Input
stringlengths 0
1.63M
| id
int64 0
2.44M
|
|---|---|
Description: 19592411-RR-48Abstract: ## INDICATION:
status post cholecystectomy on . Evaluate
for retained stone or debris within the common bile duct.
## IMPRESSION:
1. Status post cholecystectomy with a tiny amount of postoperative fluid in
the gallbladder fossa and no filling defects seen within the biliary tree.
2. Small bilateral pleural effusions and left lower lobe atelectasis.
3. Moderate cardiomegaly and a small-to-moderate pericardial effusion, which
is new since .
4. Moderate-sized axial hiatal hernia.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592411", "visit_id": "N/A", "time": "2139-04-13 17:39:00"} | 1,604,600 |
Description: 19592511-RR-20Abstract: ## INDICATION:
female status post trauma with head strike, no loss
of consciousness.
## FINDINGS:
There is no evidence for acute intracranial hemorrhage, large mass,
mass effect, edema, or hydrocephalus. Prominent ventricles and sulci suggest
mild age-related involutional changes. The basal cisterns appear patent.
Visualized bones and soft tissues are unremarkable. Increased extraaxial
space in the posterior fossa suggests degree of cerebellar atrophy. The
visualized portions of the paranasal sinuses and mastoid air cells are well
aerated.
## IMPRESSION:
No CT evidence for acute intracranial process.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592511", "visit_id": "27268572", "time": "2174-08-02 18:23:00"} | 1,604,601 |
Description: 19592511-RR-21Abstract: ## INDICATION:
female with trauma and head strike.
## FINDINGS:
There is no evidence for acute fracture or malalignment. Moderate
degenerative changes are seen in the cervical spine. There is no prevertebral
soft tissue swelling. Note is made of an unfused posterior arch of C1. A few
small subcentimeter left submandibular lymph nodes are noted. There is a 4-mm
right apical nodule, less likely a tiny focus of infection. The thyroid gland
appears generous in size; no focal nodule is detected on this non-contrast
study.
## IMPRESSION:
1. No CT evidence for acute fracture.
2. Right apical lung nodularity. This could represent a small focus of
infection in the appropriate clinical setting. Otherwise, one year follow up
CT is recommended.
These findings and recommendations were discussed with Dr. by Dr.
by telephone at 11:25 p.m. on .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592511", "visit_id": "27268572", "time": "2174-08-02 18:24:00"} | 1,604,602 |
Description: 19592511-RR-22Abstract: ## EXAM:
AP view of the pelvis and AP and lateral views of the left hip.
## CLINICAL INFORMATION:
female with history of left hip pain status
post fall.
## FINDINGS:
AP views of the pelvis and AP and lateral views of the left hip
were obtained. The bones are diffusely osteopenic, making evaluation for
subtle fractures suboptimal. Given this, there may be slight cortical
irregularitry at the left medial femoral neck, not well evaluated due to
patient positioning. The pubic symphysis and sacroiliac joints are intact.
There are severe osteoarthritic changes of the right hip with severe joint
space narrowing, particularly superiorly and uncovering of the superolateral
right femoral head as well as joint space sclerosis. There appears to be
scoliosis of the visualized lower lumbar spine although this may relate to
patient positioning. Pelvic phleboliths are seen. There is also enthesopathy
along the iliac crest and the right greater trochanter.
## IMPRESSION:
Diffuse osteopenia makes evaluation for subtle fractures
suboptimal. Possible cortical irregularity at the medial left femoral neck,
although not well evaluated due to patient positioning. Patient to have
additional traction views for further evaluation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592511", "visit_id": "27268572", "time": "2174-08-02 19:12:00"} | 1,604,603 |
Description: 19592514-RR-16Abstract: CERVICAL SPINE RADIOGRAPH PERFORMED ON
## CLINICAL HISTORY:
man status post slip and fall on ice with left
extremity paraesthesia, question traumatic injury.
## FINDINGS:
AP, lateral, swimmer's lateral, open mouth, views of the
cervical spine were provided. There is no acute cervical spine fracture or
traumatic malalignment through T1 level. There is loss of cervical lordosis.
Degenerative changes are notable at C5-C6 and C6-C7 with mild loss of disc
space and prominent anterior osteophytosis. There is no prevertebral soft
tissue swelling. C1-C2 alignment appears symmetric and normal with an intact
appearance of the dens.
## IMPRESSION:
No definite fracture or malalignment in the cervical spine. If
there is strong clinical concern, recommend CT to further assess.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592514", "visit_id": "N/A", "time": "2127-05-11 19:54:00"} | 1,604,604 |
Description: 19592514-RR-18Abstract: ## INDICATION:
man with right rib pain after fall. Please assess
for pneumothorax or fracture.
## FINDINGS:
The cardiomediastinal silhouette and hila are normal. Lungs are clear. There
is no pleural effusion or pneumothorax. There may be old left and
anterolateral rib fractures.
No acute displaced rib fracture is seen. If clinical concern for acute rib
fracture persists, suggest dedicted rib series.
## IMPRESION:
No acute cardiopulmonary process. No acute displaced rib fracture
seen. If clinical concern for acute rib fracture persists, suggest dedicted
rib series.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592514", "visit_id": "N/A", "time": "2127-06-25 18:13:00"} | 1,604,605 |
Description: 19592648-RR-21Abstract: ## INDICATION:
History: with crush injury// ?fx
## FINDINGS:
There is a minimally displaced fracture through the medial malleolus with
extension to the articular surface. There is equivocal slight widening of the
medial ankle mortise. There is concern for a nondisplaced fracture of the
distal fibula. Soft tissue swelling is seen about the ankle, laterally
greater than medially. There is a likely ankle joint effusion.
Soft tissue swelling extends to the dorsal midfoot. No additional fracture of
the left foot is seen.
## IMPRESSION:
Minimally displaced left medial malleolar fracture with extension to the
articular surface. Equivocal slight widening of the medial ankle mortise.
Concern for nondisplaced distal fibular fracture.
Soft tissue swelling, as above.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592648", "visit_id": "20871209", "time": "2179-10-28 10:27:00"} | 1,604,606 |
Description: 19592648-RR-23Abstract: ## INDICATION:
year old man with ankle fracture// trimal fracture
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 9.7 s, 20.5 cm; CTDIvol = 14.2 mGy (Body) DLP = 290.1
mGy-cm.
Total DLP (Body) = 290 mGy-cm.
## FINDINGS:
There is a comminuted intra-articular fracture with dominant transverse
component through the medial malleolus. The fracture is minimally distracted
by up to 3 mm (400:57).
There is also a nondisplaced comminuted intra-articular fracture of the distal
fibula. A vertically oriented fracture line extends up to the level of tibial
plafond (401: 84).
The ankle mortise appears congruent within the limits of non weight-bearing
study. Punctate focus of density in the medial clear space (400:65) may be a
small intra-articular bone fragment.
Os trigonum is noted with adjacent mild degenerative changes. Small joint
effusion is present at the tibiotalar and subtalar joints. Extensive soft
tissue swelling is noted surrounding the ankle. Achilles tendon is intact.
Limited evaluation of the smaller tendons appear unremarkable.
## IMPRESSION:
1. Minimally distracted comminuted fracture of the medial malleolus with
dominant transverse component.
2. Nondisplaced comminuted fracture of the lateral malleolus.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592648", "visit_id": "20871209", "time": "2179-10-28 16:13:00"} | 1,604,607 |
Description: 19592648-RR-26Abstract: ## EXAMINATION:
ANKLE (AP, MORTISE AND LAT) LEFT IN O.R.
## INDICATION:
year old man with l ankle pain// l ankle pain l ankle pain
## FINDINGS:
Two transfixing metallic screws are again seen across a medial malleolus
fracture, without evidence of hardware failure.
Fracture lines at the distal medial malleolus and distal fibula are less
conspicuous, compatible with interval healing.
Alignment at the left ankle is unchanged. No new fracture is seen. No talar
dome osteochondral lesion is identified. No suspicious lytic or sclerotic
lesion is identified.
## IMPRESSION:
1. No new fracture or dislocation.
2. Interval healing of fractures in the distal medial malleolus and distal
fibula.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592648", "visit_id": "N/A", "time": "2179-12-30 11:26:00"} | 1,604,608 |
Description: 19592648-RR-28Abstract: ## EXAMINATION:
ANKLE (AP, MORTISE AND LAT) LEFT
## INDICATION:
year old man with l ankle pain// l ankle pain l ankle
pain
## FINDINGS:
Patient is status post ORIF of the malleolus fracture with 2 screws
transfixing the fracture site. The fracture line is no longer visualized.
The previously seen lateral malleolus fracture has also healed. The alignment
is anatomic. No new fracture or dislocation. There are mild degenerative
changes of the talonavicular joint. The mortise is congruent. The tibial
talar joint space is preserved and no talar dome osteochondral lesion is
identified. No suspicious lytic or sclerotic lesion is identified. No soft
tissue calcification or radiopaque foreign body is identified.
## IMPRESSION:
Healed bimalleolus fracture. Anatomic alignment. No new fracture or
dislocation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592648", "visit_id": "N/A", "time": "2180-04-03 12:51:00"} | 1,604,609 |
Description: 19592648-RR-29Abstract: ## EXAMINATION:
MR ANKLE CONTRAST LEFT
## INDICATION:
year old man s/p ORIF L ankle fx with ? osteomyelitis//
?osteomyelitis
## FINDINGS:
There is hardware in the medial malleolus which causes prominent
susceptibility artifact limiting evaluation at that location.
## ACHILLES TENDON:
Intact. There is trace fluid in the retrocalcaneal bursa.
There is mild edema within fat pad.
## POSTERIOR TIBIAL TENDON:
Trace fluid is seen in the tendon sheath.
Flexor digitorum tendon: Normal.
Flexor hallucis tendon: Trace fluid is seen in the tendon sheath proximally..
## PERONEAL TENDONS:
There is fluid in the peroneus brevis tendon sheath
consistent with mild tenosynovitis.
Anterior tibialis tendon: Normal.
Extensor digitorum tendon: Normal.
Extensor hallucis longus: Normal.
## ANTERIOR TIBIOFIBULAR LIGAMENT:
Attenuated but intact suggestive of previous
sprain..
Posterior tibiofibular ligament: Intact.
## ANTERIOR TALOFIBULAR LIGAMENT:
Thin.
Posterior talofibular ligament: Intact; however it inserts onto the fracture
of the distal fibula.
Calcaneofibular ligament: Not well seen, likely torn.
## TIBIOTALAR LIGAMENT:
Not well evaluated due to the hardware
## TIBIOSPRING LIGAMENT:
Not well evaluated due to the hardware.
Spring ligament: Not well evaluated due to the hardware..
## SINUS TARSI:
Normal fatty signal is seen.
Plantar fascia: Intact
## TIBIOTALAR JOINT SPACE:
There is no joint effusion or osteochondral lesions.
## MARROW SIGNAL:
There is extensive marrow edema throughout the ankle and
midfoot. However, the T1 marrow signal is relatively preserved, making
osteomyelitis less likely. More prominent areas of marrow edema are seen
within the distal tibia, talus, calcaneus, and base of the fifth metatarsal.
There are fracture lines seen within the distal fibula at the level of the
ankle joint. There are areas of enhancement involving the majority of the
calcaneus, talus, distal fibula.
## OTHER FINDINGS:
None.
## IMPRESSION:
1. Prominent marrow edema and mild enhancement throughout the ankle and
midfoot most prominent within the talus, calcaneus, and fibula. Given the
relative preservation of T1 marrow signal, osteomyelitis is felt to be
unlikely. Findings are most likely related to the patient's bimalleolar
fractures with subsequent disuse osteopenia.
2. Hardware within the medial malleolus which limits evaluation of the
adjacent structures.
3. Comminuted distal fibular fracture at the level the ankle joint.
4. Mild tenosynovitis of the peroneus brevis.
5. Attenuated anterior tibiofibular ligament suggestive of prior sprain.
6. Thinned anterior talofibular ligament and poorly seen calcaneofibular
ligament suggestive of ligamentous injury.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592648", "visit_id": "N/A", "time": "2180-05-01 14:28:00"} | 1,604,610 |
Description: 19592728-RR-103Abstract: ## INDICATION:
Hepatitis C, hepatocellular carcinoma, completed chemotherapy,
please remove port.
## PHYSICIAN:
, M.D., fellow, performed the procedure. ,
M.D., attending, was present and supervising the procedure.
## MEDICATIONS:
Moderate sedation was provided by administering divided doses of
Versed totaling 2 mg and fentanyl totaling 150 mcg throughout the total
intraservice time of 29 minutes, during which the patient's hemodynamic
parameters were continuously monitored.
## PROCEDURES:
Removal of right internal jugular vein double-lumen port
catheter.
## PROCEDURE DETAILS:
Informed consent was obtained from the patient. He was
positioned supine. A scout image was obtained. The area was prepped and
draped in sterile fashion. A timeout was performed.
Local anesthesia was implied. An incision was made along the previous
incision scar. Blunt dissection was used to first retrieve the catheter which
was pulled from the vein. Blunt dissection was then used to extract the port.
The retention sutures were cut and removed intact. There was good hemostasis
with manual pressure. The pocket was closed with interrupted Vicryl
sutures in the deeper tissues and a running Vicryl subcuticular stitch. A
dressing was applied. There were no complications. The image was taken
afterward showing intact port removal.
## CONCLUSION:
Uncomplicated removal of right internal jugular vein port
catheter.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2128-11-15 14:24:00"} | 1,604,611 |
Description: 19592728-RR-105Abstract: ## EXAMINATION:
ABDOMEN US (COMPLETE STUDY)
## INDICATION:
year old man with liver transplant past diagnosis of liver
lymphoma and new onset renal failure // Please assessfor renal size, ?
obstruction, ascites and liver vasculature
## FINDINGS:
The liver is diffusely and mildly echogenic. In segment VI, there is an
ill-defined hypoechoic area of liver parenchyma traversed by a vessel which
could represent focal fatty sparing. There is no evidence of biliary
dilatation. There is no ascites, right pleural effusion or sub- or
fluid collections/hematomas.
The spleen measures 13.3 cm and has normal echotexture.
## DOPPLER:
Appropriate arterial waveforms are seen in the main hepatic artery,
the right hepatic artery and the left hepatic artery with resistive indices of
0.76, 0.74, and 0.71, respectively. The main portal vein, right and left
portal veins are patent with hepatopetal flow with normal waveform.
Appropriate flow is seen in the hepatic veins and the IVC.
The right kidney measures 9.4 cm. The left kidney measures 9.3 cm. Both
kidneys have normal cortical medullary differentiation. There is no evidence
of renal calculus, mass, or cyst. There is no evidence of hydronephrosis.
## IMPRESSION:
1. Echogenic liver consistent with hepatic steatosis with a focal ill-defined
hypoechoic area of hepatic parenchyma in segment VI. Although this finding
may represent focal fat sparing, given patient history of lymphoma suggest MRI
examination for further evaluation.
2. Patent hepatic vasculature with appropriate waveforms and flow direction.
3. Unremarkable examination of the kidneys.
## NOTIFICATION:
These findings were communicated to Dr. by Dr. on
at 12:35 approximately 15 min after discovery.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "27888132", "time": "2130-03-28 09:19:00"} | 1,604,612 |
Description: 19592728-RR-106Abstract: ## INDICATION:
year old man with Hx of HCV cirrhosis s/p liver tx in c/b
PTLD presenting w/ and incidental liver mass found on US. // Eval liver
mass for vs. recurrent PTLD.
## FINDINGS:
The liver is normal in morphology. There are no cirrhotic features. There are
no suspicious lesions. The main portal vein is patent. Hepatic artery appears
patent. The inferior vena cava anastomosis appear stable.
The patient is status post cholecystectomy. There is no biliary dilatation.
Small periportal lymph nodes and periceliac lymph nodes such as a 10 mm node
(16, 50) are stable since the CT from as well as the PET-CT from .
Once again identified are several prominent perisplenic varices.
A fat containing umbilical right periumbilical incisional hernia is once again
present, not substantially changed since .
The adrenals, kidneys, bowel appear within normal limits. Heterogeneous T2
signal within the spleen is consistent with a splenic hemangiomatosis. The
pancreas is within normal limits. There is no pancreatic ductal dilatation or
focal pancreatic lesion.
## IMPRESSION:
1. No suspicious liver lesions. No correlation for the segment 7 lesion seen
on the prior ultrasound.
2. Stable para celiac lymphadenopathy measuring up to 1 cm; per the prior
PET/CT report from , there was no FDG avid disease in this area.
3. Prominent perisplenic varices
4. Unchanged fat containing umbilical and right periumbilical incisional
hernias
5. Splenic hemangiomatosis
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "27888132", "time": "2130-03-30 17:47:00"} | 1,604,613 |
Description: 19592728-RR-107Abstract: ## INDICATION:
year old man with nodule in brachial part of elbow //
Evaluate for etiology
## FINDINGS:
At the site of the palpable abnormality indicated by the the patient, along
the the lower aspect of the elbow, there is a rounded well-circumscribed
heterogeneously hyperintense nodular focus measuring 0.9 x 0.6 x 0.9 cm. The
lesion is located in the subcutaneous fat, abutting an underlying fascial
plane. It displaces, but does not definitely extend through, the fascia.
On color Doppler imaging, a few small vessels are seen along the periphery of
the lesion and a single vessel is noted within it. Within the lesion, no
obvious thickened septations were separate nodular components are identified.
Surrounding structures are within normal limits.
## IMPRESSION:
Well-circumscribed, homogeneously hyperechoic subcutaneous mass corresponding
to the palpable abnormality, with minimal associated vascularity along the
periphery of the mass and a the single vessel within it. Appearance is
compatible with a small lipoma, though internal vessels are somewhat atypical
for that.
Recommend clinical surveillance and repeat imaging should the lesion enlarge.
In the absence of concerning clinical changes, followup ultrasound in 6 months
to confirm stability is recommended.
## RECOMMENDATION(S):
Recommend clinical surveillance and, should the lesion
enlarge, repeat imaging. In the absence of concerning clinical changes,
followup ultrasound in 6 months to confirm stability is recommended.
## NOTIFICATION:
The impression and recommendation above was entered by Dr.
on at 19:34 into the Department of Radiology critical
communications system for direct communication to the referring provider.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2131-02-19 13:29:00"} | 1,604,614 |
Description: 19592728-RR-108Abstract: ## INDICATION:
year old man with t/o recurrent PTLD> Pt is s/p liver
transplant. Pt with 10 rash thought to be leukocytoclastic vasculitis// Please
eval for recurrent PTLD
## SINGLE PHASE SPLIT BOLUS CONTRAST:
MDCT axial images were acquired
through the abdomen following intravenous contrast administration with split
bolus technique. Single phase split bolus contrast: MDCT axial images were
acquired through the abdomen following intravenous contrast administration
with split bolus technique.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 3.6 s, 28.6 cm; CTDIvol = 7.7 mGy (Body) DLP = 221.4
mGy-cm.
2) Stationary Acquisition 4.2 s, 0.5 cm; CTDIvol = 20.2 mGy (Body) DLP =
10.1 mGy-cm.
3) Spiral Acquisition 3.3 s, 21.6 cm; CTDIvol = 31.2 mGy (Body) DLP = 672.1
mGy-cm.
4) Spiral Acquisition 3.7 s, 28.8 cm; CTDIvol = 27.0 mGy (Body) DLP = 776.6
mGy-cm.
5) Spiral Acquisition 2.5 s, 19.6 cm; CTDIvol = 26.3 mGy (Body) DLP = 515.8
mGy-cm.
Total DLP (Body) = 2,196 mGy-cm.
## LOWER CHEST:
For chest findings please refer to separately dictated CT chest
report.
## HEPATOBILIARY:
The patient is status post orthotopic liver transplant. The
liver demonstrates homogenous attenuation throughout. There is no evidence of
focal lesions. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is within normal limits.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
No splenomegaly. 5 mm hypodense lesion in the anterior aspect of the
spleen (series 5, image 39) appear similar compared to prior imaging.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Visualized small and large
bowel loops demonstrate normal caliber, wall thickness, and enhancement
throughout.
## LYMPH NODES:
Marked interval decrease in size of the mesenteric lymph nodes.
## VASCULAR:
Multiple splenic varices as well as splenorenal shunts are
unchanged. There is no abdominal aortic aneurysm. Mild atherosclerotic
disease is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
Umbilical and right paraumbilical hernias are again noted and
unchanged.
## IMPRESSION:
No new lesions concerning for PTLD.
Stable findings post orthotopic liver transplant.
Multiple splenic varices are again noted and unchanged.
For chest findings please refer to separately dictated CT chest report.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2134-04-05 07:04:00"} | 1,604,615 |
Description: 19592728-RR-109Abstract: ## EXAMINATION:
CT CHEST W/O CONTRAST
## INDICATION:
year old man with t/o recurrent PTLD> Pt is s/p liver
transplant. Pt with 10 rash thought to be leukocytoclastic vasculitis// Please
eval for recurrent PTLD post liver transplant
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 4.5 s, 35.5 cm; CTDIvol = 23.3 mGy (Body) DLP = 826.2
mGy-cm.
Total DLP (Body) = 826 mGy-cm.
## FINDINGS:
NECK, THORACIC INLET, AXILLAE, CHEST WALL:
There are no thyroid lesions that
warrant further imaging.
No lymphadenopathy in the thoracic inlet.
No abnormalities on chest wall.
No atherosclerosis in head and neck vessels.
## UPPER ABDOMEN:
Please refer to same day abdominal CT report for
subdiaphragmatic findings.
## MEDIASTINUM:
Esophagus is unremarkable. Small morphologically normal
mediastinal lymph nodes, measuring up to 5 mm. No hilar lymphadenopathy.
HEART and PERICARDIUM:
Heart is normal in size. No pericardial effusions.
No atherosclerotic calcifications in thoracic aorta and coronary arteries.
## PLEURA:
No pleural effusions. Mild bilateral apical scarring.
## 1. PARENCHYMA:
And least 4 small solid nodules, one of which is calcified,
all measuring up to 3 mm and stable (4: 39, 61, 72 and 107).
## 2. AIRWAYS:
Mucous secretions in trachea and main bronchi. Diffuse bronchial
wall thickening.
## 3. VESSELS:
Mild pulmonary artery enlargement, with 3.2 cm.
## CHEST CAGE:
Mild dorsal spondylosis. No acute fractures. No lytic or
sclerotic lesions.
## IMPRESSION:
No signs of intrathoracic malignancies.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2134-04-05 07:08:00"} | 1,604,616 |
Description: 19592728-RR-30Abstract: ## INDICATION:
History of liver cancer status post RF ablation, cirrhosis, lymph
node in the pericardial area being followed on prior imaging, evaluate for
progression of disease.
## CONTRAST:
130 cc of intravenous Optiray and oral contrast were administered.
CT OF THE CHEST WITH INTRAVENOUS CONTRAST:
There are no pathologically
enlarged mediastinal, hilar, or axillary nodes. The central airways appear
patent. The heart, pericardium, and great vessels appear unremarkable. A
pericardial node 1.6 x 0.8 cm is unchanged in size.
No pulmonary nodules or masses are identified. Pleural effusions have
resolved.
CT OF THE ABDOMEN WITHOUT AND WITH INTRAVENOUS CONTRAST:
The liver is small
and nodular in contour consistent with cirrhosis. In segment VI, a branching
wedge-shaped hypodense area is consistent with the patient's RF ablation site.
Just superior to this, in segment VI, a vague nodular area best seen as a
hypoenhancing focus on the delayed images likely represents two separate
nodules, each measuring 1.1 cm in diameter (4:62). These appear more
conspicuous since the previous examination. A subcapsular nodule within
segment VII (4:59) measures 1.5 cm in diameter, little changed. 6-mm
hypoenhancing foci in segments II (3B:132) and VIII (3B:128) are unchanged.
There is no intra- or extra-hepatic biliary ductal dilation. The portal vein
is patent. The pancreas and adrenal glands appear unremarkable. There is
splenomegaly and extensive perisplenic varices consistent with splenorenal
shunt, with marked enlargement of the left renal vein. The gallbladder is
nondistended and contains calcified gallstones. No renal masses are
identified and there is no hydronephrosis. The abdominal aorta is normal in
caliber. Numerous non-pathologically enlarged mesenteric and retroperitoneal
nodes are present, along with numerous enlarged periportal and celiac nodes
which measure up to 0.8 x 2.6 cm and likely relate to cirrhosis. The large
and small bowel loops are normal in caliber. There is no ascites.
CT OF THE PELVIS WITH INTRAVENOUS CONTRAST:
The bladder, distal ureters,
prostate, and seminal vesicles, rectum and sigmoid colon appear unremarkable.
There are no pathologically enlarged pelvic or inguinal lymph nodes.
## BONE WINDOWS:
No suspicious lytic or sclerotic osseous lesions are
identified.
## IMPRESSION:
1. Increased conspicuity of segment VI and VII hepatic nodules, findings
which are concerning for hepatocellular carcinoma.
2. Unchanged segment II and VIII 6-mm nodules, a nonspecific finding.
Unchanged RF ablation defect in segment VI.
3. Cirrhosis, splenomegaly, splenorenal shunt.
4. Unchanged node.
5. Gallstones.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-05-10 13:39:00"} | 1,604,617 |
Description: 19592728-RR-31Abstract: ## STUDY:
Chemoembolization of the liver.
## INDICATION:
male with hepatocellular carcinoma presenting for
chemoembolization of the right lobe of the liver.
## RADIOLOGISTS:
Drs. and performed the procedure. Drs.
, the attending radiologists, were present and supervised
throughout the procedure.
## PROCEDURE AND FINDINGS:
Following written informed consent, the patient was
positioned supine on the angiography table. A pre-procedure timeout was
performed to confirm patient identity and the nature of the procedure to be
performed. The patient was prepped and draped in standard sterile fashion.
Local anesthesia was obtained with approximately 10 cc of 1% lidocaine in the
right groin. Using palpatory and fluoroscopic guidance, a 19-gauge single-
wall needle was used to puncture the right common femoral artery. A 0.035-
inch guidewire was then advanced through the needle into the abdominal aorta
under fluoroscopic guidance. The needle was exchanged for a 5 vascular
sheath which was then attached to a continuous heparinized saline flush.
A SOS catheter was then advanced over the wire. Selective catheterization of
the superior mesenteric artery was then performed. An angiogram subsequently
demonstrated conventional anatomy. Delayed images demonstrated a patent
portal vein. The catheter was then used to select the celiac trunk and an
angiogram was performed which demonstrated expected normal anatomic anatomy.
Tortousity of the hepatic arterial vessels, compatible with changes from
cirrhosis was identified. Based on the diagnostic findings, it was decided
that the patient would benefit from and was a good candidate for
chemoembolization. Selective catheterization of the right hepatic artery was
obtained with the use of the microcatheter and angiography was performed.
Using the microcatheter, chemoembolization was then performed with Adriamycin
mixed with Ethiodol and Optiray contrast for a total volume of 30 mL. This
mixture was given in divided doses of 3 cc each intermixed with divided doses
of 0.5-1.0 cc of intra-arterial 1% lidocaine. The total dose of intra-arterial
lidocaine was 6 cc. Approximately 3 cc of a slurry mixture of Gelfoam was
subsequently administered.
All injections were performed using fluoroscopic guidance demonstrating the
distribution of these chemo-embolic agents. A final angiogram of the right
hepatic artery demonstrated no significant residual arterial flow to the right
lobe of the liver following chemoembolization. All wires, catheters and
sheaths were removed, and hemostasis was obtained within minutes of
direct, manual compression. There were no immediate complications.
Moderate sedation was provided by administering divided doses of 2 mg of
Versed and 50 mcg of fentanyl throughout the total intraservice time of 95
minutes during which time the patient's hemodynamic parameters were
continuously monitored.
## IMPRESSION:
Successful chemoembolization of the right hepatic lobe.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-05-30 07:23:00"} | 1,604,618 |
Description: 19592728-RR-32Abstract: CT OF THE ABDOMEN WITHOUT CONTRAST:
## CLINICAL HISTORY:
man with hepatocellular carcinoma status post
chemoembolization.
## BONE WINDOWS:
There are no suspicious lytic or sclerotic lesions. Mild
degenerative changes are present in the lumbar spine.
## IMPRESSION:
Findings compatible with prior chemoembolization as above.
Heterogeneous, irregular hypodense area in the posterior aspect of the right
hepatic lobe that does not contain chemoembolization material and is
suspicious for residual tumor.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-05-31 08:44:00"} | 1,604,619 |
Description: 19592728-RR-35Abstract: ## INDICATION:
female with HCC, status post chemoembolization on
. Now with abdominal pain. Evaluate for colitis or cholecystitis.
## CT OF THE ABDOMEN:
Previously seen tiny left pleural effusion has grown,
though still measures simple fluid density. The lung bases are otherwise
clear. Again seen is a prominent cardiophrenic angle lymph node measuring 1.8
cm.
Small nodular liver, splenomegaly, and multiple varices predominantly around
the spleen are consistent with the patient's known history of cirrhosis.
Hyperdense material is seen in segments V and VIII consistent with recent
chemoembolization. Again seen is an ill- defined hypodensity in the
posterolateral aspect of the right lobe, segment VI, which is suspicious for
residual tumor. Eight-mm rounded hypodensity within the left lobe (3:14,) is
unchanged. There is slight increase in the amount of ascites at the right
edge of the liver and surrounding bowel loops.
There is no intra- or extra-hepatic biliary dilatation. The gallbladder again
has several small gallstones and is nondistended. However, there is new wall
edema, with the wall measuring up to 10 mm, suspicious for cholecystic
ischemia. The pancreas, adrenal glands, and kidneys are normal. Contrast
passes through to the distal colon, with no evidence of obstruction. There is
mild wall thickening of the jejunum (3:47) as well as the right colon (3:35),
both in the SMA distribution, and also concerning for ischemia. There is an
additional loop of possibly wall thickened versus collapsed bowel in the low
mid abdomen (3:60). The left renal vein is again enlarged, which may be
related to splenorenal shunt.
## CT OF THE PELVIS:
Fat-containing inguinal hernias are noted. There is free
a small amount of fluid in the pelvis, measuring simple fluid density. The
sigmoid colon, rectum and bladder appear normal.
No suspicious lytic or sclerotic lesions. There is moderate anasarca in the
soft tissues. There is also a fluid containing collection at the umbilicus
measuring 2.4 x 2.6 cm.
## IMPRESSION:
1. New mild bowel wall thickening of the right colon and jejunum, both in the
SMA territory, and suspicious for ischemia possibly related to recent
chemoembolization.
2. Wall thickening of the gallbladder, without gallbladder distention,
suggests cholecystic ischemia rather than obstructive cholecystitis.
3. Unchanged findings of prior chemoembolization with persistent
heterogeneous area in the posterior aspect of the right hepatic lobe that is
concerning for residual tumor.
4. Slightly increased ascites and left pleural effusion.
Findings were discussed with Dr. at noon on .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-06-02 10:59:00"} | 1,604,620 |
Description: 19592728-RR-36Abstract: ## INDICATION FOR EXAM:
man status post chemoembolization for on
here for repeat chemoembolization of the posterior portion of
the right liver lobe.
## RADIOLOGISTS:
This procedure was performed by Dr. Dr.
attending radiologist, who was present and supervising throughout the
procedure.
## PROCEDURE AND FINDINGS:
After explaining the risks and benefits of the
procedure, written informed consent was obtained from the patient. The
patient was positioned supine on the angiography table. A pre-procedure
timeout was performed to confirm patient identity and the nature of the
procedure to be performed. The patient's right groin was prepped and draped
in standard sterile fashion. Under local anesthesia with approximately 10 cc
of 1% lidocaine, using palpatory and fluoroscopic guidance, a 19-gauge single-
wall needle was used to puncture the right common femoral artery. A 0.035-
inch guidewire was then advanced through the needle into the abdominal aorta
under fluoroscopic guidance. The needle was exchanged for a 5 vascular
sheath which was then attached to a continuous heparinized saline flush. A
SOS catheter was then advanced over the wire and selective catheterization of
the superior mesenteric artery was then performed. SMA angiogram subsequently
demonstrated normal anatomy and delayed image demonstrated a patent portal
vein. The catheter was then used to select the celiac axis and an angiogram
was performed which demonstrated expected normal anatomy. Selective
catheterization of the posterior segmental branch of right hepatic vein was
obtained with the use of microcatheter and angiography was performed
demonstrating vascular tumor staining in segment VI of the liver. Posterior
segmental branch of right hepatic artery was confirmed on lateral projection
and 3D rotational angiography. Based on the diagnostic findings, it was
decided that the patient would benefit from and was a good candidate for
chemoembolization.
Using the microcatheter, chemoembolization was then performed with doxorubicin
mixed with Ethiodol and Optiray contrast for a total volume of 30 mL. This
mixture was given in divided doses of 3 cc each intermixed with divided doses
of 0.5-1.0 cc of intra-arterial 1% lidocaine injection. Total dose of intra-
arterial lidocaine was 7 cc. Approximately 3 cc of a slurry mixture of
Gelfoam was subsequently administered. All injections were performed using
fluoroscopic guidance demonstrating the distribution of these chemo-embolic
agents. A final angiogram of the right hepatic artery demonstrated no
significant residual arterial flow to the posterior segmental branch of right
hepatic artery. All wires, catheters and sheaths were removed. Hemostasis
was obtained with use of angioseal device. The patient tolerated the
procedure well and there were no immediate complications. Moderate sedation
was provided by administering divided doses of 125 mcg of fentanyl and 3 mg of
Versed throughout the total intraservice time of 1 hour and 40 minutes during
which the patient's hemodynamic parameters were continuously monitored.
## IMPRESSION:
Successful chemoembolization of the tumor in the right lobe of
liver via posterior segmental branch of right hepatic artery.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-06-09 04:55:00"} | 1,604,621 |
Description: 19592728-RR-37Abstract: ## FINDINGS:
Direct comparison is made to prior examination dated .
There is a small stable-appearing left-sided pleural effusion.
On the current examination, there is evidence of chemoembolization involving
the posterior aspect of the right lobe of the liver, the area in which the
prior focal parenchymal abnormality was identified.
Again mild gallbladder wall thickening is identified with several dependently
layering gallstones. There is slight increase in amount of free
intraperitoneal fluid.
The spleen appears enlarged.
The kidneys, adrenal glands, pancreas appear unchanged, given the limitations
of a non-contrast CT.
No lytic or blastic bony lesions are identified.
## IMPRESSION:
1. Status post chemoembolization demonstrating chemoembolization agent within
the posterior aspect of the right lobe of the liver.
2. Increase in free intraperitoneal fluid.
3. Stable gallbladder wall thickening is noted.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-06-10 10:46:00"} | 1,604,622 |
Description: 19592728-RR-40Abstract: ## INDICATION:
Recent abdominal ascites with history of hepatocellular
carcinoma. Please perform diagnostic and therapeutic paracentesis.
## PROCEDURE:
After the risks and benefits of the procedure were explained to
the patient, informed written consent was obtained. A timeout was performed
using two patient identifiers.
The patient was prepped and draped in the usual sterile fashion and an
appropriate spot for paracentesis was marked in the right lower quadrant using
ultrasound guidance. A 19 gauge catheter was inserted into the fluid
collection under ultrasound guidance and 1.5 liters of straw-colored ascites
was aspirated. Patient tolerated the procedure well, and there were no
immediate post-procedure complications. The attending radiologist, Dr.
, was present for all essential parts of the procedure.
Fluid was sent to the chemistry and microbiology laboratory for analysis as
requested.
## IMPRESSION:
Successful ultrasound-guided paracentesis of 1.5 liters.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-06-21 13:52:00"} | 1,604,623 |
Description: 19592728-RR-41Abstract: ## INDICATION:
Status post chemoembolization, presents with worsening abdominal
pain, distension, ascites, worsening liver enzymes, please assess for portal
vein thrombosis.
## FINDINGS:
The study is markedly limited and nearly non-diagnostic secondary
to marked gaseous distension. The liver is shrunken and nodular, and very
poorly visualized. Vascular anatomy could not be defined. Color Doppler was
able to demonstrate color flow within several vessels in the liver, possibly
hepatic and portal veins. The Doppler waveform obtained on one of the vessel
is more suggestive of a hepatic vein. There is a small ascites within the
right lower quadrant. The gallbladder was poorly visualized.
## IMPRESSION:
Nearly non-diagnostic study secondary to marked gaseous
distension. A repeat ultrasound after resolution of gaseous distension is
advised. Portal vein thrombosis cannot be excluded on this exam.
The limited nature of the study was discussed with Dr. .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-06-25 12:29:00"} | 1,604,624 |
Description: 19592728-RR-43Abstract: ## INDICATION:
Hepatocellular carcinoma status post chemoembolization with
falling hematocrit. Rule out retroperitoneal bleed.
## CT ABDOMEN WITHOUT CONTRAST:
Compared to there is increase in
size of small bilateral simple-appearing pleural effusions with associated
atelectasis. There is no evidence of a pericardial effusion. A 10-mm
prominent epicardial node does not appear significantly changed dating back to
.
There is again evidence of chemoembolization involving the right hepatic lobe.
There is again splenomegaly and multiple varices consistent with portal
hypertension. At least two dependent gallstones are again identified within
the gallbladder. Non-contrast evaluation of the adrenal glands, kidneys and
pancreas and loops of bowel is unremarkable. There is no free air. There is
diffuse mesenteric stranding as well as moderate intra- abdominal ascites
perhaps slightly increased in size compared to . There is no high
density retroperitoneal collections to suggest hemorrhage.
Bone windows are unremarkable.
## IMPRESSION:
1. No evidence of retroperitoneal hematoma.
2. More prominent mesenteric stranding, moderate ascites, and pleural
effusions.
3. Status post right hepatic chemoembolization with splenomegaly and varices.
4. Cholelithiasis
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-06-28 10:04:00"} | 1,604,625 |
Description: 19592728-RR-44Abstract: CT ABDOMEN AND PELVIS WITH AND WITHOUT CONTRAST
## INDICATION FOR STUDY:
Liver cancer status post radiofrequency ablation and
chemoembolization, evaluate for recurrent lesions.
Comparison is made with the most recent prior study from .
## ABDOMEN WITH CONTRAST:
There is slight decrease in the size of the right
pleural effusion with reexpansion of the right lower lobe which was previously
collapsed. No pericardial effusion is identified. Several high-attenuation
foci of Ethiodol are scattered throughout the liver, the largest in the
posterior right lobe involving segment VII. This is the site of prior
radiofrequency ablation and again noted is a low attenuation wedge-shaped
perfusion defect consistent with the prior ablation zone. Ethiodol is noted
in the periphery of the liver. This low-attenuation zone measures
approximately 16 x 14 mm in size, not appreciably changed from the prior
study. The portal vein supplying this area remains occluded. No new areas of
enhancement are identified within the liver, but the area encircling the prior
zone of ablation is significantly attenuated by the presence of Ethiodol. The
left portal vein and hepatic arteries are patent. Spleen is massively
enlarged with extensive splenic hilar varices and a spontaneous splenorenal
shunt. These are all unchanged when compared with the prior study. Multiple
periportal lymph nodes are noted with extensive varices noted in the wall of
the distal esophagus, all are unchanged from the prior study. Head, body and
tail of the pancreas are unremarkable. The adrenal glands are unremarkable.
The left and right kidneys are unremarkable with no mass lesions, stones or
hydronephrosis. The superior mesenteric vein is patent.
## PELVIS WITH CONTRAST:
Again noted is small amount of intraperitoneal fluid
scattered throughout the abdomen and pelvis, not appreciably changed. The
wall of the right colon is slightly thickened, which is a common observation
in patient with portal hypertension. Ureters are well visualized down to the
insertion into the bladder. Bladder is unremarkable with no wall thickening.
Free fluid is present within the pelvis. The prostate is not enlarged. No
deep pelvic adenopathy or inguinal adenopathy is noted. The remaining
visualized loops of small bowel are unremarkable apart from slight diffuse
thickening consistent with patient's known underlying liver disease.
## BONE WINDOWS:
No suspicious lytic or blastic lesions are identified within
the skeleton.
## REFORMATTED IMAGES:
The sagittal and coronal reformatted images demonstrate
no new focal areas of enhancement within the liver and also confirm the
presence of edema within the right colon and loops of small bowel.
## IMPRESSION:
1. Stable appearance to RF ablation zone in liver. The presence of Ethiodol
throughout the posterior right lobe limits sensitivity for excluding subtle
new areas of focal enhancement within the liver.
2. Unchanged features consistent with portal hypertension, splenomegaly with
patent portal vein and thickening of the wall of the small bowel and right
colon, all expected observations in patient with portal hypertension.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-09-14 10:05:00"} | 1,604,626 |
Description: 19592728-RR-45Abstract: ## HISTORY:
History of liver cancer status post radiofrequency ablation and
chemoembolization. Evaluate for recurrent lesions or progression of disease.
Comparison is made to most recent CT abdomen dated and prior
CT examinations dated and .
## BONE WINDOWS:
No malignant-appearing osseous lesions are identified.
## IMPRESSION:
1. No evidence of local recurrence or suspicious hepatic lesions identified.
Stable hypoattenuating lesions within the left and right hepatic lobes.
Hyperdense non-enhancing lesion within the inferior right hepatic lobe likely
represents treated disease and can be followed on subsequent exams.
2. Cholelithiasis without evidence of acute cholecystitis.
3. Unchanged sequelae of portal hypertension including numerous portosystemic
collateral vessels and splenomegaly.
4. Slight interval increase in amount of intrapelvic ascites. No significant
change to moderate pleural effusions.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-07-27 12:52:00"} | 1,604,627 |
Description: 19592728-RR-47Abstract: ULTRASOUND UNILATERAL LOWER EXTREMITY VEINS,
## HISTORY:
man with unilateral lower extremity edema and shortness
of breath; rule out DVT.
## FINDINGS:
Real-time grayscale and color flow sonography, with Doppler
interrogation, of the left lower extremity deep veins was performed in the
Radiology Department. The left lower extremity veins from the common femoral
through the popliteal, demonstrate normal compressibility, resting flow and
augmentation with calf compression. There is no intraluminal echogenic
material to suggest thrombus. There is normal phasic vascular flow in the
right common femoral vein, and normal color flow in the left upper calf veins.
## IMPRESSION:
No evidence of left lower extremity or more central DVT.
Findings discussed with Dr. by Dr. .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-08-22 18:36:00"} | 1,604,628 |
Description: 19592728-RR-49Abstract: ABDOMINAL ULTRASOUND WITH DOPPLERS
## CLINICAL HISTORY:
man with HCC and HCV, presents with right
pleural effusion and worsening liver function. Please perform Dopplers and
evaluate for thrombosis.
## FINDINGS:
Incidental note is made of a right pleural effusion.
The liver demonstrates a heterogeneous echotexture and irregular contour,
compatible with the patient's known cirrhosis. There is no intrahepatic or
extrahepatic biliary dilatation. A hypoechoic, irregularly-shaped lesion is
seen in the dome of the liver that measures approximately 1.5 x 1.4 cm (series
1, image 11). Multiple echogenic areas are seen throughout the right hepatic
lobe, likely representing chemoembolization material.
Doppler interrogation demonstrates a patent hepatic artery and patent hepatic
veins. However, no flow is identified within either the main or right and
left portal veins. These findings may reflect either bland or tumor
thrombosis. Extensive varices and a splenorenal shunt are identified in the
left upper quadrant. The spleen is enlarged and measures at least 13 cm in
length.
## IMPRESSION:
1. Absence of flow on doppler interrogation in the extrahepatic and
intrahepatic portions of the portal vein, which may be compatible with either
bland or tumor thrombosis. This is new when compared with the prior CTA of
at which time the portal vein was patent.
2. Ill-defined hypoechoic lesion in the right hepatic lobe that cannot be
further characterized on this study, but may be related to tumor recurrence.
Further evaluation with CTA may be performed for further evaluation if
clinically indicated.
4. Right pleural effusion.
These findings were discussed with Dr. at 4:00 p.m. on .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-08-24 14:29:00"} | 1,604,629 |
Description: 19592728-RR-51Abstract: ## STUDY:
CT abdomen/pelvis with and without contrast.
## HISTORY:
Hepatocellular carcinoma with increased edema.
## CT ABDOMEN:
A large right pleural effusion has increased in size since prior
study. A small left pleural effusion is unchanged. Residual
chemoembolization material is seen within the right lobe of the liver. The
hyperdense lesion previously seen in the inferior right lobe on prior exam is
inconspicuous on today's exam. A subcentimeter hypodense lesion in the left
lobe (3A, 14) and a 1.2 x 1.9 cm hypodense lesion (3B, 152) in the right lobe
of liver are stable in appearance. Multiple large calcified gallstones
measuring up to 8 mm in diameter are identified. There is no evidence of
gallbladder wall thickening or pericholecystic fluid. There is moderate
splenomegaly, unchanged. Portosystemic collateral vessels, splenorenal
shunts, and gastric and esophageal varices are stable in appearance. The
right and left portal veins are severely attenuated and diminished in caliber.
A collateral vessel is seen arising off the main portal vein trunk and
entering the ligamentum flavum. The stomach, pancreas, kidneys, and adrenal
glands are within normal limits. Enlarged peripancreatic, periportal and
aortocaval lymph nodes are stable in appearance. Moderate amount of abdominal
and pelvic ascites is present. There is no free air identified. Intra-
abdominal bowel loops are unremarkable.
## CT OF THE PELVIS:
There are bilateral fat-containing inguinal hernias. A
left inguinal lymph node measures 1.2 x 1.9 cm, stable. Moderate amount of
free fluid in the dependent portions of pelvis are identified.
## BONE WINDOWS:
A subcentimeter lucent lesion is seen in the right iliac crest
(4, 54), stable in appearance.
## IMPRESSION:
1. Severe attenuation of the portal vein with a collateral vessel arising off
the main portal vein and entering into the ligamentum flavum. Unchanged
appearance of sequelae of portal hypertension including portosystemic
collateral vessels, splenorenal shunts, and splenomegaly.
2. Minimally changed appearance of hepatic lesions. Persistent small amount
of residual chemoembolization material.
3. Cholelithiasis without evidence of cholecystitis.
4. Moderate amount of intra-abdominal ascites.
5. Interval increase in large right pleural effusion. Persistent small left
pleural effusion.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-08-25 10:27:00"} | 1,604,630 |
Description: 19592728-RR-52Abstract: ## INDICATION:
man with cirrhosis. History of liver cancer status
post RFA and chemoembolization x2. Evaluate for recurrent lesions.
## CT CHEST WITH CONTRAST:
When compared to , there has been near
complete resolution of the large right-sided pleural effusion and interval
increase in the left effusion, still small. The lungs are otherwise clear
without nodules or consolidations. There is no axillary, mediastinal, or
hilar lymphadenopathy. The heart, pericardium, and great vessels appear
normal. The airways are patent.
CT ABDOMEN WITHOUT AND WITH IV CONTRAST:
The distribution of high-attenuation
foci of Ethiodol are unchanged, the largest in the posterior lobe involving
segment VII. The low attenuation area in the area of the prior radiofrequency
ablation is unchanged. The portal vein branch supplying the segment remains
occluded. No new areas of enhancement are seen within the liver. The left
portal vein and hepatic arteries are patent. There is stable
splenomegaly (approximately 15 cm in AP diameter). There is stable splenic
hilar varices and splenorenal shunt. Varices along the distal esophagus are
stable, too. Multiple periportal lymph nodes are slightly smaller than on the
prior study. The pancreas remains unremarkable. There is cholelithiasis
without evidence of cholecystitis. The adrenal glands and kidneys are
unremarkable. There is slightly decreased small amount of ascites. Splenic
vein, portal vein, and SMV are patent. The previously noted bowel wall
thickening has almost completely resolved. Pelvic ureters and bladder,
prostate, rectum, sigmoid colon, and small bowel loops are unremarkable. The
amount of free pelvic fluid has slightly increased.
## BONE WINDOWS:
No suspicious lytic or sclerotic lesions. There is an old
fracture of the transverse process of L1 on the right.
## IMPRESSION:
1. Stability of RF ablation zone in the liver and Ethiodol distribution.
No concerning enhancing liver lesions.
2. Interval improvement of bowel wall thickening and slight interval decrease
in abdominal ascites.
3. Slightly increased pelvic ascites.
4. Near complete resolution of right-sided pleural effusion. Increased left-
sided effusion.
5. Cholelithiasis without evidence of cholecystitis.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2123-11-23 15:14:00"} | 1,604,631 |
Description: 19592728-RR-56Abstract: ## INDICATION FOR STUDY:
Hepatitis C virus and cirrhosis. Hepatocellular
carcinoma, evaluate for recurrence of lesions.
Comparison is made with prior study from .
## FINDINGS CHEST WITH CONTRAST:
When compared with the prior study, there is a
decrease in size of left effusion but increase in size of the right effusion.
No discrete pulmonary nodules are identified. No focal areas of atelectasis
or consolidation are noted. No enlarged axillary or supraclavicular nodes are
present. No enlarged mediastinal nodes are present that are in anyway changed
from the prior study. The pericardium is unremarkable. Cardiac chambers are
all unremarkable. An old healed rib fracture is noted along the right lateral
chest wall.
## ABDOMEN WITH CONTRAST:
The precardiac lymph node is stable in size and
appearance. The patient is status post RF ablation with no change in size or
appearance of the non-enhancing low attenuation ablation zone in the posterior
right lobe of the liver. Numerous aggregates of Ethiodol are again noted
unchanged in position or appearance. No enhancing mass lesions are noted
within the liver. The liver again has a nodular contour with hypertrophy of
the left lobe and atrophy of the right consistent with underlying cirrhosis.
Portal vein is widely patent but attenuated within the liver unchanged from
the prior study. Hepatic veins and hepatic arteries are all patent.
The spleen remains massively enlarged with innumerable large splenic hilar
varices noted. A large spontaneous splenorenal shunt is again seen. The
head, body and tail of pancreas are unremarkable with no pancreatic ductal
dilatation. Again seen is slight thickening of the wall of the ascending
colon not appreciably changed from multiple prior studies, small amount of
intraperitoneal ascitic fluid is scattered throughout the peritoneal cavity.
Multiple non-pathologically enlarged mesenteric lymph nodes are again seen not
changed in size or appearance. The left and right adrenal glands are
unchanged in size and appearance. The kidneys are normal in size and
appearance with no stones, mass lesions or hydronephrosis.
## PELVIS WITH CONTRAST:
Again seen is free intrapelvic fluid unchanged in
quantity compared to the prior study. The visualized loops of small bowel are
unchanged in appearance with slight thickening of the wall likely relating to
low albumin or third spacing. The appearance is unchanged from the prior
study. No mass lesions are seen within the pelvis or inguinal regions. The
prostate gland and bladder are unremarkable. The ureters are unremarkable.
## BONE WINDOWS:
No suspicious lytic or blastic lesions are seen throughout the
skeleton.
## REFORMATTED SEQUENCES:
Sagittal and coronal reformatted sequences demonstrate
a stable appearance to the RF ablation zone in the right lobe of the liver
with no evidence for recurrence in the liver.
## IMPRESSION:
1. No evidence for tumor recurrence in this cirrhotic liver. The RF ablation
zone is stable. No enhancing lesions are seen. Additional features of portal
hypertension with splenomegaly and portal varices are stable in
appearance.
2. Decrease in left pleural effusion with slight increase in right-sided
pleural effusion.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-02-01 10:06:00"} | 1,604,632 |
Description: 19592728-RR-58Abstract: ## INDICATION:
with HCC and cirrhosis. Evaluate for recurrent
lesions.
## CT OF THE CHEST:
The lungs are clear with no nodules or focal consolidations.
The left pleural effusion has resolved, and there is only a tiny right-sided
effusion remaining. Heart size is normal, and there is no pericardial
effusion. No mediastinal or hilar lymphadenopathy. A solitary 9 mm
epicardial lymph node is stable.
## MULTIPHASIC CTA OF THE ABDOMEN:
The liver is again shrunken and nodular
consistent with cirrhosis. The patient is status post RF ablation of a
segment VI lesion with no change in the size or appearance of the non-
enhancing low-attenuation ablation zone. There is no new enhancement.
Numerous aggregates of Ethiodol are unchanged in position and appearance. No
enhancing masses elsewhere in the liver. The portal vein remains attenuated
but patent and unchanged from prior studies. The hepatic veins and arteries
are patent.
The spleen remains massively enlarged with innumerable large splenic hilar
varices, esophageal and paraesophageal variecs, and a spontaneous splenorenal
shunt. Stranding within the mesentery and soft tissues has decreased from the
prior exam. Multiple non- pathologically enlarged mesenteric lymph nodes are
unchanged.
The adrenal glands, kidneys, pancreas, gallbladder stone, and intra-abdominal
small and large bowel loops are normal. A small fluid-containing umbilical
hernia is noted.
## CT OF THE PELVIS:
Small amount of non-hemorrhagic free fluid layers within
the pelvis. The bladder wall is mildly thickened, unchanged. Bilateral fat-
containing inguinal hernias are noted. The sigmoid colon and rectum are
normal. There is no pelvic lymphadenopathy.
No suspicious lytic or sclerotic lesions.
## IMPRESSION:
1. No evidence of tumor recurrence. The RF ablation zone is stable.
2. Unchanged cirrhosis and features of portal hypertension with massive
splenomegaly and extensive varices.
3. Decreased anasarca and mesenteric fluid.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-04-30 09:26:00"} | 1,604,633 |
Description: 19592728-RR-60Abstract: ## INDICATION:
with known HCC, ascites and cirrhosis. Evaluate for
portal vein thrombus.
## DOPPLER EXAMINATION OF THE LIVER:
The liver is extremely nodular and shrunken
consistent with cirrhosis. This limits evaluation for focal lesions and the
known status post chemoembolization is not clearly visualized. There is
no flow within the portal vein, even on power Doppler imaging. There are
normal arterial waveforms within the main hepatic artery. The right and
middle hepatic veins as well as the IVC demonstrate normal venous waveforms.
The common bile duct cannot be clearly seen. There are gallstones within a
nondistended gallbladder. Edema within the gallbladder wall is likely due to
chronic liver disease. The spleen remains enlarged measuring 18.7 cm in long
axis. There is no significant ascites. There is a small right pleural
effusion.
## IMPRESSION:
1. No evidence of flow within the main portal vein, a new finding since .
2. Cirrhosis and massive splenomegaly. History of HCC noted but the
posterior right lobe was not well visulaised.
3. Cholelithiasis without cholecystitis.
4. No evidence of ascites. Small right pleural effusion.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "25820610", "time": "2124-04-16 19:47:00"} | 1,604,634 |
Description: 19592728-RR-61Abstract: ## HISTORY:
male with cirrhosis and no flow in the portal vein on
ultrasound.
## FINDINGS:
The liver is small and cirrhotic, with a nodular contour. The
radiofrequency ablation site is located in segment VI, without evidence of
recurrent mass. The portal vein at the porta hepatis is severely attenuated
and narrowed. The right and left portal veins do not enhance with contrast.
The superior mesenteric vein, splenic vein, and portal confluence are patent.
Extensive varices occupy the upper abdomen. A left splenorenal shunt is
present. Moderate amount of ascites causes dielectric artifact, degrading the
images. Pleural effusions are moderate on the right and small on the left.
The spleen is enlarged, measuring up to 15.1 cm in anteroposterior diameter.
The gallbladder wall is mildly thickened diffusely. A lymph node at the porta
hepatis measures 9 mm in short axis. The pancreas, adrenal glands, and imaged
portions of the kidneys demonstrate no focal lesions. No hydronephrosis is
present. Marrow signal is within normal limits.
Multiplanar 2D and 3D reformations provided multiple perspectives for the
dynamic series.
## IMPRESSION:
1. Thrombosis of the portal vein at the porta hepatis. Patent portal
confluence, superior mesenteric vein, and splenic vein.
2. Advanced cirrhosis.
3. Portal hypertension, with extensive upper abdominal varices, splenomegaly,
and splenorenal shunt.
4. Moderate ascites.
5. Moderate right and small left pleural effusions.
6. Radiofrequency ablation site in segment VI of the liver, without evidence
of recurrent mass.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "25820610", "time": "2124-04-17 10:30:00"} | 1,604,635 |
Description: 19592728-RR-64Abstract: ## INDICATION:
man with cirrhosis and portal hypertension, evaluate
vasculature for portal vein thrombosis.
## FINDINGS:
The liver has a coarsened echotexture appearance consistent with
the patient's known cirrhosis. In segment VI of the liver there is an ill-
defined hypoechoic area which measures 1.7 x 2.4 x 1.3 cm. This appears to be
the location of the patient's prior chemoembolization. No new discrete liver
lesions are identified. There is no biliary dilatation and the common duct
measures 0.4 cm. Several small gallstones are seen but there are no signs of
cholecystitis. The spleen is enlarged measuring 14.1 cm and multiple splenic
varices are noted in the hilum. No ascites is identified on today's exam.
## DOPPLER EXAMINATION:
Color Doppler and pulse-wave Doppler images were
obtained. The main portal vein, right portal vein and left portal vein are
all patent and all demonstrate hepatofugal flow. Appropriate arterial flow
was seen in the main hepatic artery, the left hepatic artery and the right
hepatic artery. Hepatofugal flow was also noted in the splenic vein in the
midline. Appropriate flow was seen in the hepatic veins.
## IMPRESSION:
1. Reversed flow in the portal veins and the splenic vein. Appropriate flow
seen in the hepatic arteries and the hepatic veins.
2. Cirrhotic coarse-appearing liver with no new discrete lesions identified.
3. Cholelithiasis with no sign of cholecystitis.
4. Splenomegaly with multiple splenic varices.
5. No ascites identified on today's exam.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-06-01 10:03:00"} | 1,604,636 |
Description: 19592728-RR-69Abstract: ## STUDY:
CT of the head without contrast.
## INDICATION:
male with history of HCC on Coumadin, presenting with
blurry vision and acute onset of leg weakness. Assess for an acute
intracranial process.
## FINDINGS:
There is no acute intracranial hemorrhage, shift of normally
midline structures, hydrocephalus, major or minor vascular territorial
infarction. The density values of the brain parenchyma appear maintained. The
soft tissues and osseous structures are unremarkable. The visualized
paranasal sinuses and mastoid air cells appear well aerated.
## IMPRESSION:
No acute intracranial hemorrhage. Please note, MRI is more
sensitive for the detection of ischemia and metastatic lesions.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-06-16 20:59:00"} | 1,604,637 |
Description: 19592728-RR-72Abstract: ## INDICATION:
Assess for pneumothorax.
Endotracheal tube is in place with tip 5 cm above carina. Swan-Ganz catheter
terminates at junction of main and right pulmonary arteries, and right
internal jugular sheath terminates at junction of right internal jugular and
right brachiocephalic veins. Nasogastric tube terminates in stomach.
Cardiomediastinal contours appear widened, but are likely accentuated by
rotation and supine portable technique. Lungs are clear, and no pleural
effusion or definite pneumothorax is identified. Upper quadrant of the
abdomen appears relatively hyperlucent on the right, and may be due to free
intraperitoneal air from recent abdominal surgery. However, it is difficult to
distinguish from a basilar pneumothorax on a supine radiograph. Attention to
this area on followup radiograph may be helpful in this regard.
## IMPRESSION:
Right upper quadrant lucency, for which follow up radiograph is recommended to
distinguish postoperative free intraperitoneal air from a basilar
pneumothorax.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "21356657", "time": "2124-06-22 11:47:00"} | 1,604,638 |
Description: 19592728-RR-73Abstract: ## STUDY:
Gray-scale and Doppler liver ultrasound.
## INDICATION:
male status post orthotopic liver transplant on
. Please evaluate vasculature and transplant.
## GRAY-SCALE EVALUATION:
Gray-scale evaluation of the liver is limited. No
intrahepatic biliary ductal dilatation is identified. A small 3 x 1 cm
perihepatic collection is noted superiorly and not out of the relm of expected
in the recent post-operative state. No large concerning collections
identified.
## DOPPLER EVALUATION:
The hepatic veins are patent with normal waveforms. The
portal vein is patent with normal hepatopetal flow. The velocity in the main
portal vein is approximately 40 cm/sec. The intrahepatic right and left
portal venous branches are also patent with appropriate directional flow. The
left hepatic artery is patent with brisk upstroke and forward diastolic flow
with a resistive index of 0.7. The right hepatic artery demonstrates brisk
arterial flow with forward diastolic flow in which the diastolic flow is
greater than that of the left hepatic artery. This increased diastolic flow
accounts for the resistive index of 0.6.
## IMPRESSION:
1. Limited gray-scale evaluation demonstrates small expected post-operative
perihepatic collection.
2. Patent hepatic vasculature with expected waveforms as described above.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "21356657", "time": "2124-06-23 08:24:00"} | 1,604,639 |
Description: 19592728-RR-75Abstract: ## HISTORY:
Status post orthotopic liver transplant on complicated by
perihilar hematoma. Evaluate for residual fluid collection. The patient has
a history of status post RF ablation in pre-transplant.
Comparison is made to , CT and , ultrasound.
## BONE WINDOWS:
No malignant-appearing osseous lesions are identified.
## IMPRESSION:
1. No significant perihilar fluid collection identified. Small posterior
perihepatic collection abutting the diaphragm.
2. Small bilateral pleural effusions.
3. Expected induration of the mesentery and perihilar region.
4. Moderate anasarca and mild periportal edema.
5. Persistent splenic varices and splenomegaly.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "21356657", "time": "2124-06-29 10:20:00"} | 1,604,640 |
Description: 19592728-RR-76Abstract: ## HISTORY:
Liver cancer and question of recurrent lesions.
## CHEST FINDINGS:
Airways are patent to subsegmental levels bilaterally. There is no pulmonary
nodule or mass. There is no pleural or pericardial effusion. There is no
axillary, mediastinal or supraclavicular lymphadenopathy. The heart and great
vessels are unremarkable.
## ABDOMINAL FINDINGS:
The appearance of the liver is grossly normal with no focal lesion or mass. A
hypodense periportal collection likely represents an old hematoma and
inferiorly, an organized 15x17 mm (5:63) fluid collection also likely
represents old hematoma. The portal vein is patent; however, note is made of
luminal narrowing near the porta hepatis (4:33). Though this is of doubtful
hemodynamic significance, the finding should be followed on future studies.
In the spleen are multiple hypodense lesions, consistent with Gamna-Gandy
bodies. Innumerable splenic varices are noted. The stomach, small bowel,
pancreas, adrenal glands and kidneys are unremarkable. There is no free fluid
or free gas in the abdomen. There is no mesenteric lymphadenopathy, and
scattered periportal nodes are minimally changed from the study done in
with nodes measuring up to 10 mm in short axis. The previously
described anasarca along the flanks is now resolved.
## PELVIC FINDINGS:
There is no free fluid in the pelvis. The urinary bladder,
distal ureters, prostate, seminal vesicles, rectum and colon are unremarkable.
Note is made of unchanged bilateral fat-containing inguinal hernias. There is
no inguinal or pelvic lymphadenopathy.
## OSSEOUS FINDINGS:
There are no suspicious sclerotic or lytic lesions. Note
is made of a mild dextroconvex thoracolumbar scoliosis. Schmorl's node is
noted at L3 vertebral body.
## IMPRESSION:
Overall, minimally changed study since , with
small perihilar tissue, likely residua from prior hematoma, and small
posterior perihepatic fluid collection, minimally changed.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-09-20 11:46:00"} | 1,604,641 |
Description: 19592728-RR-77Abstract: ## INDICATION:
man with history of liver transplant ( ),
with recent CT scan demonstrating narrowing of the portal vein near the porta
hepatis.
## RIGHT UPPER QUADRANT ULTRASOUND:
Grayscale, color, and Doppler ultrasound
were used to evaluate the transplanted liver and vasculature. The liver is
normal in echotexture without focal abnormalities. There is no ascites. There
is no intra- or extra-hepatic biliary ductal dilatation. The spleen remains
enlarged, measuring 15 cm.
Examination of hepatic vasculature demonstrates normal directional flow and
normal waveforms throughout the portal vein and its branches, the hepatic
veins, the inferior vena cava, and the main hepatic artery. In the portal
vein, at the region of mild narrowing noted on recent CT, no luminal narrowing
is noted on ultrasound. Velocities in the main portal vein range from 30 to
45 cm/sec, with no step-up to indicate stenosis. The left, right anterior,
and right posterior portal veins are all patent with appropriate direction of
flow. Peak systolic velocity in the main hepatic artery measures less than 100
cm/sec.
## IMPRESSION:
Normal post liver transplant ultrasound. No abnormalities of
portal vein velocities in the region of reported narrowing seen on recent CT.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-10-04 14:07:00"} | 1,604,642 |
Description: 19592728-RR-78Abstract: ## INDICATION:
Liver cancer, status post transplantation. Evaluate for
recurrence.
## IV CONTRAST:
130 cc of Optiray.
CT OF THE CHEST WITH IV CONTRAST:
The lungs are clear with no focal mass or diffuse abnormality. No pulmonary
nodules seen.
The pleura shows no thickening, mass or fluid.
The heart and great vessels are unremarkable. No aneurysm.
No mediastinal or hilar lymphadenopathy. No axillary lymphadenopathy.
Bilateral gynecomastia.
CT OF THE ABDOMEN WITH IV CONTRAST:
Status post liver transplantation. No evidence of recurrent mass in the
liver. No solid or cystic nodules. No bile duct dilatation. The anastomoses
appear intact. No perihepatic fluid.
The spleen is enlarged and large perisplenic varices are seen mostly draining
in the renal vein, spontaneous splenorenal shunt.
The kidneys are of normal size with no focal cystic or solid mass. Normal
pelvicaliceal systems and ureters.
No retroperitoneal or mesenteric lymphadenopathy or other mass.
The pancreas is atrophic with no focal mass or other diffuse abnormality.
CT OF THE PELVIS WITH IV CONTRAST:
The prostate is borderline in size. No
pelvic mass or lymphadenopathy.
## IMPRESSION:
No abnormality seen in this post-transplant liver. Splenorenal
shunt, unchanged. Bilateral gynecomastia. No evidence of recurrence.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2124-12-10 15:03:00"} | 1,604,643 |
Description: 19592728-RR-80Abstract: ## CLINICAL INDICATION:
Hepatitis B, status post liver transplant. Evaluate for
recurrence.
## CHEST:
There are no pathologically enlarged thoracic lymph nodes. The heart
and great vessels are unremarkable. There is no pericardial or pleural
effusion. The lungs are normal without evidence of suspicious nodule or mass.
The central airways are patent. There is an enhancing soft tissue nodule
adjacent to the right pectoralis muscle, likely representing a small lymph
node. This is seen on image 18 of series 4, and is stable in size compared to
prior CT performed in . Bone windows demonstrate no focal suspicious
lesions.
## ABDOMEN:
There are postsurgical changes from liver transplant. The
gallbladder is surgically absent. There are no suspicious arterially
enhancing lesions. There is no biliary dilatation. Again noted are prominent
retroperitoneal lymph nodes, unchanged. The spleen measures 13.1 cm. Again
noted are prominent collateral vessels related to splenorenal shunt. The
kidneys, adrenal glands and pancreas are unremarkable. The abdominal and
bowel loops are unremarkable, and there is no free fluid.
## PELVIS:
The bladder is partially decompressed. The prostate gland and
seminal vesicles are unremarkable. The bowel loops are within normal limits,
and there is no free fluid or adenopathy.
Bone windows demonstrate no focal or suspicious lesions.
## IMPRESSION:
1. Status post liver transplant with no suspicious hepatic lesions.
2. Borderline splenomegaly and splenorenal collaterals.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2125-07-03 10:29:00"} | 1,604,644 |
Description: 19592728-RR-81Abstract: ## INDICATION:
A man with liver replacement transplant for chronic
hep C. Please do protocol CT scan to assess for recurrent HCC and mets to the
chest or pelvic area.
## OSSEOUS STRUCTURES:
The visible osseous structures show no suspicious lytic or blastic lesions. A
Schmorl's node is noted along the inferior endplate of L3 vertebral body.
## IMPRESSION:
1. No evidence of recurrence of HCC.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "N/A", "time": "2126-07-16 12:39:00"} | 1,604,645 |
Description: 19592728-RR-83Abstract: ## HISTORY:
man with and decreased urine stream, evaluate for
hydronephrosis.
## FINDINGS:
The right kidney measures 9.3 cm and the left kidney measures 9.8 cm. No
hydronephrosis is seen in the right kidney. There is mild hydronephrosis of
unknown etiology in the left kidney. No stone or solid renal mass is
visualized. A tiny simple cyst is seen at the lower pole of the right kidney
measuring 0.6 x 0.7 x 0.6 cm. The urinary bladder is partially distended but
is unremarkable. Patient chose not to void because of planned urine
collection on the medical floor.
## IMPRESSION:
Mild left hydronephrosis of undetermined etiology. Note is made that this was
not present on the renal ultrasound of . No hydronephrosis in
the right kidney. Tiny simple right renal cyst noted.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-06-23 15:47:00"} | 1,604,646 |
Description: 19592728-RR-85Abstract: ## HISTORY:
man with right upper quadrant pain, HCV cirrhosis,
status post liver transplant.
## FINDINGS:
In segment 4A of the liver there is a complex cystic mass which measures 6.9 x
4.8 x 5.4 cm. This mass was not present on the torso CT of .
This cystic mass contains some echogenic material. There is no vascularity on
color Doppler imaging and no surrounding flow is seen on Doppler. No
additional liver lesion is identified. No intrahepatic biliary dilatation is
seen. The extrahepatic common bile duct is slightly plump measuring 6 mm.
The spleen is mildly enlarged measuring 13.2 cm. No ascites is seen in the
abdomen.
## DOPPLER EXAMINATION:
Color Doppler, and spectral waveform analysis was
performed. The main, right and left portal veins are patent with hepatopetal
flow. Appropriate arterial waveforms are seen in the main, right and left
hepatic arteries. The hepatic veins are patent.
## IMPRESSION:
1. Complex cystic mass measuring 6.9 cm in segment 4A of the liver. The
appearance is suggestive of a hemorrhagic cyst, however no cyst or mass is
seen within the liver on the torso CT of . Further evaluation of
this mass could be obtained with a multiphase CT or with an MRI.
2. Patent hepatic vasculature.
3. Mild splenomegaly.
Findings of hepatic mass were discovered at 14:45 on and were
communicated by telephone to Dr. at 16:45 on the same day.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-06-24 13:54:00"} | 1,604,647 |
Description: 19592728-RR-86Abstract: ## INDICATION:
man with HCV cirrhosis, now presenting with right
upper quadrant abdominal pain, weight loss, and acute renal insufficiency.
## FINDINGS:
The imaged lung bases are clear. The imaged portion of the heart
and pericardium is normal. Prominent epicardial lymph nodes are seen
measuring up to 9 mm (2:7).
A new 5.8 x 5.2 cm well-defined hypodense mass centered in segment V/VIII of
the transplant liver. Additional ill-defined areas of hypoattenuation are
seen in the posterior segments of the right hepatic lobebut are not mass-like.
There is no biliary dilatation. The assessment of the liver lesion is limited
without intravenous contrast. The spleen is in the upper limits of normal
measuring 13.1 cm. Both kidneys are slightly atrophic, without
hydronephrosis, stones or renal masses. Mild dilation of the mid left ureter
is seen. The stomach and small bowel loops are unremarkable. There is
irregular circumferential wall thickening involving the ascending colon for
roughly 7 cm from the ileocecal valve that is supicious for tumor. The
reminder of the colon is unremarkable.
Extensive retroperitoneal and mesenteric lymphadenopathy is new since the
prior study. The largest mesenteric lymph node in the gastrohepatic ligament
measures 24 x 52 mm (2:20), and the largest left para-aortic lymph node (2:40)
measures 34 x 34 mm. Extensive portosystemic collaterals are seen with a
large left splenorenal shunt, as before. The abdominal aorta and IVC are
unremarkable in this non-contrast examination. There is no free fluid or air.
Two ventral abdominal hernias containing fat (2:23 -midline, 2:30-right upper
quadrant), are slightly larger since the prior study. An uncomplicated
fat-containing umbilical hernia is noted.
## CT PELVIS WITH INTRAVENOUS CONTRAST:
Wall thickening in a collapsed urinary
bladder relates to underdistension. The prostate, rectum and sigmoid colon
are unremarkable. No pelvic lymphadenopathy or free fluid is seen.
## BONES AND SOFT TISSUES:
No bone lesion suspicious for infection or malignancy
are detected. Lucent lesions in the right iliac bone (2:66 and 2:55) are
stable since and are likely benign.
## IMPRESSION:
Status post liver transplant, with a new hypodense right hepatic lobe mass
that on ultrsound was necrotic appearing or a compex cystic lesion. Extensive
mesenteric and retroperitoneal adenopathy. Ascending colonic abnormality also
suspicious for tumor. The above findings are most concerning for
post-transplant lymphoproliferative disorder or lymphoma with a primary
colonic neoplasm with metastases less likely.
Two uncomplicated ventral abdominal hernias containing fat are slightly larger
since the prior study. An uncomplicated fat-containing umbilical hernia is
noted.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-06-24 14:27:00"} | 1,604,648 |
Description: 19592728-RR-87Abstract: ## INDICATION:
man with HCV cirrhosis status post transplant with
new CT findings concerning for PTLD.
## CT CHEST WITHOUT INTRAVENOUS CONTRAST:
No nodules are seen in the imaged
unenhanced thyroid gland. The thoracic aorta and pulmonary artery are normal
in caliber. No pathologically enlarged axillary or mediastinal lymph nodes
are identified, ranging up to 5 mm in the right lower paratracheal station.
Evaluation for hilar lymphadenopathy is limited without IV contrast, but there
is no hilar contour abnormality to suggest significant lymphadenopathy. An
epipericardial lymph node (2:37) is unchanged since . Mild
hypoattenuation of the blood pool relative to the cardiac musculature is
compatible with known anemia. There is no pleural or pericardial effusion. A
small amount of fluid is seen in the esophagus (2:18).
Lung window images demonstrate biapical pleural parenchymal scarring. A 3 mm
nodule along the right minor fissure (4:109) and other 2 mm fissural nodules
(on the right 4:114 and 4:134 and on the left 4:96) are likely lymph nodes.
No worrisome nodule, mass or consolidation is seen. Airways are patent to the
subsegmental levels bilaterally.
The imaged abdomen is better evaluated on yesterday's CT. A 5.1 x 5.1 cm
hypodense lesion in the liver appears necrotic or a complex cystic lesion on
ultrasound . Extensive mesenteric and retroperitoneal
lymphadenopathy is again noted. The patient is status post cholecystectomy. A
wide neck ventral hernia contains mesenteric fat (2:60).
## BONE WINDOWS:
No bone finding suspicious for infection or malignancy is seen.
## IMPRESSION:
1. No enlarged lymph nodes in the chest.
2. Tiny bilateral fissural nodules are likely tiny nodes.
3. Hepatic lesion evaluated on prior ultrasound and CT. Intra-abdominal
lymphadenopathy better evaluated on CT abdomen.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-06-25 17:55:00"} | 1,604,649 |
Description: 19592728-RR-88Abstract: ## INDICATION:
man with HCV cirrhosis status post transplant on
tacrolimus with CT findings concerning for PTLD.
## CT NECK WITHOUT INTRAVENOUS CONTRAST:
Evaluation of the neck is limited by
lack of IV contrast. The nasopharynx, oropharynx, and hypopharynx are
unremarkable. The parapharyngeal soft tissues are symmetric. Streak artifact
from dental fillings obscures detail in the oral cavity, but no large mass is
seen. No periapical lucencies. The unenhanced parotid and submandibular
salivary glands are unremarkable. No nodules are seen in the unenhanced
thyroid gland. The glottic and subglottic airway is unremarkable. The
visualized paranasal sinuses and mastoid air cells are clear.
Small lymph nodes in the neck do not meet CT size criteria for pathologic
enlargement, measuring up to 7 mm in the right and left level II stations. No
bone finding suspicious for infection or malignancy is seen. Cerclage wires
are seen at the spinous processes of C5 and C6 with fusion of the C5 and C6
vertebral bodies.
Allowing for slice selection and technique, the imaged portion of the brain is
unremarkable. The lung apices are better evaluated on concurrent chest CT.
## IMPRESSION:
No cervical lymphadenopathy.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-06-25 17:56:00"} | 1,604,650 |
Description: 19592728-RR-90Abstract: ## INDICATION:
Status post liver transplant. Lesion concerning for HCC on CT.
Please evaluate.
## FINDINGS:
The liver parenchyma is of normal signal on T1- and T2-weighted imaging. No
signal dropoff on out-of-phase imaging when compared to in-phase T1-weighted
imaging to suggest fatty deposition. There is a 5.9 x 4.8-cm lesion within
segment VIII of the liver which is of intermediate increased signal on
T2-weighted imaging with some central hyperintense foci. It is of
homogenously low signal on T1-weighted imaging without any evidence of
intralesional fat. The lesion enhances post-administration of contrast and has
restricted diffusion on diffusion weighted imaging. No further liver lesions.
No intra- or extra-hepatic biliary dilatation. The portal and hepatic veins
are patent. The hepatic arterial anastomosis is patent without significant
stenosis.
The spleen is not enlarged. It is of hetrogenous T2 signal consistent with
splenic hemangiomatosis, unchanged when compared to a scan dated .
No adrenal lesion. The pancreas is slightly atrophic but remains of normal
signal. No pancreatic duct dilatation or focal pancreatic lesion.
There is extensive upper abdominal, mesenteric and retroperitoneal
lymphadenopathy. The largest node measures approximately 4.9 cm, unchanged
from the recent CT.
The kidneys enhance symmetrically. There are two 12mm lesions at the upper
pole of the right kidney which are of low signal on T1- and T2-weighted
imaging without evidence of intralesional fat. The lesions demonstrate
restricted diffusion and one has a possible focus of internal enhancement,
both suspicious for lymphomatous deposits. No further renal lesion. No
hydronephrosis.
Normal signal within the visualized skeletal system. The lung bases are
clear.
## IMPRESSION:
1. 5.9-cm lesion within the segment VIII of the liver with extensive
intra-abdominal lymphadenopathy and two suspicious lesions at the upper pole
of the right kidney. The appearances are consistent with a diffuse
intra-abdominal lymphoproliferative disorder alike PTLD or lymphoma.
2. Splenic hemangiomatosis.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-07-03 21:07:00"} | 1,604,651 |
Description: 19592728-RR-93Abstract: ## INDICATION:
man with liver transplant complicated by PTLD, to
evaluate the hepatic vasculature.
## FINDINGS:
The hypoechoicc mass in segment VIII of the liver now measures 3.2
x 3.1 x 3.0 cm, smaller since the prior study where it measured 6.9 x 5.4 x
4.8 cm. Minimal vascularity is seen along the periphery of this lesion.
There is no intra- or extra-hepatic biliary dilatation. The common bile duct
is normal measuring 4 mm. There is no ascites.
Color Doppler, and spectral analysis of the hepatic vasculature was performed.
The main,right and left portal veins demonstrate normal directional flow and
waveforms. The right, left, and middle hepatic veins and IVC demonstrate
normal venous flow. The main, right, and left hepatic arteries demonstrate
normal arterial flow.
## IMPRESSION:
1. Interval decrease in size of the right hepatic lobe mass, since
.
2. Patent hepatic vasculature.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-07-13 08:28:00"} | 1,604,652 |
Description: 19592728-RR-95Abstract: ## INDICATION:
man with history of HCV, complicated by status
post orthotopic liver transplant, now with PTLD complicated by neutropenic
fever, rule out intra-abdominal infection.
## CT CHEST:
The thyroid gland is normal in appearance. The trachea is midline
and the airways are patent to the subsegmental level. There is a millimetric
right upper lobe nodule which is unchanged from prior exam. Bilateral lungs
are otherwise clear with no new nodules, consolidations, effusions or
pneumothorax.
There is no supraclavicular, axillary, mediastinal or hilar lymphadenopathy by
CT size criteria.
A central venous catheter is in place with the tip terminating at the
cavoatrial junction. The heart, pericardium and great vessels are
unremarkable in appearance. There is mild bilateral gynecomastia. The
previously described hypodense lesion in segment VIII of the liver has
decreased in size today measuring 3.0 x 2.9 cm compared to 5.9 x 4.8 cm on
previous MR. liver otherwise enhances homogeneously with no new focal
lesions, intra- or extra-hepatic biliary duct dilatation. The portal vein is
patent. The gallbladder is surgically absent. There are multiple surgical
clips seen in the right upper quadrant. The spleen is mildly enlarged with a
maximal dimension of 14.2 cm. The pancreas is unremarkable in appearance.
There is a punctate right adrenal calcification. The adrenal glands are
otherwise unremarkable. Bilateral kidneys appear somewhat atrophied.
Otherwise, the kidneys present symmetric nephrograms and excretion of contrast
with no focal solid or cystic lesions, pelvicaliceal dilatation or perinephric
abnormalities. The previously appreciated right renal lesion seen on MRI is
not visible on today's CT examination.
The stomach, duodenum and small bowel are unremarkable in appearance with no
evidence of focal wall thickening or obstruction. Again seen is a focal
segment of irregular wall thickening in the descending colon, which is
compatible with previously biopsy-proven posttransplant lymphoproliferative
disorder though improved.
The intra-abdominal vasculature is unremarkable with normal caliber abdominal
aorta and patent celiac axis, SMA, bilateral renal arteries and . Again
seen is extensive mesenteric and retroperitoneal lymphadenopathy. However,
there appears to have been a significant decrease in size and number of
enlarged nodes. There is stranding of the mesenteric and peripancreatic fat
that is reduced in severity from prior examination and is likely a secondary
change due to widespread lymphadenopathy. Largest node is now located along
the ligament of Treitz abutting the greater curvature of the stomach on image
2:61 and measures 2.9 x 1.2 cm. A representative lymph node located adjacent
to the left renal hilum has decreased in size from 3.4 x 3.4 cm to 1.7 x 1.4
cm. Previously, the largest lymph node measured 5.2 x 2.4 cm. Again seen are
extensive portosystemic collaterals, specifically with a very large left
splenorenal shunt. There are two small fat-containing ventral hernias, which
are unchanged from prior exam. There is no pneumoperitoneum or ascites.
There is a fat-containing umbilical hernia.
## CT PELVIS:
There is nonspecific thickening of the bladder wall, which is
otherwise unremarkable in appearance. The seminal vesicles, prostate and
rectum are unremarkable in appearance. There are bilateral fat-containing
inguinal hernias. There is no pelvic free air or free fluid. There is no
inguinal or pelvic wall lymphadenopathy by CT size criteria. The prostate is
borderline enlarged.
## OSSEOUS STRUCTURES:
There are no focal blastic or lytic lesions in the
visualized osseous structures concerning for malignancy or infection. There
is partial visualization of a cerclage wire at C6.
## IMPRESSION:
1. No evidence of intra-abdominal or intra-thoracic infectious process.
2. Interval improvement in disease burden of known PTLD with decrease in
hepatic segment VIII lesion and significant decrease in retroperitoneal and
mesenteric lymph node disease burden.
3. Improvement in focal thickening of the ascending colon corresponding to
biopsy-proven PTLD.
4. Two uncomplicated fat-containing ventral hernia, fat-containing umbilical
hernia, and bilateral fat-containing inguinal hernias.
5. Nonspecific thickening of the bladder wall, which could represent
decompression or a chronic inflammatory process. There is also some mild
bilateral atrophy of the kidneys with minimal surrounding stranding which
could be representative of a chronic inflammatory process.
6. Borderline enlarged prostate.
7. Splenomegaly.
Results were discussed by Dr. with Dr. over the
telephone on at 2:18PM.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592728", "visit_id": "29273029", "time": "2128-07-15 12:09:00"} | 1,604,653 |
Description: 19592787-RR-20Abstract: CT SCAN OF THE ABDOMEN AND PELVIS WITHOUT CONTRAST
## INDICATION:
Abdominal pain, rule out mass.
## FINDINGS:
CT SCAN OF THE ABDOMEN WITHOUT CONTRAST:
Visualized lower lung fields are clear. Normal liver, spleen, adrenals,
pancreas and bile ducts. Patient is status post cholecystectomy. Normal
right kidney. There is a small 2-cm cyst at the lower pole of the left
kidney. Another slightly high-attenuation nodule seen at the upper pole,
series 102/image 70, this is too small to characterize. No evidence of
hydronephrosis or renal calculi. No adenopathy.
CT SCAN OF THE PELVIS WITH CONTRAST:
Surgical clips are noted in the
prostatic and iliac regions. Penile implant is noted. No adenopathy. Bowel
loops appear normal.
## CONCLUSION:
Left renal cyst. Status post cholecystectomy. Coronary artery
calcifications. Penile implant. No cause for patient's pain has not been
identified.
## PELVIC:
evidence of prior prostatic surgery. Penile prosthesis noted. No
adenopathy.
No suspicous bony finding.
## CONCLUSION:
Simple cyst left kidney. evidence of prior prostatic surgery. No
other significant abnormalities.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2184-05-22 13:04:00"} | 1,604,654 |
Description: 19592787-RR-21Abstract: ## INDICATION:
B-cell lymphoma and mass.
Comparison is made to previous CT abdomen dated .
## FINDINGS:
Within the thyroid, there is a hypoenhancing nodule, which measures 4 x 6 mm
in diameter. There is no significant mediastinal, hilar, or axillary
adenopathy. A 3-mm pulmonary nodule is seen on image 41, series 3, in the
left lower lobe anteriorly. Minimal atelectasis is seen in the medial segment
of the right lower lobewhich is compressive in nature from adjacent osteophyte
formation of the thoracic spine.
## ABDOMEN:
The liver, spleen, pancreas, and right kidney as well as both adrenal glands
are normal.
A parapelvic cyst is seen in the lower pole of the left kidney. This has an
enhancing thin septation within its lower aspect. This cyst measures 18 x 24
mm in its maximum transverse diameter. In addition arising from the lower
pole is a hyperdense nodule, which measures 9 x 6 mm in diameter, seen on
image 83, series 3. On the previous CT this was present and was a similar
size, and, had an attenuation of 35 Hounsfield units on non-contrast imaging.
Today, on post-contrast imaging this nodule has an attenuation of 55
Hounsfield units. It is therefore mildly enhancing and is concerning for a
small renal cell carcinoma.
There is no significant intra-abdominal or retroperitoneal lymphadenopathy.
The caliber of the small and large bowel is normal, and the bowel has a normal
appearance. There is no free air or free fluid. Diverticulosis of the colon
is seen without evidence of acute diverticulitis.
## CT PELVIS:
The urinary bladder has an unremarkable appearance. There is a low-density
rounded lesion in the right hemipelvis, as seen on image 116, series 3, which
measures 23 x 30 mm in diameter. There is an attenuation of 3 Hounsfield
units. It previously measured 29 x 20 mm in diameter. This likely represents
a bladder diverticulum. Surgical clips are seen from a previous
prostatectomy. Bilateral subcentimeter inguinal lymphadenopathy is present.
A penile prosthesis is in situ as before and is unchanged in appearance.
## BONES:
There is degenerative disease of the spine. No concerning focal bony
lesions from metastatic bone disease.
## CONCLUSION:
1. Subcentimeter hypoenhancing nodule in the left lobe of the thyroid.This
could be further evaluated with ultrasound if necessary.
2. 3mm pulmonary nodule in the left lower lobe of the lung. Attention on
followup is recommended.
3. Enhancing small mass arising from the lower pole of the left kidney. This
is concerning for a renal cell carcinoma. It has not grown significantly in
size over a year however.
4. Complex parapelvic cyst in the lower pole of the left kidney, which
contains a single thin internal septation, with no concernign features.
5. Evidence of previous prostatectomy, and likely bladder diverticulum in the
lower right hemipelvis. Penile prosthesis in situ.
This report was placed in the critical findings dashboard on the day of the
CT.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2185-05-12 10:23:00"} | 1,604,655 |
Description: 19592787-RR-23Abstract: ## CLINICAL INDICATION:
man with history of small enhancing mass in
the lower left kidney by CT on .
## FINDINGS:
In the lower pole of the left kidney, there is a partially exophytic 1.1 x
0.8-cm lesion that demonstrates low-signal intensity on T1-weighted images and
low-signal intensity on T2-weighted images with a rim of bright signal
intensity (sequence 5, image 19). On dynamic post-gadolinium sequences, there
is progressive, predominantly peripheral enhancement (sequence 1103, image
49). In addition, in the lower pole of the left kidney, there is a septated
T2 hyperintense cystic lesion measuring 3.2 x 2.6 cm that exhibits no
enhancement or nodular component on post-gadolinium sequences (sequence 113,
image 32). A single left renal artery and two right renal arteries which are
of normal caliber. Mild atheromatous changes in the aorta. No significant
lymphadenopathy. Adrenal glands are unremarkable. Visualized portions of the
liver and spleen are unremarkable. Biliary tree and pancreas show no
abnormalities. Gastrointestinal tract is unremarkable. No abnormal marrow
signal is evident.
Multiplanar 2D and 3D reformations provided multiple perspectives for the
dynamic series.
## IMPRESSION:
1. Partially exophytic, progressively enhancing small lesion arising from the
lower pole of the left kidney with imaging features that are concerning for
renal cell carcinoma, likely papillary subtype.
2. Septated cystic lesion in the lower pole of the left kidney which
demonstrates no complex features including no evidence of enhancement or
nodular component.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2185-05-28 12:30:00"} | 1,604,656 |
Description: 19592787-RR-25Abstract: ## HISTORY:
Subcentimeter nodule seen on CT scan, left lobe of the thyroid.
## FINDINGS:
The right lobe measures 4.3 x 1.6 x 1.6 cm in its sagittal, AP, and
transverse diameters. The left lobe measures 4.8 x 1.6 x 1.6 cm. In the mid
portion of the left lobe, there is a 1.2 x 1 cm hypoechoic nodule. This
corresponds to the CT abnormality, although the of the nodule
measure larger by ultrasound exam.
Few small cervical lymph nodes are noted, these are not significant in terms
of size.
## CONCLUSION:
1.2-cm nodule in the left lobe of the thyroid, mid portion.
Six-month followup is recommended to confirm stability.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2185-08-06 10:34:00"} | 1,604,657 |
Description: 19592787-RR-26Abstract: MRI OF THE KIDNEY
## INDICATION:
man with left renal lesion. Evaluation of
progression.
Comparison was performed with the prior MRI study from .
## FINDINGS:
The visualized portion of the liver, spleen, pancreas, adrenals are
unremarkable. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The portal vein is patent throughout. There is no evidence of
free fluid.
The right kidney demonstrates normal appearance without evidence of the focal
lesions.
A small exophytic lesion measuring 0.7 x 0.9 cm is again seen in the posterior
lower interpolar portion of the left kidney. This lesion demonstrates low
signal intensity on T1-weighted images and progressive enhancement and is
unchanged from prior study. Other findings concerning for a small RCC (12:22
and 10:41).
A cystic lesion with septation, measuring 2.8 x 3.5 cm, is again noted in the
lower pole of anterior portion of the left kidney. In the anterior portion of
this lesion, there is a thick sliver of high signal intensity on the
post-contrast images (12:19). This finding is unchanged from the prior study.
To differentiate between those two entities a renal mass MRI protocol with
Lasix administration can be performed in six months. Left accessory renal
artery is noted (8:24).
There is no evidence of retroperitoneal or mesenteric lymphadenopathy.
Atherosclerosis of the abdominal aorta is noted.
## IMPRESSION:
1. Unchanged appearance of 9-mm lesion in the posterior interpolar portion of
the left kidney concerning for small RCC.
2. 3.5-cm cystic lesion in the lower pole of the left kidney with a non
dependent sliver of high signal intensity on the post-contrast images.
Differential diagnosis include cystic mass with thick septal enhancement
versus caliceal diverticulum with excretion of contrast in its lumen. To
differentiate between those two entities, followup renal mass MRI study with
administration of Lasix in six months is recommended.
The findings were emailed to Dr by Dr on on 21.07.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2186-03-03 14:51:00"} | 1,604,658 |
Description: 19592787-RR-28Abstract: ## INDICATION:
History of left RCC, rule out calyceal diverticulum.
## FINDINGS:
The imaged lung bases are clear.
Within the interpolar region of the left kidney, there is a 5 x 10 mm nodule
identified. It is isointense to renal parenchyma on T1-weighted imaging and
demonstrates mild increase in signal intensity on T2-weighted imaging. It
demonstrates enhancement post-administration of IV contrast, and findings are
consistent with known small renal cell carcinoma. It is stable and unchanged
in size and appearance since prior imaging.
Adjacent to this is a 3.1 x 2.1 cm cystic lesion. It is isointense to the
kidney on T1-weighted imaging and is bright relative to renal cortex on
T2-weighted imaging. It does not contain any intravoxel fat. On
administration of Lasix, this does not distend and is therefore not a calyceal
diverticulum. There are thin wisp-like enhancing septations within it (series
10, image 25). No areas of enhancing nodularity identified. Findings are
consistent with a minimally complex cyst in the lower pole of the left kidney.
No additional renal lesions are identified. An accessory renal artery is
noted on the left side which supplies the lower pole of the left kidney
(series 10, image 22). Two renal arteries noted on the right side, (series
10, image 16). The renal veins are patent.
Of the visualized liver, there is normal hepatic parenchymal signal intensity
with no focal liver lesion. No intra- or extra-hepatic biliary dilatation.
No gallstones evident within the gallbladder. There is a replaced right
hepatic artery, (series 10, image 6). The main portal vein is patent.
Spleen is normal in size. The pancreas is of homogeneous signal intensity and
enhances normally. No pancreatic cystic lesion identified. No pancreatic
ductal dilatation. Adrenal glands are unremarkable. There are no
retroperitoneal masses or adenopathy. No abnormally dilated or thickened
small or large bowel loop in the visualized upper abdomen. No intra-abdominal
free fluid.
Bone marrow signal is normal and no osseous lesions identified.
## IMPRESSION:
1. Stable 5 x 10 mm RCC in the lower interpolar region of the left kidney.
2. Cyst with thin wisp-like septations noted in the lower pole of the left
kidney has no concerning features and is unchanged when compared to prior
imaging. This is not a calyceal diverticulum.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2186-09-07 11:27:00"} | 1,604,659 |
Description: 19592787-RR-33Abstract: ## INDICATION:
male with history of left renal cell carcinoma.
Evaluate for change.
## FINDINGS:
An exophytic lesion arising from the posterior interpolar aspect of the left
kidney (14:43) measures 10 x 9 mm, similar to prior. This lesion has low
signal on T1-weighted sequences and mildly increased signal on T2-weighted
sequences. After contrast administration, the lesion progressively enhances,
predominantly in a peripheral distribution. Since , there has
been no significant change.
A cystic lesion in the lower pole of the left kidney is again seen. This
lesion measures up to 3.2 x 2.2 cm (12:26), is hyperintense on T2 sequences,
and contains multiple non-nodular septations. The right kidney is
unremarkable.
The liver is normal without focal or diffuse signal abnormality. The
gallbladder is not identified. The intra- and extra-hepatic bile ducts,
pancreas, spleen, and adrenal glands are unremarkable.
The stomach is unremarkable. The visualized portion of the small and large
bowel are unremarkable.
No retroperitoneal or mesenteric lymphadenopathy. The portal veins are
unremarkable. Accessory left and accessory right renal arteries are noted.
The superiorly-located right renal artery has an early bifurcation. Right
hepatic artery is replaced.
The marrow signal of the visualized osseous structures is unremarkable.
## IMPRESSION:
1. 10-mm left kidney interpolar exophytic lesion, mildly hyperintense on T2
with post-contrast thickened rim enhancement. No significant change since
, though imaging findings remain suggestive of a cystic renal
cell carcinoma.
2. Left kidney lower pole complex cyst measures up to 3.2 cm, has no
worrisome feature, and is unchanged since .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2187-07-12 12:41:00"} | 1,604,660 |
Description: 19592787-RR-34Abstract: ## INDICATION:
man with left renal RCC, to assess interval change.
## FINDINGS:
The liver is normal in appearance, without focal lesions or biliary
dilatation. The patient is status post cholecystectomy. The adrenal glands,
spleen and pancreas are normal. The right kidney is normal, without
hydronephrosis or concerning renal mass. A 11 x 9 x 8 mm exophytic lesion in
the posterior interpolar region of left kidney (17:56) with progressive
enhancement, allowing for differences in technique is stable since prior
studies dating back to where it measured 11 x 9 x 7 mm. A 3.4 x
2.5 x 2.8 cm complex cystic lesion in the lower pole of the left kidney
centered in a peripelvic location (3:11), continues to demonstrate thin
internal septations with minimal enhancement, but no new nodularity or
worrisome features. This remains unchanged since the prior study, where it
measured 3.4 x 2.5 x 2.9 cm. No new worrisome renal mass is identified.
The abdominal aorta is tortuous, without aneurysmal dilation. Bilateral
accessory renal arteries are noted. There is an early branching of the right
main renal artery. Incidental note is made of replaced right and left hepatic
arteries.
The renal veins and IVC are patent. Small scattered retroperitoneal lymph
nodes are not pathologically enlarged.
S-shaped scoliosis of the lumbar spine is seen with mild degenerative changes.
No worrisome bony lesion is seen.
## IMPRESSION:
1. Small exophytic enhancing lesion in the interpolar region of left kidney,
suspicious for renal cell carcinoma is little changed since .
2. Complex cyst in the lower pole of left kidney, also stable since
without new worrisome features.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2188-09-11 10:49:00"} | 1,604,661 |
Description: 19592787-RR-36Abstract: ## INDICATION:
year old man with hepatic flexure mass found on colonoscopy //
Evaluation for metastatic disease
## DOSE:
DLP: .64 mGy-cm (abdomen and pelvis.
## IV CONTRAST:
130 mL Omnipaque injected at a rate of cc/sec
## LOWER CHEST:
The visualized portions of the lungs are clear. The heart mildly enlarged and
there is no evidence of pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout. There
is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder has been surgically removed.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
There is re- demonstration of a small exophytic mass extending from
the posterior wall of the kidney, which is unchanged from the previous
examination. There are multiple re- demonstrated cystic lesions in the kidneys
bilaterally which are unchanged from the previous examination. There are no
urothelial lesions in the kidneys or ureters. There is no perinephric
abnormality.
## GASTROINTESTINAL:
Small bowel loops demonstrate normal caliber, wall thickness
and enhancement throughout. There is a mass measuring 17 x 24 mm noted at the
hepatic flexure with overhanging edges (Image 30, 601b; Image 25, 602b; Image
3 series 39). Appendix contains air, has normal caliber without evidence of
fat stranding.
## RETROPERITONEUM:
There is no evidence of retroperitoneal and mesenteric
lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. There is moderate calcium
burden in the abdominal aorta and great abdominal arteries.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is no evidence
of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
There is a penile prosthesis.
## BONES AND SOFT TISSUES:
There is no evidence of worrisome lesions. There is multilevel moderate
degenerative changes of the spine. There are bilateral fat containing inguinal
hernias.
## IMPRESSION:
1. There is a 17 x 24 mm mass of the colon at the hepatic flexure with
overhanging edges, concerning for malignancy.
2. There is no evidence of metastatic disease.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "N/A", "time": "2189-07-10 12:54:00"} | 1,604,662 |
Description: 19592787-RR-37Abstract: ## EXAMINATION:
CHEST (PA AND LAT)
## INDICATION:
male with colonic adenocarcinoma at the hepatic
flexure status post laparoscopic hemicolectomy with pneumonia referred for 1
week follow-up.
## FINDINGS:
The lungs are hypoinflated. Right mid lung linear atelectasis or scarring is
noted. Left lung base subsegmental atelectasis is also present. There is no
pneumothorax. The heart size is suboptimally assessed due to low lung volumes.
The mediastinum is not widened. Multilevel spinal degenerative changes are
present.
## IMPRESSION:
Left lung base subsegmental atelectasis.
Right mid lung linear atelectasis or scarring.
No radiographic evidence of pneumonia.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "24142382", "time": "2189-07-31 13:29:00"} | 1,604,663 |
Description: 19592787-RR-41Abstract: ## INDICATION:
year old man with tachycardia, desat, r/p PE // r/o PE.
Patient is postoperative day 8 from left and right colectomy for colon cancer.
Ileus on outside hospital CT scan with nausea and loose stools.
## CTA CHEST:
The thoracic aorta is normal in caliber without evidence of
dissection with mild atherosclerotic calcifications along its course.
Pulmonary arterial vasculature is well visualized to the subsegmental level
without filling defect to suggest pulmonary embolism. No pathologically
enlarged supraclavicular, axillary, mediastinal or hilar lymph nodes are
identified. Moderate atherosclerotic calcifications in the LAD coronary artery
are of unknown hemodynamic significance. There is no pleural or pericardial
effusion. Linear atelectasis or scarring in the left upper lobe is new from
. There is mild dependent bibasilar atelectasis with right middle and left
lower lobe atelectasis. Mosaic attenuation suggests small airways disease. No
worrisome nodule, mass, or consolidation. Airways are patent to the
subsegmental levels bilaterally. Minimal gynecomastia is noted bilaterally.
## CT ABDOMEN:
The liver has homogeneous attenuation throughout. No focal liver
lesion is identified. There is no intra or extrahepatic bile duct dilation.
The gallbladder is surgically absent. The spleen, pancreas and bilateral
adrenal glands are unremarkable. The kidneys enhance symmetrically and excrete
contrast promptly without hydronephrosis. A 6 mm exophytic lesion at the
posterior left renal interpolar region (10:47) is better evaluated on the
prior MRI, suspicious for renal cell carcinoma. A 2.6 cm simple cyst at the
left renal lower pole is unchanged (10:50).
Oral contrast remains within small bowel without reaching the colonic
anastomotic sites. Fluid is seen in mildly dilated small bowel loops with
some more decompressed small bowel loops distally. However, there is fluid in
the colon, which is not collapsed, suggesting ileus rather than bowel
obstruction.
Small foci of extraluminal air at the right colonic anastomotic site (10:59)
are new from . This is deep to the umbilical port site, which
contains small air and more fluid than on . If there has been
interval manipulation of the port site, this air may be related to
manipulation. If there has not been manipulation, this raises the possibility
of an anastomotic leak, although no adjacent fluid is seen. The left colonic
anastomotic site appears intact. Small free air and free fluid in the left
upper quadrant are similar to the prior study without an organized fluid
collection, likely post operative or due to fat necrosis. Elsewhere, there is
small free intraperitoneal fluid without an organized fluid collection.
The abdominal aorta is normal caliber throughout with moderate atherosclerotic
calcifications along its course. The main portal vein, splenic vein and SMV
are patent. No pathologically enlarged mesenteric or retroperitoneal lymph
nodes are identified.
## CT PELVIS:
The rectum and sigmoid colon are unremarkable. Free fluid in the
pelvis is likely tracking from the abdomen. A right bladder diverticulum is
noted (10:85). The patient is status post prostatectomy. Penile implants are
in place. No pelvic or inguinal lymphadenopathy.
## BONE WINDOWS:
No bone finding suspicious for infection or malignancy is seen.
## IMPRESSION:
1. No acute aortic pathology or pulmonary embolism. No pneumonia.
2. Small foci of extraluminal air at the right colonic anastomotic site, deep
to the umbilical port site, are new from . If there has been
interval manipulation of the port site, the air may be related to
manipulation. If there is not been manipulation, this raises the possibility
of an anastomotic leak and close clinical followup is suggested.
3. Ileus. No drainable fluid collection in the abdomen or pelvis.
## NOTIFICATION:
The findings were discussed by Dr. with
on the telephone on at 12:30 and at 3:55PM.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "23888277", "time": "2189-08-06 11:42:00"} | 1,604,664 |
Description: 19592787-RR-43Abstract: ## EXAMINATION:
CONTRAST ENHANCED CT ABDOMEN AND PELVIS
## INDICATION:
Status post recent extending right colectomy now with ileus, now
status post ex lap revision of anastomosis. Evaluate for leak or abscess.
## FINDINGS:
Visualized portions of the left lower lung demonstrate atelectasis. Visualized
portions of the heart and pericardium are within normal limits.
## CT OF THE ABDOMEN:
The liver enhances homogeneously with no focal hepatic
lesions identified. There is no intrahepatic biliary ductal dilatation. The
gallbladder has been surgically removed. Surgical clips are seen in the right
upper quadrant. The pancreas is normal. There is no pancreatic duct dilatation
or peripancreatic fluid collections. The adrenal glands are normal. The
spleen is homogeneous and normal in size. In the lower pole of the left
kidney, there is redemonstration of a 3.4 x 2.4 cm hypodensity which measures
up to 5 Hounsfield units, characterized as a complex cystic lesion on prior MR
from (series 5, image 41). Additionally, there is
redemonstration of a 10 mm left peripelvic cyst. A small 6 mm exophytic
lesion in the interpolar region of the left kidney is again seen, better
assessed on prior MR, and suspicious for renal cell carcinoma (series 5, image
36). The kidneys otherwise enhance symmetrically and excrete contrast without
evidence of hydronephrosis. There is mild to moderate amount of perihepatic
ascites.
The stomach is normal. Patient is status post bilateral colectomy. Both right
and left colonic anastomoses appear grossly intact. However, note is made of
multiple mildly dilated fluid filled loops of small bowel, measuring up to 3.7
cm. No transition point is identified and fluid is seen in portions of the
distal colon. These findings could relate to ileus. Two foci of air are seen
adjacent to the duodenum and could reflect a potential leak versus residual
post-operative air (series 5, image 29). There is redemonstration of a 6.8 x
4.7 cm fat attenuating lesion in the right upper quadrant (series 5, image
29).
Surrounding the duodenum, there is a well organized fluid collection with a
mild hyperdense rim measuring 3.7 (TV) x 2.9 (AP) x 3.9 (CC) cm (series 5,
image 22; series 8, image 29). In the right paracolic gutter, there is an
additional new well organized and hypodense fluid collection with a hyperdense
rim which abuts multiple loops of bowel and measures approximately 4.3 (TV) x
3.2 (AP) x 9.3 (in coronal view) cm (series 5, image 37; series 7, image 28).
Lastly, there is a smaller hypodense fluid collection with a hyperdense rim in
the right lower quadrant, just inferior to the rectus sheath on the right
which measures 5.2 x 1.0 cm (series 5, image 58). In the left upper quadrant,
just inferior to the spleen, there is redemonstration of presumed surgical
material, possibly Surgicel, surrounded by a small amount of free fluid,
measuring up to 3.9 x 3.2 cm (series 5, image 23).
The abdominal aorta is tortuous with moderate amount of atherosclerotic
calcifications. The celiac axis, SMA, bilateral renal arteries and are
patent. Along the anterior abdominal wall at midline, there is an open wound,
with surrounding fat stranding, likely related to recent surgery.
## CT OF THE PELVIS:
A moderate amount of air is seen in the urinary bladder,
which could relate to recent instrumentation. There is redemonstration of a
right bladder diverticulum which now contains a small amount of air (series 5,
image 80). Multiple surgical clips are seen in the pelvis, patient is status
post prostatectomy. There is a moderate amount of low density attenuating
fluid in the pelvis. The rectum is grossly intact. There are bilateral fat
containing inguinal hernias. The one on the left contains a small
unobstructed loop of bowel. Penile imlpants are in place.
## OSSEOUS STRUCTURES:
No blastic or lytic lesion concerning for malignancy.
Multilevel moderate degenerative changes are noted along the lumbar spine with
anterior osteophytosis, multilevel vacuum disc phenomenon and endplate
sclerosis.
## IMPRESSION:
1. Multiple new organized fluid collections within the abdomen as described
above, raising concern for abscess/infection.
2. Two foci of air are seen adjacent to the duodenum, could reflect a
potential leak versus residual post-operative air.
3. Right and left colonic anastomoses appear grossly intact.
4. Multiple fluid-filled dilated loops of small bowel with no definite
transition point identified and fluid seen in distal colon. Findings could
relate to postsurgical ileus.
5. Moderate intra-abdominal ascites.
6. 6.8 cm fat attenuating lesion in the right upper quadrant, for which
differential diagnoses include lipoma versus low grade liposarcoma.
7. Moderate amount of air seen within the urinary bladder, likely relates to
recent instrumentation. Correlation with history recommended.
## NOTIFICATION:
Findings #1 and #3 were discussed by Dr. with Dr.
on the telephone on at 2:05 , 15 minutes after discovery of the
findings.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "23888277", "time": "2189-08-16 10:31:00"} | 1,604,665 |
Description: 19592787-RR-45Abstract: ## EXAMINATION:
ABDOMEN US (COMPLETE STUDY)
## INDICATION:
year old man with intra-abdominal abscess // please evaluate
for drainage
## FINDINGS:
Targeted sonographic imaging was performed of the right mid abdomen to
determine whether the collection seen in this region on the preceding CT, was
amenable for ultrasound guided drainage. An air and fluid containing
collection was identified in the location corresponding to that seen on prior
CT. Immediately superior to the collection is a homogeneous, hyperechoic
structure measuring 3.7 x 5.3 cm, a sonographic appearance suggestive of a fat
containing lesion. The collection to be drained was identified immediately
inferior to this and measures 3.0 x 4.2 cm. The loops of bowel adjacent to the
collection were identified. The collection was deemed amenable for ultrasound
guided percutaneous drainage.
Please note that is images of the drainage procedure which was performed
immediately following this ultrasound, are included in this same clip (images
10 through 14) but refer to the ultrasound guided drainage reported separately
under clip .
## IMPRESSION:
1. 3.0 x 4.2 cm air and fluid containing collection in the right mid abdomen
consistent with abscess, amenable to ultrasound-guided drainage. Please refer
to separately dictated report of drainage procedure which was performed
immediately following the study..
2. 3.7 x 5.3 cm echogenic structure is seen just superior to the collection to
be drained, suggestive of a fat containing lesion. Diagnostic considerations
would include lipoma or low-grade liposarcoma.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "23888277", "time": "2189-08-16 15:04:00"} | 1,604,666 |
Description: 19592787-RR-46Abstract: ## INDICATION:
year old man with intra-abdominal abscess, s/p right and left
colectomy // please evaluate for drainage of right sided intra-abdominal
abscess
## PROCEDURE:
Ultrasound-guided drainage of right mid abdominal collection.
## OPERATORS:
Dr. trainee and Dr. radiologist,
who was present and supervising throughout the total procedure time.
## SEDATION:
Moderate sedation was provided by administering divided doses of 1
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 20
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
## FINDINGS:
Air and fluid containing collection in the right mid abdomen. Please note that
images are included in CLIP number .
## IMPRESSION:
Successful US-guided placement of pigtail catheter into the right mid
abdominal collection. Sample sent for microbiology evaluation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592787", "visit_id": "23888277", "time": "2189-08-16 15:36:00"} | 1,604,667 |
Description: 19592790-RR-17Abstract: ## HISTORY:
year old woman with complex abd pain syndrome, possible enteritis
on OSH imaging, possible Crohn's disease. Assess for active intestinal
inflammation to explain her symptoms. History of appendectomy,
cholecystectomy.
## FINDINGS:
There is overall normal motility of the small bowel. Mild circumferential
thickening with slight increase transmural enhancement of the terminal ileum
and distal ileum, at least 20 cm in length, with mild bowel wall edema. This
appearance is compatible with a nonspecific terminal ileitis, which may be of
infectious or inflammatory origin. The region of inflammation appears to be
different than that seen on the prior CT. No evidence of fistula or abscess
formation. The visualized portions of the cecum and colon appear
unremarkable, the cecum appears collapsed. No evidence of obstruction.
Post-contrast image quality is somewhat degraded by motion artifact.
Partially visualized liver, spleen, pancreas, bilateral adrenal glands and
kidneys appear unremarkable. Normal caliber abdominal aorta. No evidence of
significant lymphadenopathy. No evidence of ascites. The patient is status
post cholecystectomy and appendectomy. Normal-appearing urinary bladder,
uterus, and bilateral adnexa. No evidence of pelvic free fluid. No evidence
of significant inguinal or pelvic sidewall lymphadenopathy. The visualized
osseous structures unremarkable.
## IMPRESSION:
Terminal ileitis/enteritis of infectious or inflammatory origin. No fistula
or abscess formation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592790", "visit_id": "28108465", "time": "2185-07-16 16:39:00"} | 1,604,668 |
Description: 19592790-RR-22Abstract: ## HISTORY:
Biopsy-proven enteritis with acute exacerbation of abdominal pain,
steroid refractory. Evaluate for signs of inflammatory bowel disease.
## ABDOMEN CT:
The visualized portions of the lung bases are clear. The liver
parenchyma enhances homogeneously. No focal liver lesions are identified.
There is no intrahepatic or extrahepatic biliary duct dilatation. The portal
vein is patent. The gallbladder is surgically absent. The spleen, pancreas,
adrenal glands, and left kidneys are normal. Note is made of a duplex right
kidney with 2 ureters that appear to join just above the level of the
ureterovesical junction. The stomach is unremarkable. There is a
duodenoduodenal intussusception involving the portion of the duodenum,
likely transient in nature. There is no upstream bowel dilatation. The
remainder of the small bowel and colon are unremarkable. A small caliber
tubular structure filled with oral contrast material that measures
approximately 11 mm in length extends from the base of the cecum (601 3:30),
possibly an appendiceal stump related to prior appendectomy. There is no free
fluid or free air in the abdomen. No pathologically enlarged abdominal lymph
nodes are seen. The abdominal aorta is normal in caliber.
## PELVIS CT:
The bladder, uterus, and adnexae are unremarkable. There is no
free fluid in the pelvis. No pathologically enlarged pelvic lymph nodes are
seen.
## SOFT TISSUES AND BONES:
No suspicious lytic or blastic lesions are
identified. Foci of subcutaneous air along the anterior abdominal wall could
relate to prior injections.
## IMPRESSION:
1. No CT findings suggestive of inflammatory bowel disease.
2. Duplex right kidney with two ureters that appear to join just above the
level of the ureterovesical junction.
3. Duodenoduoneal intussusception, likely tranient on nature. No upstream
bowel dilatation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592790", "visit_id": "23710613", "time": "2185-08-12 20:56:00"} | 1,604,669 |
Description: 19592790-RR-26Abstract: ## INDICATION:
year old woman with recurrent SBO at level of ileum, GI asking
for MRE to see if there is e/o ileal disease// ? e/o ileal inflammation, e/o
Crohn's
## MR ENTEROGRAPHY:
Dynamic images do not demonstrate a persistent stricture in the small bowel.
Review of the prior studies indicate patient previously had a mild small-bowel
obstruction in the mid to distal approximately 20-30 cm proximal to the
terminal ileum. There is no bowel wall edema. No mesenteric fat stranding.
No separation of bowel loops or mesenteric creep. No abnormal hyper
enhancement following contrast administration. The colon is unremarkable in
appearance. No bowel obstruction.
MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:
Visualized portions of the liver, biliary ducts, spleen, kidneys, adrenals and
pancreas are unremarkable. Status post cholecystectomy.
No ascites. No abdominal or pelvic adenopathy. There is a 2.1 x 2.1 cm
umbilical subcutaneus lesion demonstrating spontaneously hyperintense signal
intensity on both T1 and T2 weighted images and without internal enhancement
likely representing a sebaceous cyst or epidermal inclusion cyst.
MRI OF THE PELVIS WITH AND WITHOUT IV CONTRAST:
The uterus and ovaries are unremarkable. No adnexal masses. 2.2 cm cyst in
the right ovary, likely a corpus luteum. The urinary bladder is unremarkable.
## IMPRESSION:
No MR features to suggest inflammatory bowel disease.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592790", "visit_id": "27889118", "time": "2191-04-04 12:23:00"} | 1,604,670 |
Description: 19592790-RR-27Abstract: ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## INDICATION:
w/ Hx SBO, ?Hx crohn's, ?acute intermittent porphyria, here
with acute on chronic ab pain. Evaluate small bowel obstruction versus other
intra-abdominal pathology.
## SINGLE PHASE CONTRAST:
MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Patient deferred oral contrast.
Coronal and sagittal reformations were performed and reviewed on PACS.
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is surgically absent. There
is trace ascites at the hepatic dome (05:17).
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size with normal nephrogram.
There is no evidence of focal renal lesions or hydronephrosis. There is no
perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. There is wall thickening and
hyperemia of several loops of distal and terminal ileum, some which
demonstrate a targetoid appearance. There is also mild dilatation of distal
ileal small bowel loops up to 3.1 cm without evidence of distal decompression
or transition point (5: 60). There is associated fibrofatty proliferation of
the adjacent mesentry with trace mesenteric free fluid. There is also mild
thickening and hyperemia of the cecum and proximal ascending colon. The
remainder of the visualized colon and small bowel loops appear within normal
limits. No organizing fluid collections identified. The appendix is
surgically absent.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is
small volume free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The visualized uterus is unremarkable. A 4.8 x 4.3 cm
right adnexal cystic structure is likely physiologic (07:28). No left adnexal
abnormalities identified.
## LYMPH NODES:
No retroperitoneal lymphadenopathy. Scattered mesenteric root
lymph lobes not pathologically enlarged by CT size criteria (05:44, 56).
There is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. No atherosclerotic disease
is noted.
## BONES:
Small sclerotic focus within the left acetabulum is unchanged compared
to , compatible with a bone island (5:76). There is no evidence of
worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
A 2.3 x 2.1 x 2.0 cm fluid containing lesion anterior to the
umbilicus is new compared to (05:47).
## IMPRESSION:
1. Long segment thickening of the distal and terminal ileum with involvement
of the cecum and proximal ascending colon is compatible with acute Crohn's
flare with resultant partial bowel obstruction and small volume ascites.
2. 4.8 cm right adnexal cyst is likely functional. Dedicated pelvic
ultrasound may be considered if clinically warranted.
3. 2.3 cm fluid containing structure anterior to the umbilicus is of doubtful
clinical significance. Recommend correlation with physical exam.
## NOTIFICATION:
The findings were discussed with , M.D. by
, M.D. on the telephone on at 5:06 pm, 5 minutes after
discovery of the findings.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592790", "visit_id": "21224674", "time": "2191-06-22 10:40:00"} | 1,604,671 |
Description: 19592790-RR-29Abstract: ## EXAMINATION:
CT ABD AND PELVIS WITH CONTRAST
## +PO CONTRAST; HISTORY:
with Crohn's, IBD, status post
numerous SBO's with 5 exploratory laparotomies, presents with nausea,
vomiting, abdominal pain.+PO contrast // Rule out SBO, abscess
## SINGLE PHASE CONTRAST:
MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
## DOSE:
Acquisition sequence:
1) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 53.0 mGy (Body) DLP =
26.5 mGy-cm.
2) Spiral Acquisition 6.0 s, 47.6 cm; CTDIvol = 24.7 mGy (Body) DLP =
1,174.5 mGy-cm.
Total DLP (Body) = 1,201 mGy-cm.
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
## HEPATOBILIARY:
The liver demonstrates homogenous attenuation throughout.
There is no evidence of focal lesions. There is no evidence of intrahepatic or
extrahepatic biliary dilatation. The gallbladder is surgically absent.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
There is no evidence of solid renal lesions or hydronephrosis. There
is no perinephric abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. There is wall thickening and
hyperemia of several loops of distal and terminal ileum some of which
demonstrated targetoid appearance (series 601: Image 28). There is associated
fibrofatty proliferation of the adjacent mesentery with trace mesenteric free
fluid. In addition, a distal loop of small bowel measures up to 3 cm and
demonstrates an air-fluid level (series 2: Image 45). There is no frank
transition point. There is mild mucosal enhancement of the cecum, otherwise,
the colon and rectum are within normal limits. The appendix is surgically
absent.
## PELVIS:
The urinary bladder and distal ureters are unremarkable. There is a
small volume of free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The visualized reproductive organs are unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
Again seen 2.9 x 2.4 cm fluid containing lesion anterior to the umbilicus,
overall similar in appearance to most recent prior exam. Otherwise, the
abdominal and pelvic wall is within normal limits.
## IMPRESSION:
Long segment thickening of distal and terminal ileum compatible with an acute
Crohn's flare. Distal loop of small bowel measuring up to 3 cm with air-fluid
level and no transition point, consistent with a partial small bowel
obstruction.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592790", "visit_id": "N/A", "time": "2192-05-01 04:24:00"} | 1,604,672 |
Description: 19592790-RR-31Abstract: ## EXAMINATION:
CT ABD AND PELVIS W/O CONTRAST
## INDICATION:
year old woman with possible chrons // assessment of patency
capsule passage at 7
## DOSE:
Acquisition sequence:
1) Spiral Acquisition 9.9 s, 52.2 cm; CTDIvol = 17.9 mGy (Body) DLP = 939.1
mGy-cm.
Total DLP (Body) = 939 mGy-cm.
## LOWER CHEST:
Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion. Patient is status post right
mastectomy, incompletely imaged.
## HEPATOBILIARY:
The liver demonstrates homogeneous attenuation throughout.
There is no evidence of focal lesions within the limitations of an unenhanced
scan. There is no evidence of intrahepatic or extrahepatic biliary
dilatation. The gallbladder is surgically absent.
## PANCREAS:
The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
## SPLEEN:
The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
## ADRENALS:
The right and left adrenal glands are normal in size and shape.
## URINARY:
The kidneys are of normal and symmetric size. There is no suspicious
renal lesions within the limitations of an unenhanced scan. There is no
hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality.
## GASTROINTESTINAL:
The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout interval resolution. There is
still inflammatory changes along the cecum, although probably improved. The
distal ileum is more difficult to assess with this technique but is now
probably normal, at least for the most part, a substantial short-term change.
Patient is status post appendectomy. Capsule is in the lower sigmoid.
## PELVIS:
The urinary bladder is sub maximally distended appears grossly
unremarkable. There is no free fluid in the pelvis.
## REPRODUCTIVE ORGANS:
The visualized reproductive organs are unremarkable.
## LYMPH NODES:
There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
## VASCULAR:
There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
## BONES:
There is no evidence of worrisome osseous lesions or acute fracture.
## SOFT TISSUES:
There is a stable fluid collection within the periumbilical
anterior subcutaneous tissues.
## IMPRESSION:
1. Short-term improvement in abnormal appearance of the ileum although not
optimally assessed with this technique. Suspicion for persistent mild
inflammatory change along the cecum, but again not fully assessed with this
technique. Given relapsing remitting course without definite diagnosis, in
very rapid improvement over 2 days, angioedema should be considered.
2. Capsule resides in the lower sigmoid.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592790", "visit_id": "N/A", "time": "2192-05-03 18:28:00"} | 1,604,673 |
Description: 19592830-RR-11Abstract: ## HISTORY:
male with left tibial mass.
## PROCEDURE:
CT-guided left tibial mass percutaneous core biopsy.
## OPERATORS:
, M.D. and , M.D.
## ANESTHESIA:
Fentanyl 250 mcg IV, Versed 3 mg IV, and local lidocaine.
## FINDINGS:
The initial CT images demonstrate focal cortical osseous
destruction at the posteromedial aspect of the mid tibial diaphysis. An
associated soft tissue component measures 3.7 x 3.5 cm in axial .
Subsequent CT images demonstrate the needle being advanced through the soft
tissue component of the mass, through the region of cortical destruction, and
into the medullary cavity of the tibia.
## IMPRESSION:
Successful CT-guided left tibial mass biopsy.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "22656917", "time": "2149-01-04 13:17:00"} | 1,604,674 |
Description: 19592830-RR-13Abstract: COMPUTED TOMOGRAPHY OF THE THORAX
## INDICATION:
Tibia lesion concerning for Ewing sarcoma, questionable
metastasis.
## FINDINGS:
Mild motion artifacts related to breathing. Normal structure and
attenuation of the lung parenchyma. No evidence of nodular lesion suspect for
metastasis. No evidence of diffuse lung changes. The airways are patent, no
evidence of obstructing airway lesions. Normal appearance of the mediastinum
and the great vessels, no evidence of adenopathy. Normal pleural surfaces, no
pleural effusions. In the imaged parts of the upper abdominal organs, there
are no abnormalities.
## IMPRESSION:
No evidence of pulmonary metastasis. Normal thoracic CT
examination.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-01-10 10:43:00"} | 1,604,675 |
Description: 19592830-RR-17Abstract: ## INDICATION:
man with Ewing sarcoma of the left tibia, please
evaluate for new metastasis to the chest.
## FINDINGS:
No central pathologically enlarged nodes are visualized. No
pleural or pericardial effusion is noted. No pulmonary nodule or parenchymal
opacification is noted. Aorta and great vessels appear unremarkable. The
visualized part of the upper abdomen including adrenal glands, superior pole
of the kidneys, and liver appear unremarkable. There is an expansile lesion
of the superior pole of the spleen measuring 25 x 21 mm, which appears
unchanged compared to the prior study and most likely represents a hemangioma.
## BONE WINDOWS:
No concerning lytic or sclerotic lesions are identified.
## IMPRESSION:
1. No evidence of metastatic disease to the chest.
2. 25 mm expansile lesion of the superior pole of the spleen most likely
represents hemangioma. If further evaluation is required, ultrasound of the
can be obtained.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "23239087", "time": "2149-04-10 15:35:00"} | 1,604,676 |
Description: 19592830-RR-18Abstract: ## INDICATION:
man with Ewing sarcoma of the left tibia.
## FINDINGS:
Again seen is a large mass extending from the proximal-to-mid
tibial diaphysis. The mass is of heterogeneously increased signal on T2-
weighted images and predominantly isointense to muscle on T1-weighted images.
Following the administration of intravenous gadolinium, there is heterogeneous
enhancement. There is cortical penetration through the medial cortex of the
proximal tibial diaphysis. The soft tissue component extends into the
popliteal muscle and intimately abuts the soleus muscle. While it is
difficult to differentiate tumor from adjacent reactive marrow edema, the
signal abnormality in the tibia on T1 weighted images measures 18 (AP) x 26
(TV) x (CC) mm which is increased compared to the prior study. On T2
weighted images it is unchanged. The soft tissue mass measures 16 (AP) x 12
(TV) x 34 mm (CC) and is markedly decreased in size. While there are still
areas enhancement, a large portion does not enhance, likely from treatment
effect.
Mild edema is seen within the fibula bilaterally. Aside from the popliteus
muscle, the remainder of the muscles is normal in signal intensity and
morphology.
## IMPRESSION:
1. Decreased size of soft tissue mass with areas of necrosis likely
representing treatment effect. Increased extent of signal abnormality in the
tibia on T1-weighted images could be reactive edema.
2. No evidence of local metastatic disease.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "23239087", "time": "2149-04-11 20:28:00"} | 1,604,677 |
Description: 19592830-RR-19Abstract: ## HISTORY:
man with Ewing sarcoma.
## FINDINGS:
Radiographs of the left tibia and fibula again demonstrate lytic lesion
centered at the medial aspect of the proximal-to-mid tibial diaphysis. The
lesion measures approximately 5.5 cm in greatest craniocaudal dimension, which
is slightly increased(previously measures 4.7cm) and may be related to
treatment change. AP dimension of 11 mm is unchanged. Slightly altered
appearance of the cortex compared with the previous study may be related to
treatment. There are no new lesions and there is no pathologic fracture.
## IMPRESSION:
Mild interval increase in lesion length and slightly altered appearance of the
overlying tibial cortex compared with is most likely related to
treatment.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-04-19 11:30:00"} | 1,604,678 |
Description: 19592830-RR-21Abstract: ## INDICATION:
year old man with Ewings sarcoma of the left lower extremity,
post chemo and radiotherapy for restaging.
## FINDINGS:
There are new moderate predominantly lower lung patchy
peribronchiolar nodules and more confluent right middle and left lower lung
opacities with diffuse mild bronchiolar dilation which likely represents
bronchopneumonia that is new since .
Heart size is normal. There is no pleural or pericardial effusion. There is
no new central or axillary lymphadenopathy. Stable right hilar 7 mm lymph node
is stable since .
Bone windows demonstrate no lesion concerning for metastasis or infection and
no evidence of acute fracture.
## IMPRESSION:
Findings are consistent with an acute bronchopneumonia.
Although no metastatic foci are identified, reas of small airways disease and
minimal foci of consolidation could potentially obscure small metastatic
nodules. With this in mind, a follow up CT in 6- 8 weeks after therapy could
be considered to address the clinical question of pulmonary metastases.
Findings were discussed with Dr. by phone at the time of dictation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-09-21 10:47:00"} | 1,604,679 |
Description: 19592830-RR-22Abstract: ## HISTORY:
Ewing sarcoma of the left tibia, status post chemotherapy beginning
on with last chemotherapy treatment on and last radiation
treatment on . This study is a followup study to evaluate for
interval change.
## FINDINGS:
Again seen is a mass centered in the medulla of the proximal-to-mid tibial
diaphysis. Heterogeneous T2 hyperintensity and T1 hypointensity is not
significantly changed. The mass measures 8 cm in greatest craniocaudal
dimension, slightly decreased in size since the previous study (previously
measured 8.4 cm). Cortical penetration of the posteromedial proximal-to-mid
tibial diaphysis is again seen. Enhancement of the tibial mass is decreased
compared with the previous study.
Soft tissue mass along the posteromedial tibial cortex is significantly
decreased in size, measuring 1.2 cm (TV) x 0.7 cm (AP) x 1.7 cm (CC). When
measured in a similar fashion on the previous study, this mass measured 1.8 cm
(TV) x 1.3 cm (AP) x 3.4 cm (CC). The soft tissue mass demonstrates low
signal intensity on all sequences, as well as blooming on the gradient echo
sequences, likely due to calcification, or less likely from hemosiderin.
Post-contrast images demonstrate decreased internal enhancement of the soft
tissue mass with predominantly peripheral rim enhancement. Few subcentimeter
enhancing soft tissue nodules along the cortical tibial discontinuity are
unchanged.
There are no new lesions detected.
There is new hyperintensity in the soleus muscle and peroneal muscles, and
within the proximal-to-mid fibular diaphysis, with an abrupt margin,
suggestive of radiation change. There is no muscular atrophy.
## IMPRESSION:
1. Decreased in size and enhancement of soft tissue mass at the posteromedial
tibial cortex and decreased enhancement of the tibial lesion in keeping with
therapy response.
2. Presumed mild post-radiation changes in the posterior compartment of the
leg.
3. No local metastatic disease.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-10-03 13:12:00"} | 1,604,680 |
Description: 19592830-RR-23Abstract: CT CHEST OF
Comparison studies of and prior chest CTs dating back to .
## INDICATION:
Recent pneumonia in and . Evaluate for
resolution of abnormalities.
## FINDINGS:
Widespread areas of bronchial dilation and bronchial wall
thickening are again demonstrated. Areas of the peribronchiolar consolidation
and bronchiolitis show a mixed response, with a few areas showing minimal
improvement, but several new areas of involvement resulting in overall slight
worsening of the extent of disease. For example, new peribronchiolar opacities
have developed within the lingula and worsening opacities are present within
the anterior segment of the right upper lobe. On the other hand, within the
left lower lobe, there are new areas of patchy opacity anteriorly and
posteromedially, but improvement in other previous areas of involvement. New
areas of abnormality have developed posteriorly in the right lower lobe, and
previous abnormalities in the upper lobes are generally minimally improved
except for the anterior segment of the right upper lobe.
Review of CT scans prior to demonstrates no evidence of
preexisting large or small airways disease.
A small amount of residual thymic tissue is present in the anterior
mediastinum without change. No enlarged mediastinal or hilar lymph nodes are
evident on this unenhanced scan. Heart size remains normal. No pericardial
or pleural effusion.
Exam was not specifically tailored to evaluate the subdiaphragmatic region,
but no concerning abnormalities are evident in this region on this limited
assessment.
No concerning skeletal abnormalities.
## IMPRESSION:
Widespread airays infection shows mixed response, but with overall slight
increase in extent of abnormalities. It is uncertain whether this represents
an incompletely treated or recurrent infection. Considering lack of expected
improvement, atypical and opportunistic infections should be considered in
addition to usual pathogens. Although the patient is not in the usual
demographic for atypical mycobacterial infections, this infection should still
be considered given the morphology and distribution of abnormalities.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-11-05 15:04:00"} | 1,604,681 |
Description: 19592830-RR-24Abstract: ## FINDINGS:
The study is comprised of two views of the left tibia and fibula in
a series of four radiographs. The lytic lesion involving the medial cortex
and medullary cavity of the left femoral diaphysis has a stable radiographic
appearance. The size of the radiolucent abnormality is similar to , today estimated at 5.7 x 1.8 cm on AP view compared to 5.5 x 1.7 cm
. There is an ill-defined zone of transition. There is no
pathologic fracture. The left knee joint is within normal limits.
## IMPRESSION:
No significant change in size of the radiographically visible
portion of the lytic lesion involving the left femoral diaphysis known to
represent Ewing sarcoma. The extent of disease is better assessed on MR.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-10-11 11:13:00"} | 1,604,682 |
Description: 19592830-RR-26Abstract: ## INDICATION:
man with Ewing sarcoma, with persistent infiltrate
here for evaluation of progression.
## CHEST, PA AND LATERAL:
A Port-A-Cath is in place with tip at the mid SVC.
Bilateral perivascular opacities are better demonstrated on prior CT of , and not significantly changed allowing for differneces between
modalities. These appear most consistent with persistent infection, possibly
due to opportunistic pathogens in a patient on immunosuppression therapy. No
new focal consolidation is present. There is no development of lesions
concerning for metastasis in a patient with Ewing sarcoma. Cardiomediastinal
silhouette is normal.
## IMPRESSION:
Persistent bilateral perivascular opacities as compared with CT
from , likely representing persistent infection, possibly from
opportunistic pathogens in a immunosuppressed patient. No new consolidations.
No sign of parenchymal metastatic disease.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2149-12-13 12:51:00"} | 1,604,683 |
Description: 19592830-RR-29Abstract: MR CALF WITHOUT AND WITH GADOLINIUM
## INDICATION:
man with history of Ewing's sarcoma of the left
tibia, status post chemotherapy and radiation completed 5.5 months ago.
## FINDINGS:
Again seen is a mass centered in the medulla of the proximal-to-mid
tibial diaphysis. The mass demonstrates mostly T2 hyper- and T1 hypointense
appearance, not significantly changed in appearance. The mass measures 8.0 cm
in the craniocaudal dimension, unchanged in size since the previous study.
Again seen is a cortical breakthrough of the posteromedial proximal-to-mid
tibial diaphysis. The mass demonstrates peripheral enhancement following
gadolinium administration, which probably represents necrosis post-therapy.
A soft tissue component along the posteromedial tibial cortex is not changed
in size, the exact are difficult to estimate due to complex shape.
There is an area low T1 and T2 signal with blooming artifact, immediately
adjacent to the mass, which may represent a calcification, hemosiderin, or
susceptibility artifact from the prior biopsy.
There are no new lesions detected. The signal intensity of the rest of the
bone marrow otherwise is normal.
Hyperintensity in the soleus and peroneal muscles adjacent to the fibula with
an abrupt margin persists on today's study, suggestive of radiation changes.
There is no muscular atrophy.
## IMPRESSION:
1. Unchanged in size and appearance of the tibial lesion with a small soft
tissue component, as described above. No new lesions detected.
2. Presumed mild post-radiation changes in the posterior compartment of the
leg.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2150-02-25 10:07:00"} | 1,604,684 |
Description: 19592830-RR-30Abstract: ## HISTORY:
male with history of Ewing sarcoma treated last year
with chemotherapy and radiation to the leg. Persistent diffuse infiltrate
post-chemotherapy, apparently resolved on last chest radiograph. Here for
followup.
## IMPRESSION:
Mild bronchiectasis persists as residua from prior likely
infectious process. Currently no sign of infection or metastasis.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2150-02-25 15:26:00"} | 1,604,685 |
Description: 19592830-RR-31Abstract: CT OF THE LEFT LOWER EXTREMITY,
## CLINICAL HISTORY:
Ewing's sarcoma of left tibia, status post chemotherapy and
radiation. MSTS orthopedic protocol.
## FINDINGS:
Mass in the medullary cavity of the proximal/mid tibial diaphysis
is little changed in appearance, allowing for differences in modality.
Currently, it measures roughly 8.5 cm in craniocaudal dimension. There is
cortical thickening and irregularity, mainly along the medial aspect of the
lesion, involving approximately 20% of the circumference of the tibial cortex
at this location (2, 76).
There is no evidence of fracture. There is no evidence of new cortical
destruction or breakthrough. There is no periostitis or soft tissue mass.
Visualized bones are otherwise within normal limits. The surrounding soft
tissues are unremarkable.
Biomechanical assessment for research protocol will be performed and reported
separately.
## IMPRESSION:
1. Grossly unchanged appearance of left tibial lesion, allowing for
differences in modality. No fractures.
2. Biomechanical assessment will be performed and reported separately per
research protocol.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2150-05-17 12:57:00"} | 1,604,686 |
Description: 19592830-RR-35Abstract: ## INDICATION:
Patient treated for osteosarcoma,stable since last one and a half
year, recent chest radiograph showed two small nodules on the lateral view.
## AIRWAYS AND LUNGS:
Central and peripheral airways till subsegmental bronchi
are patent. Both lungs are clear. There is no lung nodule of concern.
## MEDIASTINUM:
Imaged thyroid gland is normal. Small residual thymic gland in
the anterior mediastinum is unchanged since . Heart is normal in
size without pericardial effusion. There is no pathological enlargement of
mediastinal, supraclavicular, and axillary lymph nodes. Great vessels of
thorax are normal.
## ABDOMEN:
The study is not tailored for evaluation of the abdomen; however,
limited views revealed a stable expansile hypoattenuating lesion in the upper
pole of the spleen measuring 2.4 x 2 cm, unchanged since .
## BONES:
There is no lytic/sclerotic bony lesion.
## IMPRESSION:
Both lungs are clear. There is no lung nodule of concern.
Hypoattenuating lesion in upper pole of spleen, stable since .
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "N/A", "time": "2151-03-05 08:13:00"} | 1,604,687 |
Description: 19592830-RR-9Abstract: ## HISTORY:
male with left leg pain.
## FINDINGS:
An approximately 4.5 x 1.4 x 1.4 cm lytic lesion involves the mid
to proximal left tibial diaphysis. The lesion is centered in the
posteromedial cortex, with associated cortical destruction. The zone of
transition is wide. The matrix is somewhat moth eaten. Periosteal reaction is
minimal. The extent of the associated soft tissue mass is better demonstrated
on the outside MRI. Alignment remains within normal limits.
## IMPRESSION:
Aggressive lytic lesion in the left tibial diaphysis. The most likely
differential diagnosis includes a sarcoma (possibly atypical), lymphoma, and,
in the appropriate clinical setting, infection. Biopsy is recommended.
Findings were discussed with Dr. on the day of the exam and the
patient was scheduled for a biopsy on the following day.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592830", "visit_id": "22656917", "time": "2149-01-03 14:41:00"} | 1,604,688 |
Description: 19592870-RR-34Abstract: ## HISTORY:
female with abdominal distention and pain.
## STUDY:
Portable AP chest radiograph.
## FINDINGS:
Markedly distended loops of bowel are seen below the diaphragm.
There is no distinct subdiaphragmatic air. The extent of the bowel loop
dilation obscures view of the chest. The right lung overall looks clear of
masses or consolidation. In the retrocardiac region, there is an ill-defined
opacity that could represent an area of atelectasis, scarring, or infection.
Assessment for pleural effusion is limited by overlying bowel. No
pneumothorax is seen. Examination of bony structures reveals dextroscoliosis
of the thoracolumbar spine. Calcified atherosclerotic disease is seen in the
aortic knob.
## IMPRESSION:
1. Nonspecific retrocardiac opacity which may represent atelectasis,
scarring, or infectious process.
2. Markedly dilated gas-filled loops of bowel without evidence of
perforation.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592870", "visit_id": "26977702", "time": "2139-03-08 14:15:00"} | 1,604,689 |
Description: 19592870-RR-35Abstract: ## INDICATION:
male with marked abdominal distention and pain since
yesterday, with report of dilated loops on KUB performed at rehabilitation
facility.
.
## FINDINGS:
In the visualized lung bases, there is bibasilar atelectasis, resulting from
low lung volumes due to distended abdominal viscus. Additional chronic
interstitial abnormality is seen at the left base. There is no pleural or
pericardial effusion. Note is made of a dilated main pulmonary artery
measuring up to 3.7 cm, suggesting underlying pulmonary arterial hypertension.
In the abdomen, there is marked distention of the colon, with a particularly
prominent loop of sigmoid seen arising from the pelvis and extending anterior
to the liver in the right upper quadrant, abutting the diaphragm. This loop
tapers both afferently and efferently in the pelvis, with a whorl sign and
beaking seen best on the coronal view (301B:33). Findings are compatible with
sigmoid volvulus. There is no pneumatosis. There is no free air identified.
The liver is unremarkable in size and appearance, with only a small focal
hypodensity measuring 3 mm in the left lobe, too small to characterize. There
are no further focal liver lesions. There is no intra- or extra-hepatic
biliary ductal dilation. The portal vein is patent.
The spleen contains an unchanged sub-cm hypodensity, likely a benign cyst or
hemangioma. The pancreas, adrenal glands, and kidneys are displaced by dilated
viscus, but are otherwise unremarkable. There is no hydronephrosis. There
is no pancreatic ductal dilation. There are no enhancing renal mass lesions
and no adrenal nodules identified.
The intra-abdominal loops of small bowel are similarly displaced but also
unremarkable. There is no small bowel distention. There is no free fluid or
free air in the abdomen. The aorta and mesenteric vessels are normal in
caliber and patent, with only mild atherosclerotic disease identified. There
is no mesenteric or retroperitoneal adenopathy.
## CT PELVIS:
A Foley catheter decompresses the bladder. The uterus is
unremarkable. There are no adnexal masses. The rectum is decompressed.
There is again sharp transition between the rectum and the markedly dilated
loop of sigmoid, as described above. There is no pelvic adenopathy or free
pelvic fluid.
## BONE WINDOWS:
Age indeterminant, though likely subacute to chronic rib
fractures are noted in the left and right lateral lower ribs. There is
compression deformity of the L5, L3, L2, T12, T11 vertebral bodies, new from
, though of indeterminate chronicity. There is underlying
thoracolumbar scoliosis. There are no suspicious lytic or sclerotic osseous
lesions.
## IMPRESSION:
1. Findings compatible with sigmoid volvulus.
2. No pneumatosis or free air.
3. Extensive degenerative change of the spine, of indeterminate chronicity.
4. Bibasilar atelectasis, with additional probable chronic interstitial
abnormality at the left base.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592870", "visit_id": "26977702", "time": "2139-03-08 14:17:00"} | 1,604,690 |
Description: 19592870-RR-36Abstract: AP PORTABLE CHEST, AT 18:55 HOURS.
## FINDINGS:
The study is significantly degraded secondary to respiratory
motion. There has been apparent interval placement of a nasogastric tube.
The tube is deviated cephalad at the gastroesophageal junction with the distal
tip projecting just under the left hemidiaphragm. This is presumed secondary
to significant mass effect on the collapsed stomach due to the known sigmoid
volvulus and the dilated large and presumably small bowel loops clearly
evident in the included upper abdomen. There are significantly low lung
volumes with hazy opacity, particularly at the left lung base. No clear
effusion or pneumothorax is seen. Please note the study is markedly limited
for chest evaluation due to significant rotation as well.
## IMPRESSION:
Markedly limited study as detailed above. Interval placement of
nasogastric tube as detailed above. As best can be determined, the distal tip
and side hole are likely within the gastric fundus, which is collapsed.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592870", "visit_id": "26977702", "time": "2139-03-08 18:47:00"} | 1,604,691 |
Description: 19592870-RR-37Abstract: SINGLE AP PORTABLE VIEW OF THE CHEST
## REASON FOR EXAM:
Status post intubation, asses ET tube.
Comparison is made with prior study performed three hours earlier.
ET tube tip is in standard position. The tip is 2.4 cm above the carina. Of
note, there is rotation of the patient. There are no other interval changes
with minimal opacities in the right upper lobe and left lower lobes.
Cardiomediastinal contour cannot be evaluated due to rotation of the patient.
There is no pneumothorax or pleural effusions. NG tube is in unchanged
position. Markedly distended bowel loops are again noted.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592870", "visit_id": "26977702", "time": "2139-03-08 21:50:00"} | 1,604,692 |
Description: 19592941-RR-29Abstract: ## HISTORY:
y/o female with history of spontaneous abortion presenting for
evaluation of viability.
## FINDINGS:
The LMP is .
Transabdominal and transvaginal scanning is performed, the latter to more
closely assess the embryo. A single live intrauterine gestation is visualized
with a crown-rump length of 18.5 mm corresponding to a gestational age of 8
weeks 3 days. This corresponds satisfactorily with the age by dates of 8
weeks 3 days. An exophytic fibroid is evident extending off of the superior
right uterus measuring 2.5 x 2.4 x 2.7 cm. The ovaries are unremarkable. A
2.2 cm anechoic focus within the right ovary likely represents a corpus luteal
cyst.
## IMPRESSION:
Single live intrauterine gestation. Size equals dates.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592941", "visit_id": "N/A", "time": "2180-07-03 10:19:00"} | 1,604,693 |
Description: 19592941-RR-31Abstract: ## LMP:
.
Transabdominal imaging shows a live in breech presentation. The
placenta is posterior without evidence of previa. Transvaginal imaging was
performed to better evaluate the cervix. The cervix is closed, measuring 3.4
cm. The right ovary contains a unilocular 2.4 x 2.0 x 2.0 cm corpus luteum.
The uterus is normal.
No fetal morphologic abnormalities are detected. Views of the head, face,
heart, outflow tracts, stomach, kidneys, cord insertion site, bladder, spine,
and extremities are normal.
The following biometric data were obtained:
## EFW:
271 g.
Compared to the prior exam, there has been appropriate interval growth.
## IMPRESSION:
Normal fetal survey. The fetus is in a breech presentation.
gb
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592941", "visit_id": "N/A", "time": "2180-09-14 07:58:00"} | 1,604,694 |
Description: 19592941-RR-32Abstract: ## INDICATION:
woman with size greater than dates.
## PREVIOUS SCAN DATES:
and .
There is a single live intrauterine gestation. The fetus is in cephalic
position. The placenta is posterior. There is no evidence of previa. There
is a normal amount of amniotic fluid. Views of the head, face, heart, outflow
tracts, stomach, cord insertion site, bladder, spine, and extremities were
normal. Please note, however, there is mild central dilatation of the left
kidney up to 5 mm. The uterus is normal. No adnexal abnormalities are noted.
The following biometric data were obtained:
## AGE BY DATES:
30 weeks 3 days.
Compared to the prior study, there has been appropriate interval growth.
## IMPRESSION:
1) Size equals date.
2) Mild left renal central dilatation. Given that the fetus is female, post-
natal evaluation is recommended.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592941", "visit_id": "N/A", "time": "2180-12-01 13:19:00"} | 1,604,695 |
Description: 19592941-RR-33Abstract: OB FOLLOWUP WITH MEASUREMENT
## REASON FOR EXAM:
Large for dates.
There is a single live intrauterine pregnancy with fetus in cephalic position.
The placenta is left lateral. There is no evidence of previa. There is a
normal amount of amniotic fluid. Limited views of the fetal anatomy show left
pyelectasis measuring 7 mm.
AFI is 17 cm.
The following biometric data were obtained:
## EFW:
2676 g for a 70 percentile.
## IMPRESSION:
Single live intrauterine pregnancy, appropriate interval growth.
Pyelectasis in the left kidney without frank hydronephrosis. Previously the
left renal pelvis measured 5 mm.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592941", "visit_id": "N/A", "time": "2180-12-30 11:07:00"} | 1,604,696 |
Description: 19592998-RR-87Abstract: ## INDICATION:
year old woman with history of carotid stenosis // evaluate
progression of carotid stenosis
## RIGHT:
The right carotid vasculature has mild heterogeneous atherosclerotic plaque.
The peak systolic velocity in the right common carotid artery is 52 cm/sec.
The peak systolic velocities in the proximal, mid, and distal right internal
carotid artery are 58, 53, and 34 cm/sec, respectively. The peak end
diastolic velocity in the right internal carotid artery is 17 cm/sec.
The ICA/CCA ratio is 1.1.
The external carotid artery has peak systolic velocity of 91 cm/sec.
The vertebral artery is patent with antegrade flow.
## LEFT:
The left carotid vasculature has mild heterogeneous atherosclerotic plaque.
The peak systolic velocity in the left common carotid artery is 58 cm/sec.
The peak systolic velocities in the proximal, mid, and distal left internal
carotid artery are 61, 69, and 65 cm/sec, respectively. The peak end
diastolic velocity in the left internal carotid artery is 28 cm/sec.
The ICA/CCA ratio is 1.2.
The external carotid artery has peak systolic velocity of 85 cm/sec.
The vertebral artery is patent with antegrade flow.
## IMPRESSION:
Mild heterogeneous atherosclerotic plaque of the bilateral extracranial
internal carotid arteries. No significant stenosis (less than 40%)
bilaterally.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592998", "visit_id": "N/A", "time": "2168-05-02 10:01:00"} | 1,604,697 |
Description: 19592998-RR-89Abstract: ## EXAMINATION:
GE BILATERAL DIGITAL SCREENING MAMMOGRAM WITH CAD
## INDICATION:
Postmenopausal status post hysterectomy, screening
## TISSUE DENSITY:
B -The breast tissues are fatty with some scattered
fibroglandular tissue. Minimal vascular calcification is seen. A small mass
in the upper outer left breast is stable likely representing an intramammary
lymph node. More focal nodularity in the lower left breast is likely
unchanged since suggestive of a benign finding. No suspicious mass, area
of architectural distortion, or cluster of suspicious microcalcification is
seen.
## IMPRESSION:
No specific mammographic evidence of malignancy.
## RECOMMENDATION:
Routine mammography would be recommended based on age and
risk assessment.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592998", "visit_id": "N/A", "time": "2168-12-26 12:59:00"} | 1,604,698 |
Description: 19592998-RR-90Abstract: ## EXAMINATION:
UNILAT LOWER EXT VEINS
## INDICATION:
year old woman with knee OA, developed swelling in left knee
and below patella after getting knee injection 6 weeks ago. // evaluate leg
swelling
## FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
## IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins. No
significant fluid collection or lesions in the specified area of leg swelling.
Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592998", "visit_id": "N/A", "time": "2169-02-16 15:24:00"} | 1,604,699 |
Subsets and Splits