Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: International normalised ratio increased, Mean cell volume increased, Muscle oedema, Nephropathy, Packed red blood cell transfusion
Clinical narrative: S/p pfizer vaccine 4/9/21. S/p fall. She presented last wk to the hospital in cardiogenic shock, anemia, acute RLE DVTs, AKI, and rib fractures.  She was found to have a n intramuscular hematoma along her posterior right thigh and with an acute DVT in her leg - see imaging  reports below.  Her INR was in the 7 range. She was also found to be in cardiogenic shock as mentioned above, requiring pressors.  Pressors were eventually weaned off. S/p PRBCs. Imaging studies were obtained.  Findings are listed below. Her AKI resolved by day of discharge.    Since hospital discharge: The swelling is improving along her right leg.  She is not checking her weight on a daily basis.  She has access to a scale.   She needs a refill on iron and Fosamax.  No bleeding.  On day of discharge, her hemoglobin was 8.8.  Her MCV was elevated at 100.  Her platelet count was 132.  Her INR was 1.4.  Her calcium is mildly low at 8.3.   Her coumadin is on hold at this time.   106/56 was her BP today. She's been resting well. She's doing some house chores.  She has yet to schedule a follow-up visit with for an INR check and in office checkup apt since hospital discharge.   4/23/21 RLE CT: Postop changes from ACDF for right femoral neck fracture again noted with good alignment. Early healing process of the fracture noted. No acute osseous fracture or hardware fracture. Extensive muscular and subcutaneous edema in right thigh. Two elongated intramuscular hematomas also noted at the medial posterior right thigh as above.   4/23/21 CXR: Patchy bibasilar pleural parenchymal opacities and enlarged cardiac silhouette without interval change. Multiple thoracic compression deformities better characterize on recent CT. Postoperative changes as discussed. Stable hiatal hernia.   4/23/21 RUQ Ultrasound: Mild gallbladder prominence, nonspecific. Findings similar to reference CT. No gallbladder wall thickening. Negative sonographic Murphy sign. Trace ascites. Partially evaluated right pleural effusion. Increased renal echogenicity. Correlate for medical renal disease. -1.1 cm right renal cyst.   4/22/21 PVL Study: Acute non-occlusive deep vein thrombosis in the mid and distal femoral vein within the right lower extremity. Acute non-occlusive deep vein thrombosis in the distal femoral vein within the left lower extremity.   4/21/21 Chest/Abdomen/Pelvis CT: Age-indeterminate T1, T3, T8, and T9 compression deformities. Subacute or chronic right posterior 12th, 11th, and 10th rib fractures. Intramuscular hematoma in the posterior right thigh, partially visualized. Subcutaneous contusion in the right posterior hip region. Small volume of free fluid which appears minimally complex. No convincing solid organ injury, but assessment is limited without administration of intravenous contrast. Mild biliary dilatation of uncertain etiology. Possible 1.8 cm peripherally calcified splenic artery aneurysm. Nonspecific bilateral perinephric stranding. Trace pleural effusions. Moderate sliding-type hiatal hernia. Additional incidentals as above.   4/21/21 C Spine CT: Age-indeterminate T1 compression fracture, new from March 2019. No other acute fracture or subluxation