mg/0.4 mL 40 mg subq daily Disp #*28 Syringe
## REFILLS:
*0
4. OxycoDONE (Immediate Release) mg PO Q4H:PRN Pain
do not drink alcohol or drive while taking
RX *oxycodone 5 mg tablet(s) by mouth q4hr Disp #*90 Tablet
## REFILLS:
*0
5. Senna 8.6 mg PO BID
RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day
Disp #*60 Capsule Refills:*2
6. Lisinopril 10 mg PO DAILY
## DISCHARGE INSTRUCTIONS:
1. Please return to the emergency department or notify your
physician if you experience any of the following: severe pain
not relieved by medication, increased swelling, decreased
sensation, difficulty with movement, fevers greater than 101.5,
shaking chills, increasing redness or drainage from the incision
site, chest pain, shortness of breath or any other concerns.
2. Please follow up with your primary physician regarding this
admission and any new medications and refills.
3. Resume your home medications unless otherwise instructed.
4. You have been given medications for pain control. Please do
not drive, operate heavy machinery, or drink alcohol while
taking these medications. As your pain decreases, take fewer
tablets and increase the time between doses. This medication can
cause constipation, so you should drink plenty of water daily
and take a stool softener (such as Colace) as needed to prevent
this side effect. Call your surgeons office 3 days before you
are out of medication so that it can be refilled. These
medications cannot be called into your pharmacy and must be
picked up in the clinic or mailed to your house. Please allow
an extra 2 days if you would like your medication mailed to your
home.
5. You may not drive a car until cleared to do so by your
surgeon.
6. Please call your surgeon's office to schedule or confirm your
follow-up appointment.
##
7. SWELLING:
Ice the operative joint 20 minutes at a time,
especially after activity or physical therapy. Do not place ice
directly on the skin. Please DO NOT take any non-steroidal
anti-inflammatory medications (NSAIDs such as Celebrex,
ibuprofen, Advil, Aleve, Motrin, naproxen etc).
##
8. ANTICOAGULATION:
Please continue your Lovenox for four (4)
weeks to help prevent deep vein thrombosis (blood clots). If
you were taking aspirin prior to your surgery, it is OK to
continue at your previous dose while taking this medication.
STOCKINGS x 6 WEEKS.
##
9. WOUND CARE:
Please keep your incision clean and dry. It is
okay to shower five days after surgery but no tub baths,
swimming, or submerging your incision until after your four (4)
week checkup. Please place a dry sterile dressing on the wound
each day if there is drainage, otherwise leave it open to air.
Check wound regularly for signs of infection such as redness or
thick yellow drainage. Staples will be removed by the visiting
nurse or rehab facility in two (2) weeks.
##
10. (ONCE AT HOME):
Home , dressing changes as
instructed, wound checks, and staple removal at two weeks after
surgery.
##
11. ACTIVITY:
Weight bearing as tolerated on the operative
extremity. Posterior precautions. No strenuous exercise or heavy
lifting until follow up appointment. Mobilize frequently
## PHYSICAL THERAPY:
weight-bear as tolerated with posterior hip precauations, RLE
## TREATMENT FREQUENCY:
ABD pad / paper tape dressing may be changed daily until wound
remains dry
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "17387047", "visit_id": "23109583", "time": "2167-05-15 00:00:00"} |
16179342-DS-19 | 1,187 | ## HISTORY OF PRESENT ILLNESS:
with hx of afib, tachy-brady syndrome with pacemaker,
osteoporosis, chronic back pain who presents with acute on
chronic back pain. Woke up the day before admission with
worsening pain, nontraumatic. Took an oxycodone prior to coming
to the ED without improvement. She cannot characterize it well
but repeats that it is mostly right lower lumbar, radiating down
the posterior right leg. Has chronic urinary incontinence with
no worsening incontinence or retention. Moved bowels yesterday,
no stool incontinence. No fever/chills, weight loss, night
sweats. No IVDU. Walks with a cane, limited today by pain.
In the ED, initial VS were: 98.4 76 154/82 16 97% ra, she was
noted to have an elevated INR of 4.2. They were concerned about
an epidural hematoma, but due to pacemaker a CT was
ordered which showed a stable T12 compression fracture seen on
prior imaging. was consulted because they could not
exclude a hematoma on CT. There is no available documentation of
a consultation, but recommended admission to medicine for
serial neuro exams. ED documentation states pain is on the left,
but my discussion with the patient is very clear that she points
to the right side of her body.
## PAST MEDICAL HISTORY:
- Atrial Fibrillation/counterclockwise AFlutter s/p ablation
attempt 05 now managed with rate control and pacemaker
- Pacermaker Backup with Sensa SEDR01 dual chamber
last interrogated
- Chronic Diastolic Congestive Heart Failure EF >55%
- Moderate Pulmonary Hypertension
- Mild Aortic Stenosis 1.2-1.9cm2 Mean Gradient of 10mmHg by
echo
- Mild-Moderate Mitral Regurgitation, mod to severe Tricuspid
Regurg
- Hyperlipidemia
- Hypertension
- Hypothyroidism on 88mcg of LT4 daily
- Diabetes Type II A1c 6.5%
- Osteoporosis Last BMD on Alendronate, AP -2.6
- Anemia
- h/o Lacunar Strokes
.
## FAMILY HISTORY:
There is no family history of premature coronary artery disease
or sudden death.
## GENERAL:
well appearing moving in bed without difficulty
## HEENT:
NC/AT, PERRLA, EOMI, sclerae anicteric, MMM
## NECK:
supple, no LAD, JVD:
## LUNGS:
CTA bilat, no r/rh/wh, good air movement, resp unlabored,
no accessory muscle use
## ABDOMEN:
normal bowel sounds, soft, non-tender, non-distended,
no rebound or guarding, no masses
## EXTREMITIES:
no edema, 2+ pulses radial and dp, examination of
the right knee where she indicates pain is without deformity, no
varus/valgus strain, - drawer sign. no effusion
Mild para-spinal tenderness bilaterally, spinal process pain at
the area of t12/L1
## NEURO:
awake, A&Ox3, CNs II-XII grossly intact, strength in
flexion extenion in all major muscle groups in the lower
extremities. reflexes are 1+ and symmetric in the ankles and
knees. Able to feel light touch throughout legs on both sides
but diminished on right anterior leg. No saddle anesthesia
## ADMISSION:
08:55PM WBC-10.6 RBC-4.26 HGB-12.0 HCT-37.5 MCV-88
MCH-28.2 MCHC-32.1 RDW-14.2
08:55PM NEUTS-49.0* LYMPHS-45.1* MONOS-3.8 EOS-1.3
BASOS-0.8
08:55PM PLT COUNT- yo woman with afib, chronic low back pain who presents with
acute on chronic back pain.
## #BACK PAIN:
patient's exam was very reassuring with preserved
strength and normal sensory exam in the lower extremities.
Serial neuro exams have yielded no evolving process. Abscence of
red flag symptoms other than age, no hx of fever/chills/IVDU,
trauma, saddle anesthesia to warrant imaging at this time. It is
impossible to exclude epidural hematoma, but lack of truama
history and stable exam places this low on the differential.
Patient had good response to oxycodone, along with home
gabapentin, lidocaine patch, and tramadol. evaluated her and
recommended home . She was discharged with oxycodone, tramadol
and tizanidine for several days.
## # ELEVATED INR:
Was supratherapeutic to 4.2 on admission which
decreased to 3.2 with omission of one dose of warfarin. She was
discharged with instructions to continue her 5mg of warfarin but
the clinic will call her tomorrow for follow up
instructions.
## CHRONIC ISSUES:
# DMII:
stable, continued metformin
# Urinary incontinence: continued oxybutinin
# Atrial fibrillation: CHADS2 = 5. Stable. Continued coumadin on
discharge.
# Chronic diastolic CHF: continued lasix
# Hypothyroidism: continued home levothyroxine 88mcg
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acetaminophen 1000 mg PO BID
2. Docusate Sodium 100 mg PO BID
3. Dofetilide 250 mcg PO Q12H
4. Ferrous Sulfate 325 mg PO DAILY
5. Furosemide 40 mg PO QAM
6. Gabapentin 300 mg PO QAM
7. Gabapentin 600 mg PO QPM
8. Furosemide 20 mg PO QPM
9. Levothyroxine Sodium 88 mcg PO DAILY
10. Lisinopril 10 mg PO DAILY
11. Metoprolol Tartrate 50 mg PO BID
12. Oxybutynin 5 mg PO HS
13. Polyethylene Glycol 17 g PO DAILY
14. Pravastatin 20 mg PO DAILY
15. Warfarin 5 mg PO DAILY16
Adjust as needed for INR . OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain
hold for rr<12 or somnolence
17. Enablex *NF* (darifenacin) 15 mg Oral qd
18. MetFORMIN XR (Glucophage XR) 500 mg PO BID
Do Not Crush
## DISCHARGE MEDICATIONS:
1. Acetaminophen 1000 mg PO BID
2. Docusate Sodium 100 mg PO BID
3. Dofetilide 250 mcg PO Q12H
4. Ferrous Sulfate 325 mg PO DAILY
5. Furosemide 40 mg PO QAM
6. Furosemide 20 mg PO QPM
7. Gabapentin 300 mg PO QAM
8. Gabapentin 600 mg PO QPM
9. Levothyroxine Sodium 88 mcg PO DAILY
10. Lisinopril 10 mg PO DAILY
11. MetFORMIN XR (Glucophage XR) 500 mg PO BID
12. Metoprolol Tartrate 50 mg PO BID
13. Oxybutynin 5 mg PO HS
14. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain
RX *oxycodone 5 mg tablet(s) by mouth every six (6) hours
Disp #*15
## TABLET REFILLS:
*0
15. Polyethylene Glycol 17 g PO DAILY
16. Pravastatin 20 mg PO DAILY
17. Warfarin 5 mg PO DAILY16
18. Tizanidine 2 mg PO BID
RX *tizanidine 2 mg 1 tablet(s) by mouth twice a day Disp #*10
Tablet Refills:*0
19. Enablex *NF* (darifenacin) 15 mg Oral qd
## DISCHARGE DIAGNOSIS:
Primary diagnosis:
Musculoskeletal back pain
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Ms. ,
It was a pleasure to take care of at .
were admitted for back pain that is similar to your previous
pain. We did not find any indication that needed any imaging
of your . Your pain was controlled with oral pain
medications.
Back pain:
We have started on oxycodone and tizanidine. Please continue
them while are feeling pain. However, should also follow
up with your primary care doctor so she can monitor your pain
and prescribe refills of your pain medications.
## INR:
Your INR was high when came in. We omitted a dose of
coumadin when came in, and your INR began to decrease to
normal levels. can continue to take 5mg of coumadin daily
for now, until see the clinic who will
instruct further.
Please return if:
have any new weakness or loss of sensation in your legs
are unable to urinate or lose more control of your bladder
are unable to have a bowel movement or lose control of your
stool
have fever/chills, nausea/vomiting
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16179342", "visit_id": "21941060", "time": "2188-03-21 00:00:00"} |
19900168-RR-69 | 183 | Department of Radiology
Standard Report- Carotid Series Complete
## REASON:
year old man with LMCA disease pre/op CABG.
## FINDINGS:
Duplex evaluation was performed of bilateral carotid arteries. On
the right there is a small heterogeneous plaque in the ICA. On the left there
is mild heterogeneous plaque in the ICA.
On the right systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 51/7, 68/14, 72/8, cm/sec. CCA peak systolic
velocity is 90 cm/sec. ECA peak systolic velocity is 141 cm/sec. The ICA/CCA
ratio is .80. These findings are consistent with <40% stenosis.
On the left systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 103/22, 87/13, 92/19, cm/sec. CCA peak systolic
velocity is 89 cm/sec. ECA peak systolic velocity is 165 cm/sec. The ICA/CCA
ratio is 1.1 . These findings are consistent with <40% stenosis.
There is right antegrade vertebral artery flow.
There is left antegrade vertebral artery flow.
## IMPRESSION:
Right ICA with<40% stenosis.
Left ICA with <40% stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19900168", "visit_id": "22613731", "time": "2129-03-15 09:49:00"} |
14187965-RR-99 | 444 | ## EXAMINATION:
MR CERVICAL SPINE W/O CONTRAST MR SPINE
## INDICATION:
year old woman with ongoing cervical stenosis// r/o cord
compression r/o cord compression
## FINDINGS:
Study is limited by motion degradation.
Unchanged 2 mm retrolisthesis of C6 on C7. Otherwise, alignment is anatomic.
There is loss of intervertebral disc signal and height at multiple levels of
the cervical and upper thoracic spine. There is minimal loss of height of the
C5 vertebral body which is unchanged from MRI cervical spine .
There is subtle STIR hyperintense signal at the endplates at C7-T1, T1-T2,
T2-T3, T3-T4 which likely represent type changes. Cord signal is
normal. The visualized posterior fossa is unremarkable.
At C2-C3, there is no spinal canal or right neural foraminal stenosis.
Uncovertebral and facet arthropathy results in mild left neural foraminal
narrowing.
At C3-C4, left uncovertebral and facet arthropathy and disc protrusion
resulting in moderate left-sided neural foraminal narrowing, grossly unchanged
from MRI cervical spine .
At C4-C5, there is a mild disc protrusion. Uncovertebral and facet
arthropathy results in moderate to severe right and mild left neural foraminal
narrowing.
At C5-C6, a central protrusion results in mild spinal canal narrowing,
progressed since . There is intervertebral osteophytes and
uncovertebral hypertrophy resulting in moderate to severe left-sided and
moderate right-sided neural foraminal narrowing.
At C6-C7, a disc protrusion results in moderate spinal canal narrowing,
unchanged from . There is uncovertebral hypertrophy resulting
in moderate to severe left and moderate right neural foraminal narrowing.
This is grossly unchanged from .
At C7-T1, there is a minimal disc bulge and ligamentum flavum thickening but
no significant spinal canal narrowing or neural foraminal stenosis.
At T1-T2, a disc protrusion results in mild spinal canal narrowing. In
conjunction with facet arthropathy, there is at least moderate bilateral
neural foraminal stenosis, progressed since .
Partially visualized lung apices are unremarkable. There is no prevertebral
edema. A 1.4 cm T2 hyperintense nodule in the left lobe of the thyroid is
unchanged since .
## IMPRESSION:
This study is mildly degraded by motion.
1. Multilevel cervical spondylosis, most prominent at C4-C5 where there is
moderate to severe right neural foraminal narrowing, at C5-C6 and C6-C7 where
there is moderate to severe left and moderate right neural foraminal
narrowing. The findings at C5-C6 has progressed since .
2. There is no high-grade spinal canal narrowing. Additional findings as
described above.
3. Within the limitations of motion degradation, spinal cord signal is normal.
4. Unchanged appearance since of 1.4 cm T2 hyperintense nodule in the
left lobe of the thyroid, minimally increased in size since examination of
.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14187965", "visit_id": "N/A", "time": "2172-07-19 07:17:00"} |
13193182-RR-20 | 139 | ## INDICATION:
year old woman with L wrist fx // Eval left wrist fx for
joint involvement
## RADIUS:
There is a comminuted impacted fracture of the distal radius with
multiple butterfly fragment segments. There is extension of the distal
fracture segments into the radiocarpal joint space. There is volar
displacement of the distal radius fracture by 7 mm.
## ULNA:
There is a comminuted mildly impacted fracture of the distal ulna with
dorsal angulation of the distal fracture segment. There are a few butterfly
fracture fragments along the dorsal aspect of the distal ulna.
No fracture in the carpal bones and partially visualized metacarpal bones.
## IMPRESSION:
1. Right distal radius comminuted fracture with intra-articular extension and
volar displacement of the distal fragment by 7 mm.
2. Right distal ulna comminuted fracture with mild dorsal angulation of
distal fracture segment.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13193182", "visit_id": "N/A", "time": "2137-05-23 18:34:00"} |
15148203-RR-81 | 313 | ## INDICATION:
year old woman with ileocolonic Crohn's with new diarrhea and
nausea. Staging exam.
## MR ENTEROGRAPHY:
An enhancing 1.4 cm polypoid lesion is identified at the gastric fundus/body.
The small bowel is normal in appearance without wall thickening, abnormal
enhancement, or dilation. No strictures, abscess or fistula is identified.
There is no engorgement of the vasa recta. Stool is seen throughout the colon
from the cecum to the rectum. No definite evidence of inflammatory bowel
disease or other acute or concerning colonic abnormality though the study was
not tailored to evaluate the colon.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
The liver demonstrates normal signal intensity. 8mm hemangioma is identified
within the liver, unchanged. The spleen demonstrates normal signal intensity
and is normal in size. The kidneys are symmetric without hydronephrosis. No
solid renal region is identified. The pancreas is normal signal intensity and
enhancement. Note is made of an annular pancreas without evidence of acute
pancreatitis or significant pancreatic ductal narrowing. Bilateral adrenal
glands are normal. There is no mesenteric or retroperitoneal lymphadenopathy.
The abdominal aorta is normal in caliber. Major branch vessels are patent.
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
There is no free fluid within the pelvis. The bladder is unremarkable. The
uterus and right adnexal region are within normal limits. Patient is status
post left salpingo-oophorectomy. There is no pelvic sidewall or inguinal
lymphadenopathy.
## IMPRESSION:
1. No evidence of active or chronic sequelae of Crohn's disease.
2. 1.4 cm polyp at the gastric/body. Per OMR, patient has had prior
endoscopy in with multiple fundal polyps identified. Previously the
largest measured up to 7 mm. Consider repeat endoscopy for re-evaluation.
3. Unchanged 8 mm liver hemangioma.
4. Note is made of an annular pancreas without evidence of acute or chronic
pancreatitis or significant duodenal obstruction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15148203", "visit_id": "N/A", "time": "2125-01-06 09:17:00"} |
13601509-RR-11 | 188 | ## EXAMINATION:
US RENAL ARTERY DOPPLER
## INDICATION:
year old woman with HFrEF (EF 27%), CAD, CKD admitted with
pulmonary edema, hypertension, concern for renal artery stenosis.// Please
perform renal artery doppler study bilaterally to assess for possible renal
artery stenosis
## FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity and corticomedullary differentiation are seen bilaterally.
Right kidney: 9.5 cm
Left kidney: 9.7 cm. A simple partially exophytic cyst at the lower pole of
the left kidney measures 1.1 x 1.4 x 0.9 cm.
The bladder is moderately well distended and normal in appearance. Bilateral
ureteral jets are seen on color Doppler imaging.
## DOPPLER EXAMINATION:
Arterial waveforms appear symmetrical of the main renal
artery bilaterally. Peak systolic flow in the right main renal artery
measures 59 cm/sec and in the left main renal artery measures 41 cm/sec. The
renal vein is patent bilaterally. Resistive indices of the intraparenchymal
arteries in the right kidney measure from 0.67-0.68 and in the left kidney
measure from 0.63-0.70.
## IMPRESSION:
No sonographic evidence of renal artery stenosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13601509", "visit_id": "22752600", "time": "2150-06-30 15:46:00"} |
14532362-DS-20 | 1,245 | ## HISTORY OF PRESENT ILLNESS:
year old Male with a history of CAD and HTN, and recent
cholecystitis in s/p percutaneous drain placement who
presents with right-sided abdominal pain. Notably, the patient
had his percutaneous drain removed by surgery on the day prior
to admission.
That night he developed a sharp, stabbing R sided chest pain,
that was worse with inspiration, coughing, or sneezing.
Denies any radiation, diaphoresis, back pain, or arm pain. No
pain on L side. No fevers, nausea, or vomiting. He thinks he may
have had some chills.
.
He's also had some substernal chest discomfort, which he has a
hard time describing. He took a nitro, without any relief.
.
.
In the ED initial vital signs were 97.7 69 87/52 18 98%. The
patient was given 2L IV fluids, with improvement in his BP to
104/60. Surgery was consulted given recent procedure. They
thought that the pleural effusion was the likely cause of pain,
which will resolve with anti-inflammatories. They recommended
PCP follow up. patient was admitted for hypotension. Prior
to transfer he was given 325mg po Aspirin.
.
Currently, he denies any pain or discomfort.
## REVIEW OF SYSTEMS:
(+) Per HPI
(-) Review of Systems: GEN: No fever, night sweats, recent
weight loss or gain. HEENT: No headache, sinus tenderness,
rhinorrhea or congestion. CV: No chest pain or tightness,
palpitations. PULM: No cough, shortness of breath, or wheezing.
## GI:
No nausea, vomiting, diarrhea, constipation. No recent
change in bowel habits, no hematochezia or melena. GUI: No
dysuria or change in bladder habits. MSK: No arthritis,
arthralgias, or myalgias. DERM: No rashes or skin breakdown.
## NO NUMBNESS/TINGLING IN EXTREMITIES. PSYCH:
No feelings
of depression or anxiety. All other review of systems negative.
.
## 2. CAD:
s/p stenting DES to the OM and LAD
hypertension
hypothyroidism
gout
depression
GERD
BPH
Mitral Valve prolapse.
## FAMILY HISTORY:
Mother had CABG x2 and died at the age of . Also had
cholecystitis
Father developed cancer in his
## VS:
T 96.7 HR 56 BP 107/65 RR 18 96% on RA
## HEENT:
PERRLA. MMM. no LAD. no JVD. neck supple. No cervical,
supraclavicular, or axillary LAD
## CARDS:
RR S1/S2 normal. no murmurs/gallops/rubs.
## PULM:
Marked tenderness to palpation over R sided ribs. No
dullness to percussion, CTAB no crackles or wheezes
## ABD:
BS+, soft, NT, no rebound/guarding, no HSM, no
sign
## EXTREMITIES:
wwp, no edema. DPs, PTs 2+.
## SKIN:
no rashes or bruising
## NEURO:
CNs II-XII intact. strength in U/L extremities. DTRs
2+ . sensation intact to LT, cerebellar fxn intact (FTN, HTS).
gait WNL.
.
Discharge
## VS:
T 96.7 HR 68 BP 98/62 RR 16 93% on RA
## HEENT:
PERRLA. MMM. no LAD. no JVD. neck supple. No cervical,
supraclavicular, or axillary LAD
## CARDS:
RR S1/S2 normal. no murmurs/gallops/rubs.
## PULM:
Right ribs nontender to palpation. No dullness to
percussion, CTAB no crackles or wheezes
## ABD:
BS+, soft, NT, no rebound/guarding, no HSM, no
sign
## EXTREMITIES:
wwp, no edema. DPs, PTs 2+.
## SKIN:
no rashes or bruising
## NEURO:
CNs II-XII intact. strength in U/L extremities. DTRs
2+ . sensation intact to LT, cerebellar fxn intact (FTN, HTS).
gait WNL.
## FINDINGS:
There has been interval removal of the right upper
quadrant drain.
There is a new small right pleural effusion. There is no left
pleural
effusion. Elevation of the right hemidiaphragm persists. There
is no focal
consolidation or pneumothorax. Heart size is normal. The aorta
is tortuous. There is no evidence for pulmonary edema.
## IMPRESSION:
Interval development of small right pleural
effusion.
.
Liver US
## IMPRESSION:
1. New right pleural effusion
2. Unremarkable gallbladder. No evidence of intra-hepatic
biliary
dilatation. CBD not seen
## BRIEF HOSPITAL COURSE:
year old M with a history of CAD, HTN, and recent
cholecystitis in s/p percutaneous drain placement who
presented with right-sided abdominal pain.
.
# RUQ Abdominal pain: The patient had his percutaneous drain
removed by surgery on the day prior to admission, which seems to
correlate with the onset of his symptoms. RUQ US showed no gall
bladder disease. CXR showed very small R pleural effusion, which
is likely the source of his symptoms. Most likely etiology was
reactive to his recent gallbladder process and tube removal.
Very unlikely to be cardiac, but was ruled out MI given history
of CAD and HTN. Exam mild ruq pain tenderness to palpation, but
negative sign. Tylenol mg po tid standing for R
sided chest pain which alleviated the pain .Placed on PRN
oxycodone Q6H for breakthrough pain.EKG was unremarkable
.
## 2. TRANSIENT HYPOTENSION:
Patient with initial BP of in
the ED. Resolved with IV fluids. On the floor BP was
90-110/60-70 after getting IV fluids. Likely slightly
dehydrated. Tolerated orals well on the floor. Consistent with
mild hyponatremia, and creatinine rise. Continued Metoprolol on
discharge
.
## 3. HYPONATREMIA:
Na 131 and 133 on discharge. Likely mildly
hypovolemic, given mild hypotension .Corrected with IV fluids
.
# CAD:Continued ASA, Plavix
.
# Hypothyroidism: Continued Synthroid
.
# Gout: Continued allopurinol
.
# BPH: tamsulosin
## MEDICATIONS ON ADMISSION:
Allopurinol po daily
Celexa 60mg po daily
Plavix 75mg po daily
Synthroid 50mcg po daily
Ativan 0.5mg po qhs PRN insomnia
Metoprolol 12.5mg po daily
Nitroglycerin 0.4mg SL PRN CP
Oxycodone po q6h PRN pain
Ranitidine
Tamsulosin 0.4mg po qhs
Tylenol po q8h
Aspirin 325mg po daily
## DISCHARGE MEDICATIONS:
1. docusate sodium 100 mg Capsule
## SIG:
One (1) Capsule PO BID (2
times a day).
2. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
3. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
## 5. ALLOPURINOL MG TABLET SIG:
One (1) Tablet PO DAILY
(Daily).
6. citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
7. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
9. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
10. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours): do not exceed 4 grams per day .
11. metoprolol succinate 25 mg Tablet Extended Release 24 hr
## SIG:
0.5 Tablet Extended Release 24 hr PO once a day.
12. ranitidine HCl 150 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
13. oxycodone 5 mg Tablet Sig: Tablets PO Q6H (every 6
hours) as needed for breakthrough pain.
Disp:*30 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
Primary Diagnosis
Pleural Effusion
Muskuloskeletal pain
.
Secondary Diagnosis
Systolic heart failure
## DISCHARGE INSTRUCTIONS:
It was a pleasure to care for you as your doctor.
.
You were brought to the hospital with right sided chest and back
pain. After several unremarkable tests it was thought your pain
was caused by your recent surgical procedure. Your pain was
controlled with oxycodone.
.
We made the following changes to your home medications list:
Start Oxycodone Q6H only as needed for pain. Be aware
this medication causes sedation and you should not take it when
operating large mechanical vehicles.
.
Please take the rest of your home medications as you were before
coming to the hospital.
.
Please follow up with your primary care physician in the next
week.
Weigh yourself every morning, call MD if weight goes up more
than 3 lbs.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14532362", "visit_id": "21098679", "time": "2131-04-10 00:00:00"} |
16187544-RR-33 | 188 | ## CLINICAL HISTORY:
postmenopausal woman with a 3.4 cm left adnexal
cyst on CT performed in . Ultrasound is being performed
for further evaluation.
## FINDINGS:
Transabdominal and transvaginal ultrasounds were performed, the
latter for further evaluation of the endometrium and adnexa. The uterus is
retroverted measuring 7.6 x 4.1 x 3.4 cm. There is an intramural anterior
uterine fibroid which measures 3.3 x 2.7 x 3.3 cm. A small amount of fluid is
seen in the endometrial canal. The endometrium is normal thickness measuring
3mm. The ovaries are not visualized. Within the left adnexa, there is an
anechoic cystic structure with slight wall irregularity, which measures 3.2 x
3.1 x 2.8 cm. Whether the wall irregularity is artifact or a real finding is
unknown. The overall appearance is benign.
## IMPRESSION:
1. 3.2cm left adnexal cyst with an overall benign appearance. However, given
the wall irregularity, comparison with more remote priors is recommended (if
available) and we are happy to issue an addendum. Otherwise, followup is
recommended.
2. Fibroid uterus.
Findings and recommendations emailed to Dr. 2:40pm .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16187544", "visit_id": "N/A", "time": "2141-07-31 09:38:00"} |
12145581-RR-44 | 85 | ## INDICATION:
year old woman with abdominal pain // PEG advanced to PEJ
tube, concerned for location of tube, perf.
## FINDINGS:
A percutaneous endoscopic gastrostomy is noted with a catheter seen coiled
within the stomach, crossing midline, and apparently extending into the
proximal duodenum. There are no air-fluid level identified, and there are no
abnormally dilated loops of small or large bowel. There is no evidence of
pneumatosis or pneumoperitoneum on these limited supine views.
## IMPRESSION:
PEG tube likely terminating within the proximal duodenum.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12145581", "visit_id": "22326950", "time": "2120-09-07 01:43:00"} |
19275060-RR-23 | 203 | ## HISTORY:
female with abdominal pain and report of abdominal mass
or possible small bowel diverticulum on recent outside hospital CT scan.
## BONE WINDOWS:
No suspicious lytic or sclerotic osseous lesions are
identified.
## IMPRESSION:
1. Two oval-shaped soft tissue densities of the mesentery measuring up to 2.5
cm are incompletely evaluated.
2. The more cephalad appears discrete and is not definitely associated with
small bowel. It is nonspecific but could represent an enlarged mesenteric
lymph node, peritoneal inclusion cyst, enteric duplication cyst, or possibly
diverticulum. Desmoid tumor is considered less likely given lack of
significant mesenteric scarring but this cannot be excluded.
3. The more caudad of the soft tissue densities demonstrated apparent
intraluminal filling with oral contrast on the prior outside hospital study
and is intimately associated with a small bowel loop suggesting that it is a
diverticulum, such as Meckel diverticulum. Alternatively it could simply
represent peristalsis in normal small bowel, but the presence of this area on
two separate studies would argue against this.
Further evaluation with small bowel follow-through, small bowel MR, or
followup CT study with IV and oral contrast may be helpful.
ER dashboard wet read placed at 3:45 a.m. on .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19275060", "visit_id": "25388501", "time": "2184-12-02 02:47:00"} |
17848669-RR-25 | 350 | ## REASON FOR EXAM:
Dyspnea on exertion with nearly normal echocardiogram. Known
history of asthma.
Clinical concern for interstitial lung disease.
## FINDINGS:
Thyroid gland is unremarkable. There is no pathologically enlarged
mediastinal, hilar or axillary lymphadenopathy with a 7 mm lymph node just
under the manubrium (2:12). Partially calcified 9 mm aortopulmonary window
lymph node or calcification of the ligamentous arteriosis. There is small
amount of physiologic pericardial effusion. Minimal atherosclerotic
calcifications of the coronary arteries are noted. The ascending thoracic
aorta measures 3.7 cm in diameter, upper limit of normal. The pulmonary artery
is borderline in size.
There is no pneumothorax, pleural effusion or focal pulmonary consolidation.
Subtle diffused peripheral loss of structure and hypoattenuation and of the
lung paranchyma represents mild emphysema. There is mild diffused bronchial
wall thickening and irregularity. On expiratory images, the lungs appear
grossly homogeneous with no increase in attenuation as compared to inspiratory
images, which may represent diffuse air trapping. Subtle centrilobular ground
glass opacities in the right upper lobe are poorly chacterized. There is a 6
mm nodule in the right lower lobe (104:130). There is a 2 mm left upper lobe
subpleural nodule (104:50). Biapical pleural scarring is mild.Left lower lobe
linear scar is noted.
There is a 1.4 x 0.9 cm hypodense lesion in the left lobe of the liver (4:47).
Gallstones are noted.
Severe scoliosis and degenerative changes of the spine with no bone lesion
suspicious for malignancy or infection are seen. Degenerative changes of the
left humerus also noted.
## IMPRESSION:
1. Mild emphysema.
2. Diffused bronchial wall thickening and irregularity and airtrapping most
compatible with patient's known asthma.
3. Subtle centrilobular ground glass opacities in the right upper lobe,
poorly chacterized.
4. 6 mm right lower lobe nodule and a 2 mm left upper lobe subpleural nodule.
Followup chest CT in six months is recommended for further evaluation.
5. A 1.4 cm hypodense liver lesion, likely cyst. Evaluation is limited due
to lack of IV contrast.
6. Cholelithiasis.
7. Severe scoliosis and degenerative changes of the spine.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17848669", "visit_id": "N/A", "time": "2185-12-26 12:14:00"} |
10354409-RR-12 | 408 | ## EXAMINATION:
CTA CHEST WITH CONTRAST
## INDICATION:
year old woman with T-cell lymphoma w/tachycardia, pleuritic
chest pain // signs of PE, interval change in mediastinal mass, pericardial
involvement, pericardial effusions
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 14.9 mGy (Body) DLP = 3.0
mGy-cm.
2) Stationary Acquisition 7.3 s, 0.2 cm; CTDIvol = 199.3 mGy (Body) DLP =
39.9 mGy-cm.
3) Spiral Acquisition 4.8 s, 31.1 cm; CTDIvol = 14.1 mGy (Body) DLP = 429.4
mGy-cm.
Total DLP (Body) = 472 mGy-cm.
## FINDINGS:
Again seen is an approximately 10 cm right hilar mass extending into the
mediastinum inseparable from the adjacent adenopathy. The mass causes severe
narrowing of the right proximal segmental bronchi of the right upper and right
lower lobes as well as complete occlusion of the right middle lobe evidenced
by right middle atelectases, as on prior. There is severe attenuation of the
interlobar artery and almost complete the occlusion of the proximal segmental
arteries and complete occlusion of the branches of the right upper lobe. The
mass extends into the and is inseparable from the adenopathy, seen between the
SVC and carina as well as in the subcarinal region, as on prior. For instance
the adenopathy in the periductal region measures 2 cm and the adenopathy in
the subcarinal region measures 2.5 cm. No pulmonary embolus demonstrated in
the left pulmonary artery or at the pulmonary arterial bifurcation.
Multiple bronchial arteries are again seen feeding the mediastinal mass which
is appears inseparable from the esophagus. The azygos vein is likely involved
by the tumor and there is a prominent hemi azygous and left superior
intercostal vasculature. Similarly there is displacement and involvement of
the proximal aspect of the right superior pulmonary vein.
There is patchy consolidation in the right upper lobe and atelectasis of the
right middle lobe as well as multiple secretions/debris within the right lower
bronchi distal to the right hilar mass.
## PLEURAL SPACES:
No pleural effusion or pneumothorax.
## BASE OF NECK:
Thyroid nodules are again seen.
## ABDOMEN:
Included portion of the upper abdomen is unremarkable.
## BONES:
No aggressive osseous lesions.
## IMPRESSION:
Large thoracic mass centered in the right hilum causing severe narrowing and
occlusion of the right pulmonary artery and right bronchi as detailed above.
No embolus in the visualized portions of the pulmonary arterial vasculature.
Patchy consolidation in the right lung as described.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10354409", "visit_id": "22627631", "time": "2134-04-03 12:22:00"} |
10004457-RR-22 | 218 | ## HISTORY:
Atrial flutter and spontaneous subarachnoid hemorrhage in the past.
Rule out aneurysm before anticoagulation.
## CT HEAD WITHOUT CONTRAST:
There is no evidence of hemorrhage, edema, masses,
or infarction. The ventricles and sulci are normal in caliber and
configuration. There is mild calcification of the cavernous carotid arteries
bilaterally. The right ocular lens has been resected and there is a right
lateral to.
The CTA examination of the head appears normal with no evidence of stenosis,
occlusion, or aneurysm formation.
The CTA examination of the neck demonstrates an approximately 50% stenosis of
the right internal carotid artery at its origin due to an atherosclerotic
plaque that is partially calcified. In addition, there is a focal outpouching
in the midcervical portion of the vessel that is not associated with visible
atherosclerotic plaque. This may represent a tiny pseudoaneurysm, perhaps
related to a prior dissection. This measures approximately 1 mm in diameter.
Images of the left carotid artery demonstrate calcified and noncalcified
plaque at the origin of the internal carotid artery. However, there is no
stenosis by NASCET criteria.
## IMPRESSION:
No evidence of intracranial aneurysm.
Atheromatous disease at the origins of the internal carotid arteries with a
50% stenosis of the right ICA.
1 mm outpouching from the cervical right internal carotid artery. This
suggests a tiny pseudoaneurysm.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10004457", "visit_id": "N/A", "time": "2143-02-26 13:05:00"} |
15868269-DS-4 | 1,586 | ## ALLERGIES:
No Known Allergies / Adverse Drug Reactions
## CHIEF COMPLAINT:
low back, abdominal, pelvic pain
## HISTORY OF PRESENT ILLNESS:
This is a female being transferred from
, with back pain and incontinence for rule out of a
cauda equina syndrome. Pt admits to lower back pain since last
(1 week ago). the next evening the pelvic and lower abd
pain began and she saw her OB/GYN. GYN provider treated her
empirically for PID with Rocephin and doxycycline, which was not
effective. Had a pelvic exam and ultrasound when sx did not
resolve, both of which were neg. persistent pelvic pain led to
ED visit to . There an abdominal and pelvic CT scan was
obtained which was read as being negative, there was negative GC
and Chlamydia cultures as well as a negative urine cultures, she
has no saddle anesthesia and no extremity weakness or numbness,
she has no bowel incontinence. She was transferred to when
she developed incontinence at . Pt says she urinated about 5
times in bed that day. She does not feel the urge to urinate, it
just occurs and she can't stop it when it happens. She denies
ever having sx of this before. She has had abd pain before from
ovarian cyst rupture or kidney stones, but this is different and
much worse. Pain is and not touched by dilaudid. It is
worse with straining to urinate. She says she has a high pain
tolerance and morphine has never been helpful. She denies taking
chronic opioids at home.
In the ED, initial VS 97.4, 126/73, 104, 16, 100% RA. CBC,
lactate, coags, and CHEM-7 WNL. U/A neg. RADS reports from today
@ OSH showed normal transvag u/s and pelvis; presence of R
ovarian cyst but good flow, no free fluid, otherwise normal
studies. Also at OSH, GC/CT neg, CBC normal, ESR normal, CHEM-8
WNL. On exam, rectal tone normal, neuro exam completely normal.
MRI of total spine obtained for incontinence and showed no acute
process. Pt received 3mg IV dilaudid and 20mg po diazepam in ED.
Admitted to medicine for pain control.
On arrival to the floor, VS 98.2, 100/70, 100, 14, 99% RA. Pt
still in pain. Feels groggy.
## REVIEW OF SYSTEMS:
(+) chills and sweats, nausea, vomiting, diarrhea two days ago
for one hour, dizziness,
(-) fever, blood in stool, CP, SOB, weakness, numbness
## PAST MEDICAL HISTORY:
anxiety, depression, possible suicide attempt in
## FAMILY HISTORY:
GM - crohn's, DM
father - crohn's, diverticulitis
## ADMISSION PHYSICAL EXAM:
VS 98.2, 100/70, 100, 14, 99% RA
GENERAL - groggy-looking female, NAD, slow to answer questions,
sitting forward in hosp bed
HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MM slightly dry,
OP clear
NECK - supple, no thyromegaly, no JVD, no carotid bruits
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - distractable on exam; no tenderness when pressing with
stethoscope and talking but extreme tenderness when palpating in
same areas. NABS, soft, obese abd, no rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions
## GEN:
NAD, AAOx3, pleasant and conversant
## ABD:
BS+, soft, ND, mildly tender on deep palpation though
distractable
## MSK:
mild TTP over lumbar spine and paraspinal musculature
## NEURO:
CNII-XII intact, moving all extremities,
quads/hamstrings/gastrocs/tib anterior strength throughout,
sensation to light touch intact throughout, ambulating well
independently
## IMAGING:
MRI C-spine, T-spine, L-spine w/ and w/o contrast :
1. No abnormal enhancement in the spine. Specifically, no
evidence of
epidural abscess or infectious process.
2. Slightly prominent T2-3 disc bulge, in contact with the
thoracic spinal cord, but no cord compression or cord signal
abnormalities.
3. L4-5 disc bulge with annular tear, without significant
spinal canal
stenosis or neural foraminal narrowing.
4. 1.5-cm cystic left thyroid nodule, incompletely assessed.
Consider
non-urgent dedicated thyroid ultrasound if clinically warranted.
## BRIEF HOSPITAL COURSE:
Ms. was admitted to on after evaluation in
OSH ED demonstrated concern for acute spinal cord compression.
She underwent MRI and was admitted for evaluation. Her hospital
course is as follows:
1) LBP - Patient presents with low back pain for approximately
one week radiating to abdomen and pelvis. Pain currently poorly
controlled with ibuprofen at home. Patient notes recent fall
onto buttocks while chasing her year old daughter 3 days prior
to pain onset and states her daughter (who is lbs) has been
"roughhousing" with her lately. MRI as above showing L4-5
displacement with annular tear, suggestive of organic etiology.
Underlying cause of lumbar vertebral displacement likely related
to her obesity. No cord compression identified on MRI. Patient
likely has psychosomatic component of her pain, given
distractability on her exam and prior pyschiatric diagnoses.
Regardless, she demonstrates excellent understanding of need for
pain control using NSAIDs (minimizing opioids) and necessity of
ambulation/physical activity. On discharge, pain well controlled
with acetaminophen, ibuprofen, cyclobenzaprine, and occasional
oxycodone. Discharged with total of 20 pills oxycodone 5mg for
breakthrough pain. States she wishes to avoid opioids, as she
has a young daughter to care for and is currently in school
herself. Advised to continue regular visits with PCP for ongoing
pain control.
2) Urinary incontinence - Etiology unclear. Presented with new
urinary incontinence in . Appears most likely to be
urge incontinence, as she denies symptoms of stress-induced
(valsalva, cough) urinary dribbling. "Overflow" incontinence
ruled out - PVR equal to 25cc. UA repeatedly contaminated,
likely with vaginal epithelial cells; non-concerning for UTI.
Initiated detrustor stabilizing agent, tolterodine, and
counseled on necessity of scheduled voiding, exercises,
and outpatient follow-up. Urodynamic testing may be indicated in
future if her incontinence continues to persist.
3) Bacterial vaginosis - Patient with document BV, per
discussion with patient herself and outpatient OB-GYN provider's
office. Prescribed metronidazole on , but did not have time
to fill prescription. Discharged with prescription for 7 days of
metronidazole 500mg PO BID.
4) Anxiety/depression - Stable, though her psychiatric history
undoubtedly contributes to her low back pain. Continued home
venlafaxine and clonazepam.
## TRANSITIONAL ISSUES:
- Next PCP appointment with , , on
.
- Urge incontinence: Unknown etiology. Started on tolterodine
prior to discharge. Counseled on exercises and scheduled
voiding. Will likely need to referral for urodynamic testing by
PCP if continues to persist.
- Bacterial vaginosis: Diagnosed based on wet prep at OB-GYN
office. Prescribed metronidazole by call-in from PCP, but never
picked up prescription. Discharged with prescription for 7 day
of metronidazole 500mg PO BID.
- Thyroid nodule: MRI on identified 1.5-cm cystic left
thyroid nodule, incompletely assessed. Consider non-urgent
dedicated thyroid ultrasound if clinically warranted.
- Opioid use: If continues to require opioids for pain control,
a narcotics contract would be reasonable.
- Smoking: Patient is currently an active smoker. Not yet ready
to quit during hospitalization, though did not require nicotine
patches nor did she leave floor to smoke.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Venlafaxine XR 300 mg PO DAILY
2. Clonazepam 1 mg PO TID:PRN anxiety
hold for sedation or RR<10
## DISCHARGE MEDICATIONS:
1. Clonazepam 1 mg PO TID:PRN anxiety
hold for sedation or RR<10
2. Venlafaxine XR 300 mg PO DAILY
3. Acetaminophen 500 mg PO Q6H:PRN pain
RX *acetaminophen 500 mg 1 tablet(s) by mouth q6hrs Disp #*90
## TABLET REFILLS:
*0
4. Cyclobenzaprine 10 mg PO TID:PRN back pain
RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth three times a day
Disp #*42 Tablet
## REFILLS:
*0
5. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp
#*60 Tablet
## REFILLS:
*0
6. Ibuprofen 400 mg PO Q8H:PRN pain
RX *ibuprofen 200 mg 2 tablet(s) by mouth q8hrs Disp #*90 Tablet
Refills:*0
7. MetRONIDAZOLE (FLagyl) 500 mg PO BID Duration: 7 Days
RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth twice a
day Disp #*14 Tablet Refills:*0
8. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain
RX *oxycodone 5 mg 1 tablet(s) by mouth q6hrs Disp #*20 Tablet
Refills:*0
9. Tolterodine 2 mg PO BID
RX *tolterodine [Detrol] 2 mg 1 tablet(s) by mouth twice a day
Disp #*60 Tablet Refills:*0
## PRIMARY:
- low back pain
- urge urinary incontinence
## SECONDARY:
- anxiety disorder, not otherwise specified
## DISCHARGE INSTRUCTIONS:
Dear Ms. ,
Thank you for choosing for your medical care. You were
transferred to our hospital after an evaluation in
brought up concern for damage to your spinal cord. You
had an MRI in our hospital to look for spinal cord injury.
Fortunately, your MRI did not show any damage. We are very sorry
you are continuing to experience back pain and difficulty
controlling your bladder. These problems should be discussed
with your primary care provider, who can treat them over time.
Upon discharge, please take all medications only as prescribed.
Do not drive if you are taking pain medications (cyclobenazprine
or oxycodone). Do not drink alcohol while using these
medications. Please keep your scheduled appointments with your
doctors and a copy of your medication list with you to
each appointment.
Please call Dr. office at or return to an
ER if you experience any of the following: loss of conciousness,
severe headache, worsening low back pain, numbness in your
buttocks or perianal area, weakness in your legs, trouble
walking, bowel incontinence, inability to urinate, or any other
symptoms that concern you.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "15868269", "visit_id": "23151274", "time": "2146-03-23 00:00:00"} |
12031258-RR-7 | 234 | ## SOFT TISSUE WINDOWS:
Limited provided imaging of the kidneys, aorta, psoas
muscles and bladder are unremarkable. There is a moderate amount of fecal
loading within the rectum. No abdominal free fluid or pelvic free fluid is
identified.
## BONE WINDOWS:
There is no malalignment and there are no fractures.
There are multilevel degenerative changes with vacuum phenomenon at the L4-5
and L3-4 level as well as disc space loss, most severe at the L4-5 level.
Lucent areas with surrounding sclerosis at the endplates are compatible with
Schmorl nodes, as in the thoracic spine. Anterior and posterior osteophyte
formation at multiple levels is present. Disc bulges at L2-3, L3-4 and L4-5 as
well as L5-S1 along with the posterior osteophytes contribute to mild canal
stenosis; it is noted that the patient has relatively congenitally capacious
canal.
## IMPRESSION:
No evidence of fracture.
## NOTE ADDED IN ATTENDING REVIEW:
There is no evidence of acute injury.
However, this patient does not have a capacious spinal canal; in fact, there
is congenital canal stenosis, largely on the basis of short pedicles, from the
L3/4 through the L5/S1 level.
At L4/5, in combination with disc degeneration and apparent moderate bulging,
as well as endplate and facet joint spondylosis, this results in significant
spinal canal and neural foraminal stenosis. There is also bilateral foraminal
stenosis at the L5/S1 level.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12031258", "visit_id": "N/A", "time": "2135-12-15 22:41:00"} |
19899327-RR-21 | 776 | ## INDICATION:
year old man with sternal fracture, hematoma with ? active
extrav // Please assess for active extravasation in area of sternal fracture
and embolize as needed
## OPERATORS:
Dr. and Dr.
radiologist performed the procedure. Dr.
supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
## ANESTHESIA:
Moderate sedation was not provided.
## MEDICATIONS:
1% lidocaine was injected in the skin and subcutaneous tissues
overlying the access site.
## CONTRAST:
160 ml of Optiray contrast.
## PROCEDURE:
1. Right common femoral artery access.
2. Right common femoral arteriogram.
3. Right subclavian arteriogram.
4. Right internal mammary arteriogram.
5. Gel-Foam embolization of the right internal mammary artery.
6. Left subclavian arteriogram.
7. Left internal mammary arteriogram.
8. Gel-Foam embolization of the left internal mammary artery.
## PROCEDURE DETAILS:
Following the discussion of the risks, benefits and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per protocol. Both groins were
prepped and draped in the usual sterile fashion.
Using palpatory and fluoroscopic guidance, the right common femoral artery was
punctured using a micropuncture set at the level of the mid-femoral head. A
0.018 wire was passed easily into the vessel lumen. A small skin incision was
made over the needle. Then the inner dilator and wire were removed and a
wire was advanced under fluoroscopy into the aorta. The micropuncture
sheath was exchanged for a 5 sheath which was attached to a continuous
heparinized saline side arm flush.
An angled glide catheter was advanced over wire into the thoracic
aorta. The wire was removed and several attempts were made to cannulate the
right subclavian artery with the glide catheter and a Glidewire. After this
was unsuccessful, the glide catheter was replaced with a VTK catheter. The
Glidewire was advanced via the VTK catheter into the right subclavian artery.
The VTK catheter was replaced with the Glide catheter and a right subclavian
arteriogram was performed. The glide catheter was pulled back to the origin
of the right internal mammary artery and a renegade micro catheter and
Fathom wire were used to cannulate the right internal mammary artery. The
renegade micro catheter was advanced over the wire into the proximal right
internal mammary artery, the wire was removed, and a right internal mammary
arteriogram was performed. Subsequently, a Gel-Foam embolization was
performed of the right internal mammary artery. Contrast injection following
Gelfoam embolization confirmed near stasis.
Next, the micro catheter was removed and the glide catheter was pulled back
from the right subclavian artery. A Glidewire was placed through the glide
catheter and the left subclavian artery was cannulated with the glide catheter
and Glidewire, however the access was not stable enough and subsequently the
glide catheter was replaced with the VTK catheter. The catheter and
Glidewire were used to cannulate the left subclavian artery. A left
subclavian arteriogram was performed. The Glidewire was removed and a
Renegade micro catheter and Fathom wire were used to cannulate the left
internal mammary artery. The micro catheter was advanced over the wire into
the proximal left internal mammary artery, the wire was removed and a left
internal mammary arteriogram was performed. Next, Gel-Foam embolization was
performed of the left internal mammary artery. Contrast injection following
Gelfoam embolization confirmed near stasis.
The micro catheter was removed. The wire was advanced into the VTK
catheter and the the catheter was removed over the wire. The right
common femoral arteriogram was performed. The sheath was removed and
Angio-Seal was placed. A 2+ right common femoral artery pulse was palpated
after Angio-Seal placement. Additional manual pressure was held until
hemostasis was achieved. Sterile dressings were applied. The patient tolerated
the procedure well.
## FINDINGS:
1. Right common femoral arteriogram demonstrates normal caliber right common
femoral artery with appropriate access at the mid femoral head greater than 1
cm above the bifurcation of the deep femoral artery.
2. Right subclavian arteriogram demonstrates conventional anatomy without
evidence of active extravasation or pseudoaneurysm.
3. Right internal mammary arteriogram demonstrates no evidence of active
extravasation or pseudoaneurysm.
4. Right internal mammary arteriogram post Gel-Foam embolization demonstrates
near stasis of flow.
5. Left subclavian arteriogram demonstrates conventional anatomy without
evidence of active extravasation or pseudoaneurysm.
6. Left internal mammary arteriogram demonstrates no evidence of active
extravasation or pseudoaneurysm.
7. Left internal mammary arteriogram post Gel-Foam embolization demonstrates
near stasis of flow.
## IMPRESSION:
Gel-Foam embolization of the right and left internal mammary arteries. No
active extravasation or pseudoaneurysm identified.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19899327", "visit_id": "21809146", "time": "2140-03-11 02:30:00"} |
17562504-RR-11 | 123 | ## EXAMINATION:
G-tube check, leak check, with abbreviated small-bowel
follow-through
## INDICATION:
year old man s/p hiatal hernia repair with reduction of
intrathoracic stomach and gastropexy. Now with decreased PO intake while G
tube output remains low. Imaging requested to rule out obstruction.
## DOSE:
Acc air kerma: 11 mGy; Accum DAP: 297.8 uGym2; Fluoro time: 43 seconds
## FINDINGS:
Water-soluble contrast (Optiray) was administered through the G-tube followed
by thin consistency barium with the patient supine.
Barium passed freely through the G-tube into the stomach and then into the
proximal small bowel. There is no evidence of leak or obstruction.
## IMPRESSION:
No evidence of leak or obstruction of the G-tube, stomach, and proximal small
bowel.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17562504", "visit_id": "26050314", "time": "2161-09-29 14:24:00"} |
12766659-RR-15 | 259 | ## EXAMINATION:
CT HEAD W/ CONTRAST Q1211 CT HEAD
## INDICATION:
year old woman with , schizoaffective who presented
with confusion.// Frontal lobe lesion on previous CT w/out contrast. Unable to
obtain MRI due to agitation. CT with contrast to further characterize lesion
in setting of encephalopathy
## FINDINGS:
There is no evidence of acute fracture or large territorial infarction. Again
seen is hyper enhancement in the right frontal lobe measuring 10 mm (02:22),
which appeared hyperdense on noncontrast exam from . There is
no significant edema surrounding this lesion. On the sagittal and coronal
projection, there is a possible prominent draining vein coursing nearby
(602:35, 601: 28). As previously, there is periventricular and subcortical
white matter hypodensities, which are nonspecific and may represent chronic
small vessel ischemic disease. More discrete focus of hypodensity in the left
basal ganglia is chronic. There is prominence of the ventricles and sulci
suggestive of involutional changes. There is no abnormal enhancement on post
contrast images.
Large polypoid mucous retention cyst is seen in the left maxillary sinus.
Otherwise, the visualized portion of the paranasal sinuses, mastoid air cells,
and middle ear cavities are clear. The visualized portion of the orbits are
unremarkable.
## IMPRESSION:
1.0 cm round hyperenhancing lesion in the right frontal lobe, which appeared
hyperdense on the noncontrast exam, with possible evidence of prominent
draining lesion coursing nearby. The finding is nonspecific and may represent
cavernous malformation or other vascular malformation rather than metastatic
disease or primary mass given no associated edema. Consider MRI for further
evaluation plan clinically amenable.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12766659", "visit_id": "25785795", "time": "2140-09-22 16:06:00"} |
13961294-RR-170 | 115 | ## EXAMINATION:
CHEST PORT. LINE PLACEMENT
## INDICATION:
year old woman with renal failure and respiratory failure //
HD Line placement? Contact name: : HD Line
placement?
## IMPRESSION:
Left internal jugular line tip is at the junction of left brachycephalic vein
and SVC or still and the left brachycephalic vein. The pre size assessment is
difficult giving the fact that the patient is rotated.
NG tube tip is in the stomach. Right internal jugular line tip is at the
level of superior SVC. The ET tube tip is approximately 6 cm above the
carina.
Heart size and mediastinum are similar to previous examination. There is
improved aeration of the left lung base. Multifocal parenchymal opacities are
unchanged.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13961294", "visit_id": "N/A", "time": "2152-12-16 13:15:00"} |
11266631-RR-169 | 378 | ## EXAMINATION:
CT ABD WANDW/O C
## INDICATION:
year old man with alcohol cirrhosis, history of hcc and TIPS//
r/o HCC and TIP patency
## MULTIPHASIC LIVER:
Multidetector CT of the abdomen was done
without and with IV contrast. Initially, the abdomen was scanned without IV
contrast. Subsequently, a single bolus of IV contrast was injected and the
abdomen was scanned in the early arterial phase, followed by a scan of the
abdomen in the portal venous phase, followed by a scan of the abdomen in
equilibrium phase (3-min delay).
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## LOWER CHEST:
Visualized lungs are within normal limits. There is no evidence
of pleural or pericardial effusion.
## HEPATOBILIARY:
Liver is shrunken with a nodular contour consistent with
cirrhosis. Similar appearance of the hypodense, hypoenhancing radiofrequency
ablation cavity in segment 4A. The no concerning arterially enhancing
lesions. TIPS stent appears patent. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder contains gallstones.
Moderate volume loculated perihepatic ascites is similar prior.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. A coarse calcification in the
tail the pancreas is noted and likely related to prior episode of
pancreatitis.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
Visualized portions of the kidneys are unremarkable.
## GASTROINTESTINAL:
The stomach is unremarkable. Visualized small and large
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout. Esophageal and gastric varices are noted.
## LYMPH NODES:
Enlarged gastrohepatic lymph node a measuring 11 mm is unchanged
from prior and likely reactive to underlying cirrhosis (303:41). Additional
prominent portacaval and porta hepatis nodes are prominent, but unchanged from
prior and also likely reactive to underlying cirrhosis.
## VASCULAR:
No aneurysm of the abdomen in the upper abdomen.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Bones appear diffusely demineralized. Density measurement of the L1 vertebral
body is 93 Hounsfield units.
## SOFT TISSUES:
The abdominal wall is within normal limits.
## IMPRESSION:
1. Cirrhosis with stable moderate volume loculated perihepatic ascites. No
concerning liver lesions.
2. TIPS stent appears patent, but is better evaluated with Doppler ultrasound.
3. Findings suggestion of osteoporosis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11266631", "visit_id": "N/A", "time": "2164-04-29 07:12:00"} |
19677866-RR-9 | 812 | ## INDICATION:
year old man s/p lap ccy and ioc p/w pancreatitis, with
possible partial stone obstruction in dist CBD per MRCP and failed ERCP
attempt.// Stone vs debris in the distal CBD?
## OPERATORS:
Dr. and Dr.
radiologist performed the procedure. Dr.
supervised the trainee during the key components of the procedure
and has reviewed and agrees with the trainee's findings.
## ANESTHESIA:
MAC anesthesia was administered by the anesthesiology department.
## CONTRAST:
75 ml of Optiray contrast.
## PROCEDURE:
1. Transabdominal ultrasound.
2. Ultrasound and fluoroscopic guided right percutaneous transhepatic bile
duct access.
3. Right cholangiogram
4. right biliary drain.
## PROCEDURE DETAILS:
Following the discussion of the risks, benefits, and alternatives to the
procedure, written informed consent was obtained from the patient. The patient
was then brought to the angiography suite and placed supine on the exam table.
A pre-procedure time-out was performed per protocol. The right abdomen
was prepped and draped in the usual sterile fashion.
Under Ultrasound and fluoroscopic guidance, a 21G Cook needle was advanced
into lobe of the liver. Dilute contrast was administered through the 21 cook
needle while pulling the needle back under fluoroscopic guidance until the
biliary system was opacified. A needle percutaneous transhepatic
cholangiogram was performed. Images of the access and cholangiogram were
stored on PACS. Due to poor opacification of the biliary system a headliner
wire was advanced under fluoroscopic guidance into the common bile duct. A
skin was made over the needle and the needle was removed over the wire.
The inner portion of the Accustick set was advanced over the wire. A contrast
cholangiogram was performed to confirm biliary anatomy and evaluate for
filling defects. The biliary system was felt to be accessed rather centrally.
The original inner of the Accustick sheath was left in place and an additional
more peripheral access was successfully obtained utilizing fluoroscopic
guidance and a two stick technique. Contrast was injected into the initial
Accustick sheath and a second 21 gauge Cook needle was advanced into a more
peripheral bile duct. A headliner wire was advanced into the biliary system
under fluoroscopic guidance into the common bile duct. A skin was made
over the needle and the needle was removed over the wire. An Accustick set
was advanced over the wire and the inner stiffener was withdrawn.
The headliner wire was exchanged for a Glidewire which was placed into the
common bile duct though was unable to pass through the distal common bile duct
into the duodenum. The Accustick sheath was exchanged for a sheath which
was advanced over the wire into the biliary system. A 0.038 was
advanced through the sheath and was able to pass through the distal common
bile duct. A Kumpe the catheter was advanced over the wire and the wire was
exchanged for an Amplatz wire after confirming position in the small bowel.
The Kumpe the catheter was removed over-the-wire. A 5.5
embolectomy catheter was then advanced over the wire. The balloon was inflated
and advanced through the distal common bile duct and sphincter several times
until improved patency of the distal duct was noted with no definitive filling
defects.
The catheters and sheath were removed over the Amplatz wire. An 8
dilator was advanced and removed over the wire. An internal external
biliary catheter was advanced, the wire and inner stiffener were removed and
the pigtail was formed within the duodenum. Contrast injection confirmed
appropriate position. The catheter was flushed with saline, secured with stay
sutures and stat lock to the skin and sterile dressings were applied. The
catheter was attached to a bag.
Final abdominal ultrasound images demonstrated a small subcapsular hematoma at
the access site with no free fluid. The initial access tract was then
embolized with a Gel-Foam slurry under fluoroscopic guidance upon removing the
Accustick sheath. Post ultrasound demonstrated echogenic material within the
parenchymal tract with no further evidence of subcapsular hematoma.
The patient tolerated the procedure well. There were no immediate
complications. The patient went to the PACU in stable condition.
## FINDINGS:
1. No biliary duct dilatation.
2. Narrowing of the distal common bile duct/ampulla with slow emptying of
contrast into the enteric system and possible filling defect noted best on
sequence 23. (A22)
3. Mild improvement post sweep of the common bile duct.
## IMPRESSION:
Successful PTC and sweep of the distal common bile duct/ampulla with
mildly improved patency. Resolution of the filling defect within the distal
common bile duct seen intraprocedure which may have been secondary to a small
gallstone or debris.
Successful placement of the right internal-external biliary drain.
## RECOMMENDATION(S):
Will plan repeat cholangiogram in days at which time
further biliary intervention may be performed if there is still residual
abnormality on the cholangiogram versus conversion to an anchor drain in the
hopes of removing the tube in the near future.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19677866", "visit_id": "22101891", "time": "2124-05-19 14:00:00"} |
17923811-RR-19 | 182 | ## TYPE OF EXAMINATION:
Chest AP single view.
## INDICATION:
A male patient post-upgrade of DDD-ICD to
biventricular ICD. Evaluate for possible pneumothorax.
## FINDINGS:
AP single view of the chest obtained with patient in upright
position is analyzed in direct comparison with a PA and lateral chest
examination of . Permanent pacer capsule exchange has
occurred. Previously described ICD electrode with enforced wire remains in
unchanged position and terminates in the right ventricle anterior apical
position. Right atrial electrode remains unchanged pointing towards anterior
wall of right atrium. Now a new third electrode has been placed seen to be in
a location compatible with retrograde advancement into the venous coronary
sinus and termination point in the periphery of an obtuse marginal coronary
vein. No pneumothorax has developed. The pulmonary vasculature is not
congested and no pulmonary parenchymal abnormalities or pleural densities can
be identified on this single AP chest view examination.
## IMPRESSION:
Successful conversion to biventricular ICD permanent pacer. No
evidence of pneumothorax. Moderate cardiac enlargement with left ventricular
prominence and evidence of anterior left ventricular wall myocardial
calcification, as before.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17923811", "visit_id": "21268160", "time": "2140-08-24 16:26:00"} |
10121453-RR-13 | 126 | ## INDICATION:
A man with PE, evaluate for DVT.
## FINDINGS:
Grayscale, color and Doppler images were obtained of the deep veins
of the arms bilaterally. Extensive swelling and a large occlusive thrombus is
present surrounding the i.v. line within the receiving vein. This thrombus
extends from the antecubital fossa into the axillary vein. No thrombus is
identified within the subclavian or IJ on the left side.
Normal flow, compression, and augmentation is seen in all the veins of the
right arm.
## IMPRESSION:
Extensive thrombus surrounding the IV line within the left arm
extending from the antecubital fossa to the left axillary vein. No other deep
vein thrombosis seen in the right arm.
These findings were conveyed to Dr. at the time of the
dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10121453", "visit_id": "21172289", "time": "2159-06-29 11:16:00"} |
14746821-RR-24 | 363 | ## INDICATION:
man with pancreatic surgery, post recent revision
presenting with purulent JP drainage.
.
## CT ABDOMEN:
Heart size is normal. There is no pericardial effusion. The
lung bases are clear without evidence of effusion, consolidation or
pneumothorax.
The patient is status post- 's procedure. The previously noted dominant
gas and fluid collection in the resection bed, with fluid extending to the
anterior pararenal fascia has decreased in size since , and multiple
drains are located within the resection bed. As before, discontinuity of the
pancreaticojejunostomy anastamosis is suspected. Adjacent to the liver in the
falciform ligament is a fluid- and gas- containing 3.1 x 2.2 cm collection
which is new since . In the subcutaneous tissues anterior to the upper
right rectus abdominis muscle, there is a new 3.9 x 1.8 cm collection
measuring fluid density. The remainder of the pancreas remains unchanged.
Fat stranding within the anterior abdomen is post-surgical. Again demonstrated
is wall thickending and inflammation surrounding the gastrojejunostomy and
hepaticojejunostomy, compatible with post-surgical changes.
A linear hypodensity in the lower lobe of the right liver is unchanged since
(2:29) and is of uncertain etiology. The liver is otherwise
unremarkable. The spleen and adrenals are unremarkable. Bilateral sub 5 mm
renal hypodensities likely represent cysts although are too small to be
characterized but are unchanged since . The kidneys enhance and
secrete contrast symmetrically. The intra- abdominal loops of large and small
bowel are unremarkable without evidence of pneumatosis or free air.
Circumaortic left renal vein is again noted. As before, marked
atherosclerotic narrowing of the proximal SMA is again seen.
## CT PELVIS:
The rectum, bladder and prostate are unremarkable. There are
sigmoid diverticula without evidence of diverticulitis. There is no
pelvic or inguinal lymphadenopathy.
Bone windows demonstrate no evidence of a lesion that is suspicious for
metastasis or infection with moderate multilevel degenerative changes again
noted.
## IMPRESSION:
1) New sub 3-cm fluid collections adjacent to the falciform ligament and
within the anterior abdominal wall are concerning for abscesses.
2) Previously seen gas and fluid collection within the surgical resection bed
has decreased in size.
3) Findings again raise suspicion for a pancreaticojejunostomy anastamotic
leak.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14746821", "visit_id": "N/A", "time": "2112-03-16 16:43:00"} |
13822059-RR-9 | 151 | ## INDICATION:
female status post fall with soft tissue injury right
forehead, evaluate for intracranial hemorrhage.
## FINDINGS:
There are bilateral small hypodensities in the thalami, one on each
side, that likely represent old lacunar infarcts. There is no evidence of
hemorrhage, edema, mass, mass effect, or acute territorial infarction. There
are confluent periventricular white matter hypodensities that are likely the
sequelae of chronic small vessel ischemic disease. The ventricles and sulci
are enlarged consistent with age related atrophy. There is a small mucous
retention cyst in theleft maxillary and right sphenoid sinuses. Otherwise the
paranasal sinuses and maxillary air cells are well aerated. No fractures are
identified. There is a small soft tissue defect overlying the right frontal
bone but no foreign objects identified.
## IMPRESSION:
1. Small soft tissue defect overlying the right frontal bone. No fracture.
2. No acute intracranial process.
3. Bilateral old lacunar infarcts in the thalami.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13822059", "visit_id": "N/A", "time": "2170-09-08 15:04:00"} |
11626997-RR-73 | 101 | ## HISTORY:
Prior stroke, altered mental status after a hypoglycemic episode.
Evaluate ICH, CVA.
## FINDINGS:
There is no hemorrhage, evidence for a major vascular territory infarction, or
edema. Prominence of ventricles and sulci is consistent with mild age-related
involutional changes. Mild periventricular and deep white matter
hypodensities are likely sequela of chronic small vessel ischemic disease.
The basal cisterns appear patent.
No fracture is identified. The visualized paranasal sinuses, mastoid air
cells and middle ear cavities are essentially clear.
## IMPRESSION:
No evidence for an acute intracranial abnormality. However, MRI would be more
sensitive for acute infarction if clinically indicated.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11626997", "visit_id": "25045613", "time": "2168-11-27 05:36:00"} |
13602578-RR-35 | 104 | ## HISTORY:
woman, with sizes less than dates. Confirm dates.
## FINDINGS:
Transabdominal and transvaginal examinations were performed. The
transvaginal examination was performed to better visualize the embryo.
An intrauterine gestational sac is seen, and a single live embryo is
identified with crown-rump length of 16 mm, representing a gestational age of
7 weeks 6 days. This is 8 days less than the menstrual dates of 9 weeks and 0
days. The uterus and right ovary are normal. There is a 2.9-cm likely corpus
luteal cyst in the otherwise normal left ovary.
## IMPRESSION:
Single live intrauterine pregnancy. Sizes less than dates.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13602578", "visit_id": "N/A", "time": "2110-10-14 09:01:00"} |
15735455-RR-2 | 172 | ## EXAMINATION:
COMPLETE GU U.S. (BLADDER AND RENAL) PORT
## INDICATION:
year old woman with abd pain and h/o kidney stones // h/o
kidney stones, is there a current stone or hydronephrosis? please look at
bladder kidneys and ureter and urethra if possible
## FINDINGS:
The right kidney measures 11.8 cm. The left kidney measures 11.7 cm. There is
mild hydronephrosis on the right. No hydronephrosis is seen on the left. No
renal stones or masses are identified bilaterally. Normal cortical
echogenicity and corticomedullary differentiation is present bilaterally, with
normal vascularity. No perinephric abnormality is identified.
The bladder is moderately well distended and normal in appearance. A left
ureteral jet is well seen. No right ureteral jet is identified.
Prevoid volume of the bladder is 35 cc.
Postvoid volume of the bladder is 7 cc.
## IMPRESSION:
1. Mild right hydronephrosis, with no ureteral jet identified on the right.
No renal stone is identified, although the entirety of the ureter is not
visualized.
2. Normal left kidney and urinary bladder.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15735455", "visit_id": "N/A", "time": "2150-06-14 22:08:00"} |
17723627-RR-21 | 208 | ## EXAMINATION:
UNILAT UP EXT VEINS US RIGHT
## INDICATION:
year old man with HAP, CAUTI, atrial fibrillation and heart
failure, now w/ R>L UE swelling c/f for DVT (same arm as midline)// Eval for
midline associated DVT of RUE
## FINDINGS:
There is normal flow with respiratory variation in the right subclavian vein.
Evaluation of the respiratory variation in the left subclavian vein is limited
due to patient's positioning.
Echogenic nonocclusive thrombus within the right subclavian vein extends to
the axillary and basilic veins. Nonocclusive thrombus noted in the mid
cephalic vein becomes occlusive distal at the antecubital fossa. PICC noted
within the basilic vein with an echogenic mural nonocclusive thrombus. Right
brachial vein is patent with normal color flow and spectral Doppler.
The right internal jugular is patent and shows normal color flow spectral
Doppler and compressibility.
## IMPRESSION:
1. Nonocclusive thrombus extending from the right subclavian vein to the
axillary and basilic veins.
2. Nonocclusive thrombus in the mid cephalic vein could becomes occlusive
distally at the antecubital fossa.
3. PICC line in the basilic vein with surrounding mural nonocclusive thrombus
surrounding it.
## NOTIFICATION:
The preliminary findings were provided in person by the
sonographer to the ICU team at the conclusion of this scan.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17723627", "visit_id": "29362215", "time": "2181-01-03 08:34:00"} |
19475913-RR-26 | 105 | ## INDICATION:
woman with secondary infertility. Assess for tubal
patency.
## PROCEDURE:
The risks and benefits of the procedure (diagnostic
hystersalpingogram) were explained to the patient. Written informed consent
was obtained. Preprocedural timeout confirmed the identity of the patient and
procedure to be performed. Patient was prepped in the usual fashion. With
aseptic technique, a 5 hysterosalpingogram catheter was placed into the
cervix. 6 cc of contrast was slowly administered and fluoroscopic images were
obtained. There was prompt filling of both fallopian tubes with free spill of
contrast from both tubes.
## IMPRESSION:
Free spill of contrast from both fallopian tubes seen in the
peritoneal cavity.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19475913", "visit_id": "N/A", "time": "2182-12-15 15:01:00"} |
11990952-RR-50 | 134 | ## INDICATION:
female status post PEA arrest. Evaluate for line
placement.
## EXAMINATION:
Single frontal chest radiograph.
## FINDINGS:
Since the prior examination there has been interval placement of a
right internal jugular approach central venous catheter with tip projecting in
the region of the low SVC. An enteric feeding tube has been placed which
courses below the diaphragm and out of field of view. An endotracheal tube is
in stable standard position. Two IVC filters project over the mid abdomen.
The remainder of the examination is essentially stable with diffuse asymmetric
opacification demonstrated within the left greater than right lung parenchyma.
There is no pleural effusion or pneumothorax.
## IMPRESSION:
New right internal approach central venous catheter tip terminates
in the low SVC. No pneumothorax. Enteric tube courses through stomach out of
field of view.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11990952", "visit_id": "25784664", "time": "2167-06-24 15:05:00"} |
10014869-RR-33 | 398 | ## EXAMINATION:
CTA CHEST WITH CONTRAST
## INDICATION:
History: with pleuritic pain, +D DImer. Evaluate for PE.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.9 s, 38.9 cm; CTDIvol = 8.8 mGy (Body) DLP = 343.5
mGy-cm.
2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
3) Stationary Acquisition 1.8 s, 0.5 cm; CTDIvol = 9.9 mGy (Body) DLP = 5.0
mGy-cm.
Total DLP (Body) = 350 mGy-cm.
## HEART AND VASCULATURE:
Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta has scattered atherosclerotic calcifications but is normal in
caliber without evidence of dissection or intramural hematoma. The heart,
pericardium, and great vessels are within normal limits. No pericardial
effusion is seen.
## AXILLA, HILA, AND MEDIASTINUM:
No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
## PLEURAL SPACES:
No pleural effusion or pneumothorax.
## LUNGS/AIRWAYS:
Lungs are clear without masses or areas of parenchymal
opacification. Multiple scattered pulmonary nodules are identified including
a 4 mm right lower lobe sub solid nodule (301:87), 2 mm left upper lobe
pulmonary nodule (301:74), 3 mm left lower lobe pulmonary nodule (301:114),
oblong 4 mm right lower lobe pulmonary nodule (301:172), subpleural right
middle lobe pulmonary nodule measuring up to 4 mm (301:121), 3 mm right lower
lobe pulmonary nodule (301:113), 2 mm right middle lobe pulmonary nodule
(301:107), a 2 mm right upper lobe pulmonary nodule (301:79), and a 2 mm right
upper lobe pulmonary nodule posteriorly (301:47). The airways are patent to
the level of the segmental bronchi bilaterally.
## BASE OF NECK:
Visualized portions of the base of the neck show no abnormality.
## ABDOMEN:
Included portion of the upper abdomen is unremarkable.
## BONES:
No suspicious osseous abnormality is seen.? There is no acute fracture.
## IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Multiple bilateral pulmonary nodules measuring up to 4 mm. Please see
recommendations below.
## RECOMMENDATION(S):
For incidentally detected multiple solid pulmonary nodules
smaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an
optional CT follow-up in 12 months is recommended in a high-risk patient.
See the Society Guidelines for the Management of Pulmonary
Nodules Incidentally Detected on CT" for comments and reference:
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10014869", "visit_id": "28291417", "time": "2164-06-25 18:12:00"} |
18311994-RR-33 | 104 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
former smoker h/o Non-Hodgkin's lymphoma, Stage IIIa
melanoma, multiple lung nodules, s/p redo left thoracotomy, LUL and LLL wedge
resections, now s/p CT removal // please eval for post-pull PTX. please
obtain at 1pm please eval for post-pull PTX. please obtain at 1pm
## IMPRESSION:
Compared to chest radiographs since , most recently .
Small lateral collection of left pleural air is new or newly apparent since
following removal of the left pleural drainage catheter. The
substantially larger anterior component is stable and there is no appreciable
pleural effusion. Right my is clear.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18311994", "visit_id": "23565090", "time": "2131-01-15 13:03:00"} |
18557546-RR-22 | 90 | ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
year old woman with suspected new diagnosis of cirrhosis. //
r/o infectious process r/o infectious process
## FINDINGS:
Opacities are seen at the right and left lower lobes. There is suggestion of a
small left pleural effusion. The cardiomediastinal silhouette is unremarkable.
## IMPRESSION:
Bilateral parenchymal opacities which may represent pneumonia in the
appropriate clinical setting.
## NOTIFICATION:
The impression above was entered by Dr. on
at 17:31 into the Department of Radiology critical communications
system for direct communication to the referring provider.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18557546", "visit_id": "21555673", "time": "2184-04-03 14:17:00"} |
11372257-RR-17 | 124 | ## EXAMINATION:
EARLY OB US <14WEEKS
## INDICATION:
History: with ectopic pregnancy// ?ectopic
## FINDINGS:
Located within the cesarean section scar is a single gestational sac
containing a yolk sac, but no embryonic pole. Mean sac diameter measures 7 mm
which corresponds to a gestational age of 5 weeks and 2 days. Endometrium is
normal.
There is a 3.3 x 2.9 x 2.9 cm anechoic, thin-walled simple cyst in the left
ovary. The right and left ovaries are otherwise normal in appearance. There
is no free fluid.
## IMPRESSION:
Ectopic pregnancy in the Caesarean section scar.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 10:46 pm, 2 minutes
after discovery of the findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11372257", "visit_id": "N/A", "time": "2177-06-16 21:46:00"} |
10980491-DS-9 | 926 | ## ALLERGIES:
Penicillins / Keflex / Effexor XR / lisinopril / Strattera
## HISTORY OF PRESENT ILLNESS:
with PMH of DM1, IVDA on suboxone, HCV sent in by PCP for
possible adrenal insufficiency. The patient had increasing
fatigue, frequent urination, and muscle cramps over the past
two weeks. She also had several episodes of unprovoked
diaphoresis not acccompanied by fevers or chills. She has been
experiencing lower overnight blood sugars overnight with
sometimes FSBG being in the . She denies any salt cravings,
skin changes, weight loss, annorexia, nausea, or vomiting. She
saw her PCP recently where labs showed mild hyponatremia and
hyperkalemia with sodium of 125-130 and potassium of 4.9-5.4.
She underwent a cosyntropin stimulation test on with AM
cortisol of 1.9 and post-stim increase to 16. Based on this
result she was referred to the ED for potential endocrine
consult and steroids.
In the ED, initial vitals were: 97.2 62 100% RA. Her
labs were notable for sodium of 132 and potassium of 4.9 with
cortisol of 2.5. Endocrine was consulted who recommended
starting treatment with Hydrocortisone 20 in the ED, then 20 in
the AM and 10 QPM. The patient was admitted to the medicine
floor.
## PAST MEDICAL HISTORY:
DM1, c/b neuropathy, nephropathy
Narcotic abuse, currently sober on suboxone
HepC followed in liver clinic
Cellulitis related to IVDU
Carpal tunnel syndrome
Asthmatic bronchitis
Gastric reflux
Depression
## FAMILY HISTORY:
Father - lung cancer
Mother - healthy
Sister - healthy
## HEENT:
AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,
## MMM, NECK:
nontender supple neck, 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 in all quadrants, no
rebound/guarding, no hepatosplenomegaly
## EXTREMITIES:
no cyanosis, clubbing or edema, moving all 4
extremities with purpose
## PULSES:
2+ DP pulses bilaterally
## NEURO:
CN II-XII intact, AAOx3, conversational and appropriate,
motor strength, bulk, and tone normal throughout.
## SKIN:
warm and well perfused, multiple scars IVDU per pt, no
rashes
## HEENT:
AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,
## MMM, NECK:
nontender supple neck, 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 in all quadrants, no
rebound/guarding, no hepatosplenomegaly
## EXTREMITIES:
no cyanosis, clubbing or edema, moving all 4
extremities with purpose
## PULSES:
2+ DP pulses bilaterally
## NEURO:
CN II-XII intact, AAOx3, conversational and appropriate,
motor strength, bulk, and tone normal throughout.
## SKIN:
warm and well perfused, multiple scars IVDU per pt, no
rashes
## # ADRENAL INSUFFICIENCY:
History of receiving steroid injections
in hands made secondary adrenal insufficiency most likely. Given
patient's history of DM1, considered polyglandural autoimmunity
type II as cause of patient's adrenal insufficiency. However TSH
and free T4 all normal. Outpatient followup for workup initiated
by endocrine to ensure and r/o primary or tertiary adrenal
insufficiency. Will cont steroids for symptomatic treatment.
Given Hydrocort 20mg in AM, 10mg in ( ). On
started 10mg Hydrocortisone in AM and 5mg in (15:00) per
endocrine recs.
# DM1 - Readjustment of her doses given steroid use. Morning
lantus changed from 20units to 24 units, (4 units AM, 5 units
lunch and 6 units evening of humalog) and ISS
# pain - continued on home suboxone, pregabalin,
?depakote
# HSV suppression - switched valacyclovir to acyclovir given
restriction of valacyclovir while inpt. D/c on acyclovir
## Transitional issues
- Close f/u with endocrinologist after discharge for sugar
levels and adjustment of steroid doses
- f/u on Aldosterone, Renin and ACTH labs sent (note these were
drawn ~36 hours after cosyntropin stimulation test)
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Divalproex (DELayed Release) 250 mg PO TID
2. ValACYclovir 500 mg PO Q24H
3. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID
4. Omeprazole 20 mg PO QAM
5. Citalopram 10 mg PO DAILY
6. Pregabalin 50 mg PO DAILY
7. Albuterol Inhaler 2 PUFF IH Q4H:PRN sob/wheeze
8. Glargine 20 Units Breakfast
Insulin SC Sliding Scale using HUM Insulin
## DISCHARGE MEDICATIONS:
1. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID
2. Citalopram 10 mg PO DAILY
3. Divalproex (DELayed Release) 250 mg PO TID
4. Glargine 22 Units Breakfast
Humalog 4 Units Breakfast
Humalog 5 Units Lunch
Humalog 6 Units Dinner
Insulin SC Sliding Scale using HUM Insulin
5. Omeprazole 20 mg PO QAM
6. Pregabalin 50 mg PO DAILY
7. Hydrocortisone 10 mg PO QAM
10mg in the morning
RX *hydrocortisone 10 mg 1 tablet(s) by mouth daily (every
morning) Disp #*30 Tablet Refills:*0
8. Hydrocortisone 5 mg PO QPM
5mg in the evening
RX *hydrocortisone 5 mg 1 tablet(s) by mouth Daily at 15:00 or
3:00PM Disp #*30 Tablet Refills:*0
9. Albuterol Inhaler 2 PUFF IH Q4H:PRN sob/wheeze
10. ValACYclovir 500 mg PO Q24H
## DISCHARGE DIAGNOSIS:
Primary diagnosis
Adrenal Insufficiency
Secondary diagnosis
Type 1 diabetes
## DISCHARGE INSTRUCTIONS:
Miss ,
You were admitted due to concern for adrenal insufficiency. You
were treated with steroids and your insulin levels were
readjusted to ensure the steroids do not cause high sugar
levels.
You are now on Lantus Insulin 24 units in the morning (from
20units) and on your usual Humalog 4 units AM, 5 units (lunch)
and 6 units ( ) with sliding scale.
You were also discharge on Hydrocortisone. Take 10mg in the
morning and 5mg at 3pm every day.
Please ensure close follow up with your endocrinologist at
.
Thanks for making us a part of your care.
Your Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10980491", "visit_id": "23785862", "time": "2172-10-06 00:00:00"} |
17930009-RR-94 | 228 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old woman with pancreatic cancer, multiple sclerosis s/p
stereotactic brain biopsy.
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
## FINDINGS:
Status-post left parietal approach stereotactic biopsy with expected
postprocedural changes including a small amount of pneumocephalus, a left
parietal burr hole, and overlying subcutaneous fat stranding with cutaneous
staples. Subtle new tiny focus of hyper attenuation at the site of a known
white matter lesion abutting the atrium of the left lateral ventricle may
reflect a tiny amount of procedure related hemorrhage (series 2, image 18).
No other evidence of intracranial hemorrhage. Scattered areas of juxta
cortical, deep white matter, and infratentorial hypoattenuation correspond to
lesions better assessed on recent MRI. Mild enlargement of the ventricles is
unchanged with a third ventricle diameter of 1.3 cm.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
## IMPRESSION:
1. Subtle new hyper attenuation at the site of a known white matter lesion
abutting the atrium of the left lateral ventricle may reflect a tiny amount of
procedure related hemorrhage.
2. Remainder as above.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17930009", "visit_id": "23352914", "time": "2174-03-03 18:44:00"} |
10215550-DS-14 | 1,499 | ## HISTORY OF PRESENT ILLNESS:
Ms. is a F w PMH HTN and HLD who presents to
ED from for evaluation of recurrent episodes
of
L sided weakness.
Ms. has been seen at multiple times over the
past month. Her presentations there are summarized as follows:
- P/w slurred speech in the morning. She states that this
was due to biting her tongue. Notes indicate that this occurred
while eating, though Ms. denies this on direct
questioning. She does not recall how she bit her tongue, and
believes perhaps it happened in her sleep. CT and MRI were
negative for any acute intracranial. CTA was benign. TTE showed
EF was 60% and grade 1 diastolic dysfunction. Her ASA was
increased from 81 to 162mg qD, and she was started on
atorvastatin.
- P/w L sided numbness and weakness upon awakening at 6AM.
Code stroke called, tPA not advised. Increased ASA to 325mg qD.
Sx resolved after ~24hrs.
- P/w L sided weakness and numbness upon awakening at 5AM.
Resolved after ~24 hrs.
Ms. presents today with very similar symptoms. She
reports that upon awakening at 6AM, she felt that her left leg
was numb. She was able to "shuffle" to the bathroom with the use
of her cane. When she got back to her bed, she called her
granddaughter for help. Her granddaughter "checked my arm
strength and my face" and found that "I was weak and my left
face
was swollen or something." She also states that her speech was
slurred at that time. Her granddaughter became concerned and
took
Ms. to the hospital for further evaluation.
They report that this episode is very similar to her other
presentations with the exception being that this time "all her
symptoms seemed to come on at once" (the numbness, weakness, and
slurred speech); whereas with previous presentations she would
at
first experience symptoms in her left leg, followed by arms
symptoms, and face symptoms. They report that Ms. did
return to baseline after the first two hospitalizations, though
it took a few days. She states that she had not yet fully
returned to baseline since her most recent hospitalization
("still a little bit in the cheek and arm").
At , speech was noted to be normal, and strength was
reported to be on the left. Given concern for possible
complex partial seizures, Ms. was transferred to
ED
for EEG and neurological evaluation.
Seizure screening - negative for history of seizures, history of
head trauma, nocturnal incontinence, CNS infections.
## PAST MEDICAL HISTORY:
- ?TIAs (as above)
- HTN
- HLD
- dCHF
- hypothyroidism
- invasive ductal carcinoma of R breast
- s/p lumpectomy
- s/p radiation and chemotherapy
## FAMILY HISTORY:
Mother - CVA at age
Father - CVA at age
## VS T:
98.5 HR:65 BP:144/72 RR:19 SaO2:96RA
GEN - well appearing, well developed
HEENT - NC/AT, MMM
NECK - full ROM, no meningismus
CV - RRR
RESP - normal WOB
ABD - soft, NT, ND
EXTR - atraumatic, WWP
## NEUROLOGICAL EXAMINATION:
MS - Awake, alert, oriented x 3. Attention to examiner easily
attained and maintained. Concentration maintained when recalling
months backwards. Recalls a coherent if vague history. Structure
of speech demonstrates fluency with full sentences, and normal
prosody. No paraphasic errors. Intact repetition, naming, and
comprehension. Unable to check reading due to poor visual
acuity.
CN - [II] PERRL 1.5 and sluggishly reactive. Poor visual acuity
secondary to macular degeneration. [III, IV, VI] EOMI. [V]
Reports decrement of L V1-V3 to LT and PP, ~50% of normal. [VII]
Does not activate well with volitional smile, requires
persistent
coaching. Will intermittently activate the left corner of the
mouth, and then smile with only the right side. [VIII] Hearing
intact to voice. [IX, X] Palate elevation symmetric. No
dysarthria. [XI] SCM/Trapezius strength bilaterally. [XII]
Tongue midline with full ROM.
MOTOR - Requires a great deal of encouragement to move left
side.
When checking for pronator drift, she actively resists me when I
attempt to elevate the LUE. She is able to hold the LUE
antigravity, though quickly drifts downward without pronation.
There is give-way weakness throughout the left side making
accurate strength assessment very difficult.
=[Delt] [Bic] [Tri] [ECR] [IO] [IP] [Quad] [Ham] [TA] [Gas]
[C5] [C5] [C7] [C6] [T1] [L2] [L3] [L5] [L4] [S1]
L 4+* 4+* 4+* 4+* 4+* 4-* 4+* 4+* 4+* 4+*
R 4+* 5 5 5 5 5 5 5 5 5
*Give-way weakness.
SENSORY - Reports decrement to LT and PP over the LUE (50% of
normal) and LLE (25% of normal).
REFLEXES -
=[Bic] [Tri] [ ] [Quad] [ ]
L 2 2 2 * 0
R 2 2 2 1 0
Plantar response extensor on the L, down on the R.
*S/p L knee surgery.
COORD - No dysmetria on FNF w RUE, fair RAM with R hand.
Performs
FNF very slowly with LUE and consistently misses target (aims
just below my finger every time, despite persistent correction).
Performs tapping of each finger to thumb correctly and
accurately
with L hand x1, then on subsequent trials taps at the base of
each finger with the L thumb.
GAIT - Deferred.
==============================================
## HEENT:
NC/AT, no scleral icterus noted, MMM
## NECK:
lateral range of motion of neck reduced bilaterally.
## PULMONARY:
Breathing comfortably, no tachypnea nor increased WOB
## -MENTAL STATUS:
Alert, oriented x 3. Attentive, able to name
backward without difficulty. Language is fluent with intact
repetition and comprehension. There were no paraphasic errors.
Naming intact to high and low frequency objects. Able to follow
both midline and appendicular commands.
## -CRANIAL NERVES:
PERRL 1.5 and sluggishly reactive. EOMI
without nystagmus except limited upgaze. Saccdic intrusions.
Normal saccades (vertical and horizontal). Facial sensation
intact to light touch. Face symmetric at rest and with
activation. Hearing intact to conversation. Palate elevates
symmetrically. Tongue protrudes in midline.
## -MOTOR:
Normal bulk, tone throughout except bilateral
atrophy. No pronator drift bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
Delt Bic Tri WrE FFl FE IO IP Quad Ham TA
L 4+* 5 4+ 5 5 5 5 4
R 5 5 4+ 5 5 5 5 4
-DTRs:
Bi Tri Pat Ach Pec jerk Crossed Abductors
L 2 2 2 * 0
R 2 2 2 1 0
Plantar response was mute bilaterally.
* s/p L knee surgery
## IMAGING:
1. Multilevel cervical spondylosis worse at C5-C6 with moderate
spinal canal stenosis flattening the ventral spinal cord without
evidence of cord edema. Additional areas of multilevel
degenerative changes, as detailed above.
## EEG :
This is a normal continuous EMU monitoring study.
Generalized
beta activity seen is likely a medication effect, commonly
associated with
benzodiazepines and barbiturates. There are no focal findings,
epileptiform discharges or electrographic seizures.
## EEG :
This is a normal continuous EMU monitoring study.
Generalized
beta activity seen is likely a medication effect, commonly
associated with
benzodiazepines and barbiturates. There are no focal findings,
epileptiform discharges or electrographic seizures. Compared to
the previous days' recording, there are no significant changes.
## BRIEF HOSPITAL COURSE:
Ms. was admitted with recurrent episodes of L-sided
weakness and numbness on awakening. Exam was notable for reduced
Neck ROM, BLE spasticity and significant functional overlay.
Given exam and timing of symptoms on awakening, suspicion was
high for cervical spondylosis. MRI C-spine revealed cervical
spondylosis. She was treated with soft cervical collar and
physical therapy.
======================================
## TRANSITIONAL ISSUES:
[ ] consider necessity of ASA 325 if it was increased from 81mg
to 325 mg due to the assumption that the events prompting
presentation were vascular in etiology.
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Aspirin 325 mg PO DAILY
2. Losartan Potassium 25 mg PO DAILY
3. Furosemide 10 mg PO DAILY
4. Atorvastatin 40 mg PO QPM
5. TraZODone 100 mg PO QHS
6. amLODIPine 5 mg PO DAILY
7. Levothyroxine Sodium 150 mcg PO DAILY
8. Eye Health Plus Lutein (vit A,C and E-lutein-minerals) 1,000
unit-200 mg-60 unit-2 mg oral DAILY
9. Calcium Carbonate 500 mg PO DAILY
10. Vitamin D 1000 UNIT PO DAILY
## DISCHARGE MEDICATIONS:
1. amLODIPine 5 mg PO DAILY
2. Aspirin 325 mg PO DAILY
3. Atorvastatin 40 mg PO QPM
4. Calcium Carbonate 500 mg PO DAILY
5. Eye Health Plus Lutein (vit A,C and E-lutein-minerals) 1,000
unit-200 mg-60 unit-2 mg oral DAILY
6. Furosemide 10 mg PO DAILY
7. Levothyroxine Sodium 150 mcg PO DAILY
8. Losartan Potassium 25 mg PO DAILY
9. TraZODone 100 mg PO QHS
10. Vitamin D 1000 UNIT PO DAILY
## ACTIVITY STATUS:
Ambulatory - requires assistance or aid (walker
or cane).
## DISCHARGE INSTRUCTIONS:
Ms. ,
You were admitted with episodes of left sided numbness and
weakness. We found that you have arthritis in your neck, and
after you sleep, sometimes the pressure from the arthritis on
your spinal cord causes your symptoms. To help with this, wear a
soft cervical collar at night.
Continue to work with Physical Therapy, which will also help
with the symptoms from the arthritis in your neck.
We wish you all the best.
Sincerely,
Your Neurology Team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10215550", "visit_id": "27134695", "time": "2134-04-10 00:00:00"} |
18569328-DS-28 | 2,917 | ## HISTORY OF PRESENT ILLNESS:
Mr. is a year old man with a history of multiple
myeloma now almost years status post matched related donor
allogeneic stem cell transplant (currently day +698, D0=
with complications of PTLD (treated with Velcade and
Rituxan), persistent disease (treated with DLI and ,
systemic adenovirus in with BK cystitis, pneumonias,
herpes zoster and post-herpetic neuralgia, chronic hip pain and
chronic GVHD (with signs in mouth) on prednisone and
presents with fevers for past 2 days, as high as 102.1 around 9
pm the evening prior to admission. He states that he feels
mostly well otherwise. Notes a nonproductive cough and
congestion for past days. Has shortness of breath at
baseline without any acute worsening recently. Has not been
eating and drinking much over past few days. Denies chest pain,
chills, myalgias, sore throat, sputum production, abdominal
pain, N/V/D.
In the ED, initial VS were: T 98.8 HR 68 BP 118/32 RR 18 SaO2
96% RA. Labs were significant for WBC 2.8, H/H at baseline
9.5/29.3, plt 76, Cr 2.2 (up from baseline of 1.6), lactate 1.4.
Blood cultures sent, UA negative with few bacteria, neg leuks,
and negative nitrites. CXR showed patchy lateral left basilar
opacity which could be consistent with atelectasis or
consolidation. Patient received 1L NS, 200 mg gabapentin,
bactrim DS, vanco and cefepime.
## REVIEW OF SYSTEMS:
(+) Per HPI.
Denies chills, night sweats, headache, vision changes, sore
throat, chest pain, abdominal pain, nausea, vomiting, diarrhea,
BRBPR, melena, hematochezia, dysuria, hematuria.
## ONCOLOGIC HISTORY:
, diagnosed with multiple myeloma, stage III by ISS
, s/p anterior T3 corpectomy with anterior and
posterior spinal fusion T1 thru T5 for a T3 myelomatous lesion
along with thoracic decompression laminectomy T1 to T2, T2 to
T3,
T3 to T4, and T4 to T5
, pulse dexamethasone
, completed XRT T1-T5 (3000 cGy) and T12-L4 (3000 cGy)
, 3 cycles of Velcade/dexamethasone, stopped due to
neuropathy
, completed 4 cycles of
, autologous stem cell transplant, in PR after
transplant
, completed 3 vaccinations per protocol , sacral mass causing inability to bear weight on right
lower extremity and was radiated, total dose 3500 cGy
through , multiple combinations of ,
Velcade and dexamethasone
, completed XRT to right superior pubic ramus (3500 cGy)
and left hip/proximal femur (3000 cGy)
, admitted for non ablative sibling allogeneic stem cell
transplant per protocol (TLI, ATG, clofarabine)
, diagnosed with PTLD and began treatment with Velcade
and Rituxan per protocol , d/c'd after 4 cycles due to
neuropathy.
, DLI.
*GVHD changes of mouth and skin
, noted for increasing free light chain and restarted
5 mg, on 21 day cycle with 1 week off. Took Decadron 4
mg for 4 days with starting cycle, then prednisone 10
mg
daily.
, started 5 mg daily. Prednisone 7.5 mg to 10
mg daily. Held at times due to counts or admissions. Restarted
5 mg daily as of . Took Decadron for 4 days
and then switched to Prednisone 10 mg daily.
, increased to 10 mg daily with increasing
FLC. Prednisone 7.5 mg daily.
## PAST MEDICAL HISTORY:
1. Hypertension.
2. Hypercholesterolemia.
3. Degenerative joint disease.
4. Osteoporosis secondary to multiple myeloma.
5. Obstructive sleep apnea requiring CPAP at night.
6. Episodic vertigo.
7. Ocular migraines.
8. Status post appendectomy.
9. Status post bilateral knee arthroscopies, right in , left
in .
10. Status post hernia repair as a child.
11. Admission through for
fevers and hypotension. Found to have systemic adenovirus in the
blood and urine as well as BK virus. Treated with Cidofovir with
development of RTA with .
12. Bibasilar pneumonia in LLL pneumonia in .
13. Osteonecrosis of bilateral hips, left greater than right.
14. Herpes zoster of chest with post-herpetic neuralgia
## FAMILY HISTORY:
No family history of hematologic malignancies.
## GENERAL:
Well appearing; alert and oriented.
## HEENT:
PERRL. Oropharynx is moist without thrush. There are
white plaques on buccal mucosae and tongue bilaterally which
appear chronic. No open lesions.
## LUNGS:
Decreased at left base with wheezes bilaterally
## HEART:
Regular rate and rhythm.
## ABDOMEN:
Soft, nontender with normal bowel sounds and without
hepatosplenomegaly.
## NEUROLOGIC:
Alert and oriented x 3, no focal neuro deficits.
## GENERAL:
Well appearing; alert and oriented.
## HEENT:
PERRL. Oropharynx is moist without thrush. There are
white plaques on buccal mucosae and tongue bilaterally which
appear chronic. No open lesions.
## LUNGS:
Decreased at left base
## HEART:
Regular rate and rhythm; SEM heard best at RUSB.
## ABDOMEN:
Soft, nontender with normal bowel sounds and without
hepatosplenomegaly.
## NEUROLOGIC:
Alert and oriented x 3, no focal neuro deficits.
## IMPRESSION:
Patchy lateral left basilar opacity could relate to
atelectasis,
but consolidation is not excluded in the appropriate clinical
setting.
HOSPITALIZATION & DISCHARGE:
08:05AM BLOOD WBC-2.2* RBC-2.12* Hgb-7.4* Hct-24.0*
MCV-114* MCH-35.1* MCHC-30.9* RDW-15.9* Plt Ct-72*
07:25AM BLOOD WBC-2.5* RBC-2.02* Hgb-7.3* Hct-23.1*
MCV-115* MCH-36.0* MCHC-31.5 RDW-16.0* Plt Ct-51*
08:05AM BLOOD Neuts-57 Bands-4 Lymphs-10* Monos-23*
Eos-4 Baso-1 Atyps-1* Myelos-0
07:25AM BLOOD Neuts-63 Bands-3 Lymphs-12* Monos-16*
Eos-6* Baso-0 Myelos-0
08:05AM BLOOD Hypochr-OCCASIONAL Anisocy-1+
Poiklo-OCCASIONAL Macrocy-1+ Microcy-NORMAL Polychr-OCCASIONAL
Schisto-OCCASIONAL Tear Dr-OCCASIONAL
07:25AM BLOOD Hypochr-NORMAL Anisocy-2+
Poiklo-OCCASIONAL Macrocy-3+ Microcy-NORMAL Polychr-OCCASIONAL
Ovalocy-OCCASIONAL Schisto-OCCASIONAL Tear Dr-OCCASIONAL
08:05AM BLOOD PTT-28.4
07:25AM BLOOD PTT-29.4
08:05AM BLOOD Glucose-89 UreaN-24* Creat-1.7* Na-140
K-3.3 Cl-108 HCO3-22 AnGap-13
07:25AM BLOOD Glucose-91 UreaN-21* Creat-1.6* Na-140
K-3.6 Cl-110* HCO3-22 AnGap-12
08:05AM BLOOD ALT-25 AST-17 LD(LDH)-154 AlkPhos-52
TotBili-0.1
07:25AM BLOOD ALT-25 AST-16 LD(LDH)-147 AlkPhos-49
TotBili-0.2
08:05AM BLOOD TotProt-5.0* Albumin-3.3* Globuln-1.7*
Calcium-7.5* Phos-2.4* Mg-2.1
07:25AM BLOOD Albumin-3.2* Calcium-8.0* Phos-2.2*
Mg-1.9 UricAcd-1.6*
08:05AM BLOOD PEP-HYPOGAMMAG FreeKap-PND FreeLam-PND
IgG-159* IgA-14* IgM-14*
08:05AM BLOOD EBV PCR, QUANTITATIVE, WHOLE BLOOD-PND
08:05AM BLOOD ADENOVIRUS PCR-PND
08:05AM BLOOD HERPES 6 DNA PCR, QUANTITATIVE-PND
Respiratory Viral Culture (Final :
TEST CANCELLED, PATIENT CREDITED.
Inadequate specimen for respiratory viral culture.
PLEASE SUBMIT ANOTHER SPECIMEN.
Respiratory Viral Antigen Screen (Final :
Greater than 400 polymorphonuclear leukocytes;.
Specimen inadequate for detecting respiratory viral
infection by
testing.
Interpret all negative results from this specimen with
caution.
Negative results should not be used to discontinue
precautions.
Reported to and read back by 10:30AM.
CMV Viral Load (Final :
CMV DNA not detected.
Performed by Cobas Ampliprep / Cobas Taqman CMV Test.
Linear range of quantification: 137 IU/mL - 9,100,000
IU/mL.
Limit of detection 91 IU/mL.
This test has been verified for use in the patient
population. Respiratory Viral Culture (Final :
No respiratory viruses isolated.
Culture screened for Adenovirus, Influenza A & B,
Parainfluenza type
1,2 & 3, and Respiratory Syncytial Virus..
Detection of viruses other than those listed above will
only be
performed on specific request. Please call Virology at
within 1 week if additional testing is needed.
Respiratory Viral Antigen Screen (Final :
Negative for Respiratory Viral Antigen.
Specimen screened for: Adeno, Parainfluenza 1, 2, 3,
Influenza A, B,
and RSV by immunofluorescence.
Refer to respiratory viral culture for further
information.
## BRIEF HOSPITAL COURSE:
with history of multiple myeloma year and 11 months s/p
MRD allogeneic stem cell transplant with complications of PTLD,
persistent disease, systemic adenovirus and BK cystitis,
pneumonias, and Zoster with post herpetic neuralgia who presents
with fever and congestion.
## #FEVER:
Most likely viral illness given fever and congestion.
Flu swab was checked twice (first sample was inadequate) and was
negative. CMV was negative. Adenovirus, EBV, HHV6 were pending
at time of discharge. Differential included pneumonia with
patchy opacity identified on CXR (although patient has no
worsening SOB or sputum production and opacity could represent
atelectasis). Patient was treated empirically for pneumonia
given patient is on chemotherapy and immunosuppressed. He was
initially started on vancomycin and cefepime on and was
transitioned to levofloxacin 750 mg PO Q48H (adjusted for renal
function) on . IgG was low at 159 and patient received IVIG
30 g IV x1 was given slowly (max rate of 30cc/hr) on . His
was held in setting of acute illness. Patient remained
afebrile during his hospitalization and felt better prior to
discharge. He will complete a 7 day course of levofloxacin (to
end on .
- Cr was up to 2.2 (from baseline 1.6) on admission, likely
prerenal in setting of decreased PO intake and acute illness.
Patient received IVF resuscitation and Cr returned back to
baseline 1.6 on day of discharge.
## #PANCYTOPENIA:
Patient developed worsening pancytopenia during
hospitalization. be reactive in setting of acute viral
illness or may represent worsening of myeloma. Patient's ASA was
held given low platelets and in the setting of being
held. CBC with diff should continue to be monitored in
outpatient setting and Dr. restart ASA and consider
need for bone marrow biopsy in future.
## #MULTIPLE MYELOMA:
Patient has had PTLD which responded to
Velcade and rituxan. Patient has also had persistent disease and
received DLI in . Started on low dose since
when noted increasing free light chain with good
response although when off for period of time, his free light
chains increase. Follow up scans have shown no evidence for
disease with most recent PET scan on . He has been on
low dose of 10 mg PO daily and his disease has been
relatively well-controlled over past few months. Patient's
was held in setting of acute illness and Dr.
restart in outpatient setting. SPEP and free
kappa/lambda were pending at time of discharge. His prednisone
was increased from 7.5 to 10 mg daily. He was continued on home
acyclovir and bacterium for prophylaxis.
## #ZOSTER WITH POST-HERPETIC NEURALGIA:
Patient was continued on
home Acyclovir, gabapentin 300 QAM, 200 QNOON, 300 QHS,
oxycodone and oxycontin and lidocaine patch.
## #CHRONIC GVHD:
Patient has chronic GVHD with mucosal and skin
involvement, relatively stable. Also had EGD due to dysphagia
and was noted for mild GVHD changes. Patient's prednisone was
increased to 10 mg daily and he was continued on dexamethasone
mouthwash and lidocaine/maalaox mouthwash. He was continued on
home omeprazole.
#Osteonecrosis of hip. Patient has history of chronic hip pain
which worsens when prednisone tapered. Patient's prednisone was
increased to 10 mg daily.
## #HTN:
Patient was continued on home amlodipine and carvedilol
with holding parameters. His ASA was held starting on in
setting of thrombocytopenia (and being held) and should
be restarted in outpatient setting.
## TRANSITIONAL ISSUES:
-Please recheck CBC with diff and monitor WBC, H/H, and
platelets and consider need for bone marrow biopsy
-Please restart aspirin 81 mg daily if blood counts are stable
-Please restart per Dr.
-Please note patient's prednisone dose was increased from 7.5 to
10 mg daily, can consider tapering down when appropriate
-Please follow-up SPEP, free kappa/lambda from
-Please follow-up CMV, EBV, HHV6, adenovirus sent on
-PLease follow-up final flu swab from
-Please ensure patient completes 7 day course of antibiotics
with levaquin (will end on
-PLease follow-up final blood cultures from
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Acyclovir 400 mg PO Q12H
2. Amlodipine 10 mg PO DAILY
3. Carvedilol 3.125 mg PO BID
4. Dexamethasone Oral Soln (0.1mg/1mL) 5 mL ORAL TID:PRN mouth
sores
5. Duloxetine 20 mg PO QHS
6. FoLIC Acid 1 mg PO DAILY
7. Gabapentin 300 mg PO QAM
8. Lenalidomide 10 mg PO DAILY
9. Lidocaine 5% Patch 1 PTCH TD QAM
10. Maalox/Diphenhydramine/Lidocaine 5 mL PO TID
11. Omeprazole 20 mg PO BID
12. Ondansetron 8 mg PO BID:PRN nausea
13. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
14. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H
15. PredniSONE 7.5 mg PO DAILY
16. Sulfameth/Trimethoprim SS 2 TAB PO M, W, F
17. Aspirin 81 mg PO DAILY
18. Vitamin D UNIT PO DAILY
19. magnesium oxide-Mg AA chelate 133 mg oral BID
20. Multivitamins 1 TAB PO DAILY
21. potassium & sodium phosphates mg oral TID
22. Sodium Bicarbonate 650 mg PO BID
23. Gabapentin 200 mg PO NOON
24. B Complex (B complex vitamins;<br>vit
B2-niac-B-6-B12-D-panth) 1 tab oral DAILY
25. Gabapentin 300 mg PO HS
## DISCHARGE MEDICATIONS:
1. Acyclovir 400 mg PO Q12H
RX *acyclovir 400 mg 1 tablet(s) by mouth every twelve (12)
hours Disp #*60 Capsule
## REFILLS:
*0
2. Amlodipine 10 mg PO DAILY
RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
## REFILLS:
*0
3. Carvedilol 3.125 mg PO BID
RX *carvedilol 3.125 mg 1 tablet(s) by mouth twice a day Disp
#*60 Tablet Refills:*0
4. Dexamethasone Oral Soln (0.1mg/1mL) 5 mL ORAL TID:PRN mouth
sores
Swish and Spit
RX *dexamethasone 0.5 mg/5 mL 5 mL by mouth three times a day
Disp #*1 Bottle Refills:*1
5. Duloxetine 20 mg PO QHS
RX *duloxetine 20 mg 1 capsule,delayed by
mouth at bedtime Disp #*30
## CAPSULE REFILLS:
*0
6. FoLIC Acid 1 mg PO DAILY
RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
7. Gabapentin 300 mg PO QAM
RX *gabapentin 300 mg 1 capsule(s) by mouth QAM Disp #*30
## CAPSULE REFILLS:
*0
8. Gabapentin 200 mg PO NOON
RX *gabapentin 100 mg 2 capsule(s) by mouth QNOON Disp #*60
## CAPSULE REFILLS:
*0
9. Gabapentin 300 mg PO HS
RX *gabapentin 300 mg 1 capsule(s) by mouth at bedtime Disp #*30
Capsule Refills:*0
10. Lidocaine 5% Patch 1 PTCH TD QAM
RX *lidocaine 5 % (700 mg/patch) 1 patch 12 hrs on 12 hrs off to
affected area 12 hrs on, 12 hrs off Disp #*30 Unit Refills:*0
11. Maalox/Diphenhydramine/Lidocaine 5 mL PO TID
RX *alum-mag hydroxide-simeth [Maalox Maximum Strength] 400
mg-400 mg-40 mg/5 mL 5 mL by mouth three times a day Disp #*1
## BOTTLE REFILLS:
*0
12. Multivitamins 1 TAB PO DAILY
RX *multivitamin 1 capsule(s) by mouth daily Disp #*30 Capsule
## REFILLS:
*0
13. Omeprazole 20 mg PO BID
RX *omeprazole 20 mg 1 capsule,delayed by
mouth twice a day Disp #*60 Capsule
## REFILLS:
*0
14. Ondansetron 4 mg PO Q8H:PRN nausea
RX *ondansetron 4 mg 1 tablet,disintegrating(s) by mouth every
eight (8) hours Disp #*30 Tablet
## REFILLS:
*0
15. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain
RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours
Disp #*30
## TABLET REFILLS:
*0
16. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H
RX *oxycodone [OxyContin] 20 mg 1 tablet extended release 12
hr(s) by mouth every twelve (12) hours Disp #*60 Tablet
Refills:*0
17. PredniSONE 10 mg PO DAILY
RX *prednisone 10 mg 1 tablet(s) by mouth daily Disp #*20 Tablet
Refills:*0
18. Sodium Bicarbonate 650 mg PO BID
RX *sodium bicarbonate 650 mg 1 tablet(s) by mouth twice a day
Disp #*60
## TABLET REFILLS:
*0
19. Sulfameth/Trimethoprim SS 2 TAB PO M, W, F
RX *sulfamethoxazole-trimethoprim 400 mg-80 mg 2 tablet(s) by
mouth Disp #*30 Tablet Refills:*0
20. Vitamin D UNIT PO DAILY
RX *ergocalciferol (vitamin D2) 2,000 unit 1 tablet(s) by mouth
daily Disp #*30 Capsule Refills:*0
21. Docusate Sodium 100 mg PO BID
RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day
Disp #*60 Capsule Refills:*0
22. Levofloxacin 750 mg PO Q48H
Please take through
RX *levofloxacin 750 mg 1 tablet(s) by mouth Q48H Disp #*3
Tablet Refills:*0
23. Senna 8.6 mg PO BID:PRN constipation
RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp
#*60 Capsule Refills:*0
24. B Complex (B complex vitamins;<br>vit
B2-niac-B-6-B12-D-panth) 1 tab oral DAILY
RX *B complex vitamins 1 capsule(s) by mouth daily Disp #*30
Tablet Refills:*0
25. magnesium oxide-Mg AA chelate 133 mg oral BID
26. potassium & sodium phosphates mg oral TID
## PRIMARY DIAGNOSIS:
fever, acute kidney injury
Secondary diagnoses: multiple myeloma, graft versus host disease
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure taking care of you at . You were admitted
with fever and congestion which is likely related to a viral
illness. Your Chest X-ray showed a possible pneumonia in the
left lower lung and you received IV antibiotics and were
transitioned to antibiotics by mouth. You were feeling much
better by the time of discharge. Please continue to take the
antibiotic (levaquin) through . Your is being
held while you're not feeling well and you can discuss
restarting the with Dr. . Your prednisone dose
was increased to 10 mg daily.
Please return to the emergency room if you experience fevers,
chills, chest pain, shortness of breath, or any other new or
worsening symptoms. We wish you the best,
Your team
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18569328", "visit_id": "22762045", "time": "2117-03-27 00:00:00"} |
16430748-RR-36 | 209 | ## INDICATION:
year old man with AIDS and new diagnosis of CNS lymphoma. Has
pulled multiple DHT, and because he needs to start ARVs needs a larger bore
tube. Consult is for placement of PEG. I already discussed with HCP and
sister and they are in agreement.// Placement of PEG
## OPERATORS:
Dr. radiologist performed the
procedure.
## CONTRAST:
0 ml of Optiray contrast.
## PROCEDURE:
1. Attempt to place a percutaneous 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.
A scout image of the abdomen was obtained. The stomach was insufflated with
air through the indwelling nasogastric tube. A safe percutaneous renal to
access the stomach was not obtained due to the overlying distended colon. At
this point the procedure was terminated.
The patient tolerated the procedure well and there were no immediate
complications.
## FINDINGS:
Distended colon overlying the upper segment of the abdomen precluding the safe
percutaneous window to access the stomach..
## IMPRESSION:
Unsuccessful attempt to place a percutaneous gastrostomy tube due to lack of
safe percutaneous window.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16430748", "visit_id": "N/A", "time": "2165-02-24 12:14:00"} |
18306706-RR-30 | 373 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## INDICATION:
year old woman status post glioblastoma resection and
reoperation for infection, now with seizures, evaluate for interval change.
## DOSE:
Acquisition sequence:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 5.4 s, 19.2 cm; CTDIvol = 49.6 mGy (Head) DLP =
954.0 mGy-cm.
4) Sequenced Acquisition 1.2 s, 4.3 cm; CTDIvol = 49.6 mGy (Head) DLP =
212.0 mGy-cm.
Total DLP (Head) = 1,166 mGy-cm.
## FINDINGS:
In comparison to the most recent head CT obtained , there has
been marked interval enlargement of the subcutaneous fluid collection
overlying the right craniectomy defect, which now measures approximately 9.6 x
3.4 cm in greatest axial (series 4, image 18). There is decreased
ear and increased layering fluid within this collection without evidence for
acute blood.
Right frontal subdural pneumocephalus has only slightly decreased. Right
frontal subdural fluid persists. Right temporal subdural and surgical bed
pneumocephalus has resolved. There is hypodensity in the right temporal
surgical bed without acute hemorrhage or increased mass effect. The
ventricles are stable in size
Again noted are postoperative changes in the anterior right temporal fossa
from prior in GBM resection. There has been interval resolution of the right
temporal fossa pneumocephalus, with a small amount of residual pneumocephalus
seen layering anti dependently along the right frontal cerebral convexity.
Motion artifact and near the skullbase limits evaluation of the temporal
lobes, cerebellum, and basal cisterns. Within this limitation, there is no
evidence of acute large vascular territorial infarction or new hemorrhage.
The imaged paranasal sinuses and mastoid air cells are grossly clear.
## IMPRESSION:
1. Marked interval enlargement of the subcutaneous fluid collection overlying
the right craniectomy with decreased air and increased fluid. Infection
within this collection cannot be excluded by imaging.
2. Right frontal subdural pneumocephalus has only slightly decreased. Right
frontal subdural fluid persists.
3. Right temporal subdural and surgical bed pneumocephalus has resolved. No
evidence for acute hemorrhage or increased mass effect related to the surgical
bed.
## COMMENT:
Within the preliminary report, the radiology resident described a
linear hyperdensity on image 6:5 representing the dura at the site of the
craniectomy. There is no acute hemorrhage.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18306706", "visit_id": "23106218", "time": "2138-08-20 13:16:00"} |
11968565-RR-108 | 164 | ## EXAMINATION:
BILATERAL DIGITAL 2D SCREENING MAMMOGRAM, SYNTHESIZED 2D VIEWS,
AND 3D DIGITAL BREAST TOMOSYNTHESIS; INTERPRETED WITH CAD
## INDICATION:
Screening. woman with history of the benign left
breast biopsy in and family history of breast cancer in her mother.
## TISSUE DENSITY:
C- The breast tissue is heterogeneously dense which may
obscure detection of small masses.
There is a group of coarse calcifications in the right upper outer breast,
which has increased in size from and likely represents an involuting
fibroadenoma. There is no suspicious dominant mass, unexplained architectural
distortion or suspicious grouped microcalcifications. An oval asymmetry in
the outer anterior left breast is unchanged dating back to , consistent
with a benign finding. Circumscribed oval 6 mm mass in the subareolar left
breast is unchanged dating back to , consistent with a benign
finding. The parenchymal pattern is stable.
## IMPRESSION:
No specific evidence of malignancy.
## RECOMMENDATION(S):
Age and risk appropriate screening.
## NOTIFICATION:
A summary letter will be sent to the patient with this result.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11968565", "visit_id": "N/A", "time": "2173-11-16 07:13:00"} |
11956152-RR-15 | 300 | ## EXAMINATION:
CTA CHEST WITH CONTRAST
## INDICATION:
History: with dyspnea// ? PE
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 3.5 s, 0.5 cm; CTDIvol = 33.7 mGy (Body) DLP =
16.9 mGy-cm.
2) Spiral Acquisition 3.7 s, 29.1 cm; CTDIvol = 25.7 mGy (Body) DLP = 746.6
mGy-cm.
Total DLP (Body) = 763 mGy-cm.
## HEART AND VASCULATURE:
Pulmonary vasculature is well opacified to the
subsegmental level without filling defect to indicate a pulmonary embolus. The
thoracic aorta is normal in caliber. Atherosclerotic changes are seen along
the aorta. There may be some eccentric mural thrombus along the free
proximal/origin of the left subclavian artery. Very trace pericardial fluid
may be physiologic.
## AXILLA, HILA, AND MEDIASTINUM:
No axillary, mediastinal, or hilar
lymphadenopathy is present. No mediastinal mass.
## PLEURAL SPACES:
No pleural effusion or pneumothorax.
## LUNGS/AIRWAYS:
Patient is status post left upper lobe lobectomy with
postsurgical changes including volume loss in the left hemithorax. There is
apical predominant centrilobular emphysema. Some respiratory motion
particularly through the mid to lower lungs makes assessment of the pulmonary
parenchyma less than optimal, but given this, there is mild lingular
atelectasis. No focal consolidation is seen. There is mild diffuse bronchial
wall thickening, however the airways are patent to the level of the segmental
bronchi bilaterally.
The imaged thyroid gland is homogeneous.
## ABDOMEN:
Included portion of the upper abdomen is unremarkable, aside from a
small hiatal hernia2.
## BONES:
No suspicious osseous abnormality is seen.? There is no acute fracture.
## IMPRESSION:
1. No evidence of pulmonary embolism. Atherosclerotic changes along the aorta
without acute dissection identified. Possible eccentric mural thrombus at the
origin of the left subclavian artery/very proximal left subclavian artery.
2. Centrilobular pulmonary emphysema. Mild diffuse bronchial thickening,
likely secondary to small airway disease. No focal consolidation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11956152", "visit_id": "21915705", "time": "2181-10-03 20:07:00"} |
18490093-RR-20 | 137 | ## EXAM:
MR pelvis with and without contrast.
## INDICATION:
A man with newly diagnosed rectal, moderately
differentiated adenoma with invasive submucosa at outside hospital. Evaluate
for surgical planning.
## FINDINGS:
At the rectosigmoid junction, there is prominence of the bowel wall
tissues in the left lateral aspect, which spans approximately 1.6 cm in the CC
dimension on the reconstructed plane. However on the other sequences, this
area does not persist and may represent underdistended bowel folds with biopsy
changes. No definite evidence of tumor, pathologic mural enhancement,
involvement of the adjacent fat, or abnormal pelvic lymph nodes are
demonstrated.
The prostate is mildly enlarged , however no focal lesion is appreciated. The
visualized bladder, remaining bowel, and osseous structures are otherwise
unremarkable.
## IMPRESSION:
No specific MR evidence of rectal tumor mural involvement or
extent beyond the wall.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18490093", "visit_id": "N/A", "time": "2171-06-18 07:40:00"} |
15033599-RR-129 | 411 | ## INDICATION:
CHF and complete heart block status post pacemaker, aortic
stenosis, HCV, hypothyroidism, lymphoma, SVC syndrome, dyspnea and large
bilateral pleural effusions, acute left-sided abdominal pain, evaluate for
splenic infarct.
## CONTRAST:
Oral and intravenous nonionic contrast.
CT OF THE ABDOMEN WITH INTRAVENOUS CONTRAST:
Low-density bilateral pleural
effusions, large on the right and moderate on the left, are again noted,
slightly decreased on the left. There is adjacent bilateral lower lobe
atelectasis and some peribronchial cuffing in the imaged portions of upper
lobe that may represent ongoing pulmonary vascular congestion. The right
middle lobe is atelectatic. Aortic valvular calcifications, pacemaker leads,
and coronary and mitral annular calcifications are noted. The spleen is
normal in size and enhances homogeneously without evidence of splenic infarct.
The liver, gallbladder and bilateral adrenal glands appear unremarkable. The
pancreas appears within normal limits without evidence of ductal dilation.
Subcentimeter bilateral renal hypodensities are too small to accurately
characterize and unchanged from . There is no hydronephrosis.
Although note is made of extrarenal pelvis on the right. There is a large
amount of stool in the colon. No evidence of bowel obstruction. No free
fluid or free air within the abdomen. Aortic atherosclerotic calcifications
are noted without evidence of aneurysm.
The left rectus muscle is newly expanded and asymmetric in comparison with the
right, and slightly heterogeneous in appearance. The rectus muscle itself
measures approximately 2.2 x 7.0 cm in greatest transaxial dimension. These
findings are suggestive of rectus sheath hematoma, although a clear organized
collection is not identifiable.
CT OF THE PELVIS WITH INTRAVENOUS CONTRAST:
Bladder is collapsed about a
Foley catheter. Rectum, sigmoid colon, and pelvic loops of small bowel appear
unremarkable. The uterus and adnexae appear within normal limits. There are
no pathologically enlarged pelvic or inguinal lymph nodes. Marked
atherosclerotic calcification is present in the iliac arteries bilaterally
with narrowing of the bilateral external iliac arteries.
## BONE WINDOWS:
No suspicious lytic or sclerotic osseous lesions are
identified.
## IMPRESSION:
1. New expansion of the left rectus abdominis muscle, consistent with rectus
sheath hematoma.
2. No evidence of splenic infarct as questioned.
3. Bilateral pleural effusions and findings consistent with pulmonary
vascular congestion. Left pleural effusion is slightly decreased and right is
stable.
4. Bilateral hypodense renal lesions, too small to characterize and
right-sided extrarenal pelvis with pelviectasis.
The findings were discussed by with Dr. at 7:45 p.m on
via telephone at three minutes after discovery of findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15033599", "visit_id": "25826586", "time": "2150-11-08 17:57:00"} |
10132504-RR-2 | 435 | ## HISTORY:
with fever, cough, shortness of breath with alleged
pleural fluid layering in right lower lobe on CXR// evidence of
effusion/infiltrate/mass
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 5.3 s, 41.6 cm; CTDIvol = 16.8 mGy (Body) DLP = 699.0
mGy-cm.
Total DLP (Body) = 699 mGy-cm.
## NECK, THORACIC INLET, AXILLAE:
The visualized thyroid is normal.
Supraclavicular and axillary lymph nodes are not enlarged.
## MEDIASTINUM:
Prominent mediastinal lymph nodes measuring up to 11 mm in the
subcarinal station are likely reactive.
## 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:
Aortic caliber is normal. The main, right, and left pulmonary
arteries are normal caliber.
## PULMONARY PARENCHYMA:
Right lower lobe consolidative opacity may reflect
atelectasis, however areas of heterogeneous attenuation within this region
raise concern for coexistent infection. Compressive atelectasis is also noted
within the right upper lobe. Mild centrilobular emphysema is noted within the
upper lobes. 3 mm left lower lobe subpleural pulmonary nodule is demonstrated
(4:195).
## AIRWAYS:
The airways are patent to the subsegmental level bilaterally.
## PLEURA:
There is a moderate right pleural effusion, without abnormal pleural
enhancement to suggest empyema. Small amount of fluid tracks along the minor
fissure. There is no pneumothorax.
## CHEST WALL AND BONES:
There is no worrisome lytic or sclerotic lesion.
Multilevel degenerative changes are mild. There are mild-to-moderate
degenerative changes of bilateral shoulders, left greater than right, with
hardware partially visualized within the proximal left humerus.
## UPPER ABDOMEN:
This study is not tailored for evaluation of the abdomen.
Allowing for this, the partially visualized upper abdomen demonstrates a small
hiatal hernia. Prominent subcentimeter periaortic lymph nodes in the abdomen
are also noted. Stones are seen within the nondistended gallbladder. A
subcentimeter hypodensity in the left hepatic lobe is too small to
characterize. A retroaortic left renal vein is incidentally noted.
## IMPRESSION:
1. Consolidative opacity in the right lower lobe with areas of heterogeneous
attenuation, likely reflective of a combination of compressive atelectasis
with coexistent infection.
2. Moderate right pleural effusion with a component tracking along the minor
fissure.
3. Small hiatal hernia.
4. Cholelithiasis without acute cholecystitis.
5. Mediastinal lymphadenopathy is likely reactive.
6. Mild centrilobular emphysema.
7. 3 mm left lower lobe pulmonary nodule. Optional chest CT can be obtained
in 12 months if the patient is at high risk for lung malignancy.
## RECOMMENDATION(S):
3 mm left lower lobe pulmonary nodule. Optional chest CT
can be obtained in 12 months if the patient is at high risk for lung
malignancy.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10132504", "visit_id": "N/A", "time": "2140-02-17 19:55:00"} |
13621973-RR-23 | 171 | ## EXAMINATION:
US DRAIN/INJ SMALL JOINT/BURSA W/US GUID
## INDICATION:
year old woman with swelling of the R PIP and L PIP,
possibly secondary to OA. // Please evaluate R PIP and L PIP joints
for synovitis, aspirate (if available) and send for culture, cell count,
crystal analysis. Inject with steroids.
## RIGHT SECOND PROXIMAL INTERPHALANGEAL JOINT:
Large bulky osteophytes, joint
space narrowing and mild synovial hypertrophy and hypervascularity. Trace
joint effusion.
## LEFT FIFTH PROXIMAL INTERPHALANGEAL JOINT:
Bulky osteophytes, joint space
narrowing and mild synovial hypertrophy. No significant hypervascularity.
Trace joint effusion.
## IMPRESSION:
1. Imaging Findings - severe osteoarthritis in the right second and left
fifth proximal interphalangeal joints, mild synovial hypertrophy and trace
joint fluid.
2. Procedure - no fluid could be aspirated from the right second or left
fifth proximal interphalangeal joints. A mixture of Kenalog and bupivacaine
was injected into both joints.
I Dr. personally supervised the Resident/Fellow
during the key components of the above procedure and I have reviewed and agree
with the Resident/Fellow findings/dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13621973", "visit_id": "N/A", "time": "2192-09-30 14:52:00"} |
19331480-DS-8 | 1,066 | ## ALLERGIES:
Patient recorded as having No Known Allergies to Drugs
## HISTORY OF PRESENT ILLNESS:
Ms. is a yo woman with mild mental retardation,
schizoaffective disorder, DM2, HTN and obesity, h/o breast CA
who presents with substernal chest pain/heaviness.
.
She reports that she had just eaten corned beef and was sitting
watching TV when she experienced sudden-onset, sharp, substernal
chest pain which she attributes to indigstion associated with
heartburn and belching. The pain was associated with mild
shortness of breath, difficulty taking deep breaths. It did not
radiate although she also felt some right arm heaviness. Denies
nausea, diaphoresis or palpitations.
.
She has never had pain like this before at rest or with walking.
Pain lasted several hours and resolved in ED with GI cocktail
and Morphine. She denies fevers, chills or sweats but does
report chronic cough x 1 month productive of yellow phlegm.
.
In the ED, initial VS 97.8 137/42 84 18 97% 3L. She received
aspirin, morphine and GI cocktail.
.
On the floor, she is feeling much better with no recurrence of
chest pain and asking when she will go home as she is walkign
around room and doing her hair in the bathroom.
## PAST MEDICAL HISTORY:
DM2, on insulin
HTN
Hypercholesterolemia
Breast cancer s/p bilateral mastectomy and R axillary node
dissection
Mental retardation
morbid obesity
Bipolar disorder/Schizoaffective d/o
Hypothyroidism
chronic constipation
## MOTHER:
"heart problems" at unknown age. father: DM
## GEN:
obese, cooperative, pleasant, walking around room, combing
hair
## HEENT:
EOMI, sclerae anicteric, conjunctivae clear, OP moist and
without lesion
## CV:
Reg rate, distant S1, S2. systolic murmur LUSB.
## CHEST:
Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
## ABD:
obese, soft, NT, ND, no HSM
## EXT:
R arm with lympedema, otherwise, no c/c/e
## TWO VIEWS OF THE CHEST:
The cardiomediastinal contour is
normal allowing for somewhat low lung volumes. The heart size is
top normal. However, lungs are clear, with no evidence of
pleural effusion, CHF, or pneumonia. Osseous structures are
unremarkable.
## IMPRESSION:
No evidence of acute process.
## BRIEF HOSPITAL COURSE:
yo woman with DM2, HTN, hypercholesterolemia, morbid obesity
admitted with atypical chest pain.
# Chest pain: Pt's history not c/w coronary ischemia and more
likely GERD given associated belching, acidic taste and
improvement with GI cocktail. Symptoms also occured at rest and
are not similar to any symptoms that occur with walking or
exertion. She ruled out with two sets of negative cardiac
enzymes and no ECG changes. D-dimer was negative, ruling out PE
and DVT. Counseled patient regarding avoiding GERD triggers. She
was continued on outpatient med regimen. CXR normal.
# HTN: Patient mildly hypertensive here but did not receive meds
overnight since she was unsure which medictaions she was on.
Later normotensive on home regimen lisinopril, atenolol.
# DM2: Given sliding scale in house, discharged on home
metformin and humulin.
#. Anemia: Pt with microcytic anemia. Iron studies WNL. Guaiac
negative in ED. Should pursue follow up as outpatient.
## # SCHIZOAFFECTIVE D/O:
Continued outpt regimen including Buspar,
carbamazepine, invega, ativan, sertraline trazodone prn
## # HYPOTHYROID:
Continued armour thyroid
# Chronic Constipation: continue outpateint bowel regimen
## MEDICATIONS ON ADMISSION:
Trazadone 150 qhs
Metformin 1000mg BID
Atenolol 24 mg PO daily
Buspar 5mg BID
Folic acid 1 mg daily
Carbamazepine 200mg 1 qam, 2 qhs
Magnesium oxide 400
Zoloft 200mg daily
Baclofen 10mg BID
ASA 81 mg daily
Ativan 1mg BID prn
Invega 3mg daily
Lipitor 10mg daily
Colace/Senna
Humulin N 100 50 units at bedtime
Lisinopril 5mg daily
Armour thyroid 60mg 4 tabs PO daily
Miralax
MVI
## DISCHARGE MEDICATIONS:
1. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
3. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.
4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Buspirone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Carbamazepine 200 mg Tablet Sustained Release 12 hr Sig: Two
(2) Tablet Sustained Release 12 hr PO HS (at bedtime).
8. Carbamazepine 200 mg Tablet Sustained Release 12 hr Sig: One
(1) Tablet Sustained Release 12 hr PO QAM (once a day (in the
morning)).
9. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Sertraline 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
11. Baclofen 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
12. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
13. Paliperidone 3 mg Tab,Sust Rel Osmotic Push 24hr Sig: One
(1) Tab,Sust Rel Osmotic Push 24hr PO DAILY (Daily).
14. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
16. Senna 8.6 mg Tablet Sig: Tablets PO BID (2 times a day)
as needed.
17. Polyethylene Glycol 3350 100 % Powder Sig: One (1) dose PO
DAILY (Daily).
18. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
19. Thyroid 30 mg Tablet Sig: Eight (8) Tablet PO DAILY (Daily).
## 20. MULTIVITAMIN TABLET SIG:
One (1) Tablet PO DAILY
(Daily).
21. Insulin Regular Hum U-500 Conc 500 unit/mL Solution Sig:
Fifty (50) units Injection at bedtime.
## DISCHARGE DIAGNOSIS:
Primary Diagnosis
Atypical Chest pain
Secondary Diagnosis
Type 2 Diabetes Mellitus
Schizoaffective d/o
Hypercholesterolemia
h/o breast CA
Hypothyroidism
## DISCHARGE CONDITION:
Hemodyamically stable, afebrile, chest pain resolved
## DISCHARGE INSTRUCTIONS:
You were admitted to the hospital with chest pain. Your pain was
most likely from reflux, or heartburn. Your pain was resolved
here in the hospital. We do not think this pain was from your
heart. You did not have a heart attack.
We did not make any changes to your medications. You should take
Maalox as needed for indigestion and avoid foods that are likely
to worsen heartburn including acidic foods, chocolate, mint,
tomato based foods and other foods that worsen your symptoms.
Please return to the ER or call your primary care doctor if you
develop chest pain, shortness of breath, lightheadedness,
dizziness, fever, chills, dizziness, lightheadedness, or any
other concerning symptoms.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19331480", "visit_id": "20579213", "time": "2134-03-28 00:00:00"} |
17166473-RR-93 | 103 | ## INDICATION:
female with neck pain after fall.
No prior examinations for comparison.
## FINDINGS:
There is no acute fracture or dislocation. Vertebral and disc
space height and alignment are preserved. There are several small anterior
osteophytes, and ossification of the anterior longitudinal ligament.
Visualized posterior fossa demonstrates cerebral atrophy and calvarial
hyperostosis, compatible with seizure medication changes. Mastoid air cells
and middle ear cavities are clear. Visualized paranasal sinuses are well
aerated.
Cervical lymph nodes are not pathologically enlarged. Calcifications are
noted at the bilateral carotid bifurcations. Thyroid gland is unremarkable.
Visualized lungs demonstrate apical pleural parenchymal scarring.
## IMPRESSION:
No acute fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17166473", "visit_id": "N/A", "time": "2156-01-30 16:12:00"} |
11482036-RR-58 | 356 | ## INDICATION:
Severe occipital headache, visual change and neck pain.
## HEAD CT:
There is no evidence of acute hemorrhage, edema, mass effect, or
recent infarction. A left parieto-occipital wedge-shaped hypodensity is
chronic in appearance, possibly representing a remote watershed infarct.
Additionally, there is a hypodensity in the left occipital lobe consistent
with a remote infarct. Prominence of the ventricles and sulci likely
represents generalized intraparenchymal volume loss, not out of proportion to
the patient's age. Multiple areas of confluent subcortical and
periventricular white matter hypodensities likely reflect chronic small vessel
ischemic disease. No fractures are identified. The visualized paranasal
sinuses are unremarkable.
## HEAD AND NECK CTA:
No flow-limiting stenoses are seen. Calcifications are
noted throughout the aortic arch. There are calcifications of the carotid
bifurcations bilaterally. Again, no flow-limiting stenosis is seen. The left
internal carotid artery contains areas of soft plaque at the level of C1.
There are calcifications of the bilateral carotid siphons. Note is made of
tortuosity of the vertebral arteries, particularly at the origin of the left.
The right internal carotid measures 5 mm distally and the left 5 mm distally.
There is no evidence of aneurysm formation.
A mass appearing to originate in the area of the right thyroid gland and
extending inferiorly into the mediastinum is present. The are
approximately 5.3 x 5.2 cm axially (3:23) x at least 6 cm in craniocaudal
dimension, though the inferior portion of the mass is not included in the
field of view. Central area of hypodensity could indicate necrosis. There is
deviation of the trachea to the left as well as deviation of the vasculature
around the mass.
Note is made of multilevel degenerative change, including facet arthropathy,
most significant at C6/7. The patient is status post left ocular lens
surgery.
## IMPRESSION:
1. No acute intracranial process.
2. No flow-limiting stenosis. Craniocervical vessels patent.
3. Large right neck and mediastinal mass, not fully evaluated on this
examination. Dedicated chest imaging, as clinically indicated, recommended
for further evaluation.
Wet read posted 3:24 p.m. . Results discussed with Dr. 11:40
a.m., .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11482036", "visit_id": "27844522", "time": "2184-01-20 13:50:00"} |
18487334-RR-124 | 88 | ## INDICATION:
History: with dyspnea, hypoxia, cough// eval pna
## FINDINGS:
A left chest wall pacemaker device is in place, with stable positioning of the
leads. Median sternotomy wires are re-demonstrated.
There is a dense retrocardiac opacity, which is new from the prior study
concerning for aspiration or pneumonia. No other consolidations are seen.
Mild enlargement of the cardiac silhouette is stable. No large pleural
effusion or pneumothorax.
## IMPRESSION:
Retrocardiac opacity concerning for left lower lobe aspiration or pneumonia.
has reviewed the wet reading by the resident
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18487334", "visit_id": "29374786", "time": "2197-05-16 08:52:00"} |
19673689-RR-59 | 96 | ## FINDINGS:
Overlying bandages have been removed. There is slightly increased dorsal soft
tissue swelling overlying the first ray since the previous study. Again seen
are changes from previous first metatarsal osteotomy and bunionectomy. First
metatarsal K-wire and two screws have been in place. There is increased
heterotopic bone formation and callus formation across the osteotomy site.
Alignment is improved. Degenerative changes at the dorsal aspect of the
talonavicular joint and small plantar and dorsal calcaneal enthesophytes are
seen.
## IMPRESSION:
Progressive healing status post previous bunionectomy.
Persistent, and slightly increased dorsal soft tissue swelling.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19673689", "visit_id": "N/A", "time": "2185-10-28 13:39:00"} |
15594473-RR-14 | 299 | ## HISTORY:
female with history of cirrhosis, now status post ERCP
yesterday for gallstone pancreatitis. Patient now presenting with increasing
abdominal distention.
## RIGHT UPPER QUADRANT ULTRASOUND:
The liver demonstrates a shrunken nodular
appearance, findings consistent with cirrhosis. No focal hepatic lesion is
identified. Doppler evaluation of the portal venous system demonstrates
patency of the left, main and right portal veins. Flow in the left portal
vein is extremely slow and appears reversed. Additionally, there is reversed
flow within the main portal vein. The anterior and posterior right portal
veins are also likely reversed, though Doppler waveforms were unreliable due
to patient's inability to breath-hold. Chronicity of these findings is
difficult to determine as a complete Doppler was not performed on prior
ultrasound from . There is umbilical vein is not recanalized.
The gallbladder is filled with stones and sludge and demonstrates diffuse wall
thickening, similar in appearance compared to prior. There is no gallbladder
distention, pericholecystic fluid, or tenderness on ultrasound examination.
No intrahepatic biliary ductal dilatation is identified. The common bile duct
is dilated measuring 10 mm as compared to 5 mm previously. There is a mild
amount of abdominal ascites. The spleen remains enlarged measuring 18 cm.
The pancreatic head and neck appear normal in echogenicity. Evaluation of the
body and tail is limited by overlying bowel gas.
## IMPRESSION:
1. Nodular coarse liver consistent with cirrhosis. No focal lesion.
2. Patent portal vasculature, though with slow flow and probable reversal of
flow in the left and right portal veins. Definite reversal of flow within the
main portal vein. No recanalized umbilical vein.
3. Splenomegaly and mild ascites.
4. Sludge and stone-filled gallbladder with diffuse wall thickening, likely
from underlying liver disease.
5. Dilated common bile duct measuring 10 mm, likely related to recent ERCP.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15594473", "visit_id": "28817728", "time": "2137-09-22 14:40:00"} |
13385351-RR-57 | 156 | ## EXAMINATION:
CT HEAD W/O CONTRAST Q111 CT HEAD
## HISTORY:
with recent fall, anticoagulated on apixaban //
Fracture, bleed?
## DOSE:
Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.5 mGy (Head) DLP =
824.4 mGy-cm.
Total DLP (Head) = 839 mGy-cm.
## FINDINGS:
The study is mildly limited by motion. Focal hypodensity in the anterior limb
of the left internal capsule is consistent with a prior lacunar infarction.
There is no evidence of large territory infarction,hemorrhage,edema,or mass.
Involutional changes are unchanged. Bilateral periventricular subcortical
white matter hypodensities are nonspecific but most likely represent sequela
chronic small vessel ischemic changes. Bilateral carotid siphon
calcifications are noted.
No fracture. The visualized portion of the paranasal sinuses, mastoid air
cells, and middle ear cavities are clear. The patient is status post
bilateral lens replacement.
## IMPRESSION:
1. Mildly motion limited exam. Given the limitation, no acute intracranial
process or calvarial fracture.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13385351", "visit_id": "25530622", "time": "2141-11-07 01:13:00"} |
18187889-RR-18 | 105 | ## EXAMINATION:
HIP UNILAT MIN 2 VIEWS RIGHT
## INDICATION:
year old man with r hip pain// r hip pain
## FINDINGS:
The patient is status post bipolar right hip hemiarthroplasty. Prosthetic
components including the femoral stem appear well-seated and normally aligned
without evidence of complication. There is no evidence of acute fracture or
dislocation. The symphysis pubis is unremarkable. No aggressive focal
osseous lesions. Vascular calcifications are noted. Skin staples overlie the
right anterolateral right thigh. No other unexpected radiopaque foreign body
or concerning soft tissue calcification. Diffuse osteopenia is noted.
## IMPRESSION:
Expected radiographic appearance status post bipolar right hip
hemiarthroplasty without hardware complication.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18187889", "visit_id": "N/A", "time": "2143-12-19 12:17:00"} |
12475612-RR-11 | 148 | ## INDICATION:
man with elevated AST/ALT.
## FINDINGS:
The liver demonstrates diffusely increased echogenicity without
focal liver lesions. There is no intrahepatic or extrahepatic biliary
dilatation. The common bile duct measures 3 mm and is normal. The
gallbladder is normal without gallstones or wall thickening. The main portal
vein demonstrates normal hepatopetal flow. The pancreas is partially
visualized and the pancreatic head appears unremarkable. The remainder of the
pancreas is obscured by overlying bowel gas. The aorta is of normal caliber
throughout. The right kidney measures 11.5 cm. The left kidney measures 10.8
cm. Both kidneys are normal in appearance without hydronephrosis, stones or
renal masses. The spleen is enlarged, measuring 15.1 cm. There is no
ascites.
## IMPRESSION:
1. Echogenic liver consistent with fatty infiltration. However, other forms
of liver disease including advanced liver disease/cirrhosis cannot be excluded
on this study.
2. Splenomegaly.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12475612", "visit_id": "N/A", "time": "2135-02-22 14:54:00"} |
13314834-RR-58 | 132 | ## INDICATION:
Family history of breast and ovarian cancer. Palpable lump in
the right.
GE DIGITAL BILATERAL DIAGNOSTIC MAMMOGRAM WITH COMPUTER-AIDED DETECTION:
## RIGHT BREAST ULTRASOUND:
Targeted ultrasound of the right breast was
performed. The right breast was scanned from o'clock. At 11 o'clock, 1
cm from the nipple are seen two prominent ducts without any filling defects.
Additionally, at 10 o'clock, 3 cm from the nipple is seen an oval anechoic
lesion measuring 0.6 x 0.3 x 0.6 cm. This appears to be a prominent duct
showing bifurcation. This also does not show any filling defect within. No
solid lesion of concern.
## IMPRESSION:
No evidence of malignancy. Final disposition of the palpable
area should be based on clinical evaluation.
BI-RADS 2 -- benign findings.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13314834", "visit_id": "N/A", "time": "2153-05-02 07:58:00"} |
19191528-RR-39 | 451 | ## INDICATION:
year old man with possible chronic mesenteric ischemia // ..
r/o chronic mesenteric ischemia
## FINDINGS:
The lung bases are grossly clear.
## LIVER:
Two liver lesions located in segments VI and VII (series 14, image 27
and 41) are low signal on the precontrast T1 weighted images, high signal on
T2 weighted images and demonstrates rim enhancement. There is a simple cyst or
biliary hamartoma and segment VI. Otherwise, the liver is normal in signal
intensity. There is no significant intra or extrahepatic biliary ductal
dilatation.There is no ascites.
## GALLBLADDER:
The gallbladder contains a stone. There is no evidence of
choledocholithiasis or stricture.
## PANCREAS:
There is loss of the high signal within the head, neck and proximal
body of the pancreas on the pre contrast T1-weighted images that is
hypoenhancing relative to the remaining pancreatic parenchyma and measures 7.7
x 4.6 x 2.6 cm (TRV x AP x CC). The distal pancreatic duct in the distal body
and tail is dilated with an abrupt change in caliber in the distal body at the
beginning of the mass (series 5, image 25). The tumor encases the celiac axis
including the common hepatic artery, gastroduodenal artery, the proper hepatic
artery and the splenic artery. All of the arteries are patent, however, the
origin of the celiac axis is narrowed. The splenic vein is thrombosed. The
portal vein and the superior mesenteric vein are patent, however, the portal
confluence is encased. There is classic pancreatic ductal anatomy.
## SPLEEN:
The spleen is normal in appearance.
## KIDNEYS AND ADRENALS:
The adrenal glands are normal bilaterally. There
subcentimeter renal cysts in each kidney. There is no hydronephrosis or
worrisome renal lesions.
## BOWEL:
The visualized bowel loops and mesentery are within normal limits.
## LYMPH NODES:
The multiple prominent retrocrural lymph nodes up with central
hypo enhancement concerning for necrosis (series 14, image 26, 49 and 92).
## BONES:
The osseous structures are unremarkable.
## VESSELS:
The superior mesenteric artery is patent. The patient is status post
infrarenal abdominal aortic aneurysm repair. There are stents in the bilateral
common iliac arteries and the left external iliac artery.
## IMPRESSION:
1. A large pancreatic mass centered in the neck of the pancreas measuring 7.7
cm encases the major vessels of the celiac axis and the portal confluence
which are patent. The splenic vein is thrombosed. Multiple retrocrural lymph
nodes with central hypo enhancement likely represent necrotic lymph node
metastases. Hypodense lesions with rim enhancement in the liver are concerning
for metastasis. These findings are most concerning for adenocarcinoma of the
pancreas. Upper endoscopic ultrasound with biopsy is recommended.
2. Cholelithiasis without evidence of acute cholecystitis.
## NOTIFICATION:
Findings discussed by telephone with Dr. by Drs.
at 1635.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19191528", "visit_id": "N/A", "time": "2134-10-16 11:44:00"} |
10104335-RR-11 | 146 | ## INDICATION:
with bile duct dilation on CT. Evaluate for
cholecystitis.
## RIGHT UPPER QUADRANT ULTRASOUND:
The liver is normal in echotexture, with
mild intrahepatic bile duct dilation as seen on CT. There is marked
extrahepatic bile duct dilation, measuring up to 15 mm. This tapers to the
distal CBD, however, no definite mass is seen. The pancreatic duct is also
mildly prominent measuring 4 mm. The pancreas is atrophied. The portal vein
is patent with anterograde flow. There is no ascites. The gallbladder is
distended, with gallstones, however, no evidence of cholecystitis including no
wall thickening or pericholecystic fluid. Sonographic sign was
negative.
## IMPRESSION:
1. Marked CBD dilation as seen on CT, with no definite distal mass or stone
identified, though MRCP is recommended when feasible. There is also milder
dilation of the pancreatic duct.
2. Distended gallbladder with gallstones, however, no evidence of
cholecystitis.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10104335", "visit_id": "22490224", "time": "2179-10-17 19:53:00"} |
16275555-RR-56 | 266 | ## INDICATION:
year old woman with metastatic adenoCA- off systemic therapy//
please evaluate for interval change-- compare to CT REQUEST IV
CONTRAST ONLY, NO ORAL CONTRAST DUE TO INTOLERANCE
## DOSE:
DLP: Given in abdominal CT report.
## FINDINGS:
No incidental thyroid findings. Stable right pectoral Port-A-Cath. Stable
appearance of the large mediastinal vessels, including the moderately
calcified aorta. No evidence of pulmonary embolism. Moderate coronary
calcifications, no pericardial effusion. The posterior mediastinum is
unremarkable. No evidence of adrenal lesions. At the level of the spine,
there is stable evidence of vertebral compression at the level of T11 as well
as of T5. The findings show no substantial progression as compared to the
previous examination. No new lytic foci are identified. The large right
hilar mass causing occlusion of the upper lobe bronchus with subsequent mixed
infectious and atelectatic parenchymal collapse is overall stable. Also
stable is the perifissural thickening on the right and the right pleural
effusion. The pre-existing left pleural effusion has minimally increased. A
pulmonary nodule on the left has slightly increased, from approximately 5 to
approximately 7 mm in diameter. Stable left rib lesion (6, 95). Stable right
breast lesion (6, 175). Stable left lower lobe nodule.
## IMPRESSION:
Overall stable extent and severity of the known right hilar and upper lobe
mass, causing occlusion of the right upper lobe bronchus and consolidation of
the right upper lobe. Stable right pleural effusion. Slight increase in left
pleural effusion. A pre-existing left lower lobe nodule is stable. A left
upper lobe nodule has again increased in size, making this lesions suspicious.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16275555", "visit_id": "N/A", "time": "2152-03-09 09:45:00"} |
19984418-RR-25 | 106 | ## HISTORY:
female patient with prior abnormal chest x-ray, fever,
and cough. Study to evaluate for pneumonia.
## FINDINGS:
There is now frank alveolar opacification of the right lower lobe,
extending into the right middle lobe, consistent with pneumonia. There is no
pleural effusion, pulmonary edema, or pneumothorax. The cardiomediastinal
contours are normal. The surrounding soft tissue and osseous structures
appear unremarkable.
## IMPRESSION:
Progressive worsening of right middle and lower lobe pneumonia.
Radiographic follow-up in 4 weeks following antibiotics to document resolution
of pneumonia is recommended.
The above findings were discussed with Dr. over the telephone
by Dr. at the time of this dictation.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19984418", "visit_id": "N/A", "time": "2174-05-07 14:24:00"} |
14605988-DS-8 | 1,551 | ## CHIEF COMPLAINT:
Painful rash on hands
## HISTORY OF PRESENT ILLNESS:
Mr. is a year old man
with a history of multiple allergies, allergic rhinitis, and
currently on treatment for prostatitis with bactrim who presents
with a four day history of a painful rash on his hands and
abdomen. Four days ago he went to his PCP and complained that
ciprofloxacin, which he had been taking for his prostatitis
since , was not strong enough. His PCP changed his
antibiotic to bactrim. , before he had taken his first
dose of bactrim, he began to notice that his hands were
increasingly dry and itchy. He occasionally has dry hands at
baseline, so was not initially concerned. He applied some
cortisol cream on with mild relief of symptoms. On
he again applied cortisol, and then also took benadryl.
night, at around 2am he woke up in significant pain. His
hands felt puritic, hot, and said he felt they "were about to
explode." He came in to for further evaluation.
On further questioning, the patient denies any new hand creams,
soaps, gloves, or other new exposures. There is no one else in
his family with any similar reaction. He has no pets in the
house.
Of note, the patient started having problems after he cut
his left thumb and put on a Band-Aid. He forgot he was allergic
to Band-Aids and developed skin eruption, which he thinks got
infected, and so he decided to purchase tetracycline from a
local store. After two doses, he woke up the following day with
subjective fever, chills, sweats, and diffuse itchy rash
involving most of his torso. That same day he noticed difficulty
urinating with worsening suprapubic and testicular pain, so he
presented to the ED on , where he was diagnosed with
prostatitis and discharged on ciprofloxacin and possible
allergic reaction to tetracycline (although on review of his
past medical history, note on mentioned a perscription
to tetracycline without any allergic reactions). Due to
worsening suprapubic and testicular pain a couple of days later,
he re-presenting to the ED at which time a foley catheter was
placed, relieving his pain. At the time, it was thought that
benadryl had contributed to his urinary retention and he was
encouraged to use an over-the-counter anti-histamine.
The acute illness reported as prostatitis has been complicated
by urinary retention requiring foley. He failed a voiding trial
four times with urology as an outpatient and it was thought that
his prostatitis and mild BPH may have also contributed to his
failure to void.
In the ED, initial vitals were as follows: 99.0 89 124/83 16
99%RA.
Labs were significant for WBC 11.3 with 7.1% Eos. He was given
benadryl, morphine and prednisone 60mg.
.
On the floor, patient was comfortable in bed without any pain.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.
## PAST MEDICAL HISTORY:
- Allergic Rhinits
- Migraine Headaches
- Acute prostatitis - started 4wk course of cipro
- Chronic RUQ abdominal pain - largely resolved
Past Surgical History
- Laparoscopic right inguinal hernia repair with mesh ( )
## FAMILY HISTORY:
Positive for diabetes in his mother, several
aunts and uncles. Positive for hypertension in his mother. No
family history of heart disease. His father died years ago
of prostatitis. No family history of allergic rhinitis.
## GENERAL:
Alert, oriented, no acute distress, although pain with
using his hands
## HEENT:
Sclera anicteric, MMM, oropharynx clear, no mucosal
lesions
## NECK:
Supple, JVP not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
ronchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## SKIN:
Vessicular lesions of the hands on an erythamatous base,
involving the back of the hands, most prominant on the knuckles
with extension of erythema up the forearms. Some erythematous
involvement of the right flank. No palmar involvement, with
spairing of oral mucosa.
## RECTAL:
Enlarged tender prostate, guaiac negative
Discharge Exam
## GENERAL:
Alert, oriented, no acute distress, mild puritis of
hands, but improved from initial presentation
## HEENT:
Sclera anicteric, MMM, oropharynx clear, no mucosal
lesions
## NECK:
Supple, JVP not elevated, no LAD
## LUNGS:
Clear to auscultation bilaterally, no wheezes, rales,
ronchi
## CV:
Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
## ABDOMEN:
soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
## EXT:
Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
## SKIN:
Vessicular lesions of the hands on an erythamatous base,
involving the back of the hands, most prominant on the knuckles
with extension of erythema up the forearms. Some erythematous
involvement of the right flank. No palmar involvement, with
spairing of oral mucosa. Appears similar to when initially
presented but decreased erythema
## # RASH:
Given his history of multiple drug reactions,we were
concerned that his rash may have represented a drug rash. We
held ciprofloxacin and bactrium and consulted dermatology.
Dermatology felt the skin eruption was not consistent with an
infectious etiology such as HSV or zoster. Viral cultures were
sent and are pending at time of discharge. Dermatology felt the
clinical morphology was most c/w dyshidrotic eczema, and the
itchiness described while on cipro could conceivably have been
the start of his skin eruption. The eruption on the right flank
seemed more c/w a follicular eczema. We recommended using
clobetasol 0.05% ointment to the hands BID. If not effective,
the patient was told to use occlusion (gloves over ointment).
Patient was told to avoid using the ointment for more than two
weeks and avoid using the ointment on the face, axillae and
groin. We anticipaited temporary exacerbation in the puritis
with discontinuation of prednisone PO. We arranged outpatient
dermatology follow up and have told the patient to have her
primary care physician make an allergy appointment.
## # URINARY RETENTION:
Likely due to a combination of factors
including prolonged foley use, prostatitis and BPH. He has
outpatient follow up with urology scheduled on . We
continued silodosin while in house and have advised the patient
to avoid benadryl as this can worsen urinary retenion.
## # PROSTATITIS:
He was been seen by the Group by
both Dr Dr . We have contacted Dr
Dr . Per report, there were no positive culture and
therefore no sensitivities pending. Dr we were safe
to discontinue antibiotics at this time. Since his antibiotic
use was complicating our differential for the etiology of his
rash, we elected to stop both ciprofloxacin and bactrim.
## # ELEVATED LIPASE AND AST:
We monitored while in the hospital
and they are likely due to antibiotic use. These trended
downward. We recommend outpatient follow-up to insure these
values normalized.
## # TRANSITION ISSUES:
Please follow up final viral culture data.
Please trend lipase and AST. Please have your primary care
physician arrange an appointment with an allergy specialist.
## MEDICATIONS ON ADMISSION:
- Rapaflo 8mg QD
- Cipro 500mg BID for 30 days (started , due to complete
the course on but discontinued on
- Bactrim BID (started on
## DISCHARGE MEDICATIONS:
1. silodosin 8 mg Capsule Sig: One (1) Capsule PO Daily ().
2. clobetasol 0.05 % Ointment Sig: One (1) Topical BID (2 times
a day).
3. fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
## DISCHARGE INSTRUCTIONS:
Mr ,
You were admitted to with a rash that is concerning for an
allergic reaction. We initially thought the rash may be due to
your antibiotics and it is likely that ciprofloxacin caused some
of your itching. We consulted dermatology and they felt the rash
was from eczema. We recommend that you continue to apply a
steroid ointment to your hands twice a day for no more than two
weeks. We have scheduled a follow up dermatology appointment
where they will recommend further management for your chronic
eczema. Regular application of over the counter moisturizer such
as eucerin, and avoidance of harsh soaps and detergents can help
prevent future occurences.
Since we were also concerned about possible reaction to
antibiotics, we spoke with your urologists Dr Dr
felt you did not need antibiotics at this point. All
your urine cultures have been negative for the past month. We
obtained viral cultures and performed a antigen test for herpes
and varicella. While it is unlikely the viral cultures will
demonstrate any infectious etiology, you will need your primary
care doctor to follow up these cultures as an outpatient. For
symptomatic treatment, dermatology recommends clobetasol 0.05%
ointment applied to the hands twice a day.
You continue to have urinary retention. We recommend avoiding
benadryl as this can exacerbate your urinary retention. We
recommend you take an over-the-counter antihistamine such as
Claritin or Allegra which can reduce your allergic reaction. You
have close follow up with your urologist on .
Medicaion Changes
STOP Ciprofloxacin
STOP Bactrim
START Clobetasol 0.05% ointment and apply to hands twice a day
START fexofenadine (allegra) 60mg PO twice Daily
It was a pleasure taking care of you during your hospital stay.
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14605988", "visit_id": "21006957", "time": "2136-08-22 00:00:00"} |
10229726-DS-5 | 1,903 | ## CHIEF COMPLAINT:
ALS, risk for respiratory decompensation
## HISTORY OF PRESENT ILLNESS:
is a pleasant year-old right-handed man with HTN
and
recent neurology admission ( ) for ALS confirmed
on
EMG/NCS, acetycholine receptor (binding and modulating) Ab
positive myasthenia now on Cellcept and Mestinon, and thymoma
with plan for future resection who is followed by Dr.
presents with worsening bulbar symptoms for five days with
further decline over the last two days.
Please see below for details of neurologic history and recent
admission to Neurology General service. Following discharge home
on , the patient felt that his dysphagia and
dysarthria
were 95% of baseline and felt that IVIG had been greatly
beneficial. He continued to have a sensation of throat closure
when lying flat and has been lying on his side; he was able to
sleep this way without difficulties.
He was seen by Dr. on . As an outpatient, his
Cellcept was increased from 500mg BID to BID following
discharge (not due to worsening symptoms, per patient); he
experienced nausea, so the dose was decreased to 750mg BID. He
was also started on Mestinon (currently on 30mg BID). He was
seen
by thoracic surgery on and a plan was made to pursue
thymectomy within weeks (operative date not yet confirmed).
Beginning on and worsening on and
again
on , he began to experience fatigue with chewing,
had
dysarthria with prolonged talking, and required two swallow
attempts before food would go down his esophagus. He denies
choking or gagging on his food. Because of the fatigue with
chewing, it took him an hour to eat a meal on evening. He
notes that his tongue gets tired, and he is unable to move the
food around in his mouth. He feels these symptoms are similar in
severity to those that prompted his first admission. Symptoms
are
worse at the end of the day. He feels his hand weakness and leg
weakness are unchanged since discharge; he has been taking short
walks. Also, since 1:00 today, he has noticed an increase in
twitching in his arms and legs bilaterally. He denies diplopia
or
facial droop. His dyspnea at rest is unchanged; he does have
some
mild dyspnea after walking up a flight of stairs which has
worsened over the same period. He was told by Dr.
the
phone to double his Mestinon dose this morning to 60mg, and he
felt better after this. Dr. him to come to the ED
for admission for plasmapheresis.
Per the discharge summary dated , he presented with
"approximately years of progressively worsening weakness as
well as ~4 weeks of "throat closure" sensation while lying
supine, 2 weeks of dysphagia (solids), and 1 week of dysarthria
that worsened at the end of the day or after prolonged speaking.
He underwent EMG/NCS which was consistent with motor neuron
disease (amyotrophic lateral sclerosis). His exam was also
notable for fatigable weakness, and he was subsequently found to
be acetylcholine receptor antibody positive which is consistent
with myasthenia. He underwent extensive work up which revealed
thymoma. Overall working diagnosis is that these two rare
diseases could be the result of a paraneoplastic process rather
than occurring independently although the paraneoplastic panel
is pending.
"He had CT torso, MRI chest,
thyroid US, and testicular US which only revealed anterior
mediastinal mass and slightly enlarged prostate. He also
underwent extensive laboratory evaluation for inflammatory,
infectious, and malignant processes. They were notable for
positive acetylcholine receptor antibody. Pending tests include
Syndrome panel, paraneoplastic panel from serum
and CSF, SPEP, and UPEP. His NIFs/VCs were trended and remained
in the normal range. PSA was normal. Skin evaluation did not
reveal any lesions at this time.
"He underwent biopsy of mediastinal mass with , and it
revealed
a thymoma. Thoracic surgery evaluated patient and will follow up
with him to schedule thymectomy.
"Because of his symptoms, we decided to initiate 5 days of IVIG
which he tolerated well. On day of discharge, in consultation
with Dr. initiated 500mg BID. He was seen by
, and they recommended outpatient . OT did not feel he had
any OT needs.
"Patient experiences significant respiratory distress while
lying
supine. As a result, he underwent repeat supine PFTs which did
show diaphragm weakness. Sleep medicine was consulted and agreed
with trial of BiPAP, but the patient did not tolerate this
despite different setting trials. We reviewed the risks of not
using BiPAP, and the patient was willing to accept those risks.
He may benefit from a sleep study as an outpatient. He was
counseled to use a pillow at night that can be placed behind him
while he sleeps on his side, and the patient trialed this in the
hospital.
"Patient notices difficulty with chewing
and swallowing. He had multiple bedside swallow evaluations, and
he was initially started on soft solids and thin liquids; they
ultimately felt that he was safe to continue to take regular
solids and thin liquids by mouth.
"Troponin from
0.03 to 0.05 then to 0.04 of unclear significance. He had echo
that was unremarkable and pharmacologic stress test that was
negative. Cardiology recommended starting atorvastatin as an
outpatient." They ultimately did not feel that aspirin was
indicated.
On neuro ROS, he denies headache, loss of vision, blurred
vision,
diplopia, lightheadedness, vertigo, tinnitus or hearing
difficulty. Denies difficulties comprehending
speech. Denies focal numbness or parasthesiae. No bowel or
bladder incontinence or retention.
The pt denies
recent fever or chills. No night sweats or recent weight loss
or
gain. Denies cough, shortness of breath. Denies chest pain or
tightness, palpitations. Denies nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denies arthralgias or myalgias.
Denies rash.
## PAST MEDICAL HISTORY:
- ALS diagnosed based on EMG/NCS
- Myasthenia
- Thymoma confirmed on biopsy (not yet resected)
- HTN
## HEENT:
NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
## PULMONARY:
breathing comfortably on RA, counts to 30 on
exhalation
## SKIN:
no rashes or lesions noted.
## MS:
Alert, oriented x 3. Able to relate history
without difficulty. Language is fluent with intact
comprehension. Normal prosody. There were no paraphasic errors.
Speech was dysarthric, most pronounced with lingual sounds. No
dyarthria noted. Able to follow both midline and appendicular
commands.
## CN:
Pupils 4-->2, VFF, EOMI, 2 beats of horizontal nystagmus on
rightward gaze, 1 beat on leftward gaze. No ptosis, including
with sustained upgaze. No diplopia. Negative Cogan's lid twitch.
Facial sensation V1-3 intact. No bifacial weakness. Hearing
grossly intact. No dysarthria noted. Palate/uvula/tongue
midline.
Trapezius .
## MOTOR:
Atrophy of thenar and hypothenar eminences bilaterally,
atrophy bilaterally. Right TA atrophy. Tone normal.
Fasciculations in hypothenar eminence on left. No tongue
fasciculations. Neck flexion , Extension . Full strength
in
b/l
deltoids, biceps, triceps, ECR (on the right has a
baseline Dupuytren's contracture where FEx have limited range of
motion but ultimately 4+/5 and symmetric, on left). Right
deltoid after 30 pumps. IOs 4+ right, 4 left.
R IP , L 4+/5. Quads right , left . R Hamstring
and L . R TA , R , L TA 4+/5, L
4+/5. left , right 4+/5. R toe extensors 2, toe
flexores 4-. L toe extensors 4+, flexors 4+.
## SENSORY:
LT symmetric in all four extremities. Sensation
decreased to temperature in RLE distal to mid calf, medial
sensory loss>lateral. Also PP loss circumferentially near
malleoli 20% of normal with preserved sensation distally and
proximally.
## -DTRS:
R triceps brisk, L biceps brisk, otherwise 2 except 1 at
left Achilles, absent at right Achilles. L toe equivocal, R
downgoing.
## COORDINATION:
No dysmetria on FNF and HKS.
## GAIT:
steppage gait with lifting of RLE
===========================================
## HEENT:
NC/AT, no scleral icterus noted, MMM
## PULMONARY:
breathing comfortably, no tachypnea or increased
WOB;
able to count to 48 in one breath
## -MENTAL STATUS:
Alert, oriented x3. His language is fluent with
intact comprehension. He is able to follow both midline and
appendicular commands.
## -CRANIAL NERVES:
4->2 mm b/l No ptosis. EOMI. Face is symmetric
at rest and with activation, intact to light touch. Examiner is
able to overcome his eye closure, cheek puff and mouth closure.
Hearing intact to finger rub. strength in SCM and trapezii
bilaterally.
## -MOTOR:
Head flexion and extension full.
Delt Bic Tri WrE FFl FE IO IP Quad Ham TA
L 5 5 4+ 4 5 5 5- 5 3 5
R 5 5 4+ 4 5 5 1 5 2 5
no asterixis
Fatiguability on repeated deltoid testing.
## -SENSORY:
Intact to light touch throughout. Pinprick: intact in
arms proximally and distally. Becomes less sharp at mid calf on
L leg. Intact on R leg. some hyperesthesia on R foot. No sensory
level over back.
proprioception: intact to large amplitude movements at the toes
bilaterally
## -COORDINATION:
no rebound. FNF intact, no dysmetria.
finger tapping intact.
## CXR :
Successful placement of a 23cm tip-to-cuff length tunneled
pheresis catheter. The tip of the catheter terminates in the
right atrium. The catheter is ready for use.
## BRIEF HOSPITAL COURSE:
Mr. is a year old right-handed man with past medical
history notable for amyotrophic lateral sclerosis, AChR
antibody-positive myasthenia , thymoma, and HTN admitted
with five days of fatigable chewing and dysarthria, most
consistent with flare of myasthenia . His exam was notable
for mild fatiguable deltoid weakness, no ptosis, no diplopia or
cranial nerve abnormalities. The dysarthria resolved by the time
of discharge. A tunneled line was placed and he received 1 dose
of PLEX on . Afterwards, he experience mild hypotension and
nausea and which self resolved. Given stability of symptoms, he
was planned for receiving the rest of his PLEX sessions as an
outpatient, next . Cellcept was increased to 1000mg BID and
Lisinopril was held while getting PLEX. All other home meds were
unchanged.
Transitional issues:
- hold Lisinopril while getting PLEX
- increase Cellcept to 1000mg BID
- next PLEX session
- follow-up with Dr. as outpatient
## MEDICATIONS ON ADMISSION:
The Preadmission Medication list is accurate and complete.
1. Mycophenolate Mofetil 750 mg PO BID
2. Gabapentin 300 mg PO QHS
3. Lisinopril 20 mg PO DAILY
4. Pyridostigmine Bromide 30 mg PO BID
## DISCHARGE MEDICATIONS:
1. Mycophenolate Mofetil 1000 mg PO BID
RX *mycophenolate mofetil 500 mg 2 tablet(s) by mouth twice a
day Disp #*120 Tablet Refills:*1
2. Gabapentin 300 mg PO QHS
3. Pyridostigmine Bromide 30 mg PO BID
4. HELD- Lisinopril 20 mg PO DAILY This medication was held. Do
not restart Lisinopril until you talk with your PCP.
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
You were admitted to with difficulty chewing and slurred
speech concerning for myasthenia flare. Your Cellcept was
increased to 1000mg twice a day. You had a tunneled line placed
to initiate PLEX (plasma exchange). You had your first session
on and will continue PLEX as an outpatient, with 2nd dose
planned for tomorrow. You will complete 5 sessions as an
outpatient. Because you had nausea and low blood pressure
following your first session, you will be monitored after the
sessions to ensure you tolerate it well.
Please continue your home medications as you have been taking
them, except for Lisinopril which we are holding until you are
done with PLEX to prevent further lowering your blood pressure.
Follow-up with Dr. in clinic. We will arrange for an
appointment. If you do not hear about an appointment in the next
week, please call her office at .
It was a pleasure taking care of you,
Your Neurologists
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "10229726", "visit_id": "20431767", "time": "2128-08-22 00:00:00"} |
14185672-RR-72 | 395 | ## INDICATION OF EXAM:
This is a man with AML who needs a double-
lumen tunneled catheter. The patient is status post left subclavian vein
tunneled catheter placement by surgery, this catheter is not working properly.
## RADIOLOGISTS:
The procedure was performed Drs. the
attending radiologist, who was present and supervising throughout the
procedure.
## PROCEDURE AND FINDINGS:
After informed consent was obtained from the patient
explaining the risks and benefits of the procedure, the patient was placed
supine on the angiographic table and the right neck was prepped and draped in
standard sterile fashion. Using ultrasonographic guidance and after injection
of 2% lidocaine, the right internal jugular vein was accessed with a 21- gauge
needle and a 0.018 guidewire was placed. The needle was then exchanged for a
4.5 micropuncture sheath. Hard copies of the ultrasonographic images
before and after the venipuncture were obtained. Attention was then directed
to the construction of the tunnel, which was performed using blunt dissection
and 10 cc of injection of 1% lidocaine into the subcutaneous tissue. A
scalpel was used to do an insertion site in the chest and the line was
tunneled in the tunnel. The neck incision was progressively dilated with 8
and 10 dilators and a 10 peel-away sheath was placed, over a
0.035 Amplatz wire that was placed with tip in the inferior vena. The wire
and the inner dilator were removed and the line was advanced through the peel-
away sheath all the way into the SVC. The peel-away sheath was removed. The
line was flushed and heplocked and sutured to the skin with 0 silk sutures. A
dressing was applied. The subclavian line was then removed using sterile
technique and manual compression was held for 5 minutes until hemostasis was
achieved. A final fluoroscopic image of the chest demonstrates the tip of the
catheter to be located in the distal part of the SVC. Moderate sedation was
provided by administration of divided doses of 75 mcg of fentanyl and 1 mg of
Versed throughout the total intraservice time of 45 minutes during which the
patient's hemodynamic parameters were continuously monitored.
## IMPRESSION:
1. Successful placement of a 10 double-lumen Hickman tunneled central
catheter with tip of the catheter to be located in the distal SVC.
2. Successful removal of a left tunneled subclavian catheter with sterile
technique.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14185672", "visit_id": "N/A", "time": "2136-08-21 07:26:00"} |
13283077-RR-6 | 271 | ## EXAMINATION:
MR KNEE W/O CONTRAST RIGHT
## INDICATION:
year old man with right knee pain and swelling s/p basketball
injury; +mcmurrays// eval for internal derangement, particularly lateral
meniscal tear
## MEDIAL MENISCUS:
Slight longitudinally oriented increased signal at the
periphery of the posterior horn of the medial meniscus may represent
meniscocapsular separation (image 5:9) versus normal variant. Slight
increased signal of the posterior root of the medial meniscus may represent
contusion though no definite tear is identified.
Lateral meniscus: Slight longitudinally oriented increased signal at the
periphery of the posterior horn of the lateral meniscus may represent
meniscocapsular separation (image 5:19) versus normal variant.
## ANTERIOR CRUCIATE LIGAMENT:
Complete tear of the mid substance/distal ACL.
Posterior cruciate ligament: Normal
## MEDIAL COLLATERAL LIGAMENT:
Grade 1 sprain.
Lateral collateral ligamentous complex: Normal
## CYST:
None.
Joint effusion: Moderate. Mild synovitis.
## PATELLOFEMORAL ARTICULAR CARTILAGE:
Normal
Medial articular cartilage: Small area of superficial fissuring of the central
weight-bearing portion of the medial femoral condyle (image 6:21). Tibial
plateau cartilage appears normal.
Lateral compartment cartilage: Normal
## MARROW:
Kissing contusions of the lateral femoral condyle and
posterior-lateral tibial plateau. Mild contusion of the posterior medial
tibial plateau and medial aspect of the medial femoral condyle.
## ADDITIONAL FINDINGS:
None.
## IMPRESSION:
Complete ACL tear.
Slight longitudinally oriented increased signal at the periphery of the
posterior horn of the medial and lateral menisci may represent meniscocapsular
separation versus normal variant.
Kissing contusions of the lateral femoral condyle and posterior-lateral tibial
plateau. Mild contusion of the posterior medial tibial plateau and medial
aspect of the medial femoral condyle.
Grade 1 sprain of the MCL.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13283077", "visit_id": "N/A", "time": "2134-05-09 08:32:00"} |
14448385-RR-151 | 84 | ## HISTORY:
with pain with ambulation, dementia, unsure if
fell.//fracture?
## FINDINGS:
No acute fracture or dislocation is present. A small joint effusion is noted.
Moderate tricompartmental degenerative changes are most pronounced involving
the medial and patellofemoral compartments with joint space narrowing,
subchondral sclerosis, and osteophyte formation. Vascular calcifications are
noted with a clip along the medial posterior aspect of the knee. No
concerning lytic or sclerotic osseous abnormalities are detected.
## IMPRESSION:
No acute fracture or dislocation. Moderate tricompartmental degenerative
changes, progressed from .
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14448385", "visit_id": "21664826", "time": "2183-11-09 20:31:00"} |
16009733-RR-23 | 121 | ## HISTORY:
with 1 week painless scrotal swelling and
intractable hiccups// Presence of hydrocele or other cause for profound right
sided swelling?
## THE RIGHT TESTICLE MEASURES:
4.1 x 3.3 x 3.9 cm.
The left testicle measures: 4.1 x 2.0 x 2.9 cm.
The right testicle is enlarged and hypervascular relative to the left. The
right epididymis also appears heterogeneously enlarged as well as
hypervascular. There is small amount of fluid with numerous septations around
the right testicle, that may represent a pyocele. The left testicle is normal
in echogenicity without focal abnormalities. The left epididymis is
unremarkable.
## IMPRESSION:
1. Right epididymo-orchitis.
2. Fluid surrounding the right testicle with numerous septations may represent
pyocele.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16009733", "visit_id": "N/A", "time": "2133-04-18 18:05:00"} |
13526610-RR-157 | 229 | ## CLINICAL INFORMATION:
woman with coiled aneurysm. Please
evaluate for recanalization.
## MRI HEAD:
A 9 x 9 x 9 mm pineal cyst is unchanged allowing for differences in
technique. Scattered periventricular, subcortical, and deep white matter
areas of FLAIR signal hyperintensity are nonspecific, reflect sequela of
chronic small vessel disease. The ventricles, sulci, subarachnoid spaces are
normal in size and configuration. There is no evidence of acute ischemia or
hemorrhage. There is fluid signal within the right mastoid air cells, to a
lesser extent in the left mastoid, which has increased from the prior. There
is slight mucosal thickening in the right maxillary sinus. Remaining
visualized paranasal sinuses and the orbits are unremarkable.
## MRA FINDINGS:
Susceptibility artifact in the region of the left carotid
terminus previously coiled aneurysm is again seen, but unchanged punctate foci
of signal hyperintensity at the base of the coil pack on the pre-contrast
images, but without definite enhancement on the post-contrast images to
suggest recanalization or flow. Appearance is unchanged from the prior
examination. There is no new aneurysm. The major intracranial vessels are
otherwise normal without occlusion, stenosis, or aneurysm.
## IMPRESSION:
1. Unchanged appearance of the previously coiled left carotid terminus
aneurysm.
2. Unchanged pineal cyst.
3. Mastoid fluid bilaterally, increased from the prior.
4. White matter signal hyperintensity is nonspecific and may reflect sequela
of chronic small vessel disease.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13526610", "visit_id": "N/A", "time": "2156-05-27 10:41:00"} |
14189160-RR-20 | 580 | ## INDICATION:
with hx paroxysmal afib/flutter, rheumatic
valvulardisease/mitral stenosis s/p valvuloplasty in , s/p VVIPPM (unclear
indication), HFpEF, possible amiodarone pulmonary toxicity,
syndrome who presented for increased weakness.// eval with
high res CT to look for evidence of amiodarone toxicity, organizing pna
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.3 s, 30.1 cm; CTDIvol = 8.0 mGy (Body) DLP = 240.3
mGy-cm.
2) Spiral Acquisition 5.3 s, 69.7 cm; CTDIvol = 8.8 mGy (Body) DLP = 613.4
mGy-cm.
3) Spiral Acquisition 2.3 s, 30.1 cm; CTDIvol = 8.1 mGy (Body) DLP = 242.8
mGy-cm.
4) Spiral Acquisition 2.1 s, 33.7 cm; CTDIvol = 3.9 mGy (Body) DLP = 130.9
mGy-cm.
5) Spiral Acquisition 1.8 s, 28.1 cm; CTDIvol = 3.6 mGy (Body) DLP = 100.8
mGy-cm.
6) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 3.3 mGy (Body) DLP = 1.7
mGy-cm.
7) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 16.7 mGy (Body) DLP = 8.3
mGy-cm.
Total DLP (Body) = 1,338 mGy-cm.
** Note: This radiation dose report was copied from CLIP (CT ABD AND
PELVIS WITH CONTRAST)
## CHEST PERIMETER:
No thyroid thyroid findings need any further imaging
evaluation. Supraclavicular and axillary lymph nodes are not enlarged.
Breast evaluation is reserved exclusively for mammography. No soft tissue
abnormalities elsewhere in the chest wall.
Findings below the diaphragm will be reported separately.
## CARDIO-MEDIASTINUM:
Above a large hiatus hernia is only moderate distension an
air-filled esophagus. No fluid retention to suggest obstruction.
Atherosclerotic calcification is moderate in head and neck vessels, scattered
in the coronary arteries, and severe in the lower thoracic aorta which also
contains large noncalcified plaque or mural thrombus.
Cardiomegaly, predominantly biatrial would require echocardiography for
assessment. Right ventricular transvenous pacer lead in place.
Pericardium is physiologic.
## THORACIC LYMPH NODES:
No lymph nodes in the chest are pathologically enlarged.
## LUNGS, AIRWAYS, PLEURAE:
The severity on the right of a moderately severe non
fibrosing interstitial abnormality in the upper lungs is exaggerated by
displacement and moderate to severe basal atelectasis, due to the moderate to
large layering, nonhemorrhagic right pleural effusion. The upper lobe
predominance and a small conglomerate opacity on the right, 304:47 raise
possibility of end-stage sarcoidosis, but a diagnostic alternative, amiodarone
lung injury alone or in addition to pre-existing lung disease is certainly
possible.
Mild pulmonary edema is also present. Very small left pleural effusion layers
posteriorly. Continuous right posterior costal pleural thickening enhances
slightly, 304:158-168 and 130-140, indicates either pleural reaction or in the
setting of malignancy, tumor deposits.
Moderate left basal atelectasis is attributable to the intrathoracic stomach.
Expiratory view show moderate widespread air-trapping and exaggerated anterior
displacement of the posterior walls of the trachea and main bronchi, strongly
indicative of tracheobronchomalacia. L
## IMPRESSION:
Non fibrosing interstitial lung disease, upper lobe predominant, chronicity
indeterminate, could be due to amiodarone toxicity. Prior imaging should be
obtained to see whether some some or all of this finding predates amiodarone
use.
Mild pulmonary edema. Moderate to large right pleural effusion. Severe
cardiomegaly, particularly involving the atria.
Severe atherosclerotic plaque, normal caliber descending thoracic aorta; mild
calcified coronary artery plaque.
Tracheobronchomalacia at least moderate in severity, perhaps severe. Clinical
assessment recommended.
Pleural thickening associated with moderate right pleural effusion could be
due to chronicity, but thoracentesis is recommended to exclude malignancy.
Large hiatus hernia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14189160", "visit_id": "25014686", "time": "2167-08-08 20:56:00"} |
17943302-RR-25 | 115 | ## EXAMINATION:
L-SPINE (AP AND LAT) IN O.R.
## FINDINGS:
There has been interval laminectomy spanning L3-L5 with placement of bilateral
pedicle screws without evidence of hardware complication. 5 lumbar vertebra
are visualized on the lateral projection. The bones are demineralized.
Vertebral body heights are grossly maintained without evidence for compression
fracture. There is mild multilevel intervertebral disk space narrowing most
pronounced at L5-S1. There is mild retrolisthesis of L2 on L3 with mild
anterolisthesis of L4 on L5 stable from the prior exam.
## IMPRESSION:
Interval laminectomies spanning L3-L5. Stable mild retrolisthesis of L2 on L3
and anterolisthesis of L4 on L5. Please see the operative report for further
details.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17943302", "visit_id": "20328583", "time": "2180-03-16 17:53:00"} |
18709486-RR-9 | 414 | ## STUDY:
CT chest, abdomen and pelvis with contrast and reconstructions.
## INDICATION:
Fall down 13 stairs with loss of consciousness.
## CT CHEST WITH CONTRAST:
The thyroid gland is grossly unremarkable. No
intimal flap is detected to suggest aortic dissection. There is calcified
atherosclerotic plaque throughout the thoracic aorta and branch vessels. No
filling defects are present within the pulmonary arteries to suggest
dissection, however this study was not performed to evaluate for this finding.
No axillary, mediastinal, or hilar adenopathy is detected. There is mild
bibasilar atelectasis, however no focal airspace consolidation is detected. A
focal partially calcified soft tissue nodule is noted within the left lung
apex. There is an azygos fissure and the azygos vein takes an intrapulmonary
course. Minimal subpleural blebs are noted apically. No soft tissue
abnormality is detected.
## CT ABDOMEN WITH CONTRAST:
There is both intra- and extra-hepatic biliary
ductal dilatation which is new since comparison of MRI. There is a focus
of calcification at the region of the ampulla which may represent a calculus
at the level of the ampulla. The pancreas demonstrates numerous
calcifications and ductal dilatation consistent with known chronic
pancreatitis. There is a cyst within the spleen at the superior most aspect
measuring 2.6 cm in greatest dimension. The adrenal glands and large and
small bowel loops within the abdomen are unremarkable. No free fluid or free
air is present within the abdomen. There is dense atherosclerotic plaque in
the abdominal aorta and iliac branches. The kidneys enhance and secrete
symmetrically.
## CT PELVIS WITH CONTRAST:
There is a Foley catheter within an unremarkable
bladder. The prostate gland, rectum, sigmoid colon and small bowel loops in
the pelvis are unremarkable. There is no free air or free fluid present
within the pelvis.
## OSSEOUS STRUCTURES:
There is an acute fracture of a right posterior T8 rib.
No other fractures or dislocations are detected. There is high density
material within the T7-T8 intervertebral body disc space.
## IMPRESSION:
1. Partially calcified soft tissue nodule in the left lung apex concerning
for carcinoma. Please correlate with outside hospital studies if available.
Findings emailed to the ED QA nurse at 9:32am .
2. Subacute fracture of the right posterior T8 rib.
3. New intra- and extra-hepatic biliary ductal dilatation with suggestion of
an 8 mm stone at the region of the ampulla. An MRCP may be obtained for
further evaluation of this finding.
4. Evidence of chronic pancreatitis.
5. Several subpleural blebs in the lung apices.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18709486", "visit_id": "N/A", "time": "2159-10-31 23:07:00"} |
13197290-RR-32 | 513 | ## INDICATION:
Status post fall two days ago. Increasing left hip and back
pain, dizziness, and vomiting with bruising on chest and abdominal tenderness.
## CT CHEST WITH CONTRAST:
There is no mediastinal, axillary, or hilar lymphadenopathy identified. The
main airways are patent bilaterally. The lungs are clear, without diffuse
opacity. There is a 3-mm lung nodule in the right middle lobe (2:29). There
is bilateral dependent atelectasis. The heart chambers are normal in size and
there is no pericardial effusion. There are coronary arterial atherosclerotic
calcifications and a stent. Atherosclerotic calcifications can be seen along
the entire course of the thoracic and abdominal aorta as well. There is no
pleural effusion.
## CT ABDOMEN WITH CONTRAST:
The liver, gallbladder, adrenals and spleen appear normal. There is diffuse
interdigitation of fat within the pancreatic parenchyma, making visualization
difficult. There is a 1.4-cm hypodensity at the expected location of the
distal common bile duct, which may represent distal biliary ductal dilation.
However, a cystic structure in the head of the pancreas cannot be excluded.
The portal and splenic veins are widely patent. The kidneys enhance normally
and excrete contrast symmetrically. There is a small hiatal hernia. The
stomach, duodenum, and intra-abdominal loops of bowel are unremarkable. There
is no ascites or free air within the abdomen. There are extensive
atherosclerotic calcified plaques throughout the abdominal aorta, however, the
main branches are patent, and there is no aneurysmal dilation or dissection.
There is no retroperitoneal or mesenteric lymphadenopathy. There is no
evidence of traumatic injury to the abdominal viscera. There is a small
fat-containing umbilical hernia.
## CT PELVIS WITH CONTRAST:
There is diverticulosis without evidence of diverticulitis. The pelvic loops
of large and small bowel are otherwise unremarkable. Bladder, uterus and
rectum are normal. There is no pelvic or inguinal lymphadenopathy. There is
no pelvic free fluid.
## BONE WINDOWS:
No acute fracture, dislocation, or spinal malalignment is seen. There is
levoscoliosis of the lumbar spine. There are multilevel degenerative changes
of the lumbar spine without evidence of compression fracture. Posterior
disc-osteophyte complexes cause moderate spinal canal stenosis, most markedly
from L2-L4 and T12-L1. There are no lytic or sclerotic lesions concerning for
malignancy.
## IMPRESSION:
1. No evidence of acute traumatic injury to the chest, abdomen, or pelvis.
2. A 3-mm lung nodule in the right middle lobe requires no further followup,
if the patient has low risk for malignancy. If the patient has known risk
factors, a followup CT in 12 months would be recommended if clinically
appropriate given the patient's advanced age.
3. 1.4-cm hypodensity at the expected location of the distal common bile
duct. This may represent a dilated distal common bile duct, however, a cystic
structure in the head of the pancreas cannot be excluded. Further evaluation
with MRCP can be performed for further evaluation, if clinically appropriate
given patient age.
4. Diverticulosis without diverticulitis.
5. Diffuse atherosclerotic disease.
6. Small hiatal hernia.
## NOTE:
Recommendations for suggested follow-up were communicated to Dr.
by Dr. telephone on at 12:38.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13197290", "visit_id": "21138656", "time": "2190-02-14 14:08:00"} |
12756084-RR-87 | 204 | ## INDICATION:
year old woman with hepatic insufficiency s/p extended liver
resection, intubated and sedated in ICU.// ICU CXR
## FINDINGS:
Endotracheal tube terminates approximately 5.5 cm from the carina sounds
similar to prior. A NG tube traverses the diaphragm and stomach is beyond the
inferior margin of the film. A left PICC line is more proximal terminating in
the mid SVC, whereas prior it was in the right atrium. A right Port-A-Cath
tip terminates in lower SVC, similar prior. Right upper quadrant clips likely
representing cholecystectomy clips are again visualized.
Lung are well expanded. There is probably upper lobe emphysema as
demonstrated on prior CT. There is similar degree of mild pulmonary edema.
Retrocardiac opacity may represent atelectasis or pneumonia. Curvilinear
opacities projecting over the medial right lower lung likely represents
atypical atelectasis or pleural fluid along the inferior pulmonary ligament.
The cardiomediastinal silhouette is normal. The hilar contours are normal.
A moderate right pleural effusion persists. There is residual trace left
pleural effusion. No appreciable pneumothorax.
## IMPRESSION:
Similar mild pulmonary edema. Similar moderate right pleural effusion.
Curvilinear right lung opacities may represent atelectasis or fluid along the
inferior pulmonary ligament.
Increased retrocardiac opacity may represent atelectasis or pneumonia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12756084", "visit_id": "26456833", "time": "2129-07-15 04:41:00"} |
18602138-DS-13 | 137 | ## ALLERGIES:
NSAIDS (Non-Steroidal Anti-Inflammatory Drug) / Nortriptyline /
Enalaprilat / aspirin
## CHIEF COMPLAINT:
ENTERED IN ERROR. NEEDS TO BE FORWARDED TO INTERN WHO TOOK CARE
OF IN .
## BRIEF HOSPITAL COURSE:
X
## PRIMARY:
Syncopal episode likely secondary to intravascular
volume loss from diarrhoea or arrhythmia
## DISCHARGE INSTRUCTIONS:
Dear Mr. ,
It was a pleasure having you here at the
. You were admitted here after you had an episode
of feeling dizzy and losing consciousness for a few seconds. We
believe this maybe a combination of losing large amounts of
water from taking laxatives and diarrhoea or having a fast
irregular heart beat. This is why you will have a monitor
fitted to you tomorrow for 24 hours to see if you have any
irregular heart rhythms. Please keep your appointments below.
Please also avoid any caffeine and alcohol
| mimic | {"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18602138", "visit_id": "28377383", "time": "2163-05-25 00:00:00"} |
11226572-RR-71 | 90 | ## INDICATION:
woman with pulmonary sarcoidosis, now with
pancreatitis.
Comparison is made to the CT of the abdomen and pelvis performed on .
## BONE WINDOWS:
No concerning lytic or sclerotic lesions are identified.
## IMPRESSION:
1. Normal pancreas with no evidence of pancreatitis.
2. 5-mm non-obstructing stone of the interpolar region of the left kidney.
3. Unchanged multiple exophytic fibroids unchanged since . The last
pelvic ultrasound has been performed in . For further evaluation of the
fibroid uterus and adnexa, pelvic ultrasound could be obtained. 4. Fat-
containing umbilical hernia.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11226572", "visit_id": "24073410", "time": "2164-01-26 11:44:00"} |
12637511-RR-43 | 123 | ## INDICATION:
year old man with DMII, p/w STEMI s/p PCI, now remains w/ n/v
attributed to viral gastro, Creatining worsening rapidly of unclear etiology//
eval for hydronephrosis, e/o obstruction
## FINDINGS:
There is no hydronephrosis, stones, or masses bilaterally. Normal cortical
echogenicity. Mild decreased corticomedullary differentiation are seen
bilaterally, suggesting medical renal disease. In the upper pole of the right
kidney is a well-circumscribed anechoic lesion which likely represents a renal
cyst measuring 1.4 x 1.2 x 1.2 cm.
Right kidney: 12.4 cm
Left kidney: 13.5 cm
The bladder is moderately well distended and normal in appearance.
## IMPRESSION:
Bilateral, decreased corticomedullary differentiation suggests medical renal
disease. No evidence of urinary tract obstruction.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12637511", "visit_id": "27315786", "time": "2135-05-26 10:43:00"} |
19509298-RR-103 | 131 | ## INDICATION:
A man with fever and cough, evaluate for pneumonia.
## FINDINGS:
There is leftward rotation of the patient current radiograph. Tracheostomy
tube is again seen in grossly appropriate position. Allowing for differences
in technique, the cardiomediastinal silhouettes are stable. There are low
lung volumes and a sub-optimal inspiratory effort. Right lower lung and
retrocardiac opacities likely represent basilar atelectasis, however,
pneumonia cannot be excluded in the correct clinical setting. Small bilateral
pleural effusions are likely still present. Central hilar prominence may
represent mild pulmonary vascular congestion without evidence of frank
pulmonary edema. There is no pneumothorax.
## IMPRESSION:
1. Probable bibasilar atelectasis and small bilateral pleural effusions,
however, left lower lobe pneumonia cannot be excluded in the correct clinical
setting.
2. Mild pulmonary vascular congestion without frank pulmonary edema.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19509298", "visit_id": "27971630", "time": "2194-11-29 14:46:00"} |
19154640-RR-67 | 100 | ## INDICATION:
year old man with gram neg rods in sputum culture// eval for
pneumonia
## IMPRESSION:
In comparison with the study of , there again are low lung volumes
with enlargement of the cardiac silhouette and mild elevation of pulmonary
venous pressure. Minimal if any atelectatic changes.
No convincing evidence of acute focal pneumonia.
Tracheostomy tube remains in place. Nasogastric tube extends to the upper
stomach, though the side port appears to be close to the esophagogastric
junction. For more optimal positioning, the tube should be pushed forward
about 5-8 cm.
Apparent ventriculoperitoneal shunt projects over the right hemithorax.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19154640", "visit_id": "20196064", "time": "2147-02-03 08:08:00"} |
10225793-RR-163 | 237 | ## EXAMINATION:
LIVER OR GALLBLADDER US (SINGLE ORGAN)
## HISTORY:
with cirrhosis s/p TIPS, confusion and abdominal
pain// cirrhosis s/p TIPS, evaluate for PVT or other cause of pain
## FINDINGS:
The liver appears diffusely coarsened and nodular consistent with known
cirrhosis. No focal liver lesions are identified. Specifically, the
previously described suspicious lesion in segment 8 on MRI is not well seen
the current ultrasound.
There is no ascites.
There is stable splenomegaly, with the spleen measuring 13.9 cm.
There is no intrahepatic biliary dilation. The CHD measures 9 mm.
There is no evidence of stones or gallbladder wall thickening.
The main portal vein is patent with hepatopetal flow.
The TIPS is patent and demonstrates wall-to-wall flow.
Portal vein and intra-TIPS velocities are as follows:
Main portal vein: 67 cm/sec, previously 68.4 cm/sec
## DISTAL TIPS:
149 cm/sec, previously 149 cm/sec
Flow within the left portal vein is towards the TIPS shunt. Flow within the
right anterior portal vein is towards the TIPS. Appropriate flow is seen in
the hepatic veins and IVC.
## 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 demonstrate no hydronephrosis.
## RETROPERITONEUM:
Visualized portions of aorta and IVC are within normal
limits.
## IMPRESSION:
Patent TIPS and portal veins.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10225793", "visit_id": "27427087", "time": "2134-07-27 18:54:00"} |
12063542-RR-19 | 111 | ## INDICATION:
Open heart surgery and lost needle.
Comparison is made to the prior study of .
## FINDINGS:
Single intraoperative radiograph of the chest is obtained without
the presence of a radiologist. The part of left hemithorax has been excluded
from the radiograph. No radiopaque foreign body is projecting in the thorax
to suggest the lost instrument. The overlying wires and tubes significantly
limit the evaluation. The Swan-Ganz catheter tip projects in the right
ventricular outflow tract. Endotracheal tube projects approximately 6 cm
above the carina. Bilateral chest tubes are in place. No pneumothorax is
detected.
## IMPRESSION:
Limited study but no definite evidence of radiopaque foreign body
in the thorax.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12063542", "visit_id": "20091520", "time": "2170-04-01 13:02:00"} |
11897016-DS-19 | 1,195 | ## ALLERGIES:
Penicillins / Pentasa / Actonel / NSAIDS (Non-Steroidal
Anti-Inflammatory Drug)
## MAJOR SURGICAL OR INVASIVE PROCEDURE:
exploratory laparotomy
extensive lysis of adhesions
bilateral salpingo-oophorectomy
total abdominal hysterectomy
## HISTORY OF PRESENT ILLNESS:
year old G3P3 with history of dysfunctional uterine bleeding
presents for consultation regarding bilateral adnexal masses
which were found on pelvic US.
Patient underwent a pelvic US on which demonstrated
bilateral complex avascular lesions without visualization of
normal ovaries. Possible dilated fallopian tubes with debris and
thickened mural nodularity.
Patient reports being in her usual state of health. She denies
any fever, chills, nausea, vomiting, abdominal bloating, vaginal
discharge. She at baseline has occasinal pelvic "twinges" since
her proctocolectomy.
## OBSTETRIC HISTORY:
SVD, 7#4
SVD, 9#4
SVD, 8#3 complicated by post partum hemorrhage
## GYNECOLOGIC HISTORY:
LMP
menses Q21-28 days though history of missed menses x 3 months
Dysfunctional uterine bleeding
Endometrial Biopsy-> proliferative endometrium
LSIL + HPV s/p colpo with cervical biopsies
Sexually active without any contraception currently
## PAST MEDICAL HISTORY:
- Ulcerative Colitis
- Osteoporosis
- HTN
## PAST SURGICAL HISTORY:
- Proctocolectomy with J pouch
- Ileostomy Takedown
- Appendectomy
## FAMILY HISTORY:
Paternal cousin with history of ovarian cancer diagnosed in
or . Maternal aunt diagnosed with endometrial cancer in her
. Paternal and maernal uncles and cousins with colon cancer.
Father with throat and skin cancer. Mother with HTN and heart
condition. Daughter with heart condition. No history of breast,
cervical or vaginal cancer.
## PHYSICAL EXAM:
on discharge:
afebrile, vital signs stable
## ABD:
normoactive bowel sounds, soft, nondistended, appropriate
tenderness to palpation, no rebound or guarding, staples removed
and incision was clear, dry and intact with no evidence of
surrounding erythema.
## FINDINGS:
Two upright and a single supine frontal view of the
abdomen demonstrate multiple dilated loops of small bowel and
air-fluid levels with a dilated loop of right colon consistent
with ileus. A small amount of free air is present beneath the
right hemidiaphragm on upright films consistent with recent
abdominal surgery. Midline cutaneous surgical staples extend
from the mid-to-lower abdomen. The visualized lung bases and
heart are unremarkable. The osseous structures are within normal
limits.
## IMPRESSION:
Findings consistent with postoperative ileus. Free
air beneath
the right hemidiaphragm is related to recent abdominal surgery.
## BRIEF HOSPITAL COURSE:
Ms. is a G3P2 woman who was admitted to the
gynecologic oncology service on after undergoing
exploratory laparotomy, extensive lysis of adhesions, bilateral
salpingo-oophorectomy, and total abdominal hysterectomy for
bilateral adnexal masses. There were dense adhesions throughout
the lower abdomen and pelvis. Intraoperative frozen section of
the larger right adnexal mass was consistent with benign cysts
with a small solid component, and the left adnexal masses was a
benign hemorrhagic cyst with a paratubal cyst. Please refer to
Dr. report for details of the operation.
Pre-op HCT was 36.7, EBL was 400, and her HCT was 34.7 in the
PACU. She received a TAP Block in the PACU for pain control and
was started on a dilaudid PCA. She was later transitioned to
intravenous pain medications.
On post operative day 1, her urine output was adequate, so her
foley was removed and she voided spontaneously with good urine
output. On post-operative day 4, her urine output dropped a
little because she was made NPO for concern for ileus. She
received a 500cc bolus of fluids with subsequent improvement in
her urine output.
Given the extensive lysis of adhesions involving the bowel, her
diet was advanced conservatively. She was kept NPO the night
after her operation. She was then advanced to sips on
post-operative day 1 and clears on post-operative day 2. She had
return of bowel function starting post-operative day 2, so she
was advanced to a regular diet and oral oxycodone and tylenol on
post-operative day 3. However, on the evening of post-operative
day 3, she developed increased abdominal pain and nausea,
suggestive of ileus. She was then made NPO with IVF and IV
dilaudid for pain control. A KUB was ordered on POD#5, which
showed multiple air-fluid levels consistent with an ileus. She
was kept NPO due to this. Overnight, she had an episode of
billious emesis. NG tube placement was attempted but the patient
was unable to tolerate the placement. She was given intravenous
reglan with subsequent improvement in her nausea. She had no
more episodes of emesis following this incident and her nausea
subsequently improved.
By post-operative day 7, she was tolerating sips and clears and
was saline locked at this point. By post-op day 8, she tolerated
some full liquids and toast and was discharged. However, patient
had some complaints of not feeling very well and had her blood
pressures checked and they were found to be low at ,
which resulted in a trigger. She also was tachycardic at 114 at
the time. A STAT CBC was ordered and she was started on some
intravenous fluids because of concern of dehydration from large
amount of diarrhea and little oral intake. She subsequently
developed oliguria later that evening without any more urine
output between 3pm and midnight. Her creatinine was checked and
found to be 1.1, which was a bump from the morning when her
creatinine was 0.6. She was rehydrated over the course of the
next hours and her urine output improved tremendously and her
Creatinine also was improved at 0.7 by the next morning. She was
then discharged in good condition, ambulating independently,
voiding spontaneously, and her pain was controlled with oral
medications. She had appropriate outpatient follow-up scheduled
with Dr. .
## MEDICATIONS ON ADMISSION:
lisinopril 5mg daily, loratadine 10mg daily, Ca/VitD, MVI,
acidophilus
## DISCHARGE MEDICATIONS:
1. oxycodone 5 mg Tablet Sig: Tablets PO Q3H (every 3 hours)
as needed for pain: please do not exceed 4g of acetaminophen in
24 hours.
Disp:*40 Tablet(s)* Refills:*0*
2. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed for flatulence.
Disp:*30 Tablet, Chewable(s)* Refills:*0*
3. ondansetron HCl 4 mg Tablet Sig: One (1) Tablet PO Q8H (every
8 hours) as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
## DISCHARGE DIAGNOSIS:
bilateral adnexal masses - final pathology was reassuring
Post-operative ileus
## 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:
General 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), no
heavy lifting of objects >10lbs for 8 weeks.
* You may eat a regular diet
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 were removed while you were in house
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": "11897016", "visit_id": "27379796", "time": "2137-09-30 00:00:00"} |
13111369-RR-51 | 417 | ## EXAMINATION:
MR HIP CONRAST LEFT
## INDICATION:
year old woman with AML on chemotherapy in house for 3 months
now, c/o acute on chronic L hip pain that has severely limited her functional
status (used to walk short distances with , has not even been able to
stand for weeks now). Plain film showing severe arthritis maybe AVN// What
is causing her severe pain which has limited movement preventing walking?
E/o osteonecrosis, or just osteoarthritis?
## FINDINGS:
Post images of the hip are somewhat limited due to poor signal to noise ratio.
There is severe diffuse subcutaneous edema with edema of all visualized
muscles also noted.
A small region of low signal intensity in the right iliac bone posteriorly
(03:19) corresponds to region of increased sclerosis on the prior CT study,
likely a bone island. Diffusely patchy appearance of the visualized bone
marrow is consistent with patient's known AML and/or chemotherapy response.
There is normal signal at the sacroiliac joints and lower lumbar spine.
Focused images of the left hip demonstrate no significant joint effusion.
There is complete loss of the articular cartilage. Acetabular protrusio again
noted. There is mild subchondral bone marrow edema is seen in the left hip
involving both the femoral head and the acetabulum (04:12). There is
curvilinear low signal intensity in the superior portion of the femoral head
which corresponds to the area concerning for avascular necrosis on the prior
MRI. The MRI appearances are not typical however and this more likely
represents a subchondral insufficiency fracture in the setting of severe
osteoarthritis. This is new when compared to the prior MRI study.
The left greater trochanteric bursa is distended with fluid consistent with
trochanteric bursitis (04:18).. The hamstring insertion onto the ischial
tuberosity is normal.
Evaluation of the pelvic parenchymal structures is limited. There is at least
moderate volume ascites. Probable hemorrhagic cyst in the lower pole the
right kidney (3:9). Edema of the rectal wall suspicious for proctitis,
correlate with clinical symptoms. A Foley catheter is in-situ in the bladder.
## IMPRESSION:
1. Severe degenerative changes, protrusio acetabuli in the left hip. A new
curvilinear subchondral low signal intensity in the femoral head likely
reflects a subchondral insufficiency fracture. Avascular necrosis is
considered unlikely given the MR appearances.
2. Left greater trochanteric bursitis.
3. Diffuse anasarca with edema of the subcutaneous tissues, all the visualized
musculature. Moderate volume ascites.
4. Edema of the rectal wall consistent with proctitis, recommend correlation
with clinical symptoms.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13111369", "visit_id": "28162120", "time": "2135-05-08 22:29:00"} |
10193372-RR-53 | 185 | ## INDICATION:
Followup of carotid artery stenosis.
Comparison was performed to the prior ultrasound study from .
## RIGHT:
There is severe atherosclerotic plaque seen along the right common
carotid, internal carotid and external carotid artery. The peak systolic
velocity in the right internal carotid artery from 88-180 cm/sec. The peak
systolic velocity in the right common carotid artery 77 cm/sec. The right
external carotid artery is patent. There is antegrade flow in the right
vertebral artery. The ICA/CCA ratio is 2.3.
## LEFT:
There is a moderate plaque along the left carotid bulb and internal
carotid artery. The peak systolic velocity in the left internal carotid
artery ranges from 82-109 cm/sec. The peak systolic velocity in the left
common carotid artery 79 cm/sec The left external carotid artery is patent.
There is retrograde flow in the left vertebral artery. The ICA/CCA ratio is
1.4.
## IMPRESSION:
1. 60-69% stenosis in the right internal carotid artery, similar to the prior
study.
2. No significant left internal carotid artery stenosis.
3. No change in left-sided subclavian steal.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10193372", "visit_id": "N/A", "time": "2160-05-11 10:16:00"} |
19886667-RR-18 | 170 | ## INDICATION:
year old man with suspected prostatitis// Please evaluate for
prostate abscess
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 2.7 s, 35.2 cm; CTDIvol = 8.6 mGy (Body) DLP = 301.0
mGy-cm.
Total DLP (Body) = 301 mGy-cm.
## PELVIS:
The prostate gland is enlarged measuring 7.5 x 5.7 cm and
demonstrates heterogeneous enhancement centrally. No focal rim enhancing
collection in the prostate to suggest an abscess. The partially visualized
small and large bowel are unremarkable. The urinary bladder and distal ureters
are unremarkable. There is no free fluid in the pelvis.
## LYMPH NODES:
There is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
Patent with minimal atherosclerotic disease 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:
Enlarged, heterogeneously enhancing prostate gland, which may represent BPH
and/or acute prostatitis - this is difficult to assess given the lack of prior
comparison imaging and clinical correlation is advised. No prostate abscess.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19886667", "visit_id": "25965159", "time": "2194-03-26 15:11:00"} |
14347268-RR-41 | 209 | ## STUDY:
MRI of the head with and without contrast.
## CLINICAL INDICATION:
man with history of HIV, weakness, multiple
lesions detected in the cerebellum on prior CT as well as in the left
occipital lobe.
## FINDINGS:
The FLAIR sequence demonstrates multiple scattered infra and
supratentorial hyperintense lesions. In the cerebellum, there is involvement
of the cerebellar peduncles, there is also a punctate signal within the
medulla oblongata. The supratentorial lesions are more evident in the
occipital lobes, left temporal lobe, left frontal lobe, and in the cortical
convexity bilaterally. The diffusion-weighted images demonstrate restricted
diffusion in all these lesions; however, no significant effacement of the
sulci is demonstrated. On the corresponding ADC maps, there is no evidence of
low signal and after the administration of gadolinium contrast, no enhancement
is demonstrated. The vascular structures demonstrate normal flow void signal.
Mucosal thickening is demonstrated on the left maxillary sinus, the orbit
demonstrates minimal medial wall deformity on the left orbit, the mastoid air
cells are clear.
## IMPRESSION:
Multiple infra and supratentorial lesions as described in detail
above with mild restricted diffusion on the DWI images, there is no evidence
of abnormal enhancement. Given the multiplicity, distribution, and signal
intensity in these lesions, progressive multifocal leukoencephalopathy is a
consideration.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14347268", "visit_id": "29132991", "time": "2171-10-15 12:17:00"} |
13077058-RR-16 | 311 | ## INDICATION:
with syncope with sudden onset dyspnea, evaluate for
pulmonary embolism.
## CTA THORAX:
The major thoracic vessels are well opacified. The aorta
demonstrates normal caliber throughout the chest without evidence of
intramural hematoma or dissection. There is moderate calcification at the
aortic arch. Major aortic arch branch vessels are patent and unremarkable.
The pulmonary arteries are well opacified to the subsegmental levels. There
is no evidence of an intraluminal filling defect to suggest pulmonary
embolism.
## CT THORAX:
The partially imaged thyroid is unremarkable. The esophagus is
within normal limits. There is a small hiatus hernia. Coronary artery
calcifications are severe in the LAD (see series 2, image 62). The heart may
be mildly enlarged. Trace pericardial fluid is likely within normal
physiologic range. Scattered mediastinal lymph nodes are not pathologically
enlarged. There is no discernible hilar or axillary lymphadenopathy.
Major airways are patent to subsegmental levels bilaterally. Polygonal nodule
in the subpleural right middle lobe (series 3, image 120) is suggestive of an
intrapulmonary lymph node. There is no worrisome lung nodule or lung mass
identified. There is no focal lung consolidation. Minimal subsegmental
atelectasis is seen in the dependent portions of the lower lobes. There is no
pleural effusion or pneumothorax.
The partially visualized solid and hollow viscous organs of the upper abdomen
are without acute focal abnormality on limited evaluation.
## MUSCULOSKELETAL:
There is no concerning abnormality within the subcutaneous
or musculoskeletal soft tissues of the chest wall. Flowing, confluent
anterior intervertebral osteophytosis involving the thoracic spine is
suggestive of diffuse idiopathic skeletal hyperostosis (DISH) (for example see
series 602b, image 33). The imaged thoracic vertebral bodies are normally
aligned. No concerning focal lytic or sclerotic osseous lesions are seen.
## IMPRESSION:
1. No evidence of pulmonary embolism or aortic abnormality.
2. Coronary artery calcification is severe in the LAD.
3. Findings consistent with DISH in the thoracic spine.
| mimic | {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13077058", "visit_id": "29811311", "time": "2150-01-04 19:16:00"} |
Subsets and Splits