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Description: 19592998-RR-92Abstract: ## EXAMINATION: MR KNEE W/O CONTRAST LEFT ## INDICATION: year old woman with pain, swelling in the upper medial tibia x 6 mos, xrays mild DJD, no relief from inj. // ?bony lesion/meniscal tear ## FINDINGS: There is a small joint effusion and a small amount of fluid in cyst. In the medial compartment, the meniscus is intact. Mild cartilage thinning and irregularity.No subchondral marrow edema is seen. In the lateral compartment, the meniscus is intact. Hyaline cartilage thinning and irregularity. No subchondral marrow edema is seen. In the patellofemoral compartment, there is moderately severe to severe cartilage loss along the lateral greater than medial patellar facets and along the median ridge. Along the lateral facet, subchondral cysts and edema are present. There is also probable moderate cartilage thinning/irregularity along the trochlea, with small subchondral cysts seen along the lateral edge of the lateral trochlea (5:9). . The anterior and posterior cruciate ligaments are intact. The medial collateral ligament is intact. The lateral collateral ligamentous complex is intact. Mild to moderate tendinosis in the proximal 15 mm of the patellar tendon. The quadriceps and patellar tendons are otherwise intact. Background marrow signal is within normal limits. There is edema in the subcutaneous fat anterior to the inferior patella and patellar tendon, a relatively common finding. Muscles about the knee joint are within normal limits. Incidental note is made of 2 popliteal fossa lymph nodes, not enlarged by short axis criteria. A 5.7 mm rounded high T2 focus with surrounding low signal seen anterior to the femorotibial joint midline near the insertion site of the ACL and anterior root of the lateral meniscus (6:13, 5:12). . Exact site of origin is uncertain, but the appearance appearance is compatible with a tiny ganglion cyst. ## IMPRESSION: Small joint effusion and small amount of fluid in a cyst. Tricompartmental osteoarthritis, most pronounced in the patellofemoral compartment, where it is moderately severe to severe changes are seen. No meniscal or ligament tear detected. Tiny ganglion cyst noted anterior to the femorotibial joint. Tendinosis of the proximal patellar tendon. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592998", "visit_id": "N/A", "time": "2169-07-08 08:12:00"}

Description: 19592998-RR-93Abstract: ## INDICATION: year old woman with chronic lower back pain worsening, with radiation to right thigh and calf// r/o disc herniation or spinal stenosis r/o disc herniation or spinal stenosis ## FINDINGS: Grade 1 anterolisthesis of L4 on L5 is unchanged to minimally increased. The lumbar spine is otherwise well aligned. Vertebral body signal intensities are normal, excepting mild inferior endplate degenerative changes at L3 and L4. Vertebral body heights are preserved. The spinal cord appears normal in caliber and configuration. Edema within the subcutaneous tissues overlying the lumbar spine is nonspecific. ## L1-L2: Moderate intervertebral disc desiccation. Intervertebral disc height is preserved. A small posterior disc bulge results in trace vertebral canal narrowing. No significant neural foraminal narrowing. ## L2-L3: Moderate intervertebral disc desiccation. Mild intervertebral disc height loss. Trace inferior endplate Schmorl node. A posterior disc bulge results in mild spinal canal narrowing. No significant neural foraminal narrowing. ## L3-L4: Moderate intervertebral disc desiccation. Mild intervertebral disc height loss. A posterior disc bulge and ligamentum flavum thickening results in mild to moderate spinal canal narrowing and moderate bilateral neural foraminal narrowing. Mild facet hypertrophy with a trace right facet effusion. ## L4-L5: Grade 1 anterolisthesis. Moderate intervertebral disc desiccation. Intervertebral disc height is preserved. A combination of anterolisthesis and posterior disc bulge results in moderate spinal canal narrowing and bilateral neural foraminal narrowing. Moderate facet hypertrophy with a small left facet effusion. ## L5-S1: Moderate intervertebral disc desiccation. Intervertebral disc height is preserved. A left lateralizing posterior disc bulge results in mild spinal canal narrowing and neural foraminal narrowing posteriorly displacing the S1 nerve root. Moderate facet hypertrophy with trace facet effusions. ## IMPRESSION: Mild-to-moderate multilevel lumbar spondylosis includes grade 1 anterolisthesis and moderate spinal canal and neural foraminal narrowing at L4-L5 in addition to a lateralizing posterior disc bulge at L5-S1 which posteriorly displaces the left S1 nerve root. Additional degenerative changes as described in the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19592998", "visit_id": "N/A", "time": "2169-11-07 06:27:00"}

Description: 19593028-RR-27Abstract: ## INDICATION: female with cervical motion tenderness. Please evaluate for tubo-ovarian abscess. ## LMP: . Transabdominal and transvaginal ultrasound was performed, the latter for better visualization of the endometrium and adnexa. The uterus is anteverted, anteflexed, without focal lesion detected within. The endometrium is normal in appearance measuring 6 mm. There is a small amount of physiologic free fluid. The ovaries are normal in size and appearance with normal follicular activity within. Normal arterial and venous waveforms are demonstrated to both ovaries. No adnexal masses are identified to suggest tubo-ovarian abscess. There is no hydronephrosis within the kidneys. The uterus measures 6.2 x 3.6 x 2.5 cm transabdominally. ## IMPRESSION: Normal pelvic ultrasound without ultrasound evidence of tubo- ovarian abscess. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593028", "visit_id": "29148464", "time": "2152-07-06 15:34:00"}

Description: 19593028-RR-28Abstract: ## STUDY: CT abdomen and pelvis with contrast and reconstructions. ## INDICATION: Severe abdominal pain, diarrhea, cervical motion tenderness. ## CT ABDOMEN WITH CONTRAST: The lung bases are clear without concerning nodule, opacity, or effusion. The visualized portion of the heart is unremarkable without pericardial effusion. No definite focal liver lesions are identified. The gallbladder, spleen, adrenal glands, stomach, pancreas, and visualized abdominal large and small bowel are unremarkable. The kidneys enhance symmetrically without focal lesions detected. The abdominal aorta is not focally dilated throughout its course. The celiac trunk, SMA, and are patent. No free fluid or free air is present within the abdomen. ## CT PELVIS WITH CONTRAST: The rectum, sigmoid colon, and uterus are unremarkable. The adnexal structures are grossly within normal limits, however, findings are better delineated on pelvic ultrasound from the same date. No tubular structures detected within the right lower quadrant to suggest acute appendicitis. The bladder is moderately distended with fluid without focal lesion detected within. ## OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesions are identified. ## IMPRESSION: No findings to explain patient's acute abdominal pain. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593028", "visit_id": "29148464", "time": "2152-07-06 17:15:00"}

Description: 19593028-RR-33Abstract: ## INDICATION: Intermittent lower abdominal pain, question of ovarian cyst or torsion. ## FINDINGS: Transabdominal and transvaginal examinations were performed. Transvaginal examination was performed for better visualization of the endometrium and adnexa. The uterus is normal and measures 6.8 x 2.7 x 3.9 cm. The endometrium is normal and measures 7 mm in thickness. The right ovary measures 2.5 x 3.4 x 3.5 cm. There is a simple cyst in the right ovary measuring 2.5 x 2.2 x 1.9 cm. There is normal flow in the right ovary. The left ovary measures 2.5 x 1.5 x 1.6 cm and is unremarkable and there is normal vascular flow. ## IMPRESSION: Normal study. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593028", "visit_id": "N/A", "time": "2156-06-12 21:34:00"}

Description: 19593111-RR-4Abstract: ## EXAMINATION: CHEST (PA AND LAT) ## INDICATION: with dyspnea, hypoxia, edema// >? edema effusion or infiltrate ## FINDINGS: AP upright and lateral views of the chest provided. The patient is somewhat rotated. There are small to moderate bilateral pleural effusions and associated atelectasis. There is no pneumothorax. There is suggestion of cardiomegaly. The mediastinum is not widened. There is pulmonary vasculature congestion without overt pulmonary edema. ## IMPRESSION: 1. Small to moderate bilateral pleural effusions and pulmonary vascular congestion with suggestion of cardiomegaly. Superimposed infection would be difficult to exclude in the appropriate clinical scenario. 2. No pulmonary edema. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593111", "visit_id": "26249497", "time": "2166-04-07 15:39:00"}

Description: 19593111-RR-6Abstract: ## INDICATION: yo F w/ CKD and high functional status at baseline coming in with worsening fatigue found to have leukocytosis, severe anemia, pleural effusions and abdominal distension. No PNA or UTI with unexplained WBC and anemia concerning for colitis or diverticulitis.Patient Cr at baseline.// Evaluation for abdominal process colitis vs diverticulitis ## DOSE: Acquisition sequence: 1) Spiral Acquisition 3.8 s, 49.7 cm; CTDIvol = 24.1 mGy (Body) DLP = 1,196.7 mGy-cm. Total DLP (Body) = 1,197 mGy-cm. ## LOWER CHEST: Moderate bilateral right greater than left pleural effusion with bibasilar compressive atelectasis. Small pericardial effusion. ## HEPATOBILIARY: Unremarkable liver within the limitations of this nonenhanced scan. Surgically absent gallbladder. No biliary dilatation. The well-defined rounded hypodensities adjacent to the posterior inferior margin of the liver (02:27) likely represent dropped gallstones or cholecystectomy clips. ## URINARY: Bilateral atrophic kidneys. Within the left upper pole is an intermediate density cystic lesion measuring 4.0 x 4.3 x 3.3 cm demonstrating layering hyperdense material, compatible with a cyst with proteinaceous contents. There are no other masses or suspicious renal lesions visualized within the limitations of this unenhanced scan. No hydronephrosis. ## GASTROINTESTINAL: Extensive sigmoid and descending colonic diverticulosis without evidence of acute diverticulitis. Nonvisualized appendix without secondary CT signs of acute appendicitis. No bowel obstruction, no free air, no ascites. ## PELVIS: Unremarkable bladder and distal ureters. No pelvic free fluid ## REPRODUCTIVE ORGANS: Unremarkable uterus. No abnormal adnexal masses. ## LYMPH NODES: No abdominal or pelvic adenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Moderate to severe atherosclerotic disease is noted. ## BONES: Severe left greater than right bilateral hip joint osteoarthritis is noted. The left femoral head is dysmorphic and subluxed posteriorly relative to the acetabulum (601:37). The bones are osteopenic however there are no acute displaced fractures. There is severe dextroscoliosis of the lower thoracic and lumbar spine with multilevel degenerative disc disease demonstrating severe L4-L5 disc space narrowing. ## SOFT TISSUES: Small fat containing ventral hernia. ## IMPRESSION: 1. Lobulated 2.2 x 1.4 x 3.2 cm soft tissue mass (2:6, 602:79) within the left upper breast concerning for primary breast malignancy. 2. Moderate bilateral right greater than left pleural effusion with compressive atelectasis. 3. Small pericardial effusion. ## RECOMMENDATION(S): Mammogram left breast mammogram. ## NOTIFICATION: The findings were discussed with , M.D. by , M.D. on the telephone on at 1:44 pm, 1 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593111", "visit_id": "26249497", "time": "2166-04-10 12:08:00"}

Description: 19593222-RR-10Abstract: COMPUTED TOMOGRAPHY OF THE THORAX ## INDICATION: Loculated right pleural effusion, status post thoracocentesis, evaluating underlying cause of effusions. ## FINDINGS: There is no comparison available. No incidental thyroid findings. No supraclavicular, infraclavicular, or axillary lymphadenopathy. No mediastinal lymphadenopathy. All visible mediastinal lymph nodes, notably in the precarinal area, are of normal size and morphology. There are no substantial coronary calcifications. Minimal enlargement of the right heart, minimal pleural effusion in an otherwise normal-appearing heart. On the right, a large pleural effusion, occupying approximately half of the right hemithorax, is seen. Part of the effusion is in intrafissural location. The lung parenchyma at the right lung base shows signs of atelectatic compression. In addition, however, a low-density attenuation zone is seen at the base of the right lung (2, 47). This area might represent active infection. Several borderline-sized pericardial and subpleural lymph nodes are seen in the anterior parts of the right lower hemithorax (2, 55). The pleural surfaces on the right are even, there is no indication for increased contrast uptake on the right. Mild bilateral apical thickening. Minimal airway wall irregularities and airway wall thickening. Large parenchymal scar in the middle lobe, with partial collapse of the middle lobe and a punctate calcification (4, 165). The central parts of the local regional airways are patent. Several noncharacteristic subpleural nodules are seen in both lungs. Noncharacteristic ground-glass opacities close to the compression atelectasis on the right. There is no pneumothorax. Large right renal cysts. No other relevant findings in the upper abdomen. No evidence of osteodestructive lesions. ## IMPRESSION: 1. Extensive right pleural effusion with subsequent areas of compression atelectasis. 2. Additional lung parenchymal right basal zones of decreased contrast uptake and slightly inhomogeneous appearance, suggesting the presence of active pneumonia. 2. Subtotal middle lobe collapse, likely caused by scarring, with mild local bronchiectasis and parenchymal calcification. 3. Small pericardial effusion, minimal enlargement of the right heart. 4. Several nonspecific millimetric subpleural granulomas and noncharacteristic scarring at the bases of the lingula. 5. Given the combination of findings, the effusion on the right is most likely caused by a right basal pneumonia. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593222", "visit_id": "N/A", "time": "2142-03-24 10:17:00"}

Description: 19593222-RR-16Abstract: AP CHEST 5:51 P.M., ## HISTORY: Shortness of breath and night sweats. Evaluate right pleural effusion after drainage. New air leak. ## AP CHEST COMPARED TO : Volume of air in the pleural space at the base of the right lung has increased, while a small residual right pleural effusion is stable, basal pleural tube unchanged in position. There is no apical pneumothorax. Subcutaneous emphysema in the right chest wall has increased slightly, while subcutaneous emphysema in the right neck has been present since . Small left pleural effusion unchanged. Right basal atelectasis moderately severe, stable. Heart size normal. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593222", "visit_id": "20187390", "time": "2142-03-30 17:53:00"}

Description: 19593222-RR-18Abstract: ## INDICATION: Evaluation of patient with history of shortness of breath status post paracentesis of right pleural effusion for interval change. ## CT WITH IV CONTRAST: A horizontally oriented pleural tube enters the right lateral chest and traverses along the base of the lung nearly to the spine. The lumen of the pleural tube is clear. The airways are patent to the subsegmental levels. The volume of air in a small right basilar hydropneumothorax is smaller than on chest radiographs from the same day at 17:51. A tiny loculated right lateral pleural effusion is 4.8 x 1.1 cm (2:46). Significant thickening of the parietal and visceral pleura along the right lower lobe may be responsible for partial collapse of the medial basal segment of the right lower lobe and the persistent pleural space. An 11 x 6 mm oval gas collection could be pleural, trapped in the fissure (3:44-47) or, less likely, a small pulmonary laceration. New peribronchial ground-glass and bronchiolar nodulation in the lingula and anterior segment of the left upper lobe are likely infection. Mild biapical pleural thickening is scarring. Partial collapse of the middle lobe including a punctate calcification is again noted (2:42). Multiple mediastinal lymph nodes, not meeting CT size criteria for pathologic enlargement, range in size up to 9mm in the subcarinal station, unchanged since . There is no hilar or axillary lymphadenopathy. The heart is normal size without pericardial effusion. The aorta is normal in caliber and contour. Subcutaneous emphysema from the right flank to the level of the thoracic inlet is comparable to that on the chest radiograph from . There are no bone lesions suspicious for malignancy or infection. This study is not tailored for evaluation of subdiaphragmatic structures but shows an irregularly shaped, 3.7 x 2.1 cm, hypodense (20 contiguous with or arising in the upper pole of the right kidney(2:62). Otherwise, the left kidney, liver, and stomach appear normal. ## IMPRESSION: 1. Small, loculated, right basilar hydropneumothorax, paraspinal pleural tube in place, decreased since earlier in the day. Very small loculated right lateral pleural effusion, between thickened leaves of pleura. 2. Small right pulmonary laceration or fissural pleural air collection. 3. New bronchopneumonia, left lung could be spillover pneumonitis if there is a right pleuro-pulmonary fistula. 4. Subtotal right middle lobe and segmental atelectasis, right lower lobe, could be due to pleural restriction. No bronchial obstruction. 5. Subcutaneous emphysema, right thoracoabdominal wall and neck, persitent since initiation of pleural drainage. 6. Right upper pole renal cystic lesion, warrants ultrasound characterization. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593222", "visit_id": "20187390", "time": "2142-03-30 19:25:00"}

Description: 19593222-RR-19Abstract: PRE-OP PA AND LATERAL CHEST ## HISTORY: Interval change following thoracentesis and pleural drainage. ## IMPRESSION: PA and lateral chest compared to , and chest CT scan also on : Persistent pleural space at the base of the right lung is unchanged in overall volume, now containing more fluid. Some of the apparent right pleural effusion may instead be elevated right hemidiaphragm. There is no pneumothorax. Subcutaneous emphysema in the right chest wall and right neck is unchanged. Right basal pleural tube unchanged in position. Questioned bronchopneumonia on the report of yesterday's chest CT scan may have improved. In any case it has not worsened. Severe right lower lobe atelectasis is unchanged. Cardiomediastinal and hilar silhouettes are normal. Small left pleural effusion unchanged. Heart size normal. Dr. and I discussed these findings by telephone at the time of dictation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593222", "visit_id": "20187390", "time": "2142-03-31 08:39:00"}

Description: 19593222-RR-20Abstract: ## FINDINGS: Two new right chest tubes have been placed both of them ending near the right lung apex. There is no evidence of pneumothorax. Subcutaneous emphysema along the right lateral chest wall and right supraclavicular regions are persisting, however, minimally decreased. Small right-sided pleural effusion and right lower lung atelectasis is unchanged. Small linear band-like opacity in the left mid lung suggestive of atelectasis is new. Top normal heart size, mediastinal and hilar contours are unchanged. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593222", "visit_id": "20187390", "time": "2142-03-31 16:22:00"}

Description: 19593222-RR-22Abstract: ## TYPE OF EXAMINATION: Chest AP portable single view. ## INDICATION: male patient with progressive shortness of breath and dyspnea on exertion for six weeks, Levaquin for pneumonia, right pleural effusion status post thoracocentesis on , now with persistent effusions likely emphysema. Status post VATS decortication. Evaluate for interval change. ## FINDINGS: AP single view of the chest has been obtained and is analyzed in direct comparison with the next preceding similar study of . The previously described two right-sided chest tubes placed following decortication procedure remain in unchanged position and the findings are unchanged. No pneumothorax has developed. The local small amount of chest wall emphysema remains. No new abnormalities are seen. The on previous examination identified plate atelectasis in the mid left lung field has disappeared and only a peripheral small plate atelectasis remains. No new abnormalities are seen. ## IMPRESSION: Disappearance of left-sided plate atelectasis, otherwise no significant interval change observed during the latest 20 hours examination interval. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593222", "visit_id": "20187390", "time": "2142-04-01 12:07:00"}

Description: 19593271-RR-21Abstract: ## INDICATION: female found down and unresponsive. Subsequently, transferred from outside hospital with intracranial hemorrhage. Evaluate for progression of bleed. ## FINDINGS: There is a lobulated convex and partially crescentic hyperdense extra-axial collection overlying the left parietal convexity consistent with acute hemorrhage. The collection measures 8 mm in greatest dimension which is not significantly changed from the prior. No new intracranial hemorrhage is identified. There is a large region of relative hypodensity within the right cerebral cortex involving the MCA and PCA territories concerning for acute infarct. In addition, there is relative effacement of the sulci and loss of the gray-white matter differentiation consistent with edema. There is mild mass effect on the right lateral ventricle. There is no shift of the normally midline structures or effacement of the basilar cisterns. There is a 6-mm round hypodensity in the left cerebellar cortex, which may represent an old infarct. There is near complete opacification and inspissated secretions in the bilateral maxillary, ethmoid and sphenoid sinuses. Frontal sinuses also demonstrate mucosal thickening. Bilateral mastoid air cells are well aerated. No osseous abnormality is identified. ## IMPRESSION: 1. No significant change in the extra-axial hemorrhage overlying the left parietal lobe. 2. Increased conspicuity of the relative hypodensity in the right MCA and PCA territories concerning for acute infarct with associated cerebral edema. Mild effacement of the right lateral ventricle. Otherwise, no significant mass effect. 3. Extensive bilateral paranasal sinus disease. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593271", "visit_id": "26123548", "time": "2129-08-03 01:47:00"}

Description: 19593271-RR-22Abstract: ## INDICATION: Left subdural hemorrhage, followup evaluation along with right-sided hypodense appearance. ## FINDINGS: There is diffuse hypodense appearance of the right cerebral hemisphere, including the cortex, white matter, the right-sided basal ganglia and part of the right thalamus, with a hypodense appearance extending across the corpus callosum on to the left frontal lobe. Possibilities include edema from an extensive acute infarct/hypoxic/anoxic injury. There is effacement of the sulci, with an evidence of cerebral edema. Slightly dense appearance of some of the cerebral sulci may relate to edema/associated subtle subarachnoid hemorrhage. Ther eis loss of gray-white matter differentiation. The left-sided extra-axial hemorrhage noted in the parietal region is grossly unchanged and is a transverse dimension of 1.0 cm. Prominent bifrontal extra-axial CSF spaces are noted, which may relate to mild volume loss and unchanged. Small hypodense focus noted in the left cerebellar hemisphere is again unchanged. Bilateral moderate-to-marked maxillary sinus mucosal thickening is noted along with secretions in the nasopharynx clinical noncomplete opacification of the ethmoid air cells and the sphenoid sinus, and part of the frontal sinus. Right occipital subgaleal hematoma and soft tissue swelling are again visualized. Small osteoma in the left frontal region from the inner table measuring 0.8 cm, is unchanged. A thin linear lucency noted in the right occipital bone, paramedian in location, can represent a vascular groove ( se 102/im 16) vs a thin, non-displaced fracture. ## IMPRESSION: 1. Extensive area of hypodensity involving the right cerebral hemisphere, involving the cortex, white matter and right basal ganglia, and genu of the corpus callosum, crossing across the midline to the left side involving the left frontal lobe. The possibilities include edema with extensive acute infarction/hypoxic/anoxic injury. To correlate clinically and consider CT angiogram, when the renal parameters are appropriate. MR studies are precluded given the presence of a pacemaker. Radionuclide studies can also be considered to assess for cerebral perfusion. D/w by on . 2. Unchanged appearance of the left parieto-occipital subdural hemorrhage. Questionable thin fracture/vascular groove in the right occipital bone. 3. Extensive pan paranasal sinus disease as described above, unchanged. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593271", "visit_id": "26123548", "time": "2129-08-03 09:16:00"}

Description: 19593271-RR-26Abstract: ## INDICATION: woman with right-sided stroke. ## RADIOLOGISTS: The exam was read by Dr. . ## IMPRESSION: There is no diastolic flow within the right ICA and CCA suggestive of distal right ICA occlusion. There is less than 40% stenosis within the left internal carotid artery. Findings were communicated to Dr. . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593271", "visit_id": "26123548", "time": "2129-08-03 12:45:00"}

Description: 19593338-RR-29Abstract: ## : Cardiology Staff: , MD ## GENDER: Male Radiology Staff: , MD ## STATUS: Outpatient Nursing Support: , RN ## WEIGHT (LBS): 247 Injection Site: right antecubital vein ## RHYTHM: Sinus rhythm Creatinine (mg/dl): 0.82 ## INDICATION: Heart failure. Assess for scar and activation pattern given LBBB on ECG. ## CMR MEASUREMENTS: Measurement Normal Range Left Ventricle LV End-Diastolic Dimension (mm) **76 <62 LV End-Diastolic Dimension Index (mm/m2) *33 <32 LV End-Systolic Dimension (mm) 66 LV End-Diastolic Volume (ml) ***292 <196 LV End-Diastolic Volume Index (ml/m2) **126 <95 LV End-Systolic Volume (ml) 178 LV Stroke Volume (ml) 114 LV Stroke Volume Index (ml/m2) 49 LV Ejection Fraction (%) **39 >=54 LV Mass (g) 135 LV Mass Index (g/m2) 58 <80 Basal wall thickness (mm) 8 <12 Basal infero-lateral wall thickness (mm) 3 <11 Basal wall motion Akinetic Basal infero-lateral wall motion Akinetic Mid infero-lateral wall motion Akinetic Mid inferior wall motion Akinetic Basal late gadolinium enhancement 76-100% (ischemic type) Basal infero-lateral late gadolinium enhancement 76-100% (ischemic type) Mid infero-lateral late gadolinium enhancement 76-100% (ischemic type) Mid inferior late gadolinium enhancement 76-100% (ischemic type) Q-Flow Aortic Net Forward Stroke Volume (ml) 101 Q-Flow Aortic Total Stroke Volume (ml) 104 Q-Flow Aortic Cardiac Output (l/min) 8.6 Q-Flow Aortic Cardiac Index (l/min/m2) 3.7 LV Effective Forward Ejection Fraction (%) **36 >=54 Right Ventricle RV End-Diastolic Volume (ml) 160 RV End-Diastolic Volume Index (ml/m2) 69 58-114 RV End-Systolic Volume (ml) 61 RV Stroke Volume (ml) 99 RV Stroke Volume Index (ml/m2) 43 RV Ejection Fraction (%) 62 >=46 Q-Flow Pulmonary Net Forward Stroke Volume (ml) 99 Q-Flow Pulmonary Total Stroke Volume (ml) 99 Qp/Qs 0.98 0.8-1.2 Atria Left Atrial Dimension (Axial) (mm) *45 <40 Left Atrial Length (4-Chamber) (mm) **61 <52 Left Atrial Length (2-Chamber) (mm) 60 Right Atrial Dimension (4-Chamber) (mm) *50 <50 Coronary Sinus Diameter (mm) 6 <15 Great Vessels Ascending Aorta Diameter (mm) 35 <39 Ascending Aorta Diameter Index (mm/m2) 15 <20 Transverse Aorta Diameter (mm) 28 Transverse Aorta Diameter Index (mm/m2) 12 Descending Aorta Diameter (mm) 25 <28 Descending Aorta Index (mm/m2) 11 <14 Abdominal Aorta Diameter (mm) 27 Abdominal Aorta Diameter Index (mm/m2) 12 Main Pulmonary Artery Diameter (mm) 23 <29 Main Pulmonary Artery Diameter Index (mm/m2) 10 <15 Coronary Artery Origins Normal Valves Aortic Valve Morphology Trileaflet Aortic Valve Regurgitation (Visual) Present Aortic Valve Regurgitant Volume (ml) 3 Aortic Valve Regurgitant Fraction (%) 3 <5 Mitral Valve Regurgitation (Visual) Present Mitral Valve Regurgitant Volume (ml) 10 Mitral Valve Regurgitant Fraction (%) *9 <5 Pulmonary Valve Regurgitant Volume (ml) 0 Pulmonary Valve Regurgitant Fraction (%) 0 <5 Tricuspid Valve Regurgitation (Visual) Present Tricuspid Valve Regurgitant Volume (ml) 0 Tricuspid Valve Regurgitant Fraction (%) 0 <5 Pericardium Pericardial Effusion None present * Mildly abnormal | ** Moderately abnormal | *** Severely abnormal ## STRUCTURE " T1-WEIGHTED (BLACK BLOOD): Dual-inversion T1-weighted fast spin echo images were acquired in 5-mm contiguous axial slices to evaluate cardiac and vascular anatomy. " T2-Weighted: T2-weighted fast spin echo images were acquired to evaluate edema/inflammation. ## FUNCTION " CINE SSFP: Breath-hold SSFP cine images were acquired in 8-mm slices in the 4-chamber, 3-chamber, 2-chamber, and short axis orientations. " Cine SSFP (Additional Aortic Valve Views): A short-axis series was acquired at the level of the aortic valve. ## FLOW " AORTIC VALVE FLOW: Phase-contrast cine images were acquired transverse to the proximal ascending aorta to quantify through-plane flow. " Pulmonary Valve Flow: Phase-contrast cine images were acquired transverse to the main pulmonary artery to quantify through-plane flow. ## VIABILITY " LGE (3D PSIR): Late gadolinium enhancement (LGE) images were acquired using a navigator-gated 3D phase sensitive inversion-recovery (PSIR) sequence with spectral fat saturation pre-pulses 15 minutes after injection of a total of 0.1 mmol/kg (22 mL) Gd-BOPTA (Multihance). ## LEFT VENTRICLE " LV CAVITY SIZE: Moderately increased " LV ejection fraction: Moderately depressed " LV mass: Normal " Basal wall motion: Akinetic " Basal infero-lateral wall motion: Akinetic " Mid infero-lateral wall motion: Akinetic " Mid inferior wall motion: Akinetic " Basal late gadolinium enhancement: 76-100% (ischemic type) " Basal infero-lateral late gadolinium enhancement: 76-100% (ischemic type) " Mid infero-lateral late gadolinium enhancement: 76-100% (ischemic type) " Mid inferior late gadolinium enhancement: 76-100% (ischemic type) ## RIGHT VENTRICLE " RV CAVITY SIZE: Normal " RV ejection fraction: Normal " Intra-cardiac shunt: None present ## ATRIA " LA SIZE: Moderately enlarged " RA size: Mildly enlarged ## GREAT VESSELS " ASCENDING AORTIC DIAMETER: Normal " Main pulmonary artery diameter: Normal ## VALVES " AORTIC VALVE MORPHOLOGY: Trileaflet " Aortic regurgitation jet: Present " Mitral regurgitation jet: Present " Mitral regurgitation: Mild " Tricuspid regurgitation jet: Present ## ADDITIONAL INFORMATION/FINDINGS: None. ## NON-CARDIAC FINDINGS: No additional findings. ## IMPRESSION: Moderately elongated left atrium. Mildly elongated right atrium. Normal left ventricular wall thickness and mass. Moderately increased left ventricular cavity size. There is moderate regional systolic dysfunction with akinesis and thinning of the basal-to-mid inferior and inferolateral walls. There is corresponding transmural late gadolinium enhancement in these areas, consistent with scar. There is also septal dyssynergy consistent with known left bundle branch block. The remaining segments contract well. Overall left ventricular ejection fraction is moderately depressed. Normal right ventricular cavity size and systolic function. Normal ascending aorta, descending aorta and main pulmonary artery sizes. No aortic regurgitation. Mild mitral regurgitation. No pericardial effusion. ## IMPRESSION: Moderately increased left ventricular cavity size with regional systolic dysfunction most consistent with CAD pattern. Mild mitral regurgitation. Though the left ventricular dysfunction and late gadolinium enhancement pattern is consistent with CAD, this does not explain the left ventricular cavity dilation and suggests a combined ischemic and non-ischemic cardiomyopathy. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593338", "visit_id": "N/A", "time": "2180-02-02 09:55:00"}

Description: 19593338-RR-40Abstract: ## INDICATION: year old man s/p BiV lead revision via L thoracotomy, chest tube rem . // Please repeat CXR at 1700 (tiny PTX seen on AM xray) assess for enlargement or change ## FINDINGS: Lung volumes remain low. The tiny left apical pneumothorax is no longer visualized and may have resolved. Bibasilar atelectasis is overall unchanged. No large pleural effusion, focal consolidation, or pulmonary edema. A left dual lead cardiac pacer device is unchanged. Subcutaneous emphysema is mild in the left chest wall, unchanged. ## IMPRESSION: No pneumothorax. The tiny left apical pneumothorax is no longer visualized, likely resolved in the interim. Otherwise, no significant interval change. ## NOTIFICATION: The findings were discussed with , N.P. by , M.D. on the telephone on at 6:20 , 1 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593338", "visit_id": "29953580", "time": "2181-12-18 17:11:00"}

Description: 19593353-RR-14Abstract: ## HISTORY: Postmenopausal, history of fracture, calcium with vitamin D. ## FINDINGS: In the lumbar spine, BMD was measured from L1 through L4 as 1.047 g/cm2. This corresponds to a T-score of -1.1 and a Z-score of 0.4. In the proximal femurs, BMD was measured as 0.854 g/cm2 on the right and 0.862 g/cm2 on the left. The mean BMD corresponds to a T-score of -1.3 and a Z- score of 0.1. ## IMPRESSION: BMD corresponds to the World Health Organization definition of osteopenia based on measurements in the lumbar spine and proximal femurs. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593353", "visit_id": "N/A", "time": "2132-12-02 15:29:00"}

Description: 19593353-RR-16Abstract: ## INDICATION: woman with severe abdominal pain, nausea and vomiting with right lower quadrant and upper quadrant tenderness on examination, rule out appendicitis and colitis. ## OSSEOUS STRUCTURES: Moderate degenerative disease in the vertebral column with facet arthropathy significantly at the L5-S1 level is evident. No suspicious lytic or sclerotic osseous lesions are noted. ## IMPRESSION: 1. No evidence of diverticulitis, colitis or appendicitis. 2. Approximately 2.5 cm endometrial mass. Differential diagnosis includes endometrial polyp, submucosal fibroid, endometrial hyperplasia or neoplasia. Further characterization with a dedicated pelvic ultrasound or sonohysterography is recommended. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593353", "visit_id": "N/A", "time": "2133-12-01 07:36:00"}

Description: 19593416-RR-14Abstract: ## INDICATION: woman with pleuritic chest pain and lower extremity swelling, evaluate for pulmonary embolism. ## FINDINGS: The lung parenchyma is clear. There is no consolidation, pleural effusion, or evidence of pneumothorax. There is no hilar, mediastinal, or axillary lymphadenopathy seen. The heart and pericardium are unremarkable. The great vessels are normal in caliber. There is no evidence of aortic dissection. The pulmonary arteries do not demonstrate central filling defects. The airways are patent to the subsegmental level. Esophagus appears unremarkable. ## IMPRESSION: 1. Slightly limited views of the distal pulmonary arterial branches. No evidence of central pulmonary embolus. 2. Fatty liver. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593416", "visit_id": "25208155", "time": "2166-05-21 14:40:00"}

Description: 19593443-RR-102Abstract: ## EXAMINATION: MRI ORBITS AND BRAIN WANDW/O CONTRAST T714 MR ## INDICATION: year old man with IDDM, EtOH/HCV cirrhosis s/p liver transplant on immunosuppression, and tonsillar tumor p/w bilateral CN III palsy.// assess for lesions of orbit, CNIII, cavernous sinus and brainstem contributing to b/l CN III palsy. pt with ESRD and will have dialysis after receiving contrast. ## MRI BRAIN: There is area of asymmetric enhancement involving right cavernous sinus, encircling carotid artery, slightly bowing into the sella, measuring 1 cm x 1 cm by 0.5 cm. No definite associated restricted diffusion. Subtle enhancement extends into the very proximal superior orbital fissure. Differential considerations include lymphoma, meningioma, inflammatory process including sarcoid, inflammatory pseudotumor. Metastasis is less likely. Infection is unlikely. Underlying clivus is normal, normal adjacent sphenoid sinus, without opacification. No enhancement of the skullbase foramina, pterygopalatine fossa to suggest perineural tumor. No definite abnormality left cavernous sinus. There is no evidence of hemorrhage, edema,parenchymal masses,mass effect,midline shift or infarction. The ventricles and sulci are mildly prominent in caliber, likely reflecting involutional changes. Periventricular and subcortical white matter FLAIR hyperintensities are likely due to moderate chronic small vessel disease. Degenerative changes in the cervical spine with probably moderate central canal narrowing C3-C4 level, suggestion of central disc protrusion. ## MRI ORBITS: The bony orbits and preseptal soft tissues are normal. The globes are intact and normal in appearance. The optic nerves and complex are normal, without edema or abnormal enhancement. The extraocular muscles are uniform in size and normal in signal. The lacrimal apparatus is normal. Retrobulbar soft tissues are normal. ## IMPRESSION: 1. Asymmetric enhancing soft tissue right cavernous sinus, in the region of the expected course of the third cranial nerve, consider lymphoma, meningioma, inflammatory process including sarcoid, inflammatory pseudotumor, metastasis. 2. Moderate chronic small vessel ischemic changes. 3. Probably moderate central canal narrowing C3-C4 level, suggestion of central disc protrusion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "20919046", "time": "2144-08-06 08:46:00"}

Description: 19593443-RR-103Abstract: ## EXAMINATION: LUMBAR PUNCTURE (W/ FLUORO) N8 RF SPINE ## INDICATION: year old man with polycranial neuropathy, with MRI findings concerning for right cavernous sinus inflammation vs. infection vs. tumor// unsuccessful bedside LP, requesting guidance ## FINDINGS: 22 mls of CSF were collected in 5 tubes. ## IMPRESSION: 1. Lumbar puncture at L4-5 without complication. I, Dr. supervised the trainee during the key components of the above procedure and I reviewed and agree with the trainee's findings and dictation. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "20919046", "time": "2144-08-07 11:44:00"}

Description: 19593443-RR-104Abstract: ## EXAMINATION: CT ABDOMEN AND PELVIS WITHOUT CONTRAST ## INDICATION: year old man with h/o HCV cirrhosis s/p transplant c/b ESRD, hx of tonsillar CA undergoing workup for R cavernous sinus soft tissue mass concerning for malignancy.// Evaluate for mass lesion c/w primary malignancy. ## DOSE: Acquisition sequence: 1) Spiral Acquisition 5.7 s, 75.2 cm; CTDIvol = 7.2 mGy (Body) DLP = 540.2 mGy-cm. Total DLP (Body) = 540 mGy-cm. ## LOWER CHEST: Please refer to the separately dictated report of same day CT chest ## HEPATOBILIARY: Evidence of prior orthotopic liver transplant. No discrete focal lesions seen within the limitations of an unenhanced scan. There is intrahepatic or extrahepatic biliary dilatation. There is evidence of pneumobilia in the left hepatic duct indicating patency of the hepaticoenteric anastomosis. The gallbladder is surgically absent. ## PANCREAS: Unenhanced appearance of the pancreas is grossly unremarkable. ## SPLEEN: The spleen is borderline enlarged measures 13 cm in the AP dimension.. ## ADRENALS: Unenhanced appearance is grossly unremarkable. ## URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. ## GASTROINTESTINAL: The stomach is unremarkable. The small and large bowel loops are normal in caliber. Evidence of colonic diverticulosis without evidence of acute diverticulitis. The appendix is normal. ## PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. Degenerative disc disease at L3-4. ## SOFT TISSUES: The abdominal and pelvic wall is within normal limits. Multiple radiopaque densities seen underneath the anterior abdominal wall above the pubic symphysis may represent prior abdominal wall repair. ## LOWER CHEST: Please refer to the separately dictated report of same day CT chest. ## IMPRESSION: Within limits of an unenhanced CT, no evidence of a mass lesion or lymphadenopathy in the abdomen or pelvis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "20919046", "time": "2144-08-08 11:53:00"}

Description: 19593443-RR-105Abstract: ## EXAMINATION: CT NECK W/O CONTRAST (EG: PAROTIDS) Q21 CT NECK ## INDICATION: year old man with h/o HCV cirrhosis s/p transplant c/b ESRD, hx of tonsillar CA undergoing workup for R cavernous sinus soft tissue mass concerning for malignancy.// Evalute for mass lesion c/w primary malignancy ## DOSE: Acquisition sequence: 1) Spiral Acquisition 3.6 s, 28.5 cm; CTDIvol = 5.9 mGy (Body) DLP = 166.3 mGy-cm. Total DLP (Body) = 166 mGy-cm. ## FINDINGS: Left palatine tonsil does not appear enlarged, is more prominent compared to right, likely related to prior right tonsillectomy, correlate with clinical history or direct visualization. Otherwise, evaluation of the aerodigestive tract demonstrates no abnormalities. Few punctate calcifications within left send fibular gland, which appears atrophic. Salivary glands are otherwise normal.. Thyroid is unremarkable. There is no lymphadenopathy by CT criteria. There are atherosclerotic calcifications at the bilateral carotid bulbs. There are multilevel degenerative changes in the cervical spine including mild anterolisthesis of C3 on C4. There are no suspicious osseous lesions. Contrast is seen within the distal esophagus related to CT abdomen pelvis performed on same day, consider gastroesophageal reflux. Please refer to separate report of CT chest performed on the same day for description of the thoracic findings. ## IMPRESSION: 1. Asymmetric appearance of palatine tonsils, likely related to prior right tonsillectomy, correlate with surgical history or direct visualization.. 2. No adenopathy.. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "20919046", "time": "2144-08-08 11:54:00"}

Description: 19593443-RR-106Abstract: ## EXAMINATION: CT CHEST WITHOUT CONTRAST ## INDICATION: man with history of HCV cirrhosis, status post transplant complicated by ESRD. History of tonsillar cancer undergoing workup for right cavernous sinus soft tissue mass concerning for malignancy. Evaluate for mass lesion consistent with primary malignancy. ## HEART AND VASCULATURE: Calcific atherosclerotic changes involving the coronary vessels and the thoracic aorta. Unenhanced appearance of the heart and pericardium is within normal limits. No pericardial effusion is seen. ## AXILLA, HILA, AND MEDIASTINUM: No axillary or mediastinal lymphadenopathy is present. No mediastinal mass or hematoma. ## PLEURAL SPACES: No pleural effusion or pneumothorax. ## LUNGS/AIRWAYS: Minimal subsegmental atelectasis anteriorly within the right upper lobe, otherwise the lungs are clear without masses or areas of parenchymal opacification. 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 significant abnormality. ## ABDOMEN: Included portion of the unenhanced upper abdomen is unremarkable. ## BONES: No suspicious osseous abnormality is seen.? There is no acute fracture. Radiopaque anchors seen within the right humeral head are indicative of prior rotator cuff repair. ## IMPRESSION: No evidence of primary malignancy within the thorax. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "20919046", "time": "2144-08-08 12:04:00"}

Description: 19593443-RR-110Abstract: ## INDICATION: year old man s/p DDRT// status renal vasculature ## FINDINGS: The patient is immediately status post right lower quadrant renal transplant. The transplant kidney is normal in morphology and measures 11.4 cm in length. There is no hydronephrosis. There is a small amount of perinephric fluid, without focal fluid collection. Two main renal arteries are seen. Renal artery #2: Tortuous course. Normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with elevated peak systolic velocities of 464 cm/sec near the anastomosis and 172-272 cm/sec in the midportion. Renal artery #2: Normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 44.0 cm/sec near the renal hilum. This artery cannot be followed proximally toward the anastomosis. The resistive index of intrarenal arteries ranges from 0.75 to 0.84, mildly elevated. The vascularity is symmetric throughout transplant. The transplant renal vein is patent and shows normal waveform. ## IMPRESSION: 1. Status post right lower quadrant renal transplant. Small amount of perinephric fluid, without focal fluid collection. 2. Two main renal arteries seen. One demonstrates normal peak systolic velocity near the renal hilum, but cannot be followed proximally toward the anastomosis. The other demonstrates a tortuous course with markedly elevated peak systolic velocity near the anastomosis of 464 cm/sec, compatible with anastomotic narrowing in the immediate postoperative period. Continued attention on follow-up is recommended. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-07-22 12:44:00"}

Description: 19593443-RR-111Abstract: ## INDICATION: year old man s/p DDRT now with high sanguineous JP drain output// assess for bleed, hematoma ## FINDINGS: The right transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, pyramids are normal, there is no urothelial thickening, and renal sinus fat is normal. There is no hydronephrosis. A superficial collection is seen extending across the pelvis under the patient's bandage. This collection measures 13.4 x 3.4 x 7.7 cm. The transplant vein is patent. The patient was uncomfortable and was unable to tolerate a Doppler examination. No vascular additional information was obtained. ## IMPRESSION: 1. Limited transplant kidney ultrasound. The patient was unable to tolerate the Doppler portion of the examination. The renal transplant vein is patent however no additional vascular information could be obtained. 2. Superficial collection extending transversely across the pelvis measuring 13.4 x 3.4 x 7.7 cm. ## NOTIFICATION: The findings were discussed via telephone by with Dr. on at 9:10 am, 10 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-07-28 08:07:00"}

Description: 19593443-RR-113Abstract: ## EXAMINATION: CT abdomen and pelvis ## INDICATION: year old man with post renal transplant. suspicion of retroperitoneal bleed.// Bleeding? ## DOSE: Acquisition sequence: 1) Spiral Acquisition 3.8 s, 50.7 cm; CTDIvol = 11.7 mGy (Body) DLP = 593.7 mGy-cm. Total DLP (Body) = 594 mGy-cm. ## LOWER CHEST: Visualized lung fields are within normal limits. There is no evidence of pleural or pericardial effusion. Note is made of relative low-density of the blood pool, suggesting anemia. ## HEPATOBILIARY: The patient is status post orthotopic liver transplant without evidence of complication on limited assessment. There is no evidence of focal lesions within the limitations of an unenhanced scan. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically absent. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions within the limitations of an unenhanced scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are atrophic, bilaterally. The patient is status post right renal transplant, which appears prominent and possibly edematous. There is a surgical drain at the inferior and medial aspect of the transplant. A urinary drain extends from the transplanted renal pelvis into the urinary bladder. At the medial aspect of the transplant there is a 7.6 x 4.1 x 12.7 cm high density collection, concerning for hematoma. There is no definite significant compression of the transplanted kidney by the hematoma and mild surrounding perinephric stranding, which extends into the abdominal wall musculature and superficial soft tissues, is likely postoperative. Evaluation of the vascular anastomosis is limited without intravenous contrast. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. Diverticulosis of the sigmoid colon is noted, without evidence of wall thickening and fat stranding. The appendix is normal. ## PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Heavy atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: There is a re-demonstrated high density collection within the superficial soft tissues anterior to the pelvic wall musculature (series 2, image 68), measuring up to 15.9 x 5.0 cm (series 601, image 16), compatible with hematoma and increased from ultrasound (Previously 3.4 x 7.7 x 13.4 cm). ## IMPRESSION: 1. New large peritransplant hematoma at the medial aspect of renal transplant in the region of the vascular anastomosis. Evaluation of the transplant and the vascular anastomosis is limited without intravenous contrast, however the transplant kidney does appear prominent and possibly edematous. No definite compression of the transplant kidney by the hematoma. 2. Large superficial soft tissue anterior abdominal wall hematoma, appears mildly increased. 3. Orthotopic liver transplant without evidence of complication. ## NOTIFICATION: The findings were discussed with the transplant surgery team by , M.D. on the telephone on at 5:21 pm, 5 minutes after discovery of the findings. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-07-30 15:36:00"}

Description: 19593443-RR-115Abstract: ## EXAMINATION: CT abdomen and pelvis without IV contrast. ## INDICATION: year old man with s/p DDRT course c/b afib rvr and perinephric hematoma// Hypotension. No Iv contrast ## DOSE: Acquisition sequence: 1) Spiral Acquisition 6.0 s, 47.6 cm; CTDIvol = 15.0 mGy (Body) DLP = 715.5 mGy-cm. Total DLP (Body) = 716 mGy-cm. ## LOWER CHEST: Visualized lung fields are within normal limits. There is no evidence of pleural or pericardial effusion. ## HEPATOBILIARY: There is evidence of prior orthotopic liver transplant. There is no intra or extrahepatic biliary duct dilatation. The gallbladder is surgically absent. ## PANCREAS: The pancreas is atrophic. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen is unremarkable. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The native kidneys are atrophic. Redemonstration of right lower quadrant renal transplant. There is mild fullness of the transplant collecting system with a nephroureteral stent in place. A high-density fluid collection at the medial aspect of the transplant kidney has decreased in size, now measuring 5 cm (03:53). A right surgical drain remains in place withinhematoma. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. Diverticulosis of the sigmoid colon is noted, without evidence of wall thickening and fat stranding. The appendix is normal. ## PELVIS: The urinary bladder is unremarkable. There is a left iliopsoas hematoma measuring 8.7 x 6 cm (603:56). This is increased in comparison to the prior examination. ## REPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: A high-density collection within the superficial soft tissues anterior to the pelvic wall is similar in appearance to exam dated . ## IMPRESSION: 1. Redemonstration of a right lower quadrant renal transplant with decreased size of the peritransplant hematoma at the medial aspect of the transplant. 2. Stable appearance of a superficial anterior abdominal wall hematoma. 3. Mild enlargement of a left iliopsoas hematoma. 4. Stable appearance of the liver transplant. ## NOTIFICATION: The findings were discussed with , M.D. by , M.D. on the telephone on at 4:14 pm. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-08-06 12:32:00"}

Description: 19593443-RR-117Abstract: ## EXAMINATION: RENAL TRANSPLANT U.S. RIGHT ## INDICATION: year old man with s/p DDRT course c/b afib rvr and perinephric hematoma. Raising Cr. ## FINDINGS: The right iliac fossa transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, there is no urothelial thickening, and renal sinus fat is normal. As compared to prior renal ultrasound performed , there is increased fullness in the lower pole kidney. A urinary stent is again seen within the transplant renal pelvis, better evaluated on recent CT abdomen pelvis performed . There is a hypoechoic collection posterior to the transplant kidney measuring 12.2 x 2.0 x 4.2 cm compatible with previously described peritransplant hematoma. Known drainage catheter within the very transplant hematoma is only partially evaluated on current exam. Additional superficial soft tissue hematoma at the surgical incision site is again demonstrated measuring 4.5 x 3.4 x 12.8 cm. There is no hydronephrosis and no perinephric fluid collection. The resistive index of intrarenal arteries ranges from 0.63 to 0.68, within the normal range. The visualized main renal artery demonstrates normal waveform with prompt systolic upstrokes and continuous antegrade diastolic flow with a peak systolic velocity of 272 centimeters/second, decreased compared to where it measured 464 centimeters/second. The previously described second anastomosed renal artery is not definitively seen. Transplant renal vein is patent and shows normal waveform. ## IMPRESSION: 1. There is redemonstration of a urinary stent within the transplant renal pelvis, better evaluated on recent CT abdomen pelvis performed . There is mild increased fullness of the lower pole kidney without evidence of hydroureteronephrosis. 2. Increased systolic velocity of the main renal artery at the anastomosis up to 272 cm/second is decreased compared to where it measured 464 centimeters/seconds. Findings are suggestive of decreased anastomotic narrowing. Continued close attention on follow-up imaging is recommended. A second anastomosed renal artery, previously described on prior exam performed , is not definitely seen on current exam. 3. Redemonstration of a peritransplant hematoma measuring up to 12.2 cm. 4. Superficial soft tissue hematoma is also again seen measuring up to 12.8 cm. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-08-06 11:34:00"}

Description: 19593443-RR-118Abstract: ## EXAMINATION: RENAL TRANSPLANT U.S. RIGHT ## INDICATION: year old man with deceased donor kidney transplant with creatinine remaining above 2 despite being 18 days out from transplant// Please assess vasculature of transplant kidney, two arteries sewn into one, second artery not seen on most recent ultrasound.Also assess for hydro, or hematoma/fluid collection around transplant kidney ## FINDINGS: The right iliac fossa transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, pyramids are normal, there is no urothelial thickening, and renal sinus fat is normal. Compared to the prior renal ultrasound performed on , fullness in the lower pole of the kidney is unchanged. Partial visualization of a urinary stent within the transplant renal pelvis, better visualized on recent CT abdomen and pelvis performed on . Again seen hypoechoic collection posterior to the transplant kidney measuring 11.2 x 2.8 x 7 cm, compatible with previously described peritransplant hematoma and grossly unchanged in size. Additional superficial soft tissue hematoma at the surgical incision site is again seen and grossly unchanged. The resistive index of intrarenal arteries ranges from 0.59 to 0.65, within the normal range. The main renal artery shows a normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 204 cm per second, decreased from prior exam where the measurement was 272 cm meters per second.. ## IMPRESSION: 1. Again seen mild fullness of the lower pole of the transplant kidney without evidence of hydroureteronephrosis, unchanged from prior exam. 2. Systolic velocity of the main renal artery measures 204 centimeters/second, decreased from prior exam where the measurement was 272 cm per second. 3. Re-demonstration of peritransplant hematoma measuring up to 11 cm, grossly unchanged from prior exam. 4. Superficial soft tissue hematoma is also unchanged from prior exam. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-08-09 15:14:00"}

Description: 19593443-RR-120Abstract: ## EXAMINATION: RENAL TRANSPLANT U.S. RIGHT ## INDICATION: year old man s/p DDRT with persistently elevated Cr. **Please visualize the lower and upper pole renal arteries**// **PLEASE VISUALIZE THE LOWER AND UPPER POLE RENAL ARTERIES*** Interval assessment of allograft perfusion in the setting of persistently elevated creatinine ## FINDINGS: The right transplant renal morphology is normal. Specifically, the cortex is of normal thickness and echogenicity, pyramids are normal, there is no urothelial thickening, and renal sinus fat is normal. There is no hydronephrosis. A stent is visualized in the collecting system of the transplant kidney. A hypoechoic collection which is posterior to the transplant kidney is again visualized measuring 7.1 x 2.9 x 11.2 cm (previously 11.2 x 2.8 x 7.0 cm) a superficial hematoma is again visualized at the site of the incision measuring 13.7 cm in length, stable from prior imaging. The resistive index of intrarenal arteries ranges from 0.58 to 0.64, within the normal range. The main renal artery shows a normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 248 cm/sec. Vascularity is symmetric throughout transplant. The transplant renal vein is patent and shows normal waveform. ## IMPRESSION: 1. No hydronephrosis seen in the right lower quadrant transplant kidney. A stable collection is again seen deep to the kidney and a stable superficial hematoma is also again visualized. 2. Patent renal transplant vasculature. The main renal artery peak velocity measures up to 248 cm/sec, similar to the ultrasound of . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-08-11 08:45:00"}

Description: 19593443-RR-121Abstract: ## EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD ## INDICATION: year old man s/p DDLT and DDRT now s/p fall and headstrike// r/o intracranial bleeding ## DOSE: Acquisition sequence: 1) Sequenced Acquisition 5.0 s, 20.0 cm; CTDIvol = 46.7 mGy (Head) DLP = 934.2 mGy-cm. Total DLP (Head) = 934 mGy-cm. ## FINDINGS: There is no evidence of infarction, hemorrhage, edema, or mass. Brain parenchymal atrophy. Findings consistent with mild chronic small vessel ischemic change. Mild posterior right parietal scalp soft tissue swelling. There is no evidence of fracture. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. ## IMPRESSION: No acute intracranial findings. Right parietal scalp mild soft tissue swelling. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22564265", "time": "2145-08-11 14:38:00"}

Description: 19593443-RR-123Abstract: ## INDICATION: duplex u/s to assess for vessel patency ## LIVER: The transplant hepatic parenchyma is within normal limits. No focal liver lesions are identified. There is no ascites. Bile ducts: There is no intrahepatic biliary ductal dilation. ## GALLBLADDER: The patient is status post cholecystectomy. ## PANCREAS: The pancreas is unremarkable but is only minimally visualized due to overlying bowel gas. ## SPLEEN: The background splenic parenchyma is normal. Multiple linear echogenicities within the spleen are compatible with arterial calcifications. Spleen length: 13.4 cm ## KIDNEYS: The transplant kidney is visualized in the right lower quadrant. Note is made that the transplant kidney was not fully examined on this liver ultrasound. ## DOPPLER EVALUATION: The main portal vein is patent, with flow in the appropriate direction. Main portal vein velocity is 23 cm/sec. Right and left portal veins are patent, with antegrade flow. Appropriate arterial waveforms with sharp upstrokes are seen in the hepatic arteries with resistive indices of 0.74, 0.75 and 0.74 in the main, right and left hepatic arteries respectively. Peak systolic flow in the main hepatic artery measures 56 cm/sec. The right, middle and left hepatic veins are patent, with appropriate waveforms. ## IMPRESSION: 1. Patent transplant hepatic vasculature. 2. No focal abnormality or biliary dilatation seen in the transplant liver. 3. Splenomegaly. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "27800547", "time": "2145-09-21 07:46:00"}

Description: 19593443-RR-53Abstract: ## REASON FOR EXAMINATION: Evaluation of the patient with hepatocellular cancer, pre-liver transplant evaluation. ## FINDINGS: Thyroid gland is unremarkable. Atherosclerotic calcifications are noted in the aorta and aortic branches. The aorta and pulmonary arteries are normal in diameter. Stent is noted in the LAD. There is no pericardial or pleural effusion. Anemia is suspected based on the increased density of the left ventricle as compared to the blood in the cardiac chambers. Varices are noted in the surrounding the distal esophagus. Imaged portion of the upper abdomen demonstrates stigmata of cirrhosis including substantial splenomegaly. For precise assessment of the liver, please refer to CT abdomen from and the corresponding report. Airways are patent till the subsegmental level bilaterally. Multiple centrilobular nodules are redemonstrated, unchanged since the prior study and most likely consistent with respiratory peribronchiolitis, please correlate with presence of history of smoking. Subpleural opacities in the right upper lobe, 6:113, are stable. No new pulmonary nodules to suggest metastatic spread demonstrated. The patient is after right shoulder surgery. There are no lytic or sclerotic lesions worrisome for infection or neoplasm. ## IMPRESSION: 1. No evidence of intrathoracic metastatic spread. 2. Extensive coronary calcifications. Further assessment with cardiac CT might be considered if clinically warranted prior to transplantation. 3. Stigmata of cirrhosis. 4. Unchanged stable right upper lobe subpleural area of scarring. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2140-08-21 14:32:00"}

Description: 19593443-RR-54Abstract: ## EXAMINATION: CTA ABD WANDW/O C AND RECONS ## INDICATION: year old man with cirrhosis, HCC. pre-liver transplant evaluation // assess for focal lesions, r/o lesions in the lungs. if hepatic lesions are seen please use OPTN classification ## FINDINGS: There is a 2.7 x 1.7 cm area of low attenuation within segment VII of the liver (10:90) that does not demonstrate enhancement post-contrast and is consistent with the area of previous radiofrequency ablation - this has decreased slightly in size since previous (previously 3.2 x 2 cm). No evidence of residual tumor within this area. No arterially enhancing lesions are identified within the liver. The liver has a nodular contour, consistent with cirrhosis. The hepatic artery is patent with conventional hepatic arterial anatomy. The portal and hepatic veins are patent. No intra or extrahepatic duct dilatation. There is very mild gallbladder wall edema, likely related to the chronic liver disease. The gallbladder is otherwise unremarkable. No ascites. There is moderate splenomegaly with the spleen measuring 14.9 cm in length. The spleen is otherwise unremarkable. The splenic and superior mesenteric veins are patent. There are multiple distal esophageal, paraesophageal and gastric fundal varices. There is a subcentimeter hypodensity within the upper pole of the right kidney (10:101) that is too small to be further characterized. The kidneys are otherwise unremarkable. No hydronephrosis. The adrenals are within normal limits. Pancreas divisum is noted. The pancreas is otherwise unremarkable. The visualized small and large bowel is unremarkable. No mesenteric or retroperitoneal adenopathy. The abdominal aorta is of normal caliber. There is a moderate amount of calcified atheromatous plaque within the abdominal aorta. There is a small amount of mixed soft and calcified atheromatous plaque within the proximal superior mesenteric artery, causing a mild stenosis. Please see the chest CT report for details of the chest. ## OSSEOUS STRUCTURES: Mild multilevel degenerative change is noted within the lower thoracic and upper lumbar spine. No concerning sclerotic or lytic lesions are identified within the osseous structures of the abdomen. ## IMPRESSION: 1. No evidence of disease recurrence at the site of previous radiofrequency ablation in segment VII of the liver. No evidence of HCC. 2. Patent hepatic vasculature. 3. Cirrhotic liver with evidence of portal hypertension (splenomegaly and varices as described). No ascites. 4. Pancreas divisum. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2140-10-30 12:00:00"}

Description: 19593443-RR-56Abstract: ## INDICATION: History of HCC. Please evaluate for intrathoracic metastases. ## FINDINGS: There is no axillary, hilar or mediastinal lymphadenopathy. The heart size is normal. The pericardium is intact without evidence of an effusion. Moderate calcifications are seen through the coronary arteries. The esophagus is mildly dilated with fluid seen within its lumen. There is no hiatal hernia. No esophageal wall thickening. The aorta is normal without evidence of focal aneurysm or dissection. The main pulmonary artery is normal in size. No nodules concerning for malignancy are identified. There is no pleural effusion or pneumothorax. For details of the abdomen, please refer to the dedicated CT of the abdomen performed on the same day. ## OSSEOUS STRUCTURES: No lytic or blastic lesions concerning for malignancy are identified. ## IMPRESSION: 1. No evidence of intrathoracic metastatic spread. 2. Extensive coronary calcifications. 3. Unchanged right upper lobe subpleural area of scarring. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2140-10-30 12:45:00"}

Description: 19593443-RR-57Abstract: ## INDICATION: year old man with cirrhosis, HCC, pre-liver transplant evaluation ## THORAX: Please see the separate dictated chest radiology division report for thoracic findings. ## LIVER: There is a stable segment VII 1.7 x 2.8 cm hypodensity, consistent with previous RF ablation ( ). There are no suspicious arterial enhancing lesions concerning for HCC. The portal and hepatic veins are patent, and there is no intra or extrahepatic biliary duct dilatation. The liver again shows morphological changes consistent with cirrhosis. ## GALLBLADDER: There is mild gallbladder wall edema, likely secondary to chronic liver disease. The gallbladder is not distended and does not contain radiopaque gallstones. ## SPLEEN: The spleen is enlarged measuring 14.4 cm in the craniocaudal dimension (601b:69). ## PANCREAS: The pancreas enhances homogeneously without ductal dilation or peripancreatic fat stranding. Pancreas divisum is not as well demonstrated on this study given lack of ductal dilatation. ## ADRENALS: The adrenal glands are normal in size and shape. ## KIDNEYS: The kidneys are normal in size and shape. There is a stable right upper pole punctate hypodensity, too small to characterize but statistically likely to represent a cyst ( ). The kidneys have appropriate contrast enhancement and excretion bilaterally. There is no hydronephrosis or perinephric stranding. ## BOWEL: The stomach is collapsed and well evaluated. The visualized small bowel is without obstruction or focal wall thickening. The visualized large bowel contains feces without wall thickening or evidence of obstruction. Diverticulosis is noted without evidence of diverticulitis. There is no intraperitoneal free air or free fluid. ## LYMPH NODES: There are no pathologically enlarged retroperitoneal or mesenteric lymph nodes by CT size criteria. There is no ascites. ## VESSELS & SOFT TISSUE: There is moderateatherosclerotic disease without aneurysmal dilatation of the abdominal aorta. There are paraesophageal and probably esophageal varices. There are no hernias. ## ANGIOGRAPHY AND REFORMATIONS: The estimated liver volume is 1714 cm3. The main portal vein and its major branches appear patent. Hepatic arterial, as well as portal and hepatic venous, anatomy is convention. There is a small calcified atherosclerotic plaque at the origin of the celiac axis but no significant narrowing. ## BONES: There are no suspicious lytic or sclerotic osseous lesions to suggest malignancy. ## IMPRESSION: 1. Stable segment VII hypodensity compatible with prior RF ablation. No new suspicious hepatic lesions. 2. Cirrhotic appearance of the liver with signs of portal hypertension including splenomegaly. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-01-22 13:10:00"}

Description: 19593443-RR-58Abstract: ## INDICATION: male with cirrhosis and hepatocellular carcinoma undergoing pre liver transplant evaluation. ## FINDINGS: The thyroid gland is unremarkable. A borderline enlarged right hilar lymph node measures 9 x 11 mm, unchanged (6, 102). There are no pathologically enlarged supraclavicular, mediastinal, hilar or axillary lymph nodes. The heart size is top normal, and there are scattered coronary artery calcifications. The main pulmonary artery is mildly dilated measuring up to 3.1 cm in greatest transverse dimension. There is mild dilatation of the ascending aorta relative to the descending aorta, with the maximal transverse diameter of the ascending aorta measuring 3.7 cm. No incidental pulmonary embolism is identified. A 3 mm right upper lobe solid perivascular nodule (6, 99) and a 3 mm left lower lobe nodule (6, 150) are new since the prior exam. No endobronchial lesion or pleural abnormality is identified. Mild distal esophageal wall thickening with associated submucosal varices are in keeping with the stated history of cirrhosis. For a detailed discussion of the upper abdomen, including splenomegaly, please refer to the separate report from the CT abdomen/pelvis performed concurrently. There are no bony lesions in the thorax worrisome for infection or malignancy. ## IMPRESSION: Two new solid pulmonary nodules measuring up to 3 mm are concerning for possible small metastases. A three-month followup chest CT is recommended. Cirrhosis with paraesophageal varices and splenomegaly. Mild dilatation of the main pulmonary artery may suggest pulmonary arterial hypertension in the appropriate clinical setting. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-01-22 14:27:00"}

Description: 19593443-RR-59Abstract: ## EXAMINATION: CTA ABD WANDW/O C AND RECONS ## INDICATION: year old man with cirrhosis, HCC. pre-liver transplant evaluation // assess for focal lesions, r/o lesions in the lungs. if hepatic lesions are seen please use OPTN classification ## FINDINGS: Please refer to chest CT report for further details. Cirrhotic appearing liver is again noted with capsular nodularity and a small amount of upper abdominal ascites. Similar appearance of the RFA ablation zone within segment 7, 1.3 x 2.7 cm, with internal hyperdensity, likely reflecting coagulative necrosis, with overlying capsular retraction and no suspicious arterial enhancement. No other suspicious arterial hepatic foci are noted. Conventional hepatic arterial anatomy. Patent portal veins. Mild prominence of the gallbladder wall, possibly secondary to portal hypertension. Normal pancreas. Splenomegaly, 15.1 cm. Normal adrenals. No hydronephrosis. No suspicious renal lesions. Tiny bilateral right renal hypodensities, incompletely characterized, most likely cysts. Ingested material within stomach. There is overall mild mural thickening of visualized jejunal and ileal loops, possibly secondary to portal hypertension. Stool is noted throughout the visualized colon. Moderate atherosclerosis of normal caliber abdominal aorta. Periesophageal, perigastric and anterior abdominal varices are noted. No significant upper abdominal adenopathy. No suspicious osseous lesions. Degenerative changes of the spine. ## IMPRESSION: -No evidence of recurrence adjacent to hepatic segment 7 RF ablation zone. No suspicious arterially enhancing liver lesions. -Cirrhotic appearing liver with sequelae of portal hypertension. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-05-07 13:27:00"}

Description: 19593443-RR-60Abstract: ## INDICATION: Pre-liver transplant evaluation in a patient with cirrhosis and HCC. ## DOSE: See report on the abdomen/pelvis portion of the examination. ## MEDIASTINUM: The imaged thyroid is normal. There is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy. The aorta and pulmonary arteries are normal in size. There are atherosclerotic calcifications in the thoracic aorta and the coronary arteries. The heart size is normal and there is no pericardial effusion. ## PLEURA: There is no pneumothorax. There is no pleural effusion. ## LUNGS: The airways are patent. There is no airspace consolidation. There is no diffuse interstitial abnormality. There are no concerning pulmonary nodules. The perivesicular right upper lobe nodule in the left lower lobe nodule seen on the prior examination are no longer present. ## BONES: There are no destructive focal osseous lesions concerning for malignancy within the imaged thoracic skeleton. ## UPPER ABDOMEN: Findings within the abdomen and pelvis will be reported separately by the Abdominal Radiology division. ## IMPRESSION: No evidence of intrathoracic malignancy. Previously seen pulmonary nodules are no longer present, likely representing a resolving infectious or inflammatory process. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-05-07 13:53:00"}

Description: 19593443-RR-68Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## INDICATION: w/Hep C cirrhosis, c/b HCC w/2.2cm seg VII lesion s/p RFA s/p OLT now with rising LFTs // assess vasculature, assess for biliary dilatation and for any perihepatic collections ## FINDINGS: Liver echotexture is normal. There is no evidence of focal liver lesions or biliary dilatation. There is no ascites or right pleural effusion. There is a 1.4 x 2 x 1.3 cm anechoic rounded fluid collection along the inferior margin of the liver. The spleen measures 13.3 cm and has normal echotexture. ## DOPPLER: The main hepatic arterial waveform is within normal limits, with prompt systolic upstrokes and continuous antegrade diastolic flow. Peak systolic velocity in the main hepatic artery is 141 cm/sec. Appropriate arterial waveforms are seen in the right hepatic artery and the left hepatic artery with resistive indices of 0.65, and 0.77, respectively. The main portal vein, right and left portal veins are patent with hepatopetal flow with normal waveform. Appropriate flow is seen in the hepatic veins and the IVC. ## IMPRESSION: 1. Patent hepatic vasculature with appropriate waveforms. 2. No biliary dilatation. 3. 2 cm rounded fluid collection along the inferior aspect of the liver. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "22392697", "time": "2141-08-03 13:49:00"}

Description: 19593443-RR-71Abstract: ## INDICATION: year old man with malnutrition post liver txp // Please replaced clogged PPFT ## FINDINGS: The existing tube was removed and a new tube was placed in the stomach. Under fluoroscopic guidance, the Dobbhoff tube was advanced until the tip reached the fourth portion of the duodenum. Tube position was confirmed with an injection of Optiray contrast. There were no immediate postprocedure complications. Final fluoroscopic spot images demonstrate a post pyloric feeding tube in the fourth portion of the duodenum. ## IMPRESSION: Successful placement tube in the post pyloric position. The tube is ready to use. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-08-09 14:54:00"}

Description: 19593443-RR-74Abstract: ## INDICATION: year old man with elevated LFTs POD 20 from liver transplant. Please perform gravity cholangiogram through existing drain, assess anastomosis, sphincter of Oddi. ## DOSE: Fluoroscopy time: Min 20 seconds ## FINDINGS: Initial scout images demonstrate the drain terminating in the right upper quadrant, along with overlying skin staples and multiple surgical clips. Installation of 25 cc of Optiray demonstrates opacification of the biliary anastomosis and intrahepatic biliary ducts. There is mild narrowing at the anastomosis, which does not appear pathologically stenotic. No evidence of leak. Contrast passed continuously and promptly through the sphincter of Oddi into the duodenum. ## IMPRESSION: Gravity cholangiogram via the patient's existing drain demonstrates opacification of the biliary anastomosis without evidence of stricture or leak. Contrast passes promptly into the duodenum. ## NOTIFICATION: The above findings were communicated via telephone by Dr. to from the transplant surgery team at 14:40 Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "29318015", "time": "2141-08-17 13:27:00"}

Description: 19593443-RR-75Abstract: ## INDICATION: year old man with malnutriton s/p liver txp // Place PPFT- last one clogged ## DOSE: Skin: 2 mGy ; DAP: 39.2 uGy-m2 ; Total fluoroscopy time: 14 seconds ## FINDINGS: A new 8 feeding tube was placed into the stomach with the patient in the seated position on the fluoroscopy table. Under intermittent fluoroscopic guidance, the feeding tube was advanced until the tip reached the third portion of the duodenum. Tube position was confirmed with an injection of Optiray contrast. There were no immediate postprocedure complications. Final fluoroscopic spot images demonstrate a post pyloric feeding tube in the fourth portion of the duodenum. Incidental note is made of a biliary stent in place and multiple surgical clips projecting over the abdomen. ## IMPRESSION: Successful placement of feeding tube in the post pyloric position. The tube is ready to use. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-09-19 14:49:00"}

Description: 19593443-RR-76Abstract: ## INDICATION: year old man with malnutriton s/p liver txp // PPFT that was placed on fell out. Please replace and BRIDLE. ## DOSE: Skin: 2 mGy; DAP: 48.7 uGy-m2; Total fluoroscopy time: 14 seconds ## FINDINGS: A new 8 feeding tube was placed into the stomach with the patient in the seated position on the fluoroscopy table. Under intermittent fluoroscopic guidance with the patient in supine position on the fluoroscopy table, the feeding tube was advanced until the tip reached the fourth portion of the duodenum. Tube position was confirmed with an injection of Optiray contrast. There were no immediate postprocedure complications. Final fluoroscopic spot images demonstrate a post pyloric feeding tube in the fourth portion of the duodenum. The bridle was placed to secure the feeding tube in place. Incidental note is made of a biliary stent in place and multiple surgical clips projecting over the abdomen. ## IMPRESSION: Successful placement of feeding tube in the post pyloric position and bridle to secure position. The tube is ready to use. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2141-09-21 13:28:00"}

Description: 19593443-RR-77Abstract: ## INDICATION: Right upper quadrant ultrasound including eval of portal vein. ## LIVER: Nofocal liver lesions are identified. There is small ascites. A small fluid collection along the inferior aspect of the liver has increased in size, measuring 3.6 x 3.1 x 2.9 cm, previously 1.4 x 2 x 1.3 cm. Bile ducts: A common bile duct stent is in situ. The duct is dilated, measuring 12 mm, which is larger from . Central intrahepatic ducts are mildly dilated. ## GALLBLADDER: The gallbladder is surgically absent. ## PANCREAS: Imaged portion of the pancreas appears within normal limits, with portions of the pancreatic tail obscured by overlying bowel gas. ## SPLEEN: The spleen is enlarged, measuring 14.2 cm, increased from 13.3 cm. Doppler evaluation: Main portal vein is patent, with flow in the appropriate direction Main portal vein velocity is 65.5 cm/sec. Right and left portal veins are patent, with antegrade flow Main hepatic artery is patent, with appropriate and unchanged waveform. The resistive indices of the right and left hepatic arteries are 0.79, previously 0.65 and 0.77, respectively. Right, middle and left hepatic veins are patent, with appropriate waveforms. Splenic vein and superior mesenteric vein are patent, with antegrade flow. ## IMPRESSION: 1. Increase in splenomegaly and new small volume ascites from raises the concern for developing portal hypertension. 2. Dilated common bile duct and mild dilation of the central intrahepatic ducts with a CBD stent in situ. Stent malfunction cannot be excluded. 3. Patent hepatic vasculature. Slightly increased resistive index of the right hepatic artery is of uncertain significance. 4. Increase in size of a simple appearing 3.6 cm fluid collection along the inferior aspect of the liver. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "21394425", "time": "2141-10-08 20:55:00"}

Description: 19593443-RR-79Abstract: ## EXAMINATION: CT abdomen and pelvis with intravenous contrast. ## INDICATION: year old man with PMHx notable for IDDM, HTN, OSA and 2 months and 12 days s/p standard criteria deceased donor liver transplant for hepatitis C cirrhosis complicated by HCC which has been complicated by cytopenia and elevated LFTs who is a direct admission due to outpatient labs showed a rise in his AST/ALT (110 and 125 from 33 and 29, respectively) as well as WBC of 0.8. // Had a U.S Guided Liver Biopsy today. Now complaining of progressively worse low back back surrounding the sacral area. HD stable. Concern for RP bleed after biopsy. ## DOSE: DLP: 605.63 mGy-cm (abdomen and pelvis). ## LOWER CHEST: Imaged lung bases are unremarkable without evidence of pulmonary nodule or mass. There is no pleural or pericardial effusion. Coronary artery calcifications are dense. ## HEPATOBILIARY: Postsurgical changes are consistent with provided history of hepatic transplantation. Few subcentimeter hypodensities scattered throughout the liver are too small to accurately characterize but likely represent cysts versus biliary hamartomas. The liver otherwise demonstrates homogenous attenuation throughout. There is no evidence of suspicious focal lesion. There is mild central biliary ductal prominence possibly edema with a biliary stent in the common duct. The gallbladder is surgically absent. There is moderate volume simple ascites. Fluid collection in pouch measuring 2.6 x 4.7 cm may represent focal collection of ascites, seroma, or biloma could have similar appearance. There is no evidence of active contrast extravasation or hematoma. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: Spleen is mildly enlarged measuring 13.1 cm. There is normal splenic parenchymal attenuation. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of stones, focal renal lesions or hydronephrosis. There are no urothelial lesions in the kidneys or ureters. There is no perinephric abnormality. ## GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. There are descending and sigmoid colonic diverticula without evidence of diverticulitis. Colon and rectum are otherwise within normal limits. The appendix is not visualized in this examination. ## RETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric lymphadenopathy. There is no evidence of retroperitoneal hematoma. ## VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in the abdominal aorta and great abdominal arteries. ## PELVIS: The urinary bladder and distal ureters are unremarkable. There is no evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: Reproductive organs are within normal limits. ## BONES AND SOFT TISSUES: There is no evidence of worrisome lesions. There are mild degenerative changes of the lower lumbar spine. Abdominal and pelvic wall is within normal limits. ## IMPRESSION: 1. No evidence of abdominal or retroperitoneal hematoma. No evidence of extravasation. 2. Moderate volume simple ascites. 3. Postsurgical changes consistent with provided history of hepatic transplantation. 4. Mild central biliary ductal dilatation. 5. 2.6 x 4.7 cm fluid in pouch may represent focal collection of ascites, however seroma or small biloma could have similar appearance given recent postoperative state. 6. Diverticulosis without evidence of diverticulitis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "21394425", "time": "2141-10-10 02:09:00"}

Description: 19593443-RR-81Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## INDICATION: year old man with liver transplant 2 months and 16 days ago who presented with elevated LFTs and mild restriction in right hepatic artery now with LFTs have doubled. // PLease evaluate liver vascular for thrombosis or worsening restriction. ## LIVER: The transplant liver is normal in size and the hepatic architecture is normal in appearance. There is no suspicious liver mass. A trace of fluid is noted at the anterior right lobe. The main portal vein is patent with hepatopetal flow. There is mild to moderate ascites. ## BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 0.6 cm. ## SPLEEN: The spleen is enlarged measuring 14.4 cm. ## KIDNEYS: No hydronephrosis is seen in either kidney. The kidneys are noted to be echogenic suggesting chronic parenchymal disease. ## DOPPLER EXAMINATION: The main, right and left portal veins are patent with hepatopetal flow. The splenic vein demonstrates hepatopetal flow in the midline. The hepatic veins and IVC are patent. Appropriate arterial waveforms are seen in the hepatic arteries with resistive indices of 0.76, 0.63 and 0.76 in the main, right and left hepatic arteries respectively. ## IMPRESSION: 1. Patent hepatic vasculature. Normal transplant liver Doppler examination. 2. Mild to moderate ascites. 3. Splenomegaly Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "21394425", "time": "2141-10-12 14:55:00"}

Description: 19593443-RR-82Abstract: ## INDICATION: year old man with history of who underwent liver txp ago // assess for lung mets ## FINDINGS: The thyroid is unremarkable. The axillary, supraclavicular, mediastinal and hilar lymph nodes are not pathologically enlarged. The aorta and pulmonary arteries are normal in size. There are atherosclerotic calcifications within the coronary arteries, thoracic aorta. The cardiac chambers are hypodense as compared to to myometrium, which is concerning for anemia. The pericardial effusion(3, 49) is increased in size from . The airways are patent to the subsegmental level. A 8 mm subpleural ground glass nodule in the left lower lobe (5, 206) is new since and most likely represents atelectasis. Several 2 mm subpleural opacities in the right upper and middle lobe(series 5: 63, 190) likely are intrapulmonary lymph nodes. There is a focal area of subpleural atelectasis in the right lower lobe(series 5, 189).Focal area of pleural thickening in the left lower lobe (5, 234) is unchanged from . There is no pneumothorax or pleural effusion. Mild degenerative changes within the cervical and thoracic vertebral bodies. No suspicious osseous lesions within the thorax. This examination is not tailored for subdiaphragmatic evaluation, There are tiny simple hepatic cysts. Mild ascites. Surgical clips in the abdomen are normal given patient's history of liver transplant ## IMPRESSION: Since , new 8 mm subpleural ground glass opacity in the left lower lobe likely representing atelectasis. Attention to follow-up imaging is recommended. Few subpleural nodules likely representing benign intrapulmonary lymph nodes. Increasing small pericardial effusion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2142-03-06 09:23:00"}

Description: 19593443-RR-83Abstract: ## EXAMINATION: CT ABDOMEN PELVIS WITHOUT IV CONTRAST. ## INDICATION: with back pain after colonoscopy, concern for perforationNO PO contrast // EVAL FOR PERF, PO GASTROGRAFFIN OR GASTROGRAFFIN ENEMA ONLY, NO IV CONTRAST ## LOWER CHEST: There is minimal atelectasis the dependent lung bases bilaterally. Trace left pleural effusion is noted. There is no right pleural or pericardial effusion. Low-density blood pool in the left ventricle compared with intraventricular septal myocardium suggests anemia. ## HEPATOBILIARY: The patient is post liver transplantation. The transplanted liver is homogeneous in attenuation, with no focal lesions identified based on an unenhanced scan. Moderate volume upper abdominal perihepatic and perisplenic ascites is low-density, similar in extent compared to the prior CT. There is also a focal fluid collection and pouch spanning approximately 3.8 x 2.6 cm (02:26), slightly decreased in size compared to the prior study. Moderate extra hepatic and intrahepatic biliary ductal dilation seen on prior is difficult to assess in the absence of intravenous contrast, but appears overall similar compared to the prior study. There has been interval removal of a common bile duct stent. The gallbladder is surgically absent. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions within the limitations of an unenhanced scan. There is no pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen is borderline enlarged, measuring up to 13.2 cm greatest craniocaudal dimension (601b:38), unchanged. Splenic parenchymal attenuation is unremarkable. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are of normal and symmetric size. There is no evidence of focal renal lesions within the limitations of an unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis. There is no perinephric abnormality. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber and wall thickness throughout. Thickened folds in the ascending colon are noted (601b:31, 2:39). Fluid adjacent to the ascending colon is of low density (16.9 , and there is no evidence of leak of enteric contrast, which reaches the level of the sigmoid colon. Numerous diverticula are noted throughout the sigmoid colon, with no evidence of diverticulitis. The appendix is not visualized. ## PELVIS: Moderate volume pelvic free fluid is low-density. The urinary bladder is unremarkable. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Moderate atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: Mesh repair of a right inguinal hernia is again noted. ## IMPRESSION: 1. No evidence of leak of enteric contrast or extraluminal air. 2. Mucosal fold thickening in the ascending colon is likely related to recent colonoscopy with thermal therapy of multiple angioectasias as described in the colonoscopy report in the medical record. 3. Moderate volume simple abdominopelvic ascites. 4. Focal fluid collection in Morison's pouch, possibly a seroma, slightly smaller compared to the prior study. 5. Sigmoid diverticulosis, with no evidence of diverticulitis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "21135663", "time": "2142-06-11 15:20:00"}

Description: 19593443-RR-85Abstract: ## INDICATION: year old man with liver xplant, ckd on . // etiology ## FINDINGS: The right kidney measures 12 cm. The left kidney measures 10.3 cm. There is no hydronephrosis, stones, or masses bilaterally. Slightly increased cortical echogenicity with normal corticomedullary differentiation seen bilaterally. Note is made of trace left perinephric fluid. The bladder is moderately well distended and normal in appearance. The previously described fluid collection in Morison's pouch is partially imaged on this study. ## IMPRESSION: Slightly increased bilateral cortical echogenicity suggests diffuse cortical disease. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "21135663", "time": "2142-06-12 13:46:00"}

Description: 19593443-RR-86Abstract: ## CHEST: Frontal and lateral views ## INDICATION: History: with hypertension // eval for pna ## FINDINGS: No focal consolidation is seen. There is blunting of the costophrenic angles may be due to trace pleural effusions and/or mild atelectasis. No pneumothorax is seen. The cardiac silhouette is top-normal to mildly enlarged. There is prominence of the hila without vascular congestion and underlying lymphadenopathy could be present. ## IMPRESSION: Blunting of the costophrenic angles may be due to trace pleural effusions and/or mild atelectasis. Prominence of the hila without vascular congestion could be due to prominent pulmonary vessels however underlying lymphadenopathy is not excluded. This could be further evaluated for on nonurgent chest CT. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "27116096", "time": "2142-06-23 16:30:00"}

Description: 19593443-RR-88Abstract: ## EXAMINATION: CT CHEST W/O CONTRAST ## INDICATION: year old man with h/o liver transplant with recent CXR that showed prominence of the hila without vascular congestion could be due to prominentpulmonary vessels however underlying lymphadenopathy is not excluded. // Please eval pt had recent CXR that was abnormal ## FINDINGS: The thyroid is unremarkable. The axillary, supraclavicular, mediastinal and hilar lymph nodes are not pathologically enlarged. The aorta is not aneurysmal and main pulmonary artery is mildly enlarged measuring 3.2 cm. There are atherosclerotic moderate to severe calcifications within the coronary arteries, in the thoracic aorta. The cardiac chambers are hypodense as compared to to myometrium, which is concerning for anemia. The pericardial effusion is small in stable in appearance The airways are patent to the subsegmental level. Previously described 8 mm subpleural ground-glass nodule in the left lower lobe has resolved. Subpleural 2 mm opacities in the right upper and middle lobe are stable. No new or growing pulmonary nodules. Mild dependent atelectasis in the lower lobes Several 2 mm subpleural opacities in the right upper and middle lobe likely are intrapulmonary lymph nodes. There is a focal area of subpleural atelectasis in the right lower lobe stable in appearance. There is no pneumothorax or pleural effusion. Mild degenerative changes within the cervical and thoracic vertebral bodies. No suspicious osseous lesions within the thorax. This examination is not tailored for subdiaphragmatic evaluation, There are tiny simple hepatic cysts. Partially upper abdominal ascites has increased. Multiple surgical clips related to prior hepatic transplant. ## IMPRESSION: Mild enlargement of the pulmonary arteries, bilateral hila are otherwise unremarkable. No suspicious pulmonary nodules, lymph nodes or or bony disease. Small pericardial effusion is stable. Partially imaged upper abdominal ascites has increased. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2142-07-15 16:06:00"}

Description: 19593443-RR-90Abstract: ## EXAMINATION: UPPER EXTREMITY VENOUS MAPPING ## INDICATION: year old man with CKD s/p liver tx needing mapping for access evaluation // Pt. in need of future HD fistula. Please do bilat. upper extremity vein mapping of both forearms and upper arms to assess vein patency for future AV fistula. Please also assess central veins to r/o any central stenosis. If possible, please also check radial and brachial arteries for the presence of any calcifications. Please comment on this. Pt. is coming to see the surgeon post mapping so kindly give pt. a written report to bring to the surgeon. Thank you ## FINDINGS: The bilateral subclavian veins demonstrate phasicity, suggesting central venous patency. ## RIGHT: The cephalic vein measures 0.19 cm at the wrist, 0.23 cm at the distal forearm, 0.17 cm at the proximal forearm, 0.16 cm at the distal arm, 0.19 cm at the mid arm and 0.2 cm at the proximal arm. The basilic vein measures 0.29 cm at the antecubital fossa, 0.34 cm at its mid portion, and 0.34 cm at the proximal portion. The radial artery measures 0.33 cm. The brachial artery measures 0.52 cm. No arterial calcifications are present. ## LEFT: The cephalic vein measures 0.21 cm at the wrist, 0.3 cm at the mid forearm, 0.28 cm at the proximal forearm, 0.17 cm at the antecubital fossa, 0.22 cm at the distal arm, 0.22 cm at the mid arm and 0.29 cm at the upper arm. A single image of the left brachial vein demonstrates patency. No images are saved of the left basilic vein. The radial artery measures 0.27 cm. The brachial artery measures 0.45 cm. No arterial calcifications are present. ## IMPRESSION: 1. Patent cephalic veins and right basilic vein, with measurements above. No images were obtained of the left basilic vein. 2. Patent radial and brachial arteries with no calcifications identified. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2142-08-14 09:36:00"}

Description: 19593443-RR-91Abstract: ## INDICATION: year old man with h/o liver transplant and renal failure now with ascites. Please eval portal vein for vessel patency // Please eval portal vein for vessel patency ## ABDOMINAL ULTRASOUND: . CT abdomen pelvis: . ## FINDINGS: Liver echotexture is normal. There is no evidence of focal liver lesions or biliary dilatation. There is a persistent 4.8 x 2.7 x 3.7 cm seroma in 's pouch, not significantly changed since the prior CT. There is moderate volume ascites. The spleen measures 15.3 cm and has normal echotexture. ## DOPPLER: The main hepatic arterial waveform is within normal limits, with prompt systolic upstrokes and continuous antegrade diastolic flow. Peak systolic velocity in the main hepatic artery is 93 cm/sec. Appropriate arterial waveforms are seen in the right hepatic artery and the left hepatic artery with resistive indices of 0.74, and 0.82, respectively. The main portal vein, right and left portal veins are patent with hepatopetal flow with normal waveform. Appropriate flow is seen in the hepatic veins and the IVC. ## IMPRESSION: 1. Patent hepatic vasculature with appropriate waveforms. 2. Seroma in 's pouch is not significantly changed. 3. Persistent splenomegaly. 4. Moderate volume ascites. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2142-08-01 13:53:00"}

Description: 19593443-RR-93Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## INDICATION: man status-post liver transplant with stage 2 fibrosis. Evaluate for ascites and portal vein patency. ## FINDINGS: Liver echotexture is mildly coarse. No evidence of focal liver lesions or biliary dilatation. The common hepatic duct measures 0.5 cm. A moderate volume of ascites is seen largely around the liver and in the right lower quadrant with smaller amounts in the left lower quadrant and around the spleen. No right pleural effusion. The spleen remains enlarged, measuring 14.6 cm (previously 15.3). The spleen has normal echotexture. Limited views of the kidneys show no hydronephrosis. ## DOPPLER: The main hepatic arterial waveform is within normal limits, with prompt systolic upstrokes and continuous antegrade diastolic flow. Peak systolic velocity in the main hepatic artery is 81.8 cm/sec. Appropriate arterial waveforms are seen in the right hepatic artery and the left hepatic artery with resistive indices of 0.86, and 0.81, respectively. The resistive index of the main hepatic artery is 0.84. The main portal vein and the right and left portal veins are patent with hepatopetal flow and normal waveforms. Appropriate flow is seen in the hepatic veins and the IVC. ## IMPRESSION: 1. Patent hepatic vasculature with mildly elevated hepatic artery resistive indices. 2. Moderate-volume ascites. 3. Splenomegaly (14.6 cm). Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2142-12-04 07:34:00"}

Description: 19593443-RR-95Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## INDICATION: year old man s/p liver transplant for ETOH cirrhosis of the liver c/b now in renal failure // liver u/s to r/o any focal lesions and vessel patency ## FINDINGS: Liver echotexture is mildly coarsened. There is no evidence of focal liver lesions or biliary dilatation. The common hepatic duct measures 0.5 cm. There is moderate ascites and a partially visualized right pleural effusion. A small seroma is again noted in 's pouch, measuring 2.5 x 2.1 x 2.3 cm, decreased in size compared to . The spleen measures 14.2 cm (previously 14.6 cm) and has normal echotexture. ## DOPPLER: The main hepatic arterial waveform is within normal limits, with prompt systolic upstrokes and continuous antegrade diastolic flow. Peak systolic velocity in the main hepatic artery is 128. Appropriate arterial waveforms are seen in the right hepatic artery and the left hepatic artery with resistive indices of 0.82, and 0.87, respectively. The main portal vein and the right and left portal veins are patent with hepatopetal flow and normal waveform. Appropriate flow is seen in the hepatic veins and the IVC. ## IMPRESSION: 1. Patent hepatic vasculature with no focal lesions identified. 2. Moderate ascites and right-sided pleural effusion. 3. Stable splenomegaly, measuring 14.2 cm. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "25695081", "time": "2143-05-21 10:51:00"}

Description: 19593443-RR-98Abstract: ## INDICATION: year old man with ETOH cirrhosis of the liver c/b HCC in . Patient has ESRD on dialysis// chest and abdomen CT scan of the liver to r/o metastatic disease ## MULTIPHASIC LIVER: Multidetector CT of the abdomen and pelviswas done as part of CT torsowithout and with IV contrast. Initially, the abdomen and pelviswas scanned without IV contrast. Subsequently, a single bolus of IV contrast was injected and the abdomen was scanned in the early arterial phase, followed by a scan of the abdomen and pelvisin the portal venous phase, followed by a scan of the abdomen in equilibrium phase (3-min delay). Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: ERROR: unknown web service failure. ## LOWER CHEST: Please refer to separate report of CT chest performed on the same day for description of the thoracic findings. ## HEPATOBILIARY: Again seen is an orthotopic liver transplant. A few arterially enhancing lesion lesions, without correlate on additional phases are demonstrated peripherally within the right lobe of the liver, for instance on 06:13. These are nonspecific, possibly perfusional. Multiple hypodense lesions are noted throughout the liver which are too small to definitively characterize, stable. No concerning fluid collections within the liver. Interval decrease of a seroma inferior to the biliary anastomosis. There is no intrahepatic biliary dilatation. Prominence of the donor common bile duct is stable. The recipient CBD is normal caliber. There is new trace pneumobilia of uncertain etiology. The gallbladder is within normal limits. Trace ascites, improved. ## PANCREAS: The pancreas is unremarkable. There is no peripancreatic stranding. ## SPLEEN: Spleen is again borderline enlarged measuring 14.0 cm. No focal splenic lesion. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are unremarkable. ## GASTROINTESTINAL: No bowel obstruction. Small hiatal hernia the appendix is normal. ## PELVIS: Trace free fluid in the pelvis. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Extensive atherosclerotic disease is again noted. Hepatic arteries are patent. Portal vein and hepatic veins are patent. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: The abdominal and pelvic wall is within normal limits. ## IMPRESSION: 1. No findings of recurrent or metastatic HCC in the abdomen or pelvis. 2. New trace pneumobilia of uncertain etiology. No focal fluid collections within the liver and patent hepatic arteries. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2143-09-02 13:01:00"}

Description: 19593443-RR-99Abstract: ## DOSE: DLP: Given in abdominal CT report. ## FINDINGS: No incidental thyroid findings. No supraclavicular, infraclavicular or axillary lymphadenopathy. No enlarged lymph nodes in the mediastinum. Mild stable dilatation of the main pulmonary artery. Severe coronary calcifications, mild valvular calcifications. No pericardial effusion. No abnormalities in the posterior mediastinum. Upper abdominal findings are described in detail in the dedicated abdominal CT report. Mild degenerative changes at the level of the ribs, the sternum, or the vertebral bodies. No vertebral compression fractures. Mild bilateral apical scarring. No pleural abnormalities. No pleural thickening. The airways are patent. No diffuse lung disease. Minimal non characteristic scarring in the anterior portions of the right upper lobe (16, 79). No suspicious lung nodules or masses. ## IMPRESSION: Stable examination as compared to . No metastatic disease to the thorax. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593443", "visit_id": "N/A", "time": "2143-09-02 13:02:00"}

Description: 19593505-RR-23Abstract: ## INDICATION: with hand injury after dog jumped and struck her fingers/hand. +pain // r/o acute process ## FINDINGS: There is an acute minimally displaced oblique fracture through the mid right fourth metacarpal. It is seen to involve the mid diaphysis with mild medial displacement of the distal fracture fragment. No angulation. No extension to the joint space. No additional acute fracture. Orthopedic hardware with plate and transfixing screws seen along the dorsal aspect of the distal right radius. ## IMPRESSION: Acute oblique minimally displaced fracture through the right fourth metacarpal. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593505", "visit_id": "N/A", "time": "2115-05-29 19:23:00"}

Description: 19593505-RR-25Abstract: ## INDICATION: year old woman with hemorrhagic thyroid nodule in // f/u nodule ## THE RIGHT LOBE MEASURES: (Transverse) 1.5 cm x (anterior-posterior) 1.2 cm x (craniocaudal) 4.1 cm. The left lobe measures: (Transverse) 2.1 x (anterior-posterior) 1.6 x (craniocaudal) 4.3 cm. Isthmus anterior-posterior diameter is 0.4 cm. The thyroid parenchyma is homogenous and has normal vascularity. Unchanged appearance of few colloid cysts within the right thyroid lobe. On the left, there is a known heterogeneous, cystic and solid nodule measuring 1.3 x 1.3 x 1.9 cm, previously 2.4 x 1.5 x 2.3 cm. Few coarse calcifications are noted. No lymphadenopathy. ## IMPRESSION: Again noted is a heterogeneous, cystic and solid nodule in the left thyroid lobe that is slightly smaller today in comparison to the prior examination. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593505", "visit_id": "N/A", "time": "2115-10-17 13:27:00"}

Description: 19593611-RR-29Abstract: ## HISTORY: Evaluation for abscess in a patient with a left lower quadrant pain and likely diverticulitis. ## FINDINGS: The visualized portions of the lung bases are clear. There is no pleural or pericardial effusion. CT abdomen with IV and oral contrast: The liver enhances homogeneously without focal lesions or evidence of intrahepatic biliary duct dilation. The portal vein is patent. The gallbladder is unremarkable. The pancreas is unremarkable without evidence of pancreatic duct dilation. The spleen and adrenal glands are unremarkable. The kidneys concentrate and excrete contrast symmetrically. No renal lesions are identified. The stomach is partially filled with contrast and is unremarkable. The small and large bowel are unremarkable without evidence of wall thickening or obstruction. No pericolon fat stranding or fluid collections are identified. No free air, free fluid or abdominal lymphadenopathy is identified. The appendix is located in the right lower quadrant and appears normal. CT pelvis with IV and oral contrast: The bladder, prostate and seminal vesicles are unremarkable. No free air, free fluid or pelvic lymphadenopathy is identified. There are bilateral fat containing inguinal hernias. ## OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesions are identified. ## IMPRESSION: No radiographic evidence of diverticulitis, abscess or other abnormalities to explain the patient's abdominal pain. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593611", "visit_id": "N/A", "time": "2172-03-21 12:26:00"}

Description: 19593611-RR-30Abstract: ## HISTORY: Testicular pain, left greater than right. ## FINDINGS: The right testicle measures 3.9 x 2.3 x 5.3 cm. The left testicle measures 3.4 x 2.7 x 5.0 cm. Bilateral testicular texture is echogenic consistent with microlithiasis. In the right epididymal head are several simple cysts the largest measuring 0.9 cm. There is a small amount of simple fluid surrounding the epididymal head. There is a 1.1 cm cyst in the left epididymal head with low-level internal echoes and no vascularity. Duplex Doppler for of the testicles show normal arterial and venous waveforms. ## IMPRESSION: Microlithiasis of the testicles. No follow up is indicated. There is a left spermatocele and several epididymal head cysts on the right. There is no sonographic evidence of torsion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593611", "visit_id": "N/A", "time": "2172-04-22 13:32:00"}

Description: 19593611-RR-31Abstract: ## EXAMINATION: MR HEAD W AND W/O CONTRAST ## INDICATION: year old man with trauma . now dizziness also family history of MS // bleed MS. ## : Sagittal FLAIR, axial FLAIR, T1 pre and postcontrast, T2, gradient echo, diffusion weighted, sagittal MPRAGE postcontrast with coronal and axial reformats sequences of the brain following departmental MS protocol. 12 cc Gadavist. . ## MRI HEAD: No evidence of intra or extra-axial mass, hemorrhage or acute infarct. There are scattered punctate nonenhancing T2/FLAIR subcortical and periventricular white matter hyperintensities, which are nonspecific. There is prominence of the ventricles, greater than would be expected for the degree of sulcation and brain volume. In addition, there is asymmetry of the lateral ventricles (the right being larger than the left). These findings appear chronic and likely congenital as there is no evidence for transependymal flow to suggest acute hydrocephalus and the cisterns and cerebral aqueduct are widely patent. The major intracranial flow voids are preserved. No regions of abnormal enhancement. Mild mucosal thickening of the maxillary sinuses, frontal sinuses and ethmoid air cells. Sphenoid sinuses are clear. The orbits are unremarkable. The mastoid air cells demonstrating very mild fluid signal inferiorly. ## IMPRESSION: 1. Nonspecific subcortical T2/FLAIR nonenhancing white matter changes, not in the usual distribution of demyelinating disease, although this is not excluded. Such findings may also be seen in a broad range of setting such as small vessel ischemic disease or chronic migraine. 2. No evidence of intracranial hemorrhage. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593611", "visit_id": "N/A", "time": "2173-09-29 19:59:00"}

Description: 19593675-RR-29Abstract: ## HISTORY: male with rhabdomyolysis. Evaluation for pulmonary edema. ## PA AND LATERAL CHEST RADIOGRAPH: Large heterogeneous consolidation within the right lung base appears similar compared to recent prior and is concerning for pneumonia. Per the clinical team, the patient is a smoker and has no symptoms of infection. Given that clinical history, another alternative could be a large pulmonary mass or post obstructive atelectasis, though atypical. Further characterization with chest CT should be considered. There is no pulmonary vascular congestion or interstitial edema. Mild blunting of the right costophrenic angle suggests a stable small right-sided pleural effusion. Cardiomediastinal and hilar contours are within normal limits. There is no pneumothorax. ## IMPRESSION: 1. Large right lower lobe heterogeneous consolidation, concerning for pneumonia. Given the lack of symptomatology, this could be a large pulmonary mass or post-obstructive atelectasis. Chest CT is necessary for further characterization. 2. No pulmonary vascular congestion or edema. Dr. discussed the above findings with Dr. at 12:25 pm on by telephone. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "23468523", "time": "2193-09-22 09:54:00"}

Description: 19593675-RR-30Abstract: ## INDICATION: Consolidation on chest x-rays without signs or symptoms of pneumonia. 30-pack-year history of smoking. Further characterization of the consolidations. ## CT CHEST: MDCT imaging was performed from the thoracic inlet to the upper abdomen without IV or oral contrast. IV contrast was not administered due to the patient's renal failure. ## FINDINGS: There is a large consolidation with air bronchograms in the right lower lobe. In the periphery of this consolidation are multiple areas of ground-glass opacity. Small areas of consolidation with surrounding ground-glass opacities are also present in the left lower lobe (2:44) and in the right middle lobe (3:34). Small bilateral pleural effusions are present. No pneumothorax is present. There are numerous enlarged mediastinal nodes including a right paratracheal node measuring 13 mm. Calcification of the left main, LAD, circumflex and right main coronary arteries are present. Aortic valvular calcifications are present. A small pericardial effusion is present. The thyroid appears normal. Although not tailored for subdiaphragmatic evaluation, the upper abdomen appears normal. ## BONE WINDOWS: Nondisplaced chronic and healing rib fractures are present at the right eleventh posterior rib (2:54) and left ninth lateral rib (2:55). No suspicious bone lesions are identified. ## IMPRESSION: 1. Multifocal consolidations with surrounding ground-glass opacities predominantly in the right lower lobe. Small bilateral pleural effusions. Mediastinal adenopathy. While these findings would be suggestive of a bacterial pneumonia, the absence of clinical signs of infection raises the possibility for this being a multifocal bronchioalveolar carcinoma. Either bronchoscopy or short-term radiographic evaluation after appropriate treatment would be indicated. 2. Chronic nondisplaced partially healed right and left rib fractures as described. 3. Coronary artery calcifications. Aortic valvular calcifications. These findings were discussed via telephone with Dr. , at approximately 3 p.m. on . Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "23468523", "time": "2193-09-22 13:34:00"}

Description: 19593675-RR-31Abstract: ## REASON FOR EXAMINATION: Fever and oxygen requirement in a patient with history of congestive heart failure. PA and lateral upright chest radiographs were reviewed in comparison to and chest CT from . Heart size is top normal. Mediastinum is stable. Currently, there is minimal interstitial engorgement that might be concerning for mild interstitial pulmonary edema. There is on the lateral demonstration of small bilateral effusions, symmetric and adjacent opacity not very well seen on the PA view. Those findings are most likely representing interstitial edema but basal consolidation in particular in the right lower lung cannot be entirely excluded. Followup of the patient after diuresis and antibiotic treatment in four weeks is recommended for documentation of resolution. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "29853928", "time": "2195-02-06 04:02:00"}

Description: 19593675-RR-34Abstract: ## INDICATION: man with history of renal disease and acute on chronic CHF, with left lower extremity cellulitis, evaluate lower extremities. ## FINDINGS: Doppler waveform analysis, pulse volume recordings, and ankle-brachial indices were evaluated bilaterally. On the right, there is a triphasic waveform through most of the extremity, converting to a monophasic waveform at the level of the dorsalis pedis. Right ankle-brachial index measures 1.07. Relatively symmetric pulse volume recordings, with slight diminishment at the level of the metatarsal. On the left, there is triphasic waveform from the femoral to the popliteal levels, converting to monophasic waveform at the level of the tibial and dorsalis pedis arteries. Left ankle-brachial index measures 0.81. Slight reduction in pulse volume recordings from the level of the calf to the ankle. ## IMPRESSION: Findings consistent with moderate left tibial disease, and mild right tibial disease. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "29853928", "time": "2195-02-07 10:44:00"}

Description: 19593675-RR-36Abstract: ## INDICATION: man with diabetes, congestive heart failure, and CKD, now presents with right foot cellulitis, to rule out osteomyelitis. ## FINDINGS: Extensive subcutaneous soft tissue and intramuscular edema along the dorsal and volar aspects of the right foot, is consistent with cellulitis. A more focal area of fluid is seen along dorsal second interspace (3:13), with fluid surrounding the plantar aspect of the second toe. Given lack of intravenous contrast, assessment of focal rim enhancing abscess is seen. No signal abnormality is seen within the right foot bones to suggest osteomyelitis (there is preserved T1 marrow signal). The visualized muscles and tendons are intact. ## IMPRESSION: No evidence of right foot osteomyelitis. Extensive subcutaneous soft tissue edema with more focal fluid collections surrounding the second interspace and second toe compatible with cellulitis. Assessment for focal abscess is limited, given lack of intravenous contrast. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "29853928", "time": "2195-02-08 20:36:00"}

Description: 19593675-RR-38Abstract: ## HISTORY: man with stage III/IV kidney disease and resistant hypertension. ## FINDINGS: The right kidney measures 10.9 cm and the left kidney measures 11.6 cm. There is no hydronephrosis. No perinephric fluid collection is identified. No cyst or stone or solid mass is seen in either kidney. The prevoid bladder is partially distended and is normal in appearance. ## DOPPLER EXAMINATION: Color Doppler and spectral waveform analysis was performed. Normal arterial waveforms with sharp upstrokes are seen in the main renal artery bilaterally. Normal venous flow is seen in the main renal vein bilaterally. Resistive indices are elevated bilaterally. In the right kidney the RIs of the intraparenchymal arteries range from 0.81 - 0.86. RIs in the left kidney range from 0.88 - 0.91. ## IMPRESSION: 1. No hydronephrosis. Unremarkable appearance of the kidneys. 2. No evidence of renal artery stenosis. Bilateral resistive indices are elevated consistent with chronic renal disease. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "29853928", "time": "2195-02-13 13:23:00"}

Description: 19593675-RR-42Abstract: ## INDICATION: Patient with third webspace abscess. Please evaluate third metatarsal head resection. ## FINDINGS: Right foot, three views. Please note, at the time of dictation, operative report is not available for review. There has been interval resection of the right third metatarsal head and likely the base of the third proximal phalanx. Sharply demarcated lytic changes are also noted within the lateral aspect of the second metatarsal head. There is less well defined lucency of the lateral base of the second proximal phalanx; it is unclear if this represents infectious process or post-surgical change. Evaluation of the medial aspect of the fourth metatarsal head is somewhat limited by overlying packing material, though there appears to be no change compared to prior. Associated soft tissue swelling and subcutaneous gas are noted, but are not unexpected in the perioperative period. ## IMPRESSION: Status post third metatarsal head resection and likely partial resection of the third proximal phalanx and second metatarsal head. Luceny of the base of the second proximal phalanx may reflect unreported post-surgical change, though infection is not excluded. Please correlate with operative history. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "20994523", "time": "2195-04-03 14:10:00"}

Description: 19593675-RR-44Abstract: ## HISTORY: Acute on chronic renal failure please assess renal vasculature. ## FINDINGS: Right kidney measures 10.9 cm. Left kidney measures 10.7 cm. No stones, masses, or hydronephrosis identified in either kidney. Color and spectral Doppler evaluation of the renal vasculature was performed. The main renal veins are patent bilaterally. The main renal arteries are patent bilaterally with peak systolic velocity of 68.4 cm/second on the right and 59.8 cm/second on the left. Intrarenal waveforms show sharp systolic upstrokes with continuous antegrade diastolic flow and resistive indices within normal limits to mildly elevated bilaterally, ranging from 0.69-0.73 on the right and from 0.77-0.80 on the left. The urinary bladder appears within normal limits with bilateral ureteral jets visualized. Renal cortex is minimally echogenic bilaterally. ## IMPRESSION: 1. No stones, masses, or hydronephrosis. Essentially normal renal Doppler examination, with minimally elevated resistive indices which can relate to medical renal disease. Minimally echogenic renal cortex can also be seen in medical renal disease. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "20994523", "time": "2195-04-09 08:53:00"}

Description: 19593675-RR-45Abstract: VEIN MAPPING FOR ARTERIOVENOUS FISTULA, BOTH UPPER EXTREMITIES ## RIGHT ARM: The right brachial artery measures 4 mm in diameter and the radial artery, 1.9 mm. No calcification is seen on either. The right basilic is patent, measuring 2.2-2.5 mm below the elbow, 3-3.5 mm above the elbow. The basilic measures 1.8 mm at the elbow and 3.5-5.1 mm in the upper arm. Phasic flow is seen in both subclavian suggesting patency centrally. ## LEFT ARM: The left brachial artery measures 3.9 mm and the radial artery, 2.1. No calcifications. The cephalic vein is patent, but measures 1-2.2 mm below the elbow, 2 mm at the elbow and 2.2-2.8 mm above the elbow. The basilic vein is quite small measuring 1.3 below the elbow and 4.7-5.5 high up just close to the upper arm and axilla. ## IMPRESSION: 1. Arterial measurements on both upper extremities as indicated above with no calcifications. 2. Vein mapping as noted. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "N/A", "time": "2196-05-22 13:13:00"}

Description: 19593675-RR-49Abstract: ## INDICATION: year old man with h/o CKD (AVF placed in but no dialysis yet), DM c/b diabetic foot ulcer who comes in with foot infection skin removal. // Question of flow for LEFT LOWER EXTREMITY arterial flow given recent ulcer and plan to amputate ## FINDINGS: On the right side, triphasic Doppler waveforms are seen in the right femoral, superficial femoral, popliteal, posterior tibial and monophasic at the dorsalis pedis arteries. The right ABI was 1.27. On the left side, triphasic Doppler waveforms are seen at the left femoral, superficial femoral, popliteal, and biphasic waveforms at the posterior tibial and dorsalis pedis arteries. The left ABI was 0.92. Pulse volume recordings showed symmetric amplitudes bilaterally, at all levels with mildly dampened waveforms at the metatarsal levels. ## IMPRESSION: Evidence of mild arterial insufficiency in the bilateral lower extremities. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "21387022", "time": "2196-10-27 08:56:00"}

Description: 19593675-RR-51Abstract: ## EXAMINATION: FOOT AP,LAT AND OBL LEFT ## INDICATION: year old man s/p partial L digit amputation // post op eval ## FINDINGS: Interval amputation of the third toe from level of base of middle phalanx. No new bone destruction. Plantar and dorsal calcaneal spurs. Vascular calcification. There appears to be a small juxta-articular erosion along the great toe proximal phalanx head, adjacent to the interphalangeal joint. There is mild first MTP degenerative change. Fine osseous details obscured by overlying cast. ## IMPRESSION: Postoperative changes. Incidental small juxta-articular erosion along the IP joint of the great toe - recommend correlation for symptoms here. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "21387022", "time": "2196-10-28 17:54:00"}

Description: 19593675-RR-53Abstract: ## EXAMINATION: SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA LEFT ## INDICATION: year old man with Pain after Left hum fx. // OA F/U LEFT PROXIMAL HUMERAL FX 10 MONTHS AGO DUE TO FALL CHECK HEALING ## FINDINGS: There is a prior surgical fracture at the humerus with superomedial impaction of the shaft into the humerus. There no bridging callus formation. There is subluxation of the humeral head. The visualized lung is within normal limits. There are no other fractures. ## IMPRESSION: A prior surgical fracture of the humerus with subluxation of the humeral head. There is no bridging callus. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593675", "visit_id": "N/A", "time": "2197-09-17 13:47:00"}

Description: 19593689-RR-14Abstract: Department of Radiology Standard Report Carotid US ## REASON: year old man with h/o right CEA and CAD. ## FINDINGS: Duplex evaluation was performed of bilateral carotid arteries. On the right there is no plaque in the ICA. On the left there is significant heterogeneous plaque seen in the ICA, and moderate homogeneous plaque in the CCA.. On the right systolic/end diastolic velocities of the ICA proximal, mid and distal respectively are 107/23, 113/41, 89/35, cm/sec. CCA peak systolic velocity is 105 cm/sec. ECA peak systolic velocity is 237 cm/sec. The ICA/CCA ratio is 1.0. These findings are consistent with no stenosis. On the left systolic/end diastolic velocities of the ICA proximal, mid and distal respectively are 163/39, 159/50, 64/22, cm/sec. CCA peak systolic velocity 138/37 cm/sec. ECA peak systolic velocity is 190 cm/sec. The ICA/CCA ratio is 1.7. These findings are consistent with 60-69% stenosis. Right antegrade vertebral artery flow. Left antegrade vertebral artery flow. ## IMPRESSION: Right ICA no stenosis. Left ICA 60-69% stenosis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593689", "visit_id": "20017597", "time": "2139-03-03 13:13:00"}

Description: 19593690-RR-14Abstract: ## EXAMINATION: CHEST (AP AND LAT) ## INDICATION: with question of recrudescence of stroke, please eval for occult pneumonia ## FINDINGS: Moderate enlargement of the cardiac silhouette is present. The aorta is tortuous with atherosclerotic calcifications noted at the knob. There is likely a moderate-sized hiatal hernia. Hilar contours are normal. No pulmonary edema seen. Linear and streaky opacities in the lung bases likely reflect areas of atelectasis. Lungs are hyperinflated with relative attenuation of pulmonary vascular markings towards the apices suggestive of emphysema. No focal consolidation or pneumothorax is duct identified. Moderate degenerative changes are noted in the thoracic spine. ## IMPRESSION: Streaky bibasilar atelectasis without focal consolidation. Emphysema and probable moderate size hiatal hernia. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593690", "visit_id": "26244397", "time": "2174-02-01 16:57:00"}

Description: 19593690-RR-15Abstract: ## EXAMINATION: CTA HEAD AND CTA NECK PQ147 CT HEAD NECK. ## INDICATION: History of prior infarct and right carotid artery stenosis presenting with left facial droop and left arm weakness. ## DOSE: Acquisition sequence: 1) Sequenced Acquisition 7.2 s, 18.0 cm; CTDIvol = 56.1 mGy (Head) DLP = 1,009.3 mGy-cm. 2) Stationary Acquisition 4.5 s, 0.5 cm; CTDIvol = 98.0 mGy (Head) DLP = 49.0 mGy-cm. 3) Spiral Acquisition 4.8 s, 37.5 cm; CTDIvol = 31.8 mGy (Head) DLP = 1,194.5 mGy-cm. Total DLP (Head) = 2,253 mGy-cm. ## CT HEAD WITHOUT CONTRAST: There is an area of right posterior frontal encephalomalacia suggestive of chronic infarct (03:25). There is no evidence of no evidence of acute large territorial infarction, hemorrhage, edema, or mass. TThere is prominence of the ventricles and sulci suggestive of involutional changes. Areas of confluent periventricular, subcortical and deep white matter hypodensity are in a configuration most suggestive of chronic small vessel ischemic disease. . There is a tiny mucous retention cyst in the floor of the left maxillary sinus. The remainder of the visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. ## CTA HEAD: There are mild atherosclerotic calcifications in the V4 segments of the bilateral vertebral arteries without significant narrowing. There is mild atherosclerotic calcification of the bilateral intracranial internal carotid arteries without significant narrowing. There is minimal irregularity of the left M1 segment of the MCA without significant narrowing, likely secondary to atherosclerotic disease. The vessels of the circle of and their principal intracranial branches appear patent without significant stenosis, occlusion, or aneurysm formation. The dural venous sinuses are patent. ## CTA NECK: There is mild calcified and noncalcified atherosclerotic plaque of the aortic arch. There is variant common origin of the brachiocephalic and left common carotid artery. There is minimal atherosclerotic calcification of the origin of the right bilateral vertebral arteries without significant narrowing. There is moderate left and severe right calcified and mainly noncalcified atherosclerotic plaque of the carotid bifurcations. There is near complete occlusion of the right internal carotid artery at its takeoff with a thin wisp the lumen remaining, with likely greater than 90% stenosis (5:104). There is no significant left internal carotid artery stenosis by NASCET criteria. The carotid and ertebral arteries and their major branches appear normal with no evidence of stenosis, dissection or occlusion. ## OTHER: There is severe centrilobular emphysema. Scattered calcified granulomas are noted. The visualized lung apices are otherwise grossly clear. The visualized portion of the thyroid gland is within normal limits. There is no lymphadenopathy by CT size criteria. ## IMPRESSION: 1. Small chronic right posterior frontal infarct. 2. Otherwise no evidence of acute large territorial infarct or hemorrhage. 3. Patent intracranial vasculature without significant stenosis, occlusion, or aneurysm formation. 4. Moderate left and severe right calcified and mainly noncalcified atherosclerotic plaques of the carotid bifurcations with near complete occlusion of the right internal carotid artery with greater than 90% stenosis. 5. Otherwise patent cervical vasculature without occlusion, or dissection. 6. Severe centrilobular emphysema. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593690", "visit_id": "26244397", "time": "2174-02-01 18:11:00"}

Description: 19593690-RR-16Abstract: ## INDICATION: Atrial fibrillation, right internal carotid artery stenosis, prior infarct presenting with new left facial weakness and worsening of existing left arm and leg weakness. Evaluate for infarct. ## FINDINGS: There is slow diffusion in the right frontal lobe in a watershed distribution with associated FLAIR hyperintensity. Additional numerous punctate areas of slow diffusion are noted throughout the year right frontal and right parietal lobe as well as another punctate focus in the right caudate head with associated FLAIR hyperintensity. There is no evidence of hemorrhage, masses, mass effect, or midline shift. There is prominence of the ventricles and sulci suggestive involutional changes. Confluent areas of periventricular, subcortical, deep and pontine white matter T2/FLAIR hyperintensity are in a configuration suggestive of chronic small vessel ischemic disease. The principal intracranial vascular flow voids are preserved. The visualized paranasal sinuses are grossly clear. The orbits are grossly unremarkable. . ## IMPRESSION: 1. Acute to subacute right frontal infarct in a right MCA/ACA watershed distribution. 2. Numerous scattered punctate areas of slow diffusion in the right frontal and right parietal lobes as well as the right caudate head compatible with acute to subacute infarct, in a thromboembolic distribution. 3. No hemorrhage or suggestion of mass. 4. Mild global atrophy and areas of white matter signal abnormality in a distribution suggestive of chronic small vessel ischemic disease. Note that reported prior imaging from dated is not available for review. ## NOTIFICATION: Neurology was aware of findings at time of dictation. A wet read was provided by Dr. on at 06:59 stating "Areas of slow diffusion is identified at the right frontal lobe and caudate head, in watershed distribution. The affected area demonstrates FLAIR hyperintensity. Findings are suggestive of late acute/subacute infarct. periventricular white matter FLAIR hyperintensities are nonspecific." Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593690", "visit_id": "26244397", "time": "2174-02-03 00:12:00"}

Description: 19593690-RR-18Abstract: ## INDICATION: year old man with s/p R CEA // Eval re-stenosis ## RIGHT: The right carotid vasculature has mild heterogeneous calcified atherosclerotic plaque. The peak systolic velocity in the right common carotid artery is 70 cm/sec. The peak systolic velocities in the proximal, mid, and distal right internal carotid artery are 35, 63, and 77 cm/sec, respectively. The peak end diastolic velocity in the right internal carotid artery is 24 cm/sec. The ICA/CCA ratio is 1.1. The external carotid artery has peak systolic velocity of 159 cm/sec. The vertebral artery is patent with antegrade flow. ## LEFT: The left carotid vasculature has mild heterogeneous calcified atherosclerotic plaque. The peak systolic velocity in the left common carotid artery is 56 cm/sec. The peak systolic velocities in the proximal, mid, and distal left internal carotid artery are 62, 84, and 81 cm/sec, respectively. The peak end diastolic velocity in the left internal carotid artery is 35 cm/sec. The ICA/CCA ratio is 1.5. The external carotid artery has peak systolic velocity of 87 cm/sec. The vertebral artery is patent with antegrade flow. ## IMPRESSION: There is less than 40% stenosis within the internal carotid arteries bilaterally. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593690", "visit_id": "N/A", "time": "2174-03-11 12:21:00"}

Description: 19593690-RR-19Abstract: ## EXAMINATION: CTA AORTA/BIFEM/ILIAC RUNOFF W/WANDWO C AND RECONS ## INDICATION: year old man with Claudication// Eval possible Agram vs bypass ## RUN OFF CTA: Non-contrast images and arterial phase images were acquired from diaphragm through toes. Delayed images were obtained from the knees to the toes. Oral contrast was not administered. MIP reconstructions were performed on independent workstation and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Spiral Acquisition 8.4 s, 133.7 cm; CTDIvol = 2.2 mGy (Body) DLP = 295.1 mGy-cm. 2) Spiral Acquisition 8.3 s, 132.4 cm; CTDIvol = 6.7 mGy (Body) DLP = 882.2 mGy-cm. 3) Spiral Acquisition 4.1 s, 65.4 cm; CTDIvol = 5.3 mGy (Body) DLP = 344.8 mGy-cm. 4) Stationary Acquisition 5.1 s, 0.5 cm; CTDIvol = 27.8 mGy (Body) DLP = 13.9 mGy-cm. Total DLP (Body) = 1,536 mGy-cm. ## VASCULAR: There is an infrarenal aneurysm of the abdominal aorta, measuring approximately 4.3 x 4.4 cm. There is severe narrowing at the origin of the celiac artery (image 21, series 3). The superior mesenteric and renal arteries are widely patent. The inferior mesenteric artery is occluded at its origin, reconstituted distally via collaterals. There is extensive atherosclerotic disease of the abdominal aorta and its major branches, with complete thrombotic occlusion of the left common, external iliac, and common femoral arteries. The left internal iliac is reconstituted via collaterals. The left femoral artery is reconstituted via collaterals. The left profunda femoris is widely patent. The left femoral artery is moderately atherosclerotic, with mild-to-moderate atherosclerotic narrowing throughout its course and complete occlusion just above the knee. A large arterial collateral extends along the medial aspect of the knee, reconstituting the distal left popliteal artert. The tibioperoneal trunk is widely patent. Three-vessel runoff in the left lower extremity is maintained to just above the ankle (image 593, series 3). There is diminutive flow in the anterior tibial and peroneal arteries at the level of the ankle, with robust flow in the posterior tibial artery. The right common iliac is severely atherosclerotic with mild narrowing. The right internal iliac is aneurysmal, measuring up to approximately 1.4 cm. The right external iliac is occluded shortly after its origin, reconstituting at the level of the profunda femoris, via collaterals. The right femoral artery is occluded throughout its course, reconstituting at the level of the right popliteal artery. The tibioperoneal trunk is widely patent. Flow in the anterior tibial artery is maintained to the mid right lower extremity. 2 vessel runoff is maintained beyond the ankle in the right lower extremity, with diminutive flow in the peroneal artery. ## LOWER CHEST: Large hiatal hernia noted, containing the stomach. There is bronchiectasis and scarring/atelectasis at the lung bases. Pulmonary nodule with large coarse calcification noted at the right lung base, measuring 7 mm. ## HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Benign-appearing cystic liver lesions measure up to 3 cm. Additional subcentimeter hypoattenuating liver lesions are too small to characterize, most likely biliary hamartomas or cysts. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits, without stones or gallbladder wall thickening. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ## ADRENALS: The right and left adrenal glands are normal in size and shape. 5 mm left adrenal adenoma noted. ## URINARY: The kidneys are of normal and symmetric size with normal nephrogram. Simple renal cysts measure up to 4.7 cm. Subcentimeter hypoattenuating renal lesions are too small to characterize, most likely representing cysts. No concerning renal lesions or hydronephrosis.. ## GASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness and enhancement throughout. There is colonic diverticulosis without diverticulitis. ## LYMPH NODES: Mildly prominent retroperitoneal lymph nodes noted. There is a 1 cm peripancreatic node noted on image 38 of series 3. ## PELVIS: Thickening of the bladder wall is likely related to chronic obstructive uropathy. Diverticulum noted along the anterior bladder wall (image 29, series 3). There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: The prostate is enlarged. ## BONES: No concerning osseous lesions, noting multilevel degenerative changes. ## SOFT TISSUES: The abdominal and pelvic wall is within normal limits. ## IMPRESSION: 1. Complete occlusion of the left common iliac, external iliac, and common femoral artery and proximal superficial femoral artery. Distal reconstitution at the level of the distal superficial femoral artery above the knee. Three-vessel runoff is maintained to just above the ankle, via collateral reconstitution. 2. Complete occlusion of the right external iliac, common femoral, and femoral artery. Distal reconstitution at the level of the popliteal artery via colaterals, with 2 vessel runoff at the level of the ankle, diminutive flow in the anterior tibial and peroneal arteries. 3. Infrarenal abdominal aortic aneurysm (4.4 cm) with extensive mural thrombus. 4. Right internal iliac artery aneurysm (up to 1.4 cm). 5. Severe narrowing at the origin of the celiac artery. 6. Occlusion of the origin of the inferior mesenteric artery. 7. Enlarged prostate, with thickening of the bladder wall, likely related to chronic obstructive uropathy. 8. Diverticulosis 9. Large hiatal hernia, containing most of the stomach. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593690", "visit_id": "N/A", "time": "2174-09-20 15:11:00"}

Description: 19593730-RR-17Abstract: ## EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN) ## INDICATION: male with cirrhosis, acute decompensation, cat bite to left upper extremity with swelling ## LIVER: The hepatic parenchyma appears coarsened and echogenic. There is no focal liver mass. The main portal vein and its major branches are patent with normal hepatopetal flow. Evaluation of the common hepatic artery is somewhat limited but increased peak systolic velocity is noted. This could be partly technical or relate to compensatory increased flow. The hepatic veins are patent. There is no ascites. ## BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 5 mm. ## GALLBLADDER: There is gallbladder sludge, and gallbladder wall thickening is likely secondary to chronic liver disease. There is a small cholesterol polyp. ## PANCREAS: The pancreas is not well seen secondary to overlying bowel gas. ## SPLEEN: Normal echogenicity, measuring 18.9 cm. ## IMPRESSION: 1. Cirrhotic appearance of the liver with signs of portal hypertension including splenomegaly. 2. Patent portal vein with normal hepatopetal flow. 3. Increased peak systolic velocity within the common hepatic artery could be due to technical factors or reflect compensatory increased flow versus stenosis. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593730", "visit_id": "N/A", "time": "2136-11-11 22:58:00"}

Description: 19593730-RR-20Abstract: ## INDICATION: male with fall, altered mental status, thrombocytopenia. ## FINDINGS: There is no evidence of acute intracranial hemorrhage, edema, mass effect, or large vascular territorial infarction. The ventricles and sulci are normal in size and configuration. The basal cisterns appear patent, and there is preservation of normal gray-white matter differentiation. No fracture or osseous lesion is identified. The globes are intact. Mild mucosal thickening is noted within the right sphenoid sinus. ## IMPRESSION: No acute intracranial hemorrhage or mass effect. Correlate clinically to decide on the need for further workup or followup. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593730", "visit_id": "22305515", "time": "2136-11-12 00:02:00"}

Description: 19593730-RR-21Abstract: ## INDICATION: male with fall, altered mental status, thrombocytopenia ## FINDINGS: There is no evidence of acute fracture or traumatic malalignment. There is mild anterolisthesis of C3-C4. There is no prevertebral soft tissue swelling. Degenerative changes are most notable at C5-C6 and C6-C7 with disk space loss and endplate irregularities, uncovertebral and facet degenerative changes at multiple levels from C3 -C6 levels. There is mild left foraminal narrowing at C5-6 and C6-7 levels. Assessment of foraminal narrowing is somewhat limited due to the angulation. No significant canal narrowing from osseous components. Carotid calcifications noted on the left side. Soft tissues of the neck are partially imaged hence limited assessment. The visualized lung apices are clear. ## IMPRESSION: No acute fracture or traumatic malalignment. Multilevel, multifactorial degenerative changes, with mild left-sided foraminal narrowing as described above. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593730", "visit_id": "22305515", "time": "2136-11-12 00:03:00"}

Description: 19593730-RR-33Abstract: ## FINDINGS: An endotracheal tube terminates 6.2 cm above the carina. Orogastric tube extends to at least the level of the stomach, with the tip excluded by this study. A right IJ catheter terminates at the lower SVC. The heart size is top normal, appearing slightly improved since . Central pulmonary vascular congestion has improved, and pulmonary edema is nearly resolved. A left pleural effusion has resolved. No pneumothorax is detected. There is no new focal consolidation. ## IMPRESSION: Decreased central pulmonary vascular congestion with nearly-resolved pulmonary edema. Resolved left pleural effusion. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593730", "visit_id": "22305515", "time": "2136-11-14 03:50:00"}

Description: 19593791-RR-18Abstract: ## INDICATION: A man with kidney stones. Status post percutaneous nephrolithotomy. ## FINDINGS: There are persistent bilateral stones in both kidneys. The largest on the left is in the inferior pole and measures up to 1.8 cm in size. A 1.2 cm stone is also noted in the interpolar region on the left. On the right, there are persistent stones bilateral double J catheters are demonstrated in good position. The gas pattern is normal. No other abnormalities are noted. ## IMPRESSION: 1. Persistent bilateral stones as described. 2. Bilateral double J stents in good position. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2143-07-07 13:13:00"}

Description: 19593791-RR-23Abstract: ANTEGRADE NEPHROSTOGRAM, PERCUTANEOUS NEPHROSTOMY WIRE PLACEMENT FOR NEPHROLITHOTOMY/NEPHROTRIPSY ## PHYSICIANS: Drs. . The Attending Radiologist, Dr. , was present and supervising throughout the entire procedure. ## INDICATION: Left renal calculus, need for wire placement prior to percutaneous nephrolithotomy. ## ANESTHESIA: Moderate sedation was provided by administering divided doses of 2 mg of Versed and 125 mcg of fentanyl throughout the total intraservice time of 2 hours and 45 minutes, during which the patient's hemodynamic parameters were continuously monitored. ## IMPRESSION: Uncomplicated placement of two access wires via the lower pole calix of the left kidney with the distal aspects located within the urinary bladder. ## PLAN: The patient is to be transported to the operating room for nephrolithotomy. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "24466445", "time": "2144-07-06 10:48:00"}

Description: 19593791-RR-25Abstract: ## STUDY: CT of the abdomen and pelvis without contrast. ## HISTORY: male status post left-sided percutaneous nephrolithotomy and left ureteral stent exchange on , presenting for evaluation of residual calculi. The patient has a history of multiple sclerosis. ## OSSEOUS STRUCTURES: There is diffuse osteopenia. A bilobed hyperdense focus within the left iliac bone most likely represents a small bone island (2:82). Small adjacent hyperdense focus also likely represents a bone island (2:86). These foci are unchanged significantly compared to . Mild depression of the superior endplate of the L1 vertebral body is new compared to the CT of and probably reflects a compression fracture (301B:39). ## IMPRESSION: 1. Evidence of recent left renal procedure including air within the left renal collecting system and perinephric and ureteral inflammatory change as described. At least two hyperdense fragments are identified in the lower pole of the left kidney and may represent residual, nonobstructing calculi. Left percutaneous nephrostomy tube and left ureteral double-J stent. 2. Right renal staghorn calculi with essentially unchanged hydronephrosis involving the upper pole, likely chronic. New right ureteral hydronephrosis and thickening of the ureteral wall may reflect underlying inflammatory process. 3. Suprapubic catheter and thickening of the bladder wall may be related to patient's known neurogenic bladder, but cystitis cannot be excluded on the basis of this examination. 4. Extensive stool including large volume of stool within the rectal vault. Minimal associated rectal wall thickening. 5. New compression fracture involving the L1 vertebral body compared to the CT of , age indeterminate. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "24466445", "time": "2144-07-07 11:09:00"}

Description: 19593791-RR-26Abstract: ## HISTORY: Status post PCNL. SUPINE ABDOMINAL RADIOGRAPH ## FINDINGS: Since the prior CT examination, there has been removal of a percutaneous nephrostomy foley catheter. There is a left-sided double pigtail ureteral catheter in the left renal pelvis extending into the bladder. In the lower pole of the left kidney is a 7-mm renal calculus. In the inferior pole of the right kidney is an 11-mm renal calculus and in the superior pole of the right kidney is an irregularly shaped 14-mm renal calculus. Allowing for differences in technique, the size of these calculi appear grossly unchanged, compared to prior study. There is significant stool in the rectal vault and a nonspecific bowel gas pattern with air and stool in the colon. Degenerative changes are seen in the lumbar spine. ## IMPRESSION: 1. Bilateral renal calculi with left double-J ureteral stent. 2. Nonspecific bowel gas pattern with air and stool in the colon and significant stool in the rectum. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2144-08-06 13:35:00"}

Description: 19593791-RR-27Abstract: ## HISTORY: male with renal stone status post shockwave lithotripsy. Evaluate for residual stone burden. ## ABDOMEN, SUPINE: There has been interval removal of the left nephroureteral stent. There are multiple calcific densities overlying the right renal shadow, compatible with renal calculi. Direct comparison to the prior study from is limited due to overlying stool on the prior study. Several calcific densities also overlie the left renal shadow, the largest measuring approximately 2 cm, also reflecting left renal calculi. There is a nonspecific bowel gas pattern, without obstruction or ileus. Visualized thoracolumbar spine revealed mild degenerative changes of the lower lumbar spine. Sclerotic lesions within the left ilium likely reflect bone islands. ## IMPRESSION: 1. Interval removal of left nephroureteral stent. 2. Bilateral renal calculi. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2144-11-07 12:08:00"}

Description: 19593791-RR-28Abstract: ## CLINICAL INFORMATION: The patient is a man with right kidney stone. A request was made to place right PCN wires for lithotripsy. ## OPERATORS: Dr. , Dr. and Dr. , the attending radiologists who supervised the procedure. ## PROCEDURE: Right PCN wire placement. ## SEDATION: Moderate sedation was provided by administering divided doses of total of 150 mcg of fentanyl and 2 mg of Versed throughout the total intraservice time of 1 hour 30 minutes, during which the patient's hemodynamic parameters were continuously monitored. Lidocaine was used for local anesthesia. ## PROCEDURE AND FINDINGS: After the risks and benefits of the procedure as well as conscious sedation were explained, informed consent was obtained. The patient was brought to the angiographic suite and placed prone on the imaging table. Preprocedure huddle and timeout were performed. After the right flank was prepped and draped in the usual sterile manner, the right lower renal calyx was accessed with a Chiba needle under fluoroscopic guidance and ultrasonic guidance. The inner stylet of the Chiba needle was removed. Contrast injection through the sheath demonstrated the tip of the needle sheath was located inside the calyx. A 0.018 Headliner wire was then placed through the sheath into the right renal calyces and pelvis. The sheath was then removed. An Accustick system was then placed over the wire into the right collecting system. The wire and the inner stiffeners of the Accustick system were removed. Contrast injection through the outer sheath of the Accustick system demonstrated the tip of the sheath was located in the right renal pelvis. A 0.035 wire was then placed through the sheath into the right collecting system with the tip looped inside the right renal pelvis. The sheath was then removed and replaced with a 5 Kumpe catheter. The wire was then manipulated down into the right ureter with the help of the Kumpe catheter and the Kumpe catheter was advanced over the wire into the right ureter. The wire was then removed. A 0.035 super- stiff Amplatz wire was then placed through the Kumpe catheter and advanced down into the right ureter and into the bladder with the tip forming loop inside the bladder. The Kumpe catheter was then removed and a 6 sheath was placed over the Amplatz wire into the right collecting system. The wire was then placed through the sheath into the right collecting system with the tip forming loop inside the right renal pelvis. Both the Amplatz wire and the wire together with the sheath were secured to the skin with tapes. A sterile dressing was applied. The patient tolerated the procedure well, and there were no immediate complications. ## IMPRESSION: Placement of right percutaneous nephrostomy wires via the right lower calyx access with the blue Amplatz wire tip looped inside the bladder and the green wire with its tip looped inside the right renal pelvis. This procedure is preparation for right percutaneous nephrostolithotripsy. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "24695009", "time": "2145-01-25 09:02:00"}

Description: 19593791-RR-32Abstract: ## HISTORY: male with renal stones, following percutaneous nephrolithotomy. ## ABDOMEN, TWO VIEWS: Comparison to radiographs from . There has been interval decrease in the right renal calculi. At least two radiodensities measuring up to 1.3 cm in diameter are present in the right abdomen. No stones are clearly visualized in the left kidney. Extensive bowel gas limits visualization in this examination. The bowel gas pattern is unremarkable. Retained stool is noted in the colon and rectum. Again seen are two sclerotic densities overlying the left ilium, likely representing bone islands. There is unchanged mild degenerative disease of the lower thoracolumbar spine and bilateral hip joints. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2145-03-04 13:52:00"}

Description: 19593791-RR-33Abstract: ## INDICATION: man with history of renal stones. ## FINDINGS: Again visualized are multiple right kidney (renal pelvis) and right ureteral stones which compared to are slightly increased in size, the largest measuring 1.8 x 1 cm (previous exam from , maximum diameter: 1.3 cm). There is unchanged significant fecal loading in the ascending and descending colon, unchanged compared to . There is also again seen a significantly dilated large bowel loop in the mid abdomen which is air-filled and increased luminal diameter compared to prior exam, currently measuring 6.5 cm, likely normal sigmoid colon. ## IMPRESSION: 1. There is interval increase in size of the multiple right kidney and ureteral stones. 2. There is unchanged significant fecal loading in the ascending, descending colon and rectum. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2145-05-20 13:08:00"}

Description: 19593791-RR-35Abstract: ## INDICATION: man with history of stones, for percutaneous nephrostogram of the right kidney and wire placement for intraoperative lithotripsy. ## PROCEDURE: 1. Ultrasound and fluoroscopically guided percutaneous antegrade nephrostogram, right kidney. 2. Wire placement (x2). 3. Post-placement nephrostogram. ## PHYSICIANS: Dr. , the attending radiologist, was present and supervising throughout the procedure. Dr. , fellow. ## MEDICATIONS: 1% local lidocaine. The patient received divided doses of a total of 75 mcg IV fentanyl and 1.5 mg IV Versed throughout the intra- procedure time, during which continuous hemodynamic monitoring was performed. ## PROCEDURE: Prior to initiation of the procedure, written informed consent was obtained and a pre-procedure timeout was performed. The right flank was prepped and draped in a sterile manner. Under the ultrasound guidance, a needle was advanced into the renal collecting system. Contrast opacification was performed. Next, a middle pole calyx was selected and a 21-gauge needle was advanced into the middle pole calyx. A 0.018 guidewire was advanced into the collecting system and into the aorta. The needle was exchanged for an Accustick set sheath, and a 0.035 Amplatz wire was placed with the distal tip in the bladder. The Accustick sheath was exchanged for an 11 Tip 5 sheath, which was positioned within the right renal pelvis. A second 0.035 wire was advanced such that the tip was in the distal ureter. Post-placement nephrostogram was performed. The sheath was secured to the skin with a suture, and both wires were labeled, and a sterile dressing was placed over the wires. The patient tolerated the procedure well and was transported to the operating room after the procedure. ## FINDINGS: 1. Multiple filling defects within the right renal collecting system, and radiopaque foci on fluoroscopy, consistent with multiple stones as seen on prior imaging. 2. Successful access with the right middle pole calyx. 3. Two wires were placed via the right middle pole calyx. A 0.035 Amplatz (blue) wire was placed with the distal tip in the bladder. A second 0.035 wire (green) was placed such that the distal tip was in the distal ureter. ## IMPRESSION: Successful right percutaneous nephrostogram and wire placement for intraoperative lithotripsy. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "22439905", "time": "2145-09-06 09:54:00"}

Description: 19593791-RR-36Abstract: ## HISTORY: man, with history of renal stone. Now status post interval removal of percutaneous nephrostomy tube. ## CT ABDOMEN WITHOUT CONTRAST: The lung bases are clear without pleural effusions. The non-IV contrast study limits evaluation of intra-abdominal parenchymal organs. Allowing for the limitations, the liver, gallbladder, spleen, adrenal glands are gross normal. The stomach, duodenum and loops of small bowels are unremarkable. The right kidney measures 11.9 cm. The left kidney measures 13.1 cm. No perinephric stranding or fluid collection is noted. Moderate bilateral nephrolithiasis is again noted. On the right side, there is apparently increased stone burden, with migration of a stone into the UPJ, but without complete obstruction. Mild right hydroureteronephrosis persists. Again noted is a 10-mm exophytic, relatively hypodense lesion in the right lower pole, incompletely evaluated in the current study. In the left kidney, there is interval removal of the left percutaneous nephrostomy tube and left ureteral stent. Small stones layer in the dependent portion of the collecting system. No obstructing stone is noted. Cortical thinning is most evident in the left lateral cortex. There is interval increased degree of now moderate hydronephrosis. Abrupt tapering is noted at the left UPJ, possibly secondary to adhesion. The left ureter is nearly normal in caliber. Multiple small retroperitoneal nodes are seen in the para-aortic region, at the level of the kidneys, with the largest one measure 8 mm on the right (image 2:38) and 8 mm on the left (image 2:41), not pathologically enlarged by CT criteria, likely reactive to the underlying renal pathology. There is no free air or fluid in the intra-abdominal cavity. ## CT PELVIS WITHOUT CONTRAST: An indwelling suprapubic catheter is noted in the collapsed bladder. There is a small amount of intraluminal air in the bladder, compatible with recent instrumentation. There is no stone in the distal ureters or the bladder. Moderate fecal loading is most evident in the rectal vault. No free air, fluid or gross lymphadenopathy is noted in the pelvis. Scattered vascular calcification is noted in the descending aorta and its major branches. ## BONE WINDOW: No suspicious lytic or sclerotic lesion is noted. ## IMPRESSION: 1. Interval removal of the left percutaneous nephrostomy tube and left ureteral stent. Small non-obstructing stones layering in the dependent portion of the left collecting system. Interval increase of left-sided moderate hydronephrosis. Abrupt tapering at the left UPJ, possibly from adhesion. No left hydroureter. 2. Interval increase of stone burden in the right kidney. Relatively unchanged degree of mild hydroureteronephrosis. A partially obstructing stone extends into the right UPJ. 3. No perinephric fluid collection to suggest abscess. 4. Indwelling suprapubic urinary catheter in a collapsed bladder. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2145-08-07 10:39:00"}

Description: 19593791-RR-41Abstract: ## TYPE OF EXAMINATION: Chest AP portable single view. ## INDICATION: male patient with PICC in place, check position. ## FINDINGS: AP single view of the chest has been obtained with patient in sitting semi-upright position. Available for comparison is a preceding chest examination of . On the single view examination again relatively high positioned diaphragms are noted being the cause of the bilateral plate atelectases. No evidence of acute parenchymal infiltrates is present. A right-sided PICC line is identified and seen to terminate overlying the SVC at a level 2 cm below the carina. No pneumothorax has developed. On the preceding study of similar findings were observed. A right-sided PICC line existed already at that time and appeared to be in slightly lower termination position. ## IMPRESSION: Stable chest findings. PICC line on right side terminating in acceptable position. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "29624673", "time": "2145-10-03 13:49:00"}

Description: 19593791-RR-42Abstract: ## FINDINGS: Extensive confluent white matter lesions are seen in the periventricular and subcortical white matter in the supratentorial brain. There are also similar changes in the pons, midbrain and bilateral cerebellar hemispheres. There is enhancement in the right parietal subcortical white matter, right frontal lobe centrum semiovale, punctate enhancing focus in the left frontal lobe and in the left parietal lobe as well as left temporal periventricular white matter and the left inferior cerebellum. The left inferior cerebellar lesion appears to be new compared to . There is no evidence for hydrocephalus or acute ischemia. Intracranial flow voids are maintained. ## IMPRESSION: Extensive white matter changes with multiple enhancing lesions which were previously non enhancing,as described above. Meta Data: {"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19593791", "visit_id": "N/A", "time": "2146-11-04 11:33:00"}