Datasets:

yousefg

/

scientific_studies

like 1

Description: 19594642-RR-13Abstract: ## EXAMINATION: CT ABD AND PELVIS WITH CONTRAST ## NO PO CONTRAST; HISTORY: M with PMH of nephrolithiasis s/p R laser lithotripsy of 4mm stone presenting with severe RLQ pain since this morningNO PO contrast // r/o appendicitis ## SINGLE PHASE CONTRAST: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 24.1 mGy (Body) DLP = 12.0 mGy-cm. 2) Spiral Acquisition 6.4 s, 50.1 cm; CTDIvol = 10.1 mGy (Body) DLP = 504.3 mGy-cm. Total DLP (Body) = 516 mGy-cm. ## LOWER CHEST: Aside from mild dependent atelectasis, the 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 within normal limits. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is a 4 mm nonobstructing stone in the right lower pole (2:38). Additional nonobstructing punctate 1 mm calculus within the right interpolar region is also noted (601:32). The previously seen stone at the right ureterovesical junction is no longer visualized. There is no evidence of solid renal lesions or hydronephrosis. There is no perinephric abnormality. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The appendix is fluid-filled and further dilated measuring up to 1.6 cm (2:66) with hyperemic and thickened walls, adjacent fat stranding, mural thickening and edema at the base of the cecum. There is no periappendiceal fluid collection. There is no pneumoperitoneum. The colon and rectum are otherwise within normal limits. ## PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly unremarkable. ## LYMPH NODES: Multiple enlarged right lower quadrant ileocolonic lymph nodes are likely reactive. There is no retroperitoneal lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. No significant atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: The abdominal and pelvic wall is within normal limits. ## IMPRESSION: 1. Uncomplicated acute appendicitis. No evidence of perforation or periappendiceal fluid collection. 2. Two nonobstructing right renal calculi, the largest being a 4 mm calculus in the right lower pole kidney. The previously seen stone at the right ureterovesical junction is no longer visualized. No hydroureteronephrosis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594642", "visit_id": "N/A", "time": "2155-12-08 21:59:00"}

Description: 19594642-RR-14Abstract: ## INDICATION: year old man with right distal ureteral stone // please evaluate for hydronephrosis and presence of ureteral jets ## FINDINGS: Redemonstrated in the right lower pole is a nonobstructing renal calculi measuring approximately 0.8 cm. The previous 3 mm non-obstructing stone in the left kidney is no longer visualized. There is no hydronephrosis, or masses bilaterally. Normal cortical echogenicity and corticomedullary differentiation are seen bilaterally. Right kidney: 11.0 cm Left kidney: 11.1 cm The bladder is moderately distended and normal in appearance. Ureteral jets not visualized however the bladder was not completely full. ## IMPRESSION: 1. Redemonstrated 0.8 cm right lower pole nonobstructing stone. No evidence of hydronephrosis. 2. Previous 3 mm left-sided stone is no longer visualized. No evidence of left-sided stone or hydronephrosis. 3. Ureteral jets are not visualized. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594642", "visit_id": "N/A", "time": "2156-07-27 14:10:00"}

Description: 19594642-RR-8Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## INDICATION: with RUQ pain // eval gallstones, cholecystitis ## FINDINGS: The liver appears normal in grayscale appearance, size, without focal lesion. There is no biliary ductal dilation with the common bile duct measuring 4mm. The main portal vein is patent with hepatopetal flow. The gallbladder appears normal. The pancreas is grossly unremarkable though poorly visualized. No ascites is seen. Mild right hydronephrosis. A nonobstructing stone is seen in the lower pole of the right kidney. ## IMPRESSION: 1. Mild right hydronephrosis with nonobstructing stone in the lower pole of the right kidney. Passing right ureteral stone not excluded. Please correlate clinically. 2. No acute gallbladder process. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594642", "visit_id": "N/A", "time": "2155-11-16 13:37:00"}

Description: 19594642-RR-9Abstract: ## EXAMINATION: CT ABD AND PELVIS W/O CONTRAST ## NO PO CONTRAST; HISTORY: with R sided abdominal pain, hydronephrosis on USNO PO contrast // eval R ureteral stone ## DOSE: Acquisition sequence: 1) Spiral Acquisition 6.2 s, 49.1 cm; CTDIvol = 8.3 mGy (Body) DLP = 405.8 mGy-cm. Total DLP (Body) = 406 mGy-cm. ## FINDINGS: Visualized lung bases appear clear. Within the limitations of a non-contrast examination, no focal liver lesions are identified. There is no biliary dilatation. Gallbladder appears normal. Pancreas is unremarkable. Spleen is normal in size and appearance. Adrenals appear normal. The right kidney shows mild hydroureteronephrosis associated with a stone at the right pelvic brim measuring up to 3 mm. Mild congestive stretched fat stranding about the right kidney and upper ureter. Within the right kidney, and 2 mm stone is found in the upper pole and, in the lower pole an additional 3 mm stone. Mild medullary nephrocalcinosis on each side. No well-formed stones found on the left side, however. The stomach and small bowel are unremarkable. Large bowel also appears normal. Incidental appendecoliths in the tip of the appendix, but no evidence of appendicitis. Prostate is at the upper limits of normal size. Distal ureters, seminal vesicles and bladder appear normal. No lymphadenopathy or free fluid. Aorta is normal in caliber. Vascular structures are otherwise difficult to assess. Vertebral body heights and interspaces are preserved in height. No suspicious bone lesions. ## IMPRESSION: Small obstructing right ureteral stone, measuring up to 3 mm. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594642", "visit_id": "N/A", "time": "2155-11-16 17:26:00"}

Description: 19594776-RR-10Abstract: ## INDICATION: male with G-tube which is occasionally leaking, evaluate for peritonitis. ## ABDOMEN: The visualized lungs demonstrate bibasilar atelectasis. There is no pleural effusion or pneumothorax. The imaged portion of the heart is normal in size, and there is no pericardial effusion. The liver enhances homogeneously without focal lesions. The gallbladder is decompressed. The spleen, pancreas, and adrenal glands are unremarkable. The kidneys enhance symmetrically and excrete contrast without hydronephrosis. The abdominal aorta and its major branches are unremarkable. There is an infrarenal IVC present. There is no retroperitoneal or mesenteric lymphadenopathy. A percutaneous gastrostomy tube is present with 2.5 cm of side-holes seen in the subcutaneous tissue along the tract. There is no abscess formation or associated soft tissue stranding. There is no peritoneal free fluid or hyperenhancement to suggest an underlying peritonitis. The imaged small and large bowel are normal. ## BONE: There are sclerotic lesions seen in the mid-to-lower thoracic spine. ## IMPRESSION: Percutaneous gastrostomy tube sideholes are outside of the stomach, along the catheter track; this can be advanced by 3 cm for better positioning. No evidence for peritonitis or abdominal free fluid. These findings were discussed with Dr. by Dr. by telephone on at 16:40 hours. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2144-04-30 13:05:00"}

Description: 19594776-RR-11Abstract: ## INDICATION: male with G-tube presenting with right upper quadrant abdominal pain and elevated LFTs. Rule out gallstone disease. ## FINDINGS: The liver is normal without focal or textural abnormality. The main portal vein is patent with hepatopetal flow. The gallbladder is distended but demonstrates no wall thickening. Sonographic sign was reported to be absent. The gallbladder contains a few amorphous echogenic lesions that demonstrate no posterior acoustic shadowing or internal vascularity, most compatible with sludge balls. These were not previously visualized on CT. The common duct measures 5 mm and there is no evidence of intra- or extra-hepatic bile duct dilatation. The visualized portion of the pancreas is unremarkable. The pancreatic tail is obscured by overlying bowel gas. ## IMPRESSION: Distended gallbladder containing a few sludge balls. No specific signs for acute cholecystitis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "22329213", "time": "2144-06-12 18:36:00"}

Description: 19594776-RR-12Abstract: ## HISTORY: Elevated white blood cell count, right upper quadrant pain and increased oxygen requirement. ## FINDINGS: Low lung volumes are present. This accentuates the size of the cardiac silhouette which is likely top-normal. The mediastinal and hilar contours are unremarkable. There is crowding of the bronchovascular structures. Patchy opacities in the lung bases likely reflect atelectasis. No pleural effusion is present. No pneumothorax or overt pulmonary vascular congestion is present. An inferior vena cava filter is detected. There are no acute osseous abnormalities. ## IMPRESSION: Low lung volumes with bibasilar atelectasis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "22329213", "time": "2144-06-12 19:09:00"}

Description: 19594776-RR-13Abstract: ## INDICATION: male with increasing oxygen requirements with history of DVTs. Rule out pulmonary embolism. ## CHEST CTA: The thoracic aorta is normal without evidence of aneurysm or dissection. The main pulmonary artery has a normal caliber. The lobar, segmental, and subsegmental pulmonary arteries are normal without filling defect. The great vessels are otherwise unremarkable. ## CHEST: The thyroid is unremarkable. No axillary, supraclavicular, mediastinal, or hilar lymphadenopathy. Atherosclerotic calcification is seen in the left anterior descending coronary artery, significant in this age group. The heart is otherwise unremarkable. The mediastinum is unremarkable. The pericardium is intact without effusion. The central airways are patent. Bibasilar atelectasis is present, left greater than right, increased since . No pulmonary consolidation or pleural effusion is identified. No pneumothorax. The chest wall is unremarkable. ## OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for malignancy. ## IMPRESSION: 1. No pulmonary embolism. Bibasilar atelectasis. 2. Coronary artery atherosclerotic calcification, significant in this age group. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "22329213", "time": "2144-06-12 19:51:00"}

Description: 19594776-RR-24Abstract: MRI OF THE BRAIN WITHOUT AND WITH CONTRAST, MRA OF THE BRAIN WITHOUT CONTRAST, MRA OF THE NECK WITH CONTRAST, ## HISTORY: male with history of multiple brainstem infarcts as well as fusiform basilar artery aneurysm with thrombus and dilated vertebral arteries; evaluate for interval infarcts, compare to MRI. ## FINDINGS: The study is compared with a series of MR examinations from dating from through . N.B. Many of these studies, uploaded to PACS, contained only localizer images or so-cold "paperwork". The most diagnostic series consists of a non-enhanced cranial MR examination dated . Comparison is also made with the VCT" cranial CTA of . Allowing for extensive susceptibility artifact at the level of the central skull base, there is no focus of slow diffusion to suggest acute ischemia, including in the posterior fossa. However, there is a remarkable appearance to the intracranial vertebrobasilar system, which demonstrates marked ectasia and tortuosity, particularly evident in the basilar artery, with an appearance suggestive of underlying dolichoectasia. The distal left vertebral and basilar arteries demonstrate a marked "targetoid" appearance, due to extensive lamellated and rim-calcified thrombus throughout much of their extent. This demonstrates a rim-"blooming" susceptibility artifact, particularly anteriorly. On the MP-RAGE sequence, the lumen of this vessel enhances avidly and uniformly, as do the distal vertebral arteries. However, the basilar artery through much of its extent, to approximately the level of the left cerebral peduncle, which it markedly indents, demonstrates differential reduced flow-related enhancement in comparison to the remaining vessels of the circle of . The markedly distorted and elevated basilar summit demonstrates a markedly abnormal rostral location at approximately the level of the foramen of . Note that its distal branches, specifically the posterior cerebral arteries demonstrate normal flow-related and contrast enhancement. In contradistinction, the AICA vessels are relatively attenuated, with significantly reduced flow-related and contrast enhancement, particularly on the left; the superior cerebellar arteries are also markedly reduced in caliber and enhancement and difficult to identify on all sequences. The axial images are otherwise notable for the marked mass effect of the dilated basilar artery with indentation or frank invagination of the left paramedian anterior aspect of the brainstem, commencing at the level of the interpeduncular cistern and extending to the level of the superior cerebellar peduncles. There is continued mass effect more caudally with effacement of, particularly, the left medullary pyramid. Allowing for this, there is no evidence of encephalomalacia or gliosis to reflect previous infarction, particularly in the posterior fossa (as in the given history). However, while there is no evidence of vascular territorial infarction and no finding to specifically suggest gliosis, there are at least two sites of possible chronic infarction involving the left and right paramedian ventral brainstem at the level of the superior cerebellar peduncles (5:10 and 5:9) respectively; the brainstem also appears globally atrophic. There is no intra- or extra-axial hemorrhage, with no other susceptibility artifact, beside that emanating from the basilar arterial mural thrombus. The axial T1-weighted SE sequences demonstrate no evidence of intramural hematoma to suggest underlying dissection involving either cervical vertebral artery. The vertebral arteries are normal in course, caliber, and intrinsic signal intensity from their subclavian origins through their distalmost V4 segments where the fusiform aneurysmal dilatation, above, commences. The aortic arch and great vessel origins are unremarkable. The common and cervical internal and external carotid arteries demonstrate normal course, caliber, and contour. They demonstrate normal uniform contrast enhancement with no flow-limiting stenosis, significant mural irregularity, or evidence of dissection. ## VERY UNUSUAL APPEARANCE, INCLUDING: 1. Marked vertebrobasilar dolichoectasia with severe fusiform aneurysmal dilatation of the basilar artery, which measures up to 14 mm (AP), at the level of the cerebral peduncles. 2. This vessel demonstrates extensive nearly-circumferential mural thrombus, as on the previous Encinitas) studies from . 3. Marked distortion and attenuation of the AICA and SCA vessels, as before. 4. Marked mass effect with invagination of the brainstem, also not significantly changed. 5. No evidence of acute ischemia, with findings that specifically suggest previous infarction, particularly in the posterior fossa as queried. 6. Unremarkable cervical vessels; specifically, there is no evidence of underlying vertebral artery dissection. ## COMMENT: These findings were discussed with Dr. requesting neurologist), via telephone, at 1525H on , roughly 20 minutes after discovery. The possibility of underlying Ehlers-Danlos disease or other vasculopathy was also discussed. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2145-02-02 15:14:00"}

Description: 19594776-RR-30Abstract: ## INDICATION: History of fusiform aneurysm with thrombus also with brainstem strokes, quadriplegic, reports two weeks of increased hoarseness and hypophonia, evaluate for infarct or hemorrhage. ## FINDINGS: At the level of the skull base, there is extensive susceptibility artifact limiting evaluation for acute ischemia. Within this limitation, there is no slow focus of diffusion identified throughout the remainder of the brain. No new T2 abnormalities are present within the posterior fossa. There is stable marked ectasia and tortuosity of the vertebrobasilar system consistent with dolichoectasia. As previously stated, the targetoid appearance of the distal left vertebral and basilar artery with rim of blooming susceptibility artifact is likely due to calcified mural thrombus. On T2-weighted imaging, intracranial flow voids are preserved throughout the system; however, both on this sequence and on the time-of-flight imaging, there appears to be slightly differential flow compared to remaining craniocervical vessels, possibly due to slower velocity. There is fusiform dilatation of the basilar tip immediately rostral to the foramen of , measuring 14mm. On time-of-flight imaging, the distal branches of the posterior circulation, specifically the posterior cerebral and superior cerebellar arteries are difficult to visualize likely reflecting noncontrast technique, though their patency is presumed given the lack of parenchymal changes. The anterior inferior cerebellar artery is diminutive bilaterally, left greater than right, but patent. There is stable marked invagination of the left anterior aspect of the brainstem extending from the interpedicular cistern to the level of the superior cerebellar peduncle. More caudally, the vertebral artery appears to contact if not have mass effect on the left medullary pyramid. Overall, the diencephalon appears grossly atrophic with multiple stable T2 hyperintensities immediately posterior to the brainstem indentation (9:44, 9:50) which likely represent remote infarct. There is no intra-axial hemorrhage. There is no evidence of dissection, stenosis, or aneurysm. ## IMPRESSION: Stable markedly abnormal appearance of the basivertebral arterial system and diencephalon. Specifically: 1. Stable marked vertebrobasilar dolichoectasia with fusiform aneurysmal dilatation of the basilar artery with extensive partially calcified mural thrombus. 2. Poor visualization of the posterior circulation on this non-contrast study; however, there are no changes in the surrounding parenchyma to suggest infarct. 3. Vertebrobasilar dolichoectasia causes stable mass effect with invagination of the brainstem which is atrophic. 4. No evidence of acute ischemia. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2145-10-29 15:50:00"}

Description: 19594776-RR-33Abstract: ## INDICATION: Routine year screening. Pt refused conventional colonoscopy. // Screening. ## FINDINGS: On the very limited non contrast low-dose supine series of the abdomen and pelvis the lung bases appear grossly clear. The liver, spleen, pancreas, adrenal glands, and kidneys appear grossly unremarkable, but evaluation of these structures is significantly limited due to image noise from low dose technique and lack of intravenous contrast. This exam is not diagnostic for identifying solid organ masses. A PEG tube is seen positioned in the stomach. No enlarged mesenteric or retroperitoneal lymph nodes are identified. Incidental note is made of malrotation of the bowel with all of the small bowel being in the right side of the abdomen and the majority of the colon being on the left side of the abdomen. The cecum does cross midline to terminate in the right lower quadrant, but previously on the study from it was in the left lower quadrant. The colon was poorly insufflated on the initial images as the patient had issues retaining the carbon dioxide and was frequently expelling it. Furthermore, the colon is diffusely filled with liquid stool which would significantly limit diagnostic interpretation and was also clogging the insufflation catheter. Therefore, the patient was instructed to remain on clear liquids for today and take another bottle of magnesium citrate and return tomorrow for reattempt after further prep. An IVC filter is noted. The osseous structures are unremarkable. ## IMPRESSION: Unable to complete CT colonography due to inadequate bowel prep. The patient will return tomorrow for repeat attempt as discussed in detail above. Incidental note made of malrotation of the bowel. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2146-03-25 13:46:00"}

Description: 19594776-RR-35Abstract: ## CT COLONOGRAPHY: Severely limited study due to large amount of fluid within the colon. Patient is unable to hold insufflated air as demonstrated on . Only 5 axial images were obtained to evaluate fecal load. ## IMPRESSION: Canceled CT colonography due to large amount of fluid within the colon. The patient is unable to hold insufflated air is demonstrated on and is a poor candidate for future CT colonography given this limitation. ## NOTIFICATION: The findings were discussed by Dr. with , Nurse Dr. on the telephone on at 3:50 , 5 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2146-03-28 14:20:00"}

Description: 19594776-RR-36Abstract: ## EXAMINATION: US ABD LIMIT, SINGLE ORGAN ## INDICATION: year old man with purulent drainage from g-tube site. Assess for fluid collection in abdominal wall ## FINDINGS: Approximately 1.6 x 1.0 cm hypoechoic area within the skin and subcutaneous tissue which demonstrates posterior shadowing is most consistent with scar from prior G-tube placement. No drainable fluid collection. No sinus tract identified. No subcutaneous edema. ## IMPRESSION: 1.6 cm hypoechoic area within the skin and subcutaneous tissue is most consistent with scar from prior G-tube placement. No drainable fluid collection. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2146-09-25 06:00:00"}

Description: 19594776-RR-37Abstract: ## INDICATION: year old man with G tube replacement ## FINDINGS: The percutaneous gastric catheter is noted with tip terminating in the left upper quadrant medially. Multiple clips are seen in the left upper quadrant. An inferior vena cava filter is in unchanged position. Bowel gas pattern is unremarkable except for large amount of stool of the left colon and rectum. Following the administration of oral contrast material through the catheter, oral contrast opacifies the stomach and duodenum. No extraluminal contrast is definitively noted on this single view. ## IMPRESSION: Gastrostomy tube appears to be in standard position within the stomach Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594776", "visit_id": "N/A", "time": "2146-09-25 14:26:00"}

Description: 19594787-RR-13Abstract: RIGHT ELBOW, THREE VIEWS ## FINDINGS: There is a comminuted intra-articular fracture of the distal humerus. The fracture appears to extend across the base of the capitellum and trochlea. The capitellum is displaced proximally and rotated anteriorly. There is dislocation of the articulation between the capitellum and the radius as a result of this. There is some apparent medial displacement of the trochlea with respect to the proximal ulna and distal humerus. Incidental note is made of enthesophytes at the medial and lateral epicondyles. An apparent longitudinally orientated additional fracture line component extends along the lateral aspect of the distal humerus to the supracondylar region. A small longitudinal lucent line extending to the articular surface of the radial head is suspicious for an additional nondisplaced fracture. There is extensive soft tissue swelling. ## IMPRESSION: 1. Comminuted intra-articular displaced fracture of the distal humerus with marked displacement of the capitellar fragment. 2. Intra-articular radial head fracture. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2132-07-26 08:55:00"}

Description: 19594787-RR-16Abstract: RIGHT HUMERUS, THREE VIEWS ## INDICATION: Distal humerus fracture, assess for healing. ## FINDINGS: The projection is different to the prior study as the current examination is a humerus radiograph other than elbow. The distal humeral fracture was better assessed on elbow views. There is evidence of a comminuted intra-articular distal humeral fracture. Fragment alignment is not as well depicted though there is likely persistent displacement of the capitellum and dislocation of the radiocapitellar articulation. Mild residual widening of the elbow joint is also seen. Fracture is again seen to involve the base of the trochlea. No humeral shaft fracture is seen. A rounded density is demonstrated adjacent to the anterior proximal right humeral shaft, possibly representing loose body within the biceps tendon sheath. There is evidence of glenohumeral degenerative joint disease with joint space narrowing. There is also narrowing of the acromiohumeral interval, suggesting rotator cuff tear. ## IMPRESSION: Comminuted distal humeral fracture with intra-articular extension and persistent radiocapitellar dislocation. Alignment of fragments and healing is difficult to accurately compare with the prior study as the projection was different. Suggest additional followup with elbow radiographs. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2132-08-09 09:18:00"}

Description: 19594787-RR-17Abstract: ## HISTORY: Right humerus followup. RIGHT HUMERUS, TWO VIEWS. There is diffuse osteopenia. There is a comminuted fracture of the distal humerus which probably extends into the joint space. Assessment of the elbow joint itself is limited on these views which are centered in the mid shaft of the humerus. Marked narrowing of the acromiohumeral distance is consistent with a chronic rotator cuff tear. A 6-mm calcification adjacent to the proximal humerus is again seen, ? loose body related to the biceps tendon sheath. ## IMPRESSION: Fracture of the distal humerus, similar in appearance to . If clinically indicated, dedicated elbow films may help to better delineate details of the distal humeral fracture fragments. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2132-09-20 09:40:00"}

Description: 19594787-RR-19Abstract: ## HISTORY: -year-old female with left leg swelling and pain. ## FINDINGS: Grayscale, color, and spectral Doppler evaluation was performed of the left lower extremity veins. There is normal phasicity of the common femoral veins bilaterally. There is normal compression and augmentation of the left common femoral, proximal femoral, mid femoral, distal femoral, popliteal, posterior tibial, and peroneal veins. There is moderate left calf edema. ## IMPRESSION: No evidence of DVT in the left lower extremity. Moderate left calf edema. Findings were communicated via phone call by Dr. to Dr. on at 16:01. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2135-02-03 14:30:00"}

Description: 19594787-RR-20Abstract: ## INDICATION: woman with iron-deficiency anemia, and a non-diagnostic upper GI endoscopy and colonoscopy. ## MRI ABDOMEN: The imaged portion of the liver is unremarkable, except for a few tiny biliary hamartomas (13:24, 29, 75). The gallbladder is normal. There is no intra- or extra-hepatic bile duct dilation. The right adrenal gland is normal. There is mild thickening of the left adrenal gland, without a focal mass. The spleen is unremarkable, except for a 4 mm cyst. A few renal peripelvic and cortical cysts are seen in both kidneys, left greater than right. A 2.1 cm simple renal cortical cyst is seen in the interpolar region of right kidney. A few scattered mesenteric lymph nodes in the abdomen are not pathologically enlarged. The abdominal aorta has moderate atherosclerotic disease, without aneurysmal dilation. There is mild stenosis of the right proximal common iliac artery. Moderate degenerative changes are seen throughout the lumbar spine with a mild S-shaped scoliosis. ## MR ENTEROGRAPHY: The stomach and small bowel loops are normal, without evidence of abnormal wall thickening, edema or focal mass. The large bowel is unremarkable, except to note scattered sigmoid colonic diverticulosis, without evidence for active inflammation. Uncomplicated right groin hernia containing a loop of small bowel (1202:75) is noted, in a location slightly higher than an inguinal hernia. ## MRI PELVIS: The urinary bladder, rectum and sigmoid colon are normal. The uterus is not visualized. No pelvic free fluid. Small pelvic side wall lymph nodes are not pathologically enlarged. No marrow signal abnormality is seen. ## IMPRESSION: 1. Uncomplicated small right groin hernia containing a loop of small bowel. This may represent a femoral hernia though may be slightly more superiorly located than typically seen. No focal bowel abnormality identified to explain the patient's iron-deficiency anemia. 2. Scattered sigmoid colonic diverticulosis, without active inflammation. 3. Bilateral peripelvic and right renal cortical cysts. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2135-09-15 10:07:00"}

Description: 19594787-RR-21Abstract: ## EXAMINATION: CT C-SPINE W/O CONTRAST ## INDICATION: female approximate 1.4 weeks status post fall, now with left shoulder pain and radicular symptoms. Evaluate for cervical spine fracture. ## DOSE: Acquisition sequence: 1) Spiral Acquisition 6.4 s, 25.1 cm; CTDIvol = 37.3 mGy (Body) DLP = 936.0 mGy-cm. Total DLP (Body) = 936 mGy-cm. ## FINDINGS: There is mild anterolisthesis of C7 on T1, grossly unchanged. The visualized osseous structures are osteopenic. No definite fractures are identified.Multilevel degenerative changes of the cervical spine are most pronounced at C3-C4, C4-C5, C5-C6, and C6-C7, were there is endplate sclerosis, severe disc space narrowing, and osteophytosis. No evidence of bony spinal canal stenosis. There is no prevertebral soft tissue swelling. Postsurgical changes related to prior right mandibular surgery are noted. A 1.1 cm nodule in the left thyroid lobe is noted (3:54). Limited imaging of lungs demonstrates approximately 3 mm right upper lobe ground-glass opacity. ## IMPRESSION: 1. No definite evidence of cervical spinal fracture. 2. 1.1 cm left thyroid lobe nodule. The College of Radiology guidelines suggest that in the absence of risk factors for thyroid cancer, no further evaluation is recommended. 3. Multilevel severe degenerative changes of the cervical spine as described. 4. Nonspecific right upper lobe 3 mm ground-glass opacity. he Society guidelines for pulmonary nodule guidelines suggest for ground glass nodules less than or equal to 5 mm no CT followup is required. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2137-12-26 13:56:00"}

Description: 19594787-RR-22Abstract: ## EXAMINATION: CHEST (AP AND LAT) ## HISTORY: with shortness of breath and crackles on lung exam// ?pulmonary edema ## FINDINGS: Moderate cardiac enlargement is unchanged with dense mitral annular calcifications again noted. Diffuse atherosclerotic calcifications of the thoracic aorta are re-demonstrated. Mediastinal and hilar contours are unchanged and unremarkable. Pulmonary vasculature is not engorged. Blunting of the left costophrenic sulcus persists, likely reflective of a small pleural effusion. Lungs are otherwise clear without focal consolidation. No pneumothorax is seen. The osseous structures are diffusely demineralized with mild multilevel degenerative changes. ## IMPRESSION: Persistent small left pleural effusion. No pulmonary edema. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "26871526", "time": "2138-10-21 14:19:00"}

Description: 19594787-RR-25Abstract: ## INDICATION: year old woman with upper GI bleeding post SBE and APC now with severe abdominal pain. Assess for free air. ## FINDINGS: There are no abnormally dilated loops of large or small bowel. Mildly distended cecum. There is no free intraperitoneal air. Osseous structures are notable for mild degenerative changes of bilateral hips with subchondral sclerosis and small osteophytes. Limited evaluation of lower lumbar spine is notable for degenerative changes with osteophytes and endplate sclerosis. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. ## IMPRESSION: 1. No free intraperitoneal air no obstruction. 2. Mild degenerative changes of bilateral hips and lower lumbar spine. ## NOTIFICATION: The findings were discussed with Dr. . by , M.D. on the telephone on at 9:11 pm, 5 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "23243383", "time": "2138-11-28 19:42:00"}

Description: 19594787-RR-28Abstract: ## EXAMINATION: CTA HEAD AND CTA NECK Q16 CT NECK ## HISTORY: with left facial numbness// ? evidence of stroke or hemorrhage ## DOSE: Acquisition sequence: 1) Sequenced Acquisition 18.0 s, 18.0 cm; CTDIvol = 50.2 mGy (Head) DLP = 903.1 mGy-cm. 2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 54.5 mGy (Head) DLP = 27.2 mGy-cm. 3) Spiral Acquisition 4.9 s, 38.9 cm; CTDIvol = 31.0 mGy (Head) DLP = 1,206.2 mGy-cm. Total DLP (Head) = 2,136 mGy-cm. ## CT HEAD: There is no evidence for acute hemorrhage, vascular territorial infarction, mass effect, or edema. Small chronic infarct right cerebellum, stable since . The ventricles and sulci are prominent. There is gross preservation of gray-white matter differentiation. Aerosolized secretions are seen within the left sphenoid sinus. Minimal mucosal thickening is seen involving scattered ethmoid air cells. There is under pneumatization versus postsurgical change valve in the left mastoid air cells. The remainder of the paranasal sinuses, middle ear cavities, and mastoid air cells are clear. The patient is status post bilateral lens resections.. ## CTA HEAD AND NECK: There is a normal 3 vessel aortic arch with mild calcifications seen at the origins of the great vessels. Moderate calcifications are seen at the origin of the left V1 segment. Otherwise, the vertebral arteries are patent without high-grade stenosis or occlusion. The bilateral common carotid arteries are patent. Mild left and moderate right calcifications are seen at the bilateral carotid bulbs. There is no evidence of internal carotid stenosis by NASCET criteria. Mild calcifications are noted involving the bilateral cavernous internal carotid arteries. Mild luminal irregularity and narrowing is seen involving the right greater than left A1 segments, distal left M1 segment and left P1 segment, likely secondary to atherosclerotic disease. The right posterior communicating arteries open and dominant. The left posterior communicating artery is also patent. There is no evidence for high-grade stenosis, occlusion, or aneurysm greater than 3 mm. ## OTHER: There are multiple metallic wires seen throughout the right mandible, likely postsurgical. A small punctate focus of hyperdensity in left mandible may also be postsurgical. Mild pulmonary interstitial edema. Innumerable nodules are seen, measuring up to 8 mm at the right upper lobe. Several is are solid versus ground-glass, and many appear similar as compared to cervical spine CT dated . The right pulmonary artery is mildly enlarged at 2.6 cm. The thyroid is mildly heterogeneous with a 1.0 cm hypodense nodule seen on the left. There is no cervical lymphadenopathy by CT size criteria. Degenerative arthritis right shoulder. Advanced degenerative changes cervical spine. ## IMPRESSION: 1. No evidence for acute hemorrhage or acute infarction. 2. Mild-to-moderate global parenchymal volume loss. 3. Small chronic right cerebellar infarct. 4. Multifocal, mild-to-moderate atherosclerotic disease described throughout the intracranial and cervical vasculature. No evidence for high-grade stenosis, occlusion, or aneurysm. 5. Innumerable upper lung ground-glass and solid nodules measuring up to 8 mm, many of which appear similar from . Few mildly prominent mediastinal lymph nodes, may be reactive. 6. Mild interstitial pulmonary edema. 7. 1.0 cm hypodense left thyroid nodule. ## RECOMMENDATION(S): For incidentally detected multiple subsolid nodules bigger than 6mm, CT follow-up in 3 to 6 months is recommended. Subsequent management should be based on the most suspicious nodule(s). See the Society Guidelines for the Management of Pulmonary Nodules Incidentally Detected on CT" for comments and reference: Thyroid nodule. No follow up recommended. Absent suspicious imaging features, unless there is additional clinical concern, College of Radiology guidelines do not recommend further evaluation for incidental thyroid nodules less than 1.0 cm in patients under age or less than 1.5 cm in patients age or older. ## SUSPICIOUS FINDINGS INCLUDE: Abnormal lymph nodes (those displaying enlargement, calcification, cystic components and/or increased enhancement) or invasion of local tissues by the thyroid nodule. , et al, "Managing Incidental Thyroid Nodules Detected on Imaging: White Paper of the ACR Incidental Findings Committee". J 12:143-150. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2139-09-04 22:36:00"}

Description: 19594787-RR-31Abstract: ## EXAMINATION: Video oropharyngeal swallow study. ## INDICATION: year old woman with dysphagia. Evaluation for swallowing dysfunction. ## DOSE: Fluoro time: 04:53 min. ## FINDINGS: Barium was administered with passage visualized through the oropharynx and upper esophagus. There was no evidence of penetration or aspiration with all consistencies. Patient demonstrated delayed swallowing initiation with oral phase hesitancy, likely volitional. Limited visualization of the esophagus demonstrated mild retention of nectar thick liquids at the distal portion of the esophagus, however there was no evidence of retrograde flow. There was free passage of the 13 mm barium tablet with no evidence of holdup. ## IMPRESSION: No evidence of penetration or aspiration. Please note that a detailed description of dynamic swallowing as well as a summative assessment and recommendations are reported separately in a standalone note by the Speech-Language Pathologist (OMR, Notes, Rehabilitation Services). Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "23311336", "time": "2139-09-15 09:30:00"}

Description: 19594787-RR-34Abstract: ## INDICATION: year old woman with MR mitraclip with residual stenosis resulting in heart failure, now undergoing eval for open surgical MVR.// evaluate carotid arteries for disease, prior to CABG ## RIGHT: The right carotid vasculature has mild heterogeneous atherosclerotic plaque. The peak systolic velocity in the right common carotid artery is 95 cm/sec. The peak systolic velocities in the proximal, mid, and distal right internal carotid artery are 70, 87, and 81 cm/sec, respectively. The peak end diastolic velocity in the right internal carotid artery is 19 cm/sec. The ICA/CCA ratio is 0.9. The external carotid artery has peak systolic velocity of 67.7 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 88 cm/sec. The peak systolic velocities in the proximal, mid, and distal left internal carotid artery are 67, 77, and 80 cm/sec, respectively. The peak end diastolic velocity in the left internal carotid artery is 19 cm/sec. The ICA/CCA ratio is 0.9. The external carotid artery has peak systolic velocity of 62.7 cm/sec. The vertebral artery is patent with antegrade flow. ## IMPRESSION: Less than 40% stenosis in the bilateral internal carotid arteries. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "20435085", "time": "2139-10-24 08:35:00"}

Description: 19594787-RR-35Abstract: ## EXAMINATION: CHEST PORT. LINE PLACEMENT ## INDICATION: year old woman s/p MVR// Fast track early extubation Contact name: , Phone: 1 ## IMPRESSION: In comparison with study of , the patient has undergone a mitral valve repair and there are intact midline sternal wires. Endotracheal tube tip lies approximately 3 cm above the carina. Right IJ catheter extends to the midportion of the SVC. What appears to be a Swan-Ganz catheter from the femoral vein extends to the proximal portion of the right pulmonary artery. Left chest tube is in place and there is no evidence of pneumothorax. Basilar atelectatic changes are seen. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "20435085", "time": "2139-10-26 14:38:00"}

Description: 19594787-RR-37Abstract: ## INDICATION: year old woman with status post MVR, ASD closure, RIJ line changed over wire to TLC// evaluate new line Contact name: : ## FINDINGS: Compared to the previous study from earlier in the same day, the small left pleural effusion and atelectatic changes at the left base appear stable. Atelectatic changes are noted at the right lung base, somewhat progressive when compared to the previous study. The tip of the right IJ line is in the right atrium. The aorta is atherosclerotic. Sternal wires appear intact. The patient is status post mitral valve replacement. ## IMPRESSION: As above Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "20435085", "time": "2139-10-27 16:47:00"}

Description: 19594787-RR-39Abstract: ## EXAMINATION: CHEST (AP AND LAT) ## HISTORY: with shortness of breath and chest pain after MVR// Please evaluate for pneumonia, effusion, or pulmonary HTN ## FINDINGS: Patient is status post median sternotomy and mitral valve replacement. Heart size is difficult to assess as the heart is obscured by a moderate size right and small left pleural effusions. The right pleural effusion appears similar to the prior exam with the left pleural effusion appearing slightly decreased in size. Atherosclerotic calcifications of the aortic knob are again noted. There is mild pulmonary vascular congestion, improved from the prior study. Bibasilar airspace opacities likely reflect atelectasis. No pneumothorax is detected. No acute osseous abnormality is detected. ## IMPRESSION: 1. Moderate-sized right pleural effusion is unchanged with decreased size of small left pleural effusion. 2. Mild pulmonary vascular congestion, improved from the prior exam. 3. Bibasilar airspace opacities likely reflect compressive atelectasis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25656555", "time": "2139-11-04 16:23:00"}

Description: 19594787-RR-41Abstract: ## INDICATION: year old woman s/p right thorocentesis// eval for effusion/pneumo eval for effusion/pneumo ## IMPRESSION: Compared to chest radiograph on . Following thoracentesis evacuate in most of the previous moderate right pleural effusion there is a moderate to large right pneumothorax extending from the apex to the diaphragmatic surface. Moderate right lower lobe atelectasis has not improved. Small to moderate left pleural effusion and moderate left lower lobe atelectasis are unchanged. Left upper lobe is clear. Heart size is normal. There is no pulmonary edema or vascular engorgement. ## NOTIFICATION: The findings were discussed with , NP by , M.D. on the telephone on at 2:47 pm, 1 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25656555", "time": "2139-11-05 14:25:00"}

Description: 19594787-RR-42Abstract: ## INDICATION: year old woman s/p CT placement for right pneumothorax. ## FINDINGS: There is a interval placement of a right-sided chest tube which terminates overlying the thoracic spine and medial border of the right lung. There has been interval resolution of right-sided pneumothorax. There is a small right-sided pleural effusion which is new since most recent chest radiograph. Small left pleural effusion is unchanged. There is bibasilar atelectasis. Cardiomediastinal silhouette is within normal limits. ## IMPRESSION: 1. Interval resolution of right-sided pneumothorax. 2. Interval placement of right-sided chest tube which terminates overlying the thoracic spine and medial border of the right lung. Lateral view chest radiograph can be considered for better evaluation of the chest tube position. 3. Small right-sided pleural effusion is new as compared to chest radiograph earlier today. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25656555", "time": "2139-11-05 16:40:00"}

Description: 19594787-RR-44Abstract: ## INDICATION: year old woman// Placement ## FINDINGS: The right chest tube has been retracted, the tip now projecting over the right paraspinal region. The size of the right pleural effusion appears to have increased since 1 hour prior. A small left pleural effusion is unchanged. Opacities overlying the right pleural effusion likely reflect atelectasis. The size and appearance of the cardiac silhouette is unchanged. There is no pneumothorax identified. ## IMPRESSION: Slight interval retraction of the right chest tube. There is apparent increase in size of the right pleural effusion since prior. No pneumothorax is identified. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25656555", "time": "2139-11-05 18:45:00"}

Description: 19594787-RR-45Abstract: ## INDICATION: year old woman with right pleural effusion and PTX// interval AM xray ## FINDINGS: Right chest tube appears stable in position. Small residual right apical pneumothorax is seen. Increased opacification of the right lung base is likely due to right lower lobe collapse and pleural fluid. Small left pleural effusion is unchanged. Moderate enlargement of the cardiac silhouette is stable. Median sternotomy wires remain midline, intact. ## IMPRESSION: Stable right chest tube with small residual right apical pneumothorax. Increased opacification of the right lung base likely reflects right lower lobe collapse and pleural fluid. Unchanged small left pleural effusion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25656555", "time": "2139-11-06 07:59:00"}

Description: 19594787-RR-48Abstract: ## INDICATION: year old woman with removal of right CT// eval for pTX ## FINDINGS: In comparison with a study obtained on the same day, 2 hours prior, the right chest as been removed. There is a small right apical pneumothorax, similar appearance to the previous study. No other significant changes . ## IMPRESSION: Interval removal of right chest tube with redemonstration of small right apical pneumothorax. ## NOTIFICATION: The findings were discussed with , M.D. by , M.D. on the telephone on at 3:58 pm, 10 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25656555", "time": "2139-11-07 13:56:00"}

Description: 19594787-RR-50Abstract: ## EXAMINATION: CHEST (PA AND LAT) ## INDICATION: History: with dyspnea, cough// ? pna ?fluid overload ## FINDINGS: Patient is status post median sternotomy, CABG, and mitral valve repair. Mild cardiac enlargement is unchanged. The mediastinal and hilar contours are similar. Pulmonary vasculature is not engorged. Lungs are hyperinflated without focal consolidation. Complete or near complete resolution of a left pleural effusion is noted. No pneumothorax. No acute osseous abnormality. Osseous structures are diffusely demineralized. ## IMPRESSION: No evidence for pneumonia or pulmonary edema. Complete or near complete resolution of a previously noted left pleural effusion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2140-05-09 12:07:00"}

Description: 19594787-RR-51Abstract: ## EXAMINATION: CTA chest with intravenous contrast ## INDICATION: A female with dyspnea. ## DOSE: Acquisition sequence: 1) Stationary Acquisition 3.0 s, 0.5 cm; CTDIvol = 9.7 mGy (Body) DLP = 4.9 mGy-cm. 2) Spiral Acquisition 3.8 s, 29.6 cm; CTDIvol = 8.4 mGy (Body) DLP = 249.0 mGy-cm. Total DLP (Body) = 254 mGy-cm. ## FINDINGS: The aorta and its major branch vessels are patent, with no evidence of stenosis, occlusion, dissection, or aneurysmal formation. There is no evidence of penetrating atherosclerotic ulcer or aortic arch atheroma present. There is ulcerated atherosclerotic plaque along the aortic arch and descending aorta. Limited study at the segmental and subsegmental pulmonary arteries of the bilateral lower lobes are not well opacified. The pulmonary arteries are well opacified to the lobar level, with no evidence of filling defect within the main, right, left, lobar, segmental or subsegmental pulmonary arteries. The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain. There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. The thyroid gland appears unremarkable. There is no evidence of pericardial effusion. There is no pleural effusion. There are subtle scattered central lobar pulmonary nodules in the right upper lung, may be due to small airway disease, small airways infection or inflammation, (series 3, image 92). The airways are patent to the subsegmental level. Limited images of the upper abdomen are unremarkable. The patient is status post CABG and median sternotomy with intact sternal wires. No lytic or blastic osseous lesion suspicious for malignancy is identified. ## IMPRESSION: 1. Limited study as the subsegmental and segmental pulmonary arteries in the bilateral lower lobes due to respiratory motion. Within the limitation of the study, no evidence of central pulmonary embolism or acute aortic abnormality. 2. Subtle scattered, millimetric centrilobular pulmonary nodules in the right upper lung may be due to small airway disease, small airways infection or inflammation. ## NOTIFICATION: The ED nurse was emailed about the change in wet read and will inform the patient. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2140-05-09 19:06:00"}

Description: 19594787-RR-52Abstract: ## EXAMINATION: CTA CHEST WITH CONTRAST ## HISTORY: with dyspnea, hypoxia, elevated d-dimer.// Evaluate for PE ## DOSE: Acquisition sequence: 1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 15.2 mGy (Body) DLP = 7.6 mGy-cm. 2) Spiral Acquisition 3.1 s, 24.1 cm; CTDIvol = 14.2 mGy (Body) DLP = 340.8 mGy-cm. Total DLP (Body) = 348 mGy-cm. ## HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the subsegmental level without filling defect to indicate a pulmonary embolus. The thoracic aorta is normal in caliber without evidence of dissection or intramural hematoma. Median sternotomy and post CABG changes are noted. No pericardial effusion is seen. ## AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass. The esophagus is patulous. ## PLEURAL SPACES: No pleural effusion or pneumothorax. ## LUNGS/AIRWAYS: A small group of pulmonary nodules measuring up to 4 mm in the right upper lobe (02:20) are unchanged since the prior CT from . There is a 4 mm pulmonary nodule in the right middle lobe (02:55) is unchanged. A 3 mm right perifissural nodule (02:45) is unchanged. A 3 mm pulmonary nodule in the left lower lobe (2:60), is unchanged since the prior study. An 8 mm pulmonary nodule in the left lower lobe (02:50) is new since the prior study from . Chronic atelectasis/scarring in the right lower lobe is noted. The airways are patent to the level of the segmental bronchi bilaterally. ## BASE OF NECK: Visualized portions of the base of the neck show no abnormality. ## ABDOMEN: Included portion of the upper abdomen is unremarkable. ## BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. ## IMPRESSION: 1. No evidence of pulmonary embolism or aortic abnormality. 2. 8 mm left lower lobe pulmonary nodule, new since the prior study. Multiple additional smaller scattered pulmonary nodules are unchanged since the prior study. For incidentally detected multiple solid pulmonary nodules measuring 6 to 8mm, a CT follow-up in 3 to 6 months is recommended in a low-risk patient, with an optional CT follow-up in 18 to 24 months. In a high-risk patient, both a CT follow-up in 3 to 6 months and in 18 to 24 months is recommended. 3. Patulous esophagous. Recommend swallowing study for evaluation of aspiration. ## RECOMMENDATION(S): Swallowing studies and esophagogram to assess for aspiration Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "25131795", "time": "2140-12-31 05:10:00"}

Description: 19594787-RR-54Abstract: ## INDICATION: W/PMHX OF DIASTOLIC HF, MILD AS SEVERE 4+MR MITRACLIP ## IMPRESSION: Please note that this report only pertains to extracardiac findings. Linear atelectasis within the right lower lobe. Known pulmonary nodules are better visualized on the recent chest CTA. Subcentimeter T2 hyperintense lesions within the liver are incompletely characterized, but likely represent cysts or biliary hamartomas. Small hiatal hernia. Mild levoconvex scoliosis of the lumbar spine. The entirety of this Cardiac MRI is reported separately in the Electronic Medical Record (OMR) - Cardiovascular Reports. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594787", "visit_id": "N/A", "time": "2141-01-16 09:14:00"}

Description: 19594816-RR-17Abstract: ## HISTORY: Pain after forced movement, pain over base of third metatarsal and lateral. RIGHT FOOT THREE VIEWS. RIGHT ANKLE, THREE VIEWS. ## RIGHT ANKLE, THREE VIEWS: No fracture, dislocation or degenerative change is detected about the right ankle. The mortise is congruent. No OCD is identified. No gross soft tissue swelling is appreciated radiographically. ## RIGHT FOOT, THREE VIEWS: No fracture, dislocation or degenerative change is detected on these non-standing views. Faint ossific density projecting lateral to the base of the first metatarsal appears to represent a normal variant ossicle. By report, there is no specific clinical concern for a Lisfranc injury. If the patient haS mid foot pain raising concern for Lisfranc injury, then further assessment with an AP standing view help to demonstrate abnormal widening at the base of the and metatarsal bones. Findings discussed with covering house officer on the afternoon of the exam. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594816", "visit_id": "N/A", "time": "2116-02-03 12:08:00"}

Description: 19594822-RR-4Abstract: ## EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/ CONTRAST Q1217 CT HEAD SINUS. ## INDICATION: year old woman with focal severe pain in the left lower jaw that started in the tooth and then spread to the TMJ and mandible. Focal abscess? ## DOSE: Found no primary dose record and no dose record stored with the sibling of a split exam. !If this Fluency report was activated before the completion of the dose transmission, please reinsert the token called CT DLP Dose to load new data. ## FINDINGS: Streak artifact from dental amalgam limits evaluation. There is mild leftward deviation of the nasal septum with a bony spur. There is minimal mucosal thickening of the ethmoid sinuses. Otherwise, the paranasal sinuses are clear, with no significant mucosal thickening or air-fluid levels. The ostiomeatal units are patent. The cribriform plates are intact. The lamina papyracea are intact. There are no destructive osseous changes. No periapical lucencies are identified in the maxilla mandible. The parapharyngeal fat planes are symmetric. No focal fluid collections are identified. The parotid and submandibular glands are symmetric without evidence of surrounding inflammatory changes. There are a couple nonenlarged level 1B and level 2 lymph nodes. Otherwise, no lymphadenopathy by CT size criteria. The mastoid air cells and middle ear cavities are clear. The globes are intact. The intraconal and extraconal fat planes are maintained. ## IMPRESSION: 1. No focal or organizing fluid collections to suggest abscess formation. No evidence of inflammatory changes. 2. No periapical lucencies in the maxilla or mandible. 3. No significant mucosal thickening of the paranasal sinuses. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594822", "visit_id": "N/A", "time": "2136-12-30 14:31:00"}

Description: 19594838-RR-14Abstract: ## HISTORY: Status post right dynamic hip screw placement on with diminished hematocrit and questionably increased swelling in the right thigh. Evaluate for post-operative complications or hematoma formation. Comparison is made to prior radiographs dated . ## FINDINGS: There is mild uniform enlargement of muscle groups in all compartments of the right thigh, with a small intramuscular hematoma noted medial to the surgical site. Additionally, a 15 x 22 mm simple fluid collection is present adjacent to the greater trochanter. Dynamic hip screws noted to bridge a comminuted partially impacted intertrochanteric fracture and the surgical hardware appears intact, with no evidence of short-term complication. There is mild right-sided subcutaneous edema. The bladder is distended, and the remaining incompletely visualized pelvic organs appear grossly unremarkable. ## IMPRESSION: 1. Small simple fluid collection adjacent to the greater trochanter, with no other fluid collection. 2. Diffuse surrounding muscular edema and small intramuscular hematoma, medially. 2. No immediate surgical hardware complications noted status post placement of dynamic hip screw for comminuted right intertrochanteric fracture. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594838", "visit_id": "N/A", "time": "2111-02-09 14:46:00"}

Description: 19594844-RR-8Abstract: ## REASON FOR EXAM: Pregnant with vaginal spotting. Clinical concern for ectopic pregnancy. ## FINDINGS: Patient's last menstrual period is . A gestational sac containing an embryo with crown-rump length of 1.2 cm corresponding to 7 weeks and 4 days gestation is seen. Embryonic heart rate is identified. There is a subchorionic hemorrhage extending more than 180 degrees surrounding the gestational sac and measuring up to 4 mm in thickness. Bilateral ovaries are normal. No ectopic pregnancy is seen on this transabdominal scan. ## IMPRESSION: Single live intrauterine pregnancy. Subchorionic hemorrhage extending more than 180 degrees surrounding the gestational sac and measuring up to 4 mm in thickness. OB follow-up is suggested. Dr. was aware of the above findings at time of dictation at approximately 7 pm, . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594844", "visit_id": "N/A", "time": "2133-05-09 15:30:00"}

Description: 19594936-RR-17Abstract: ## FINDINGS: No meniscal tear is detected. Cruciate and collateral ligaments appear unremarkable. There is curvilinear fluid intensity anterior to the patella and also in the medial aspect of the patella. This is consistent with mild prepatellar fluid or bursitis. The fluid measures approximately 4.8 cm in span and approximately 0.4 cm in thickness. Marrow signal is normal. There is no evidence of fracture or marrow edema. Cartilage is normal. There is a very tiny cyst identified. There is physiological glenohumeral joint fluid. ## IMPRESSION: 1. Prepatellar fluid collection. 2. No meniscal tear. 3. Tiny cyst. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19594936", "visit_id": "N/A", "time": "2155-07-18 20:43:00"}

Description: 19595050-RR-16Abstract: ## INDICATION: Woman with chest pain and shortness of breath. ## OSSEOUS STRUCTURES: The visible osseous structures are unremarkable. ## IMPRESSION: 1. No evidence of pulmonary embolism or acute aortic syndrome. 2. Bilateral axillary lymphadenopathy. Bilaterally suggests systemic process and clinical correlation is recommended with possible recent infection or inflammatory process or history of malignancy, neoplastic process not excluded. If no clinical correlation found, further work-up is warranted. Consider biopsy. 3 month follow-up imaging to assess for resolution/interval change. Given patient age, mammography (if not recently obtained) should also be considered. These findings as well as the recommendation for clinical correlation and possible biopsy were communicated via telephone to MD at 10 pm on . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595050", "visit_id": "22394791", "time": "2113-01-11 14:39:00"}

Description: 19595050-RR-17Abstract: ## HISTORY: Prior chest CT demonstrated bilateral axillary lymphadenopathy, and a three-month followup is being obtained. ## FINDINGS: Bilateral axillary lymphadenopathy is not appreciably changed from . A 19 mm x 17 mm left axillary node is the largest in the left axillary station and a 10 mm x 24 mm right axillary node is the largest on the right. Central lymph nodes are not pathologically enlarged, with paratracheal lymph nodes measuring only up to 6 mm. The heart is normal in size and there is no pleural or pericardial effusion. A 5-mm RLL pulmonary nodule (4:137) is unchanged. The lungs are otherwise clear. This examination is not tailored for subdiaphragmatic evaluation other than to note normal-appearing adrenal glands. ## IMPRESSION: 1. No appreciable change in bilateral axillary lymphadenopathy, which should be palpable on physical examination, and followup should be assessed on clinical grounds. 2. No central adenopathy. 3. Three month stability of a 5-mm pulmonary nodule within the right lower lobe. A follow-up Chest CT in eight months should be obtained to document one-year stability. These recommendations were posted to the critical results dashboard at 11:43 a.m. on . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595050", "visit_id": "N/A", "time": "2113-05-19 16:35:00"}

Description: 19595062-RR-10Abstract: ## INDICATION: Perirectal abscess and external opening found on exam. Please evaluate fistula tract. ## FINDINGS: Endoanal sonography shows a heterogeneously hypoechoic tract extending from the right posterolateral anal canal (5 o'clock in the dorsal lithotomy position) at the anal verge, coursing superiorly in intersphincteric location, and appearing to communicate with the mucosa in the right lateral aspect of the canal, at 3 o'clock in the dorsal lithotomy position, approximately 1.5-2 cm from the verge. In addition, it is noted that the echogenic region of apparent inflammatory change and fibrosis about the tract extends to and involves the internal sphincter in the mid canal, approximately 2 cm from the verge, about the location where the tract communicates with the mucosa. No perirectal abscess is noted. No obvious external opening was visible at the perineum to cannulate and therefore peroxide fistulography could not performed, despite repetitive attempts to cannulate. ## IMPRESSION: Linear intersphincteric fistula tract extending from 5 o'clock at the anal verge to 3 o'clock in the mid anal canal approximately 2 cm from the anal verge, seen on preliminary, non-peroxide imaging. The internal sphincter shows increased echogenicity suggestive of more marked inflammatory process involving the sphincter at this location. If the fistula recurs with perineal drainage, further attempts at peroxide fistulography could be performed. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595062", "visit_id": "N/A", "time": "2132-10-07 13:11:00"}

Description: 19595062-RR-12Abstract: ## INDICATION: male with known anal fistula, now with increased anal fistula drainage and urethral drainage. Evaluate for communicating fistula/abscess. ## FINDINGS: Perianal tract originates proximally in the 4 o'clock position, 2.5 cm above the anal verge, extends in the intersphincteric space and exits the skin at the 6 o'clock position along the left gluteal cleft. There is mo abscess, other fistula, free fluid or lymphadenopathy. In the left mid and base of the prostate, note is made of a region of low signal on the T2- weighted images (series 3:20). The rectum, sigmoid colon, bladder, and seminal vesicles are normal. ## IMPRESSION: 1. Small intersphincteric perianal tract as described above. No abscess or other fistula. 2. In the left mid and peripheral base of the prostate, note is made of a region of low signal on the T2- weighted images. While this finding is non- specifiic and can be seen with prostatitis; prostate cancer could have a similar appearance. Correlation with physical exam and lab values is recommended. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595062", "visit_id": "N/A", "time": "2133-03-17 07:34:00"}

Description: 19595081-RR-20Abstract: ## EXAMINATION: Chest and pelvis radiograph ## INDICATION: man with history of trauma ## CHEST: The lungs are overall clear without focal consolidation. The heart is mildly enlarged with mild central pulmonary vascular engorgement without overt interstitial pulmonary edema. No pleural effusion or or pneumothorax is seen. ## PELVIS: Evaluation of the pelvis is mildly limited due to underpenetration. No displaced fracture or dislocation of the proximal femurs and the pelvis is seen. The evaluation of the sacrum is limited. ## IMPRESSION: -Mild cardiomegaly and vascular engorgement without overt pulmonary edema. -Limited evaluation of the pelvis due to underpenetration. No displaced fracture or dislocation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595081", "visit_id": "N/A", "time": "2112-10-04 03:30:00"}

Description: 19595081-RR-21Abstract: ## EXAMINATION: WRIST(3 + VIEWS) RIGHT PORT ## HISTORY: with right wrist pain s/p mvc// wrist fracture wrist fracture ## FINDINGS: There is mild elevation of the pronator quadratus fat pad. No acute displaced fractures or dislocation are seen. There are no significant degenerative changes. Carpal bones are well aligned. Mineralization is normal. There are no erosions. ## IMPRESSION: Mild elevation of the pronator quadratus fat pad without visualization of fracture line. If clinically indicated, obtain short-term follow-up radiograph for further evaluation. No displaced fracture or dislocation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595081", "visit_id": "N/A", "time": "2112-10-04 05:52:00"}

Description: 19595535-RR-18Abstract: ## EXAMINATION: NUCHAL TRANSLUCENCY US, SINGLE/FIRST FETUS ## INDICATION: year old woman with pregnancy// check fetal NT. Check fetal well being ## FINDINGS: Transabdominal imaging demonstrates an intrauterine gestational sac with a single living fetus with a crown rump length of 57 mm representing a gestational age of 12 weeks, 2 days corresponding satisfactorily to the menstrual age of 12 weeks, 4 days. The nuchal translucency measures 1.5 mm. The certified NT sonographer is S. , # . The uterus demonstrates an exophytic left fibroid measuring 7.5 x 8.3 x 5.6 cm. The right ovary is not discretely seen. The left ovary is normal. A tubular hypoechoic structure within the right adnexa demonstrating homogeneous internal echoes likely represents a hematosalpinx. On the left, a tubular anechoic structure within the left adnexa, separate from the ovary, likely represents a small hydrosalpinx. ## IMPRESSION: 1. Size equals dates. Nuchal translucency measuring 1.5 mm. 2. Fibroid uterus. Nonvisualized right ovary. Normal left ovary. 3. Small small to moderate right hematosalpinx, and small left hydrosalpinx. Recommend attention at the time of follow up. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595535", "visit_id": "N/A", "time": "2160-09-19 08:04:00"}

Description: 19595535-RR-19Abstract: ## EXAMINATION: FULL FETAL LOW RISK ## INDICATION: FFS, check fetal well-being ## FINDINGS: There is a single live intrauterine gestation. The fetus is in breech position. The placenta is anterior. There is no evidence of previa. There is a normal amount of amniotic fluid. Views of the fetal head, face, heart, stomach, kidneys, cord insertion site, bladder, spine, 3 vessel cord, and extremities are normal. Visualization of the profile and outflow tracts was limited due to fetal positioning. No fetal morphologic abnormalities are detected. A large left anterior fibroid is again noted measuring 7.8 x 6.1 x 5.8 cm, previously a 7.5 x 8.3 x 5.6 cm. No adnexal abnormalities are seen. The following biometric data were obtained: BPD 45 mm, 19 weeks 5 days. HC 163 mm, 19 weeks 1 days. AC 140 mm, 19 weeks 3 days. FL 30 mm, 19 weeks 3 days. ## AGE BY US: 19 weeks 3 days. Age by Dates: 19 weeks 4 days. EFW 286 g Compared to the prior exam there has been appropriate interval growth. ## IMPRESSION: 1. Single, live fetus measuring size equals dates. 2. No fetal morphologic abnormalities are detected, but views of the outflow tract profile are limited. 3. Fibroid uterus. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595535", "visit_id": "N/A", "time": "2160-11-07 14:18:00"}

Description: 19595535-RR-20Abstract: ## EXAMINATION: OB F/U W/O MEASUREMENTS ## INDICATION: year old woman with single pregnancy for views of the outflow tract profile are limited on FFS// F/U views of the outflow tract profile are limited on FFS ## FINDINGS: There is a live in breech presentation. The placenta is anterior. There is no evidence of previa. There is a normal amount of amniotic fluid. Additional views were obtained of the fetal heart including outflow tracts and fetal facial profile were obtained. No fetal morphologic abnormalities are detected. Uterine fibroids are present. The largest fibroid is located in the left uterine region measuring 9.2 x 5.5 x 5.7 cm, previously 6.1 x 7.8 x 5.8 cm. No adnexal masses are seen. ## IMPRESSION: 1. Single live intrauterine gestation in breech presentation. Additional views of the fetal facial profile and outflow tracts were obtained and were normal. This completes the full fetal survey. 2. Uterine fibroids. Larger than on prior examination. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595535", "visit_id": "N/A", "time": "2160-11-24 07:07:00"}

Description: 19595535-RR-21Abstract: ## EXAMINATION: FETAL BPP WITH MEASUREMENTS ## INDICATION: year old woman with decreased fetal movement// decreased fetal movement. check well being ## FINDINGS: There is a live in cephalic presentation. The placenta is anterior. There is no evidence of previa. There is a normal amount of amniotic fluid with an amniotic fluid index of 16 cm. A biophysical profile was performed. There were 2 points each for breathing, motion, tone, and fluid for a total score . No fetal morphologic abnormalities are detected. The uterus is normal. No adnexal masses are seen. The following biometric data were obtained: BPD 70 mm, 28 weeks 2 days. HC 262 mm, 28 weeks 4 days. AC 266 mm, 30 weeks 5 days, 83 %. FL 54 mm, 28 weeks 4 days. ## AGE BY US: 29 weeks 1 days. Age by Dates: 29 weeks 2 days. EFW 1421 g, 60% (based on LMP) Compared to the prior exam there has been appropriate interval growth. ## IMPRESSION: Single live fetus with size equal to dates. The fetus demonstrates appropriate movement. BPP . AFI of 16 cm. ## NOTIFICATION: The findings were communicated to Dr. office by the radiology technician after discussion with Drs. on at 3:00 pm, 10 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595535", "visit_id": "N/A", "time": "2161-01-14 13:48:00"}

Description: 19595535-RR-22Abstract: ## EXAMINATION: FETAL BPP WITH MEASUREMENTS ## INDICATION: year old woman with single pregnancy and post dates// post dates testing, check fetal well-being and EFW ## FINDINGS: There is a live in cephalic presentation. The placenta is anterior. There is no evidence of previa. There is a normal amount of amniotic fluid with an amniotic fluid index of 11.38 cm. No fetal morphologic abnormalities are detected. The uterus is normal. No adnexal masses are seen. The following biometric data were obtained: BPD 86.5 mm, 35 weeks 0 days. HC 316.5 mm, 35 weeks 4 days. AC 355.5 mm, 39 weeks 4 days. FL 73.4 mm, 37 weeks 4 days. ## AGE BY US: 37 weeks 0 days. Age by Dates: 40 weeks 2 days. EFW 3365 g (7 lb 7 oz), 46% (based on LMP) Compared to the prior exam there has been 22 days less than expected interval growth. ## IMPRESSION: 1. Single intrauterine pregnancy, size within normal limits for dates. Estimated fetal weight of 7lb 7oz, 46th percentile based on LMP. 2. AFI measuring 11.4 cm. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595535", "visit_id": "N/A", "time": "2161-04-01 10:29:00"}

Description: 19595535-RR-24Abstract: ## INDICATION: year old woman with known fibroid // check fibroid ## FINDINGS: The uterus is anteverted. The uterus is enlarged and measures 12.2 x 6.0 x 8.6 cm. Uterine fibroids are demonstrated. The largest fibroid is exophytic located in the region of the fundus measuring 8.0 x 6.9 x 5.0 cm, previously 7.5 x 8.3 x 5.6 cm. Other smaller intramural fibroids are present. The endometrium is homogenous and measures 10 mm. The ovaries are normal with 3.5 x 3.2 cm hemorrhagic corpus luteum on the right. There is no free fluid. ## IMPRESSION: 1. Enlarged fibroid uterus. When compared to prior ultrasound, the size of the largest fibroid is not significantly changed. 2. Normal ovaries. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595535", "visit_id": "N/A", "time": "2161-06-22 09:57:00"}

Description: 19595558-RR-19Abstract: ## INDICATION: History: with AMS// ?PNA ## FINDINGS: Blunting of the left costophrenic angle is seen, which may be due to a small pleural effusion. Left base opacity could be due to pleural effusion and atelectasis, but underlying pneumonia or aspiration is not excluded. No evidence of pneumothorax. Cardiac silhouette size is mildly enlarged. The aorta is calcified. The aortic knob may be mildly dilated. There is mild pulmonary vascular congestion. ## IMPRESSION: Blunted left costophrenic angle suggests small pleural effusion. Left base opacity could be due to combination of pleural effusion and atelectasis, but underlying pneumonia and/or aspiration is not excluded. The aortic knob may be mildly dilated. Mild pulmonary vascular congestion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595558", "visit_id": "20219908", "time": "2122-04-13 13:19:00"}

Description: 19595558-RR-20Abstract: ## EXAMINATION: CHEST PORT. LINE PLACEMENT ## INDICATION: year old man with new CVL for pressors// eval line placement Contact name: : ## IMPRESSION: There has been interval placement of a left internal jugular central venous catheter which terminates in the upper superior vena cava. There are new patchy perihilar opacities, which are slightly more pronounced on the right, which may represent pulmonary edema or developing infection. Mild blunting of the left costophrenic angle is unchanged and may represent a small pleural effusion. There is no pneumothorax. The cardiomediastinal silhouette is stable in appearance. The osseous structures are unchanged. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595558", "visit_id": "20219908", "time": "2122-04-13 21:07:00"}

Description: 19595654-RR-17Abstract: ## HISTORY: Neck pain. CERVICAL SPINE, TWO VIEWS. There is mild left convex curvature of the cervical at C4/5, which may be positional. There is borderline straightening of usual lordosis. C1 through C7/T1 disc space is visualized on the lateral view. No prevertebral soft tissue swelling is identified. Vertebral body heights are preserved. Disc heights are preserved. No subluxation is detected. No gross degenerative change is seen. ## IMPRESSION - CSPINE: 1. Borderline straightening of lordosis, which can relate to muscle spasm. Possible minimal left convex curvature, which may also be positional. 2. No gross degenerative changes. THORACIC SPINE, TWO VIEWS. On the lateral view, the upper vertebral bodies are obscured by overlying anatomy. Allowing for this, vertebral body heights are preserved. No gross degenerative changes are identified. No subluxation is seen. No focal lytic or sclerotic lesion is detected. ## IMPRESSION - T-SPINE: 1. T-spine x-ray examination within normal limits. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595654", "visit_id": "N/A", "time": "2164-06-10 11:57:00"}

Description: 19595665-RR-7Abstract: ## HISTORY: man with prostate cancer, for staging. ## FINDINGS: The prostate gland measured 5 x 3.6 x 5.5 cm, yielding an estimated prostate volume of 52 cm3. The central gland was enlarged and showed a heterogenous swirled and whorled appearance with well-defined nodules indicative of BPH. The peripheral zone is diffusely heterogenous in signal intensity. There are focal areas of reduced signal seen in the peripheral zone of the left mid gland; however, there is no corresponding abnormal enhancement on the post-contrast images. On the pre-contrast T1-weighted images, there are extensive areas of abnormal signal seen in the peripheral zone consistent with post-biopsy hemorrhage. There is, however, a 6mm area of intense early enhancement seen in the right mid gland (301:41), in the paramidline location. Adjacent to this is a more extensive area of less intense enhancement extending to the left side in the mid-gland-to-apex region (301:41-46). Also in the left base, there is a 4-mm focus of early enhancement with washout (301:36) which is concerning for a second area of tumor involvement vs lower grade disease. There is no evidence of extracapsular spread. The seminal vesicles and neurovascular bundles appear to be intact. No pelvic lymphadenopathy is seen. The visualized bone marrow is unremarkable. ## IMPRESSION: Bilateral gland-confined disease, primarily along the midline in the mid-gland-to-apex, MRI stage T2c. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595665", "visit_id": "N/A", "time": "2139-10-15 09:28:00"}

Description: 19595724-RR-16Abstract: ## FINDINGS: Noncompressible thrombus is seen within the left common femoral, proximal and distal superficial femoral, and popliteal veins. Patent wall-to-wall flow is demonstrated within the left posterior tibial and peroneal veins. There is normal flow, compressibility, and/or augmentation within the right common femoral, superficial femoral, popliteal, peroneal, and posterior tibial veins. ## IMPRESSION: 1. Noncompressible thrombus from the left common femoral to popliteal veins, with sparing within the mid segment of the left superficial femoral vein. 2. No right DVT. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595724", "visit_id": "N/A", "time": "2166-04-27 16:12:00"}

Description: 19595754-RR-36Abstract: TWO VIEWS OF THE T-SPINE AND TWO VIEWS OF THE LUMBAR SPINE. ## THORACIC SPINE: There is no evidence of fracture or abnormal alignment of the thoracic spine. The vertebral body heights and intervertebral body spaces are preserved. There is no focal lucent or sclerotic lesion. ## L-SPINE: There are five non-rib-bearing L-type vertebral bodies. Vertebral body heights and intervertebral disc space heights are preserved. Normal lumbar lordosis is preserved. There is no focal lucent or sclerotic lesion. The evaluation of the sacrum is limited by overlying bowel contents. ## IMPRESSION: No evidence of acute fracture in the thoracic or lumbar spine. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2136-01-15 10:25:00"}

Description: 19595754-RR-38Abstract: ## INDICATION: Patient is a male with HIV. Now with left ankle pain with ambulation. Evaluate for etiology of pain. ## EXAMINATION: Two views of the left tibia, fibula, three views of the left ankle, and three views of the left foot. ## LEFT TIBIA AND FIBULA: No fracture is detected in the tibia or fibula. No focal lytic or sclerotic lesions or periosteal new bone formation. No soft tissue calcifications. Limited assessment of the knee joint is unremarkable. ## LEFT ANKLE: No fracture, dislocation, or degenerative change. The mortise is preserved on this non-stressed view. No erosions, lytic or sclerotic lesions. No soft tissue calcifications or radiopaque foreign bodies. ## LEFT FOOT: There is mild metatarsus varus with hallux valgus. No fracture, dislocation, or degenerative change. No erosions, lytic or sclerotic lesions. No radiopaque foreign bodies or soft tissue calcifications. ## IMPRESSION: No fracture or dislocation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2137-09-26 10:15:00"}

Description: 19595754-RR-41Abstract: ULTRASOUND SOFT TISSUES OF THE NECK ## HISTORY: patient with an approximately 2 cm enlarged left anterior cervical lymph node. ## FINDINGS: In the area of clinical finding, just to the left and inferior to the thyroid cartilage there is a chain of elongated lymph nodes measuring 4 in number. The short-axis diameter of these lymph nodes varies between 0.4 and 0.6 cm. The long-axis measurement of the individual nodes varies between 1.3 and 1.7 cm. All of the lymph nodes appear to have a normal shape and fatty hilum. No suspicious features are identified. ## CONCLUSION: Small lymph nodes in the area of clinical concern. The lymph nodes appear to have normal size and shape individually. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2140-04-21 14:18:00"}

Description: 19595754-RR-44Abstract: ## EXAMINATION: US NECK, SOFT TISSUE ## INDICATION: year old man with of enlarged L anterior cervical nodes, not resolving, please evaluate, smokes marijuana, but not tobacco, o/w normal exam // assess L anterior cervical mass ## FINDINGS: Targeted ultrasound of the left neck soft tissue reveals multiple normal-appearing lymph nodes with parallel orientation the skin surface, maximum AP dimension 6mm.. No suspicious lymph nodes. ## IMPRESSION: Multiple morphologically normal appearing left neck level 4 lymph nodes, similar to , could be reactive or hyperplastic. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2144-10-21 14:50:00"}

Description: 19595754-RR-45Abstract: ## EXAMINATION: CT NECK W/CONTRAST (EG:PAROTIDS) Q22 CT NECK ## INDICATION: year old man with left neck mass x years// left neck mass ## DOSE: Acquisition sequence: 1) Spiral Acquisition 5.3 s, 34.1 cm; CTDIvol = 7.3 mGy (Body) DLP = 244.7 mGy-cm. 2) Spiral Acquisition 2.1 s, 3.2 cm; CTDIvol = 8.4 mGy (Body) DLP = 24.3 mGy-cm. 3) Spiral Acquisition 2.1 s, 3.2 cm; CTDIvol = 8.4 mGy (Body) DLP = 24.3 mGy-cm. Total DLP (Body) = 293 mGy-cm. ## FINDINGS: External marker overlying the left anterolateral neck at the level of the cricoid cartilage (series 3, image 51) indicates the patient's region of palpable a interest. Deep to the marker and platysmas muscle is a nonenhancing fat attenuation 3.6 x 1.6 x 4.2 cm (TRV, AP, SI) well encapsulated lesion with a few small vessels coursing through it, compatible with a lipoma. The lesion exerts posterior mass effect on the left sternocleidomastoid muscle. Evaluation of the aerodigestive tract demonstrates no mass and no areas of focal mass effect. The salivary glands enhance normally and are without mass or adjacent fat stranding. The thyroid gland appears normal. There is no lymphadenopathy by CT criteria. The neck vessels are patent. The imaged portion of the lung apices are clear and there are no concerning pulmonary nodules. There are no osseous lesions. Mild degenerative changes of the cervical spine is most prominent at C3-C4 and C5-C6 where there are small central protrusions which do not significantly narrow the spinal canal. No high-grade neural foraminal narrowing. ## IMPRESSION: 1. Deep to an external marker and platysmas muscle at the left anterolateral neck at the level of the cricoid cartilage is a 4.2 cm well encapsulated fatty lesion most compatible with a lipoma. 2. No other mass lesions are identified. The visualized aerodigestive tract is unremarkable. 3. Additional findings as described above. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2146-05-11 07:18:00"}

Description: 19595754-RR-48Abstract: ## EXAMINATION: CT ABD AND PELVIS WITH CONTRAST ## INDICATION: with well controlled HIV, months of early satiety, nausea vomiting, abdominal pain and 20 lb weight loss. ## LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart is unremarkable. ## ABDOMEN: A hyperdense lesion is noted within segment 3 of the liver, series 5, image 17 and series 6 image 13, measuring 12 x 18 x 15 mm, indeterminate. A tiny hyperdense lesion is seen at the hepatic dome on series 6, image 33 measuring 7 x 9 x 9 mm, also indeterminate. A peripheral hypodensity is noted in segment 6 on series 5, image 25 measuring 8 x 14 x 13 mm, not fully characterized. While these lesions may represent benign entities, given clinical history, recommend correlation with MRI. The spleen is normal in size. Adrenals are normal bilaterally. The pancreas enhances normally without concerning lesion or signs of inflammation. The kidneys enhance symmetrically. No concerning lesion or hydronephrosis. The abdominal aorta is mildly calcified though normal in caliber. No retroperitoneal, or mesenteric adenopathy. The stomach and duodenum appear normal. ## PELVIS: Small bowel loops demonstrate no signs of ileus or obstruction. The appendix is normal. The colon contains enteric contrast and appears normal. Mild diverticulosis without diverticulitis. No pelvic free fluid. No pelvic sidewall or inguinal adenopathy. The urinary bladder appears normal. The prostate is unremarkable. ## BONES: No worrisome lytic or blastic osseous lesion is seen. Mild degenerative disc disease at L5-S1 noted. ## IMPRESSION: 3 discrete small liver lesions which can be further characterized by MRI. Otherwise, unremarkable CT exam. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2147-10-11 07:03:00"}

Description: 19595754-RR-50Abstract: ## HISTORY: with hx of lap chole yesterday, now with diffuse abdominal pain and tenderness. Evaluation for pneumoperitoneum. ## FINDINGS: There are no abnormally dilated loops of large or small bowel. Mild fecal loading noted within the ascending colon. Minimal amount of free intraperitoneal air under the right hemidiaphragm, in keeping with history of recent laparoscopic cholecystectomy. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or radiopaque foreign bodies. Surgical clips in the right upper quadrant consistent with recent cholecystectomy. ## IMPRESSION: 1. Minimal amount of free intraperitoneal air under the right hemidiaphragm, in keeping with history of recent laparoscopic cholecystectomy. 2. Mild fecal loading noted within the ascending colon. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "26338096", "time": "2147-10-30 11:52:00"}

Description: 19595754-RR-51Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## HISTORY: with lap chole on , presents with abdominal pain and mild transaminitis. Evaluation for biliary pathology. ## LIVER: Numerous echogenic lesions are noted within the liver parenchyma, with the largest in the left hepatic lobe measuring 1.7 x 1.9 x 1.5 cm, better assessed on CT abdomen/pelvis from . The background hepatic parenchyma appears within normal limits. The contour of the liver is smooth. The main portal vein is patent with hepatopetal flow. There is no ascites. ## BILE DUCTS: There is no intrahepatic biliary dilation. ## GALLBLADDER: The patient is status post cholecystectomy. ## PANCREAS: The pancreas is not well visualized, largely obscured by overlying bowel gas. ## KIDNEYS: Limited views of the kidneys show no hydronephrosis. ## RETROPERITONEUM: The visualized portions of aorta and IVC are within normal limits. A small right pleural effusion is noted. ## IMPRESSION: 1. Status post cholecystectomy, without evidence of acute biliary pathology identified. 2. Numerous echogenic lesions are noted within the liver parenchyma, with the largest in the left hepatic lobe measuring 1.7 x 1.9 x 1.5 cm, better assessed on CT abdomen/pelvis from . Further evaluation with dedicated MRI is recommended for characterization. 3. Small right pleural effusion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "26338096", "time": "2147-10-30 13:39:00"}

Description: 19595754-RR-52Abstract: ## INDICATION: year old man with HIV, recent admission to for gallstone pancreatitis, s/p CCY , here with worsening pain.// eval for potential worsening pancreatitis, ?gallstone. Also to evaluated liver lesion seen on CT scan ## LOWER THORAX: There is trace pleural effusion, slightly more on the right. Enhancing consolidations at the lung bases are consistent with atelectasis. ## LIVER: Liver demonstrates homogeneous signal intensity throughout. There is no significant drop in signal on opposed phase imaging to suggest hepatic steatosis. There are approximately 7 hepatic lesions that are hyperintense on T2 weighted imaging and demonstrate progressive discontinuous peripheral nodular enhancement, consistent with hemangiomas. The largest in segment measures up to 16 mm (04:22). This accounts for the indeterminate hepatic lesions seen on the prior CT. No concerning hepatic lesion. ## BILIARY: Gallbladder is surgically absent. CBD is dilated measuring up to 12 mm, with smooth tapering at the level of the ampulla. There is also mild central intrahepatic biliary dilation. No choledocholithiasis or obstructing lesion identified. ## PANCREAS: There is heterogeneous signal intensity throughout the pancreas, consistent with pancreatitis. Marked peripancreatic fat stranding is most pronounced along the head and neck, consistent with acute inflammation. There is a peripancreatic fluid collection along the inferior margin of the pancreas that measures up to 5.2 x 1.3 cm (4:2). Similarly, small pockets of fluid in the pancreatic head measure 0.9 cm (04:15), and 0.7 cm (04:11) which may represent developing collections. Main pancreatic duct is not dilated. ## SPLEEN: Spleen is normal in size, without focal lesions. ## ADRENAL GLANDS: Normal in size and shape. ## KIDNEYS: Kidneys are normal in size and shape. No solid parenchymal lesions are identified. There is no hydronephrosis. ## GASTROINTESTINAL TRACT: Stomach is unremarkable. There is no bowel obstruction or ascites. ## LYMPH NODES: A few prominent peripancreatic lymph nodes are likely reactive. ## VASCULATURE: Abdominal aorta is not aneurysmal. Celiac artery, superior mesenteric artery, and bilateral renal arteries are patent. Portal venous system is patent. ## OSSEOUS AND SOFT TISSUE STRUCTURES: No worrisome osseous lesions are identified. Soft tissues are unremarkable. ## IMPRESSION: 1. Moderate intrahepatic and extrahepatic biliary dilation with smooth tapering at the level of the ampulla, may reflect a combination of post cholecystectomy ectasia and/or ampullary stenosis, although a small ampullary neoplasm cannot be excluded. No choledocholithiasis. Endoscopic ultrasound could be performed for further evaluation if clinically warranted. 2. Acute interstitial edematous pancreatitis with an associated 5.2 x 1.3 cm acute peripancreatic fluid collection. Additional subcentimeter pockets of fluid in the uncinate process may represent small developing fluid collections. No pseudoaneurysm or portal venous system thrombosis. 3. Approximately 7 hepatic cavernous hemangiomas measuring up to 16 mm. No concerning hepatic lesion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "26338096", "time": "2147-10-31 00:17:00"}

Description: 19595754-RR-53Abstract: ## EXAMINATION: CTU (ABD/PEL) W/ANDW/O CONTRAST ## INDICATION: year old man with recent h/o gallstone pancreatitis s/p lap choly now with one week of L back and L lower abd pains, very tender in LLQ on exam// r/o diverticulitis, ?kidney stone on L ## CTU: Multidetector CT of the abdomen and pelvis were acquired prior to and after intravenous contrast administration with the patient in prone position. The non-contrast scan was done with low radiation dose technique. The contrast scan was performed with split bolus technique. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Spiral Acquisition 7.9 s, 51.1 cm; CTDIvol = 5.2 mGy (Body) DLP = 260.3 mGy-cm. 2) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 8.8 mGy (Body) DLP = 1.8 mGy-cm. 3) Stationary Acquisition 7.4 s, 0.2 cm; CTDIvol = 117.8 mGy (Body) DLP = 23.6 mGy-cm. 4) Spiral Acquisition 8.1 s, 52.6 cm; CTDIvol = 8.9 mGy (Body) DLP = 461.9 mGy-cm. 5) Spiral Acquisition 6.6 s, 42.7 cm; CTDIvol = 5.6 mGy (Body) DLP = 233.8 mGy-cm. Total DLP (Body) = 981 mGy-cm. ## LOWER CHEST: There are scattered millimetric peribronchovascular nodules, mild diffuse bronchial wall thickening, and small cysts throughout the bilateral lower lungs. There is no evidence of pleural or pericardial effusion. ## HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There are 8 enhancing lesions throughout the liver measuring up to 1.8 cm within the lateral segment of the left hepatic lobe (14:27). At least 7 of these lesions were seen on the prior MRI performed and were characterized as hemangiomas. A 3 mm enhancing lesion along the falciform ligament within segment II (11:39) was not apparent on the prior MRI but was likely present on the CT performed in and also likely represents an hemangioma. There is no evidence of intrahepatic biliary dilatation. The common bile duct is dilated up to 0.9 cm, decreased from the recent MRCP when it measured 1.2 cm, and similarly tapers to the ampulla. The gallbladder is surgically absent. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is mild peripancreatic stranding about the head and neck, which allowing for differences in modality, appears slightly decreased compared to the MRI performed . A peripancreatic fluid collection inferior to the pancreas along the anterior pararenal fascial plane (11:70, 14:31) is again seen, also slightly decreased in the axial plane measuring 4.8 x 0.9 cm (11:70), previously 5.9 x 1.1 cm. Few tiny peripancreatic fluid collections elsewhere measure up to 1.2 cm (11:54) and also appear slightly decreased. ## SPLEEN: The spleen shows normal size and attenuation throughout. Subcentimeter enhancing foci in the superior aspect of the spleen (11: 34 and 37) are unchanged, likely hemangiomas. ## ADRENALS: The bilateral adrenal glands are mildly thickened without focal nodularity, similar to prior. ## URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no nephrolithiasis or ureterolithiasis. There is no hydronephrosis. There is no perinephric abnormality. There is no evidence of solid renal lesions. There is no evidence of urothelial lesions. Apparent mild bladder wall thickening is likely due to underdistention and/or chronic urinary outflow obstruction in the setting of prostatomegaly. The distal ureters are unremarkable. ## GASTROINTESTINAL: Apparent circumferential thickening of the gastric wall in the region of the antrum (11:43) is likely due to peristalsis or reactive to pancreatic inflammation. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Mild diverticulosis of the sigmoid colon is noted, without evidence of wall thickening or fat stranding. The appendix is normal. ## PELVIS: There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: The prostate is enlarged. ## LYMPH NODES: Few prominent subcentimeter peripancreatic nodes do not meet CT size criteria for pathologic enlargement and are likely reactive. There is no mesenteric, pelvic, or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: The abdominal and pelvic wall is within normal limits. ## IMPRESSION: 1. Sequela of prior pancreatitis in the form of mild peripancreatic stranding and scattered peripancreatic fluid collections, which allowing for differences in modality, all appear decreased since the MRI performed . 2. Millimetric peribronchovascular nodules, diffuse bronchial wall thickening, and small cysts within the bilateral lower lungs. Constellation of findings are nonspecific and may be sequela of prior infection, although PCP should be excluded. 3. No new acute intra-abdominal pathology. No renal calculi or evidence of acute diverticulitis. 4. Persistent mild common bile duct dilatation which tapers to the ampulla. Review of the prior MRI suggests this is likely secondary to sphincter of Oddi dysfunction. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2148-02-01 10:41:00"}

Description: 19595754-RR-55Abstract: ## INDICATION: year old man with 3 months of left low back pain with radiation down lateral LLE // r/o lumbar DJD, disc rupture r/o lumbar DJD, disc rupture ## FINDINGS: Alignment is normal. Vertebral body heights are preserved. The conus terminates at L1 vertebral body level. Multilevel degenerative disc disease as evidenced by T2 hypointense signal with height loss involving L3-L4, L4-L5 and L5-S1 intervertebral disc is observed. Associated degenerative endplate marrow signal changes and endplate osteophytes, including type 1 signal changes on the right at L5-S1. ## L1-L2: Unremarkable. No spinal canal or neural foraminal narrowing. ## L2-L3: Unremarkable. No spinal canal or neural foraminal narrowing. ## L3-L4: Mild posterior disc bulge without significant spinal canal narrowing. There is minimal narrowing of the subarticular recess bilaterally, more so on the left than the right. No neural foraminal narrowing. ## L4-L5: Mild posterior disc bulge without central canal narrowing. There is minimal narrowing of the subarticular recess bilaterally resulting in crowding of the traversing L5 nerve root without contact. There is mild left and no right neural foraminal narrowing. ## L5-S1: Degenerative disc height loss as well as posterior disc protrusion without significant spinal canal narrowing. There is mild-to-moderate right and no significant left neural foraminal narrowing.. Disc protrusion narrows the right subarticular recess without contacting the exiting or traversing nerve roots. There is no evidence of infection or neoplasm. ## IMPRESSION: 1. Multilevel degenerative disc disease mostly involving L3-L4, L4-L5 and L5-S1. Findings are most pronounced at L4-L5 and L5-S1, with mild left and mild-to-moderate right neural foraminal narrowing at these levels respectively. ## PREVALENCE: Prevalence of lumbar degenerative disk disease in subjects without low back pain: Overall evidence of disk degeneration 91% (decreased T2 signal, height loss, bulge) T2 signal loss 83% Disk height loss 58% Disk protrusion 32% Annular fissure 38% Jarvik, et all. Spine 26(10):1158-1166 Lumbar spinal stenosis prevalence- present in approximately 20% of asymptomatic adults over years old , et al, Spine Journal 9 (7):545-550 These findings are so common in asymptomatic persons that they must be interpreted with caution and in context of the clinical situation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595754", "visit_id": "N/A", "time": "2148-04-05 16:22:00"}

Description: 19595757-RR-58Abstract: ## INDICATION: Patient with soft tissue mass in right supraclavicular fossa. Evaluate soft tissue mass. There are no prior studies for comparison. ## SOFT TISSUE ULTRASOUND: A targeted examination of the right supraclavicular fossa was performed, in the area of concern pointed out by the patient. The left supraclavicular fossa was examined for comparison purposes. In the area of clinical concern, a smoothly marginated solid hypoechoic soft tissue mass is identified, measuring approximately 5.0 x 1.8 x 4.2 cm. The mass is quite homogeneous throughout, except for a single ring-like calcification seen centrally with some shadowing, measuring about 5 mm. No cystic spaces are seen within the lesion. Vascularity is present within this structure, though not increased. The lesion is quite asymmetric with the left side. ## IMPRESSION: Soft tissue mass of the right supraclavicular fossa, solid and indeterminant, but not suggestive of a lipoma. Soft tissue neoplasm is favored, and infectious and inflammatory etiologies are considered unlikely. Further evaluation with MRI is recommended. Findings were relayed to the critical results dashboard for communication with the ordering physician. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595757", "visit_id": "N/A", "time": "2167-07-31 13:18:00"}

Description: 19595757-RR-59Abstract: MRI OF THE SOFT TISSUE OF THE NECK: ## HISTORY: Soft tissue mass in the right supraclavicular fossa, question neoplasm. Comparison is made with ultrasound from . There is a fat-containing 4.4 x 2.5 cm lesion in the right posterior cervical space which extends posteriorly to overlie the paraspinal musculature almost to the midline. There appears to be a prominent vessel in its mid portion. There is no nodular enhancement to suggest liposarcoma. There is no exophytic mucosal mass. There is no pathologic adenopathy by imaging criteria. There are multilevel degenerative changes in the cervical spine. No thyroid mass is seen. ## IMPRESSION: Findings most suggestive of a lipoma in the right posterior cervical space extending posteriorly into the subcutaneous tissue, almost to the midline. There is no solid nodular enhancement to suggest liposarcoma. On the recent ultrasound, there was note made of a hyperechoic density within this mass. This may represent a focus of calcification within a vessel, but would recommend correlation with CT of the neck for further evaluation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595757", "visit_id": "N/A", "time": "2167-08-04 13:43:00"}

Description: 19595757-RR-60Abstract: ## CT ABDOMEN: Imaged lung bases demonstrate decrease mild scaring and atelectasis in the medial right lung base. There is no new lung nodule, pleural effusion, or pneumothorax. There are coronary calcifications, unchanged since . There is no pericardial effusion. The liver enhances homogeneously without focal lesion. There is no intra or extra biliary dilatation. The gallbladder, spleen, pancreas and adrenal glands appear normal. The stomach, loops of small bowel appear normal. The kidneys are small in size, unchanged since . Otherwise, the kidneys enhance and excrete contrast symmetrically without stones, masses or hydronephrosis. There is diffuse calcified atherosclerosis throughout the aorta and its branches with small calcified plaques at the origin of the celiac and SMA without significant stenosis or aneurysm formation. There is no free air, free fluid or lymphadenopathy. ## PELVIS: The bladder and distal ureters are normal. Stable enlarged prostate measures 4.7 x 6 x 4.6 cm. There are few colonic diverticuli without diverticulitis. The rectum is normal. There is no inguinal or pelvic lymphadenopathy, or free fluid. There is no opacification from the superficial femoral up to the right iliac vein, which is concerning for deep vein thrombosis. ## BONES: Stable small sclerotic focus in a left rib. There are multilevel degenerative changes throughout the thoracolumbar spine without osseous lesion concerning for malignancy or infection. A new spine fusion hardware from L2-L5 appears intact. ## IMPRESSION: 1. No opacification of the superficial femoral vein up to the right iliac vein, which is highly concerning for deep vein thrombosis. 2. No renal/ureteric calculi. 3. Diverticulosis without diverticulitis. These findings were discussed by phone with Dr. on the time of reporting. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595757", "visit_id": "N/A", "time": "2168-10-15 15:37:00"}

Description: 19595757-RR-64Abstract: ## INDICATION: male with history of CHF, status post CABG, now with worsening dyspnea on exertion, here to evaluate for evidence of heart failure. ## FINDINGS: Frontal and lateral radiographs of the chest show persistent low inspiratory lung volumes with increased size of small bilateral pleural effusions from . Mild pulmonary edema bilaterally is improved from the preceding radiograph. The pulmonary vasculature is not engorged. No focal consolidation or pneumothorax is present. A tiny calcified nodule in the periphery of the left upper lobe is stable from . The patient is status post median sternotomy and CABG with preserved alignment. The cardiac silhouette is unchanged. The mediastinal and hilar contours are stable. No prominence of the azygos vein is seen. ## IMPRESSION: Findings consistent with chronic heart failure. No evidence of acute exacerbation. Findings were communicated by Dr. to Dr. by phone at 13:50 p.m. on . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19595757", "visit_id": "N/A", "time": "2170-08-08 13:07:00"}