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13578203-RR-13

## CLINICAL HISTORY: woman with VP shunt and high white count, mental retardation. Assess shunt. ## FINDINGS: AP and lateral skull, AP neck and chest as well as the abdomen were provided. ## FINDINGS: A right parietal bone access VP shunt is seen with ventriculostomy extending to the approximate level of the right lateral ventricle. Shunt tubing extends also through a separate entry point in the right occipital bone and shunt tubing then travels inferiorly through the soft tissues of the right neck, right chest. Tubing is seen terminating in the right lower quadrant. There is no sign of shunt kinks or discontinuity. The lungs appear clear bilaterally. Bowel gas pattern is unremarkable. Bones appear intact. ## IMPRESSION: Shunt positioned as described without evidence of kinks or discontinuity.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13578203", "visit_id": "N/A", "time": "2131-07-31 17:27:00"}

17822878-RR-44

DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM, ## CLINICAL INFORMATION: Pain in the right axillary tail/lower axilla at the site of previous biopsy revealing a benign reactive lymph node. Now for further evaluation. ## FINDINGS: Routine views of both breasts were performed using GE digital mammography. Comparison made with . Both breasts demonstrate a heterogeneously dense glandular pattern. Overlying the right pectoralis muscle in the axilla, there are a few new surgical clips seen from patient's excisional biopsy of a benign lymph node. No dominant mass, significant clustered calcification, or architectural distortion is seen. Stable benign intramammary lymph node is again noted in the upper outer superficial right breast. For further evaluation of focal axillary tail/lower axillary pain, ultrasound was performed. No fluid collection is identified. At the inferior aspect of the surgical scar in the upper outer quadrant, a 1 x 1.1 x 0.5 cm benign- appearing lymph node is seen. There is an adjacent smaller benign- appearing lymph node measuring 0.3 x 0.5 x 0.3 cm. No suspicious mass is identified. ## IMPRESSION: New surgical clips overlying the right axillary region consistent with patient's surgical excisional biopsy of a lymph node revealing benign reactive process. Ultrasound directed to the area of focal pain reveals no suspicious mass. Incidentally noted are two benign-appearing lymph nodes at the inferior aspect of the scar. Results discussed with the patient. BI-RADS 2 - benign.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17822878", "visit_id": "N/A", "time": "2137-05-03 14:48:00"}

18887130-RR-158

## EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD ## INDICATION: year old woman with neutropenic fever and headache // evaluate for intracranial bleed, stroke ## DOSE: Acquisition sequence: 1) Stationary Acquisition 4.0 s, 15.1 cm; CTDIvol = 49.8 mGy (Head) DLP = 752.0 mGy-cm. Total DLP (Head) = 752 mGy-cm. ## FINDINGS: Metallic streak artifact related to prior supraclinoid ICA embolization and dental amalgam streak severely limits the study at the skullbase. Within this confine: There is no evidence of acute large territory infarct, hemorrhage, edema, or mass effect. There is prominence of the ventricles and sulci suggestive of age-related involutional changes. 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: Metallic streak artifact related to prior supraclinoid ICA embolization and dental amalgam streak artifact severely limits evaluation near the skullbase. Within this confine: 1. No acute intracranial abnormalities on noncontrast head CT. Specifically no large territory infarct or intracranial hemorrhage. The paranasal sinuses appear clear. The mastoid air cells are clear.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18887130", "visit_id": "28046425", "time": "2186-03-11 14:39:00"}

11721267-RR-15

## INDICATION: Head strike last night with persistent pain and dizziness. ## FINDINGS: There is no evidence of hemorrhage, edema, mass, mass effect, or large vascular territory infarction. The ventricles and sulci are normal in size and configuration for the patient's age. The basal cisterns are patent. There is preservation of gray-white matter differentiation. No fracture is identified. The visualized paranasal sinuses, mastoid air cells and right middle ear cavity are clear. Cerumen is present in the left middle ear cavity. The soft tissues are unremarkable. ## IMPRESSION: No acute intracranial abnormality.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11721267", "visit_id": "N/A", "time": "2150-12-20 21:44:00"}

18725847-RR-61

## INDICATION: Recent diagnosis invasive lobular carcinoma left breast. Evaluate extent of disease and screen the right breast. ## FINDINGS: Breast tissue is heterogeneously dense. Background enhancement is mild to moderate. In the right breast, there are scattered subcentimeter T2 bright nodules consistent with cysts. There are also scattered foci of enhancement. In the left breast, there is a spiculated enhancing mass at the 6 o'clock position posterior depth corresponding to the biopsy-proven invasive lobular carcinoma. On MR, the mass measures 2.2 cm AP x 0.7 cm craniocaudal x 1.8 cm transverse. There is artifact within the mass from a biopsy marking clip status post ultrasound core biopsy. CAD imaging shows rapid washout, also supporting a diagnosis of malignancy. In the left breast, o'clock position, there are two nodular areas of enhancement at an anterior depth, containing two biopsy marking clips. This corresponds with the areas which were biopsied with ultrasound guidance on and , and yielded "stromal fibrosis" following the first ultrasound-guided core biopsy and "dense fibrous breast tissue with columnar cell change and hemosiderin laden macrophages, no malignancy" at the second biopsy. The more anterior nodular area of enhancement measures 1.2 cm in greatest dimension and the more posterior and inferior nodular area of enhancement measures 8 mm in greatest dimension. Kinetics demonstrate progressive enhancement in these areas. There is an additional lobulated enhancing nodule in the upper inner quadrant of the left breast approximately at a middle depth. This nodular area of enhancement measures 6 mm in greatest dimension and demonstrates progressive enhancement kinetics. On T2 imaging, a portion of the nodule is T2 hyperintense. ## IMPRESSION: 1. Spiculated enhancing mass left breast 6 o'clock position corresponding to biopsy-proven invasive lobular carcinoma. 2. Nodular areas of enhancement at the o'clock position of the left breast with progressive enhancement kinetics, corresponding to the areas which were biopsied with ultrasound and showed benign pathology. Given the variable appearance of lobular carcinoma at MR, excision of this area is still recommended based on imaging appearance. 3. 1.2 cm lobulated enhancing nodule upper inner quadrant of the left breast, which may represent a fibroadenoma. Targeted ultrasound and biopsy is recommended if the patient is planning breast conservation therapy. 4. No evidence of malignancy in the right breast. BI-RADS 6 - known carcinoma. Targeted ultrasound and biopsy of the nodule in the upper inner quadrant of the left breast recommended. Findings E-mailed to Dr. in Breast Care Center on .

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18725847", "visit_id": "N/A", "time": "2158-06-25 19:20:00"}

14249143-RR-21

## EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD ## INDICATION: Mr. is an year old man invasive gastric cancer, diastolic CHF, AF, hematuria, CAD and chronic HBV infection, who presented with generalized weakness and abnormal lab results at nursing home. // s/p fall on anticoagulation ## DOSE: Acquisition sequence: 1) CT Localizer Radiograph 2) CT Localizer Radiograph 3) Sequenced Acquisition 16.0 s, 16.4 cm; CTDIvol = 49.0 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. ## FINDINGS: Acute right parafalcine subdural hemorrhage measuring up to 5 mm (series 2, image 24). There is also a small amount of serpentine acute blood adjacent to the right falx suggesting subarachnoid hemorrhage (series 2, image 23). No shift of normally midline structures. Is prominence of the ventricles and sulci suggest cortical atrophy, likely age related. Hypodensities within the left basal ganglia may represent old lacunar infarcts. No large acute territorial infarct. The basilar cisterns are patent. Extensive internal carotid artery calcifications are noted. No evidence of a fracture. There is partial opacification of the paranasal sinuses. Aerosolized secretions are noted in the right maxillary sinus. There is mild mucosal thickening of the left maxillary sinus. There is mild mucosal thickening of the left sphenoid sinus. The right sphenoid sinus is clear. Frontal sinuses clear. The right frontal sinuses hypoplastic or absent. The mastoid air cells are underpneumatized, particularly on the right. The lens of been replaced. The orbits are otherwise unremarkable. ## IMPRESSION: 1. Small 5-mm focal acute right parafalcine subdural hemorrhage. 2. Small subarachnoid hemorrhage along the right falx. 3. No evidence of fracture. 4. Paranasal sinus disease as above. ## NOTIFICATION: The findings were discussed by Dr. with Dr. on the telephoneon at 6:11 AM, 1 minutes after discovery of the findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14249143", "visit_id": "24965477", "time": "2177-01-04 05:11:00"}

15265088-RR-20

## TYPE OF EXAMINATION: Chest PA and lateral. ## INDICATION: Preoperative to aortic valve replacement and possible coronary artery bypass surgery in patient with history of aortic stenosis. ## FINDINGS: PA and lateral chest views were obtained with patient in upright position. The heart is mildly enlarged. The configuration indicates a prominence of the left ventricular contour, finding which in conjunction with the moderately widened thoracic aorta is suggestive of hypertension. Most striking prominence of the ascending aorta is noted and no conclusive evidence for aortic valve calcifications is seen on the PA and lateral chest views. Pulmonary vasculature is not congested and no acute pulmonary infiltrates are present. Lateral and posterior pleural sinuses are free of fluid accumulations. Noteworthy is a moderately sized hiatal hernia in retrocardiac position with typical air-fluid level. Our records do not include a previous chest examination available for comparison. ## IMPRESSION: No evidence of acute pulmonary congestion or infiltrates on preoperative chest examination. Observe presence of a moderately sized hiatal hernia.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15265088", "visit_id": "N/A", "time": "2160-01-11 15:19:00"}

19407684-RR-34

PORTABLE AP UPRIGHT CHEST RADIOGRAPH ## HISTORY: woman with cough and fever. Evaluate for pneumonia. ## FINDINGS: The cardiac silhouette is indistinct but appears normal in size. The hilar and mediastinal contours appear grossly unremarkable; however, the evaluation is limited due to patient rotation. There is marked calcification of the aortic arch. There is right apical pleural scarring, unchanged. There is increased interstitial markings superiorly and bilaterally suggestive of underlying emphysema. The lungs also appear slightly lucent. There is elevation of the left hemidiaphragm as well as left basilar atelectasis. The left cardiac border as well as diaphragm is obscured, likely related to basilar atelectasis or an early left basilar pneumonia. There is a small left pleural effusion. The right lung appears clear. There are degenerative changes noted of the thoracolumbar spine. Bones are diffusely osteopenic. Otherwise, there are no soft tissue or osseous structural abnormalities. ## IMPRESSION: 1. Left basilar consolidation representative of atelectasis or early pneumonia. 2. Small left pleural effusion. 3. Underlying apical emphysema. Right apical scarring.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19407684", "visit_id": "24667745", "time": "2119-01-19 08:52:00"}

14190536-RR-11

## EXAMINATION: MR CERVICAL, THORACIC AND LUMBAR SPINE W/O CONTRAST ## INDICATION: Patient with multiple myeloma and severe low back pain, concern for cord compression. ## FINDINGS: There is diffuse heterogeneity of signal throughout the entire spine compatible with infiltrative process from multiple myeloma. Anterior wedge compression fractures of T9 and T11 are present, with loss of over 50 % of anterior vertebral body height at the level of T9 and more than 75 % of at the level of T11. There is also compression deformity of T12 spanning the whole vertebral body with at least 50 % of height. There is minimal retropulsion of a bony fragment at T11 described in detail in the thoracic portion of this report, but there is no evidence of spinal canal stenosis or cord compression. No other fracture is identified throughout the spine. There is no prevertebral soft tissue swelling or paraspinal soft tissue abnormality. Degenerative changes are seen throughout the spine: ## CERVICAL SPINE: The aerodigestive tract is unremarkable. Imaged portions of the lungs and cerebellum are normal. ## C1-C2: The lateral masses are symmetric with respect to the dens. No spinal canal narrowing. No abnormality of the alar ligaments. ## C2-C3: There is normal disc height. No disc bulge or spinal canal or neural foraminal narrowing is present. ## C3-C4: Minimal disc bulge without spinal canal stenosis or neural foramina narrowing. ## C4-C5: Minimal disc bulge without spinal; canal stenosis or neural foramina narrowing. ## C5-C6: There is low T2 signal of the disc, loss of disc space and disc bulge resulting in mild indentation into the spinal canal but no contact with the cord. Mild right neural foramen narrowing is present. Unremarkable left neural foramen. ## C6-C7: There is normal disc height. No disc bulge or spinal canal or neural foraminal narrowing is present. ## C7-T1: There is normal disc height. No disc bulge or spinal canal or neural foraminal narrowing is present. ## THORACIC SPINE: There are anteriorly wedged compression fractures of T9 and T11 as well as compression deformity of T12 resulting in exaggeration of the thoracic kyphosis without vertebral malalignment. The thoracic spinal cord shows normal morphology and signal intensity. The posterior elements and paraspinal soft tissues are normal. T1 through T7: There is no disc herniation, or spinal canal or neural foraminal stenosis. ## T7-T8: There is low T2 signal of the disc, loss of disc space and minimal disc bulge resulting in mild indentation into the spinal canal but no contact with the cord. T8-T9 through T10:T11: There is minimal disc bulge at all levels resulting in mild indentation into the spinal canal but no contact with the cord. No neural foramina narrowing. ## T11-T12: There is retropulsion of a small bony fragment from the posterosuperior corner of T12 with superimposed disc bulge resulting in moderate spinal canal stenosis and impingement of the disc upon the cord which appears deformed but without definite signal abnormality at this level - apparent central linear high T2 signal in the cord is not confirmed in the axial views and likely the result of artifact. Bilateral neural foramina narrowing is present with contact seen between the disc and the exiting T12 roots on both sides. ## LUMBAR SPINE: The vertebral body height and alignment is maintained. ## T12-L1: There is minimal disc bulge resulting in mild indentation into the spinal canal but no contact with the cord. No neural foramina narrowing. ## L1-L2: There is low T2 signal of the disc, loss of disc space and disc bulge resulting in mild indentation into the spinal canal but no contact with the cord. Mild right neural foramen narrowing. Normal left neural foramen. L2-L3 and L3-L4: There is no disc herniation, spinal canal or neural foraminal stenosis. ## L4-L5: There is low T2 signal of the disc and disc bulge resulting in mild indentation into the spinal canal but no contact with the cord. No neural foramina narrowing is seen. ## L5-S1: There is no disc herniation, or spinal canal or neural foraminal stenosis. The conus medullaris and cauda equina have normal morphology and signal intensity.The conus medullaris terminates at the L1 level. The posterior elements and paraspinal soft tissues are normal. No gross abnormality is seen in the included structures of the posterior mediastinum and retroperitoneum. ## IMPRESSION: 1. Diffuse heterogeneity of signal throughout the entire spine compatible with infiltrative process from multiple myeloma. 2. Anteriorly wedge compression fractures of T9 and T11 as well as compression deformity of the whole vertebral body of T12 are present, with only minimal retropulsion of a bony fragment at T11-T12 that although impinges upon the thecal sac and deforms the cord, does not result in cord compression. No cord signal abnormality identified. 3. Degenerative changes of the spine resulting in multilevel neural foramina narrowing, more conspicuous at T11-T12, are described in detail in the body of the report. ## NOTIFICATION: The findings were discussed by Dr. with Dr. on the telephone on at 8:45 AM, immediatley after discovery of the findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14190536", "visit_id": "N/A", "time": "2180-09-01 18:13:00"}

12544973-RR-14

## EXAMINATION: CT abdomen and pelvis with contrast ## NO PO CONTRAST; HISTORY: with abdominal pain, vomiting s/p left nephrectomy 5 days agoNO PO contrast // Obstruction, abscess, ileus ## SINGLE PHASE SPLIT BOLUS CONTRAST: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Spiral Acquisition 0.6 s, 6.5 cm; CTDIvol = 8.2 mGy (Body) DLP = 52.9 mGy-cm. 2) Stationary Acquisition 5.0 s, 0.5 cm; CTDIvol = 48.1 mGy (Body) DLP = 24.1 mGy-cm. 3) Spiral Acquisition 5.2 s, 56.5 cm; CTDIvol = 12.8 mGy (Body) DLP = 722.9 mGy-cm. Total DLP (Body) = 800 mGy-cm. ## LOWER CHEST: Bibasilar atelectasis is noted. There is trace bilateral pleural effusion. There is no pericardial effusion. Multiple collateral vessels are seen at the level of the left scapula possibly related to partial venous obstruction. ## ABDOMEN: Study is moderately degraded by streak artifact from previously administered barium contrast within the colon and motion. ## HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is mild intrahepatic and extrahepatic biliary dilatation which may be secondary to cholecystectomy, however this is new since . ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: Patient is status post left nephrectomy with postsurgical staples and foci of free air noted in the left nephrectomy bed. The right kidney is of normal and symmetric size with normal nephrogram. Subcentimeter hypodensity in the inferior pole of the right kidney is too small to characterize likely simple cyst. There is no right hydronephrosis. There is no perinephric abnormality. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Assessment of the colon is limited by oral contrast with in the ascending, transverse, and proximal and distal colon. Within these limitations, no significant abnormalities detected. The appendix is normal. ## PELVIS: The urinary bladder is distended and contains contrast. Foci of gas within the anterior bladder may be secondary to recent instrumentation. There is mild free fluid in the pelvis. At the level of the postsurigcal clips in the left hemipelvis there is a small nondrainable fluid collection (4:59). ## REPRODUCTIVE ORGANS: A 2.4 x 3.0 cm round cystic lesion with rim enhancement in the left hemipelvis likely represents a left adnexal cyst within the left ovary which could be reassessed with ultrasound the patient has pain in this region. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions or acute fracture. ## SOFT TISSUES: A small area of hemorrhage hemorrhage in the subcutaneous tissues with stranding and foci of air overlying the left anterior abdominal wall is likely postsurgical. ## IMPRESSION: 1. Study is moderately degraded by streak artifact from previously administered barium contrast with in the colon and motion. 2. Status post left nephrectomy with postsurgical staples and foci of air noted in the surgical site and left hemipelvis. At the level of the postsurigcal clips in the left hemipelvis there is a small nondrainable fluid collection. 3. A 2.4 x 3.0 cm round cystic lesion with rim enhancement in the left hemipelvis likely represents a left adnexal cyst within the ovary. If the patient has pain in this region follow-up with ultrasound could be performed. 4. There is mild free fluid in the pelvis. 5. Gas within the distended bladder is likely secondary to recent instrumentation. 6. A small hemorrhage in the subcutaneous tissues with stranding and foci of air overlying the left anterior abdominal wall likely postsurgical. 7. There is mild intrahepatic and extrahepatic biliary dilatation which may be secondary to cholecystectomy, however this is new since . Recommend correlation with LFTs. 8. Free intraperitoneal air in keeping with recent surgery is noted for which clinical and radiographic follow-up may be performed to ensure resolution. ## NOTIFICATION: The findings were discussed with , M.D. by , M.D. on the telephone on at 10:38 AM, 15 minutes after discovery of the findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12544973", "visit_id": "27794528", "time": "2186-04-01 03:47:00"}

17321845-RR-10

## INDICATION: Assess for obstruction or strictures in neo-bladder. ## ABDOMEN, SINGLE VIEW: Nonspecific bowel gas pattern. Clips are seen in the lower pelvis and right lower quadrant likely related to cystectomy and ileal conduit. No suspicious lytic or blastic lesion but extensive degenerative changes in the lumbar spine. ## POUCHOGRAM: After insertion of a Foley catheter into the ileal conduit, Conray was introduced via gravity and 60 cc, there was immediate reflux to the mid ureteral level. After raising the container of Conray, reflux was seen through the left pelvicaliceal system. Then, reflux was seen into the distal right ureter to the mid ureteral region. Given this reflux with gravity, no Conray injection was performed. The patient noted pain as the container of Conray was raised. No stricture was seen to the level of the reflux: mid ureteral on the right and pelvicalyceal on the left. ## IMPRESSION: Bilateral conduit ureteral reflux early and pronounced on the left, and both occurring prior to maximal distension.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17321845", "visit_id": "N/A", "time": "2116-04-25 10:21:00"}

17392100-RR-10

## INDICATION: woman with history of recurrent pleural effusions, status post talc pleurodesis. ## PORTABLE AP UPRIGHT CHEST: The left pigtail pleural catheter is in the same position. The small left apical pneumothorax is stable. A small loculation alongside the lingula of the persistent small left pleural effusion is new. A small right pleural effusion is stable in volume but different in distribution. ## IMPRESSION: 1. Stable, small left apical pneumothorax. New small loculation of left pleural effusion alongside the lingula. Left pleural drain unchanged in position. 2. Small to moderate right pleural effusion, also stable in volume but different in distribution.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17392100", "visit_id": "23263814", "time": "2167-03-29 09:32:00"}

13160555-RR-49

CT CHEST WITHOUT CONTRAST ## REASON FOR EXAM: man with prior history of smoking with right upper lobe nodule. Evaluate for change. ## FINDINGS: Right upper lobe peribronchovascular partially nodular opacities increased. Right basilar peribronchial opacities also increased, could be atelectasis. Small-to-moderate right and tiny left pleural effusions are new. 2-mm left upper lobe (4a:62) and 4 mm left lower lobe (4a:57) nodules are unchanged. There is no new lung nodule. Mild paraseptal upper lobe emphysema is unchanged. Mild areas of bronchiectasis in both bases are too subtle to depict today given marked motion artifacts. Calcified nodules are likely unchanged. An aberrant right subclavian artery is again noted. Mediastinal lymph nodes are still scattered but not enlarged using CT criteria. Signs of anemia are suggested by relative hypodensity of intracardiac blood. Cardiomegaly is mild. Fluid is still present in pericardial recesses. Airways are patent to segmental level. This study was not tailored for subdiaphragmatic evaluation, but the upper abdomen is unremarkable. There is no bone lesion suspicious for malignancy. ## IMPRESSION: 1. Worsening right upper lobe peribronchovascular opacity with bronchiolectasis, could be worsening infection, should be followed shortly in two to three months after antibiotic treatment. Malignancy is much less likely given variations between CTs since . New small-to-moderate and tiny left pleural effusion also favor infection, less likely residual edema. 2. Signs of previous granulomatous exposure. Unchanged 4-mm and less lung nodules since , do not warrant further followup. 3. Mild upper lobe emphysema. 4. Aberrant right subclavian artery, a normal variant. 5. Signs of anemia.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13160555", "visit_id": "N/A", "time": "2121-10-31 14:28:00"}

11819173-RR-14

## EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT ## INDICATION: year old man with right Achilles pain. Review of OMR indicates a history of previous Achilles tendon repair. ## FINDINGS: The Achilles tendon silhouette is enlarged, with a fusiform configuration. A 9 x 2 and mm ossification within the mid Achilles tendon is compatible with a dystrophic calcification. The calcification lies approximately 8.1 cm above the posterosuperior corner of the Achilles. No bony donor site is identified. There is mild stranding in fat pad. Note is made of a configuration along the posterosuperior calcaneus. No acute fracture, dislocation, or gross degenerative change is detected. The tibial talar joint space is preserved and congruent and no talar dome osteochondral lesion is identified. No bone erosion. No additional soft tissue calcification or radiopaque foreign body is identified. ## IMPRESSION: 1. Fusiform enlargement of the Achilles tendon silhouette, with small dystrophic calcification noted within the tendon. The appearance is suggestive of Achilles tendinopathy. However, this appear in should be correlated with details of the previous surgical history. 2. Small calcaneal deformity.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11819173", "visit_id": "N/A", "time": "2140-02-13 13:19:00"}

15677328-RR-23

## EXAMINATION: CT C-SPINE W/O CONTRAST ## INDICATION: with fall. Evaluate for fracture or bleed. ## FINDINGS: Vertebral body heights are maintained and there is no evidence of fracture. Multilevel degenerative changes characterized by intervertebral disc height loss, marginal osteophyte formation, and endplate sclerotic changes. Multilevel moderate central canal narrowing is demonstrated, most pronounced at the C3/4, C5/6 and C6/7 levels due to posterior disc osteophyte complexes. Uncovertebral osteophytes result in mild neural foraminal narrowing at multiple levels. Multiple level facet arthropathy is also seen. No acute alignment abnormality is identified. No prevertebral soft tissue abnormality. No lymphadenopathy is present by CT size criteria. The thyroid is unremarkable. The visualized lung apices are clear. Dense atherosclerotic calcification is seen at the carotid bifurcations bilaterally. ## IMPRESSION: Multilevel degenerative changes with no acute alignment abnormality or fracture.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15677328", "visit_id": "23970916", "time": "2188-10-25 17:55:00"}

15622747-RR-49

## INDICATION: w/CAD s/p CABG, spinal stroke, iron def anemia presenting with worsening dyspnea and edema // Eval for congestion ## FINDINGS: AP portable upright view of the chest. Midline sternotomy wires are noted. Overlying EKG leads are present. There is mild opacity at the left lung base most suggestive of atelectasis though difficult to entirely exclude pneumonia the correct clinical setting. Elsewhere lungs are clear. No edema. Cardiomediastinal silhouette is stable. Aorta is mildly calcified. Bony structures are intact. Degenerative changes are noted at the left shoulder with high-riding left humeral head which appears to contact the undersurface of the left acromion. No free air below the right hemidiaphragm. ## IMPRESSION: Subtle opacity at the left lung base likely atelectasis though difficult to entirely exclude pneumonia in the correct clinical setting. Otherwise unremarkable.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15622747", "visit_id": "27318319", "time": "2124-05-01 12:30:00"}

14000215-RR-50

## EXAM: Right wrist, four views and right shoulder, three views. ## RIGHT SHOULDER: Three views of the right shoulder were obtained. No evidence of acute fracture or dislocation is seen. The right acromioclavicular joint is intact. The right upper outer hemithorax demonstrates low lung volumes. ## RIGHT WRIST: Four views of the right wrist were obtained. No evidence of acute fracture or dislocation is seen. There is minimal degenerative change at the first carpometacarpal joint. There appears to be a small subchondral cyst in the lunate, measuring 2-3 mm. ## IMPRESSION: No evidence of acute fracture or dislocation.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14000215", "visit_id": "N/A", "time": "2189-03-18 19:51:00"}

19992875-RR-43

## HISTORY: man with history of primary biliary cirrhosis and elevated total bilirubin. Evaluation for vessel patency. ## FINDINGS: The left lung base demonstrates a linear area of scarring and atelectasis, likely related to postsurgical changes from left-sided thoracotomy, as seen on chest CT from . The previously demonstrated hepatomegaly is again seen, and is unchanged in size since the prior study, again measuring approximately 24 cm in craniocaudal dimension, as before. Subcentimeter T2 hyperintense foci within the right hepatic lobe are again seen, and are consistent with biliary hamartomas. No suspicious focal liver lesions are identified. No intra or extrahepatic biliary ductal dilatation is noted. The gallbladder is collapsed. The spleen is also enlarged, and is increased in size compared with the prior study, now measuring 22.5 cm in craniocaudal dimension, previously measuring 21 cm. No focal lesions are identified within the spleen. The pancreas is unremarkable and there is no pancreatic ductal dilatation or focal lesions. No retroperitoneal, mesenteric or portal hepatic lymph adenopathy is present. The previously seen area of cortical scarring in the superior pole of the right kidney is unchanged in appearance since the prior study. Additionally, there is a 1.3 cm T2 hyperintense renal cyst in the inferior pole of the right kidney which is unchanged (4:44). Otherwise, the kidneys are unremarkable and excrete contrast symmetrically. The bilateral adrenal glands are also unremarkable. The portal vein is patent with no evidence of the thrombus. The hepatic arterial supply is also patent. Note is made of a replaced right hepatic artery, arising from the superior mesenteric artery and a replaced left hepatic artery, arising from the left gastric artery. The common hepatic artery arises from the celiac axis, and appears to supplies only the gastroduodenal artery. The intra-abdominal loops of large and small bowel are unremarkable and there is no abnormal bone marrow signal. ## IMPRESSION: 1. Stable hepatomegaly with stable biliary hamartomas with no evidence of suspicious focal hepatic or splenic lesions identified. 2. Hepatic vasculature is patent. Notable variant hepatic arterial anatomy with replaced right as well as left hepatic arteries. 3. Mild interval progression of splenomegaly. 4. Stable right inferior pole renal cyst and right upper pole cortical scarring. 5. Atelectasis and scarring in the left lung base, likely related to prior left thoracotomy.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19992875", "visit_id": "N/A", "time": "2160-07-03 13:19:00"}

16008060-RR-42

## HISTORY: Status post minimally invasive esophagectomy in for T1b adenocarcinoma of the esophagus, status post laparoscopic cholecystectomy on . ## FINDINGS: Please see the dedicated chest radiology division for thoracic findings. The liver enhances homogeneously without any focal hepatic lesions. No intrahepatic biliary dilatation is noted, and the portal veins and hepatic veins appear patent. The gallbladder has been surgically removed. The spleen appears normal in size and shape. The pancreas enhances homogeneously without any ductal dilation or peripancreatic stranding. The adrenal glands appear normal in size and shape bilaterally. A 2.6 x 3.1 x 2.6 cm left upper pole renal cyst is noted (4:60,8:46). Smaller subcentimeter hypodensities in the right kidney are too small to characterize but likely represent cysts (4:72,8:40). The kidneys are normal in size bilaterally, and they show appropriate contrast excretion without evidence of hydronephrosis or perinephric stranding. The patient is status post esophagectomy with gastric pull-through. The small bowel opacifies with oral contrast without wall thickening or obstruction. The appendix is not well visualized, but there no secondary findings to suggest appendicitis. The large bowel contains stool without evidence of wall thickening or obstruction. There is no intraperitoneal free air or free fluid. The abdominal aorta is of normal caliber without aneurysmal dilatation. There aorta and its major branches appear patent. There are no mesenteric or retroperitoneal lymph nodes enlarged by CT size criteria. The bladder is minimally distended without any focal wall thickening. The prostate is enlarged. The rectum contains stool and is unremarkable. There is no pelvic free fluid. No pelvic sidewall or inguinal lymph nodes are enlarged by CT size criteria. No hernias are appreciated. There are no suspicious osteolytic or osteoblastic lesions seen to suggest malignancy. ## IMPRESSION: 1. Status post esophagectomy with gastric pull-through without evidence of local recurrence or metastatic disease in the abdomen or pelvis. 2. Enlarged prostate gland.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16008060", "visit_id": "N/A", "time": "2176-12-27 08:18:00"}

18719217-RR-10

## EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD ## INDICATION: woman with fall and trauma to back of head. Evaluate for intracranial hemorrhage. ## DOSE: Acquisition sequence: 1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.5 mGy (Head) DLP = 802.7 mGy-cm. Total DLP (Head) = 803 mGy-cm. ## FINDINGS: No evidence of acute infarction, hemorrhage, edema, or mass effect. Hypodensity within the left frontal lobe is expected in the setting of resolving parenchymal hemorrhage. Gray-white matter differentiation is preserved throughout. The ventricles and sulci are normal in size and configuration for the patient's age. Small, 7 mm extra-axial structure arising from the left vertex could be a meningioma, unchanged (series 601b, image 63; series 2, image 26). No evidence of fracture. Soft tissues changes and at radiopaque material in the posterior occiput are less pronounced compared to the prior exam. The visualized portion of the paranasal sinuses, mastoid air cells, and middle ear cavities are essentially clear. The visualized portion of the orbits are unremarkable. ## IMPRESSION: 1. No intracranial hemorrhage. 2. Nearly resolved left frontal lobe intraparenchymal hemorrhage. 3. No fracture. 4. Chronic soft tissue changes overlying the right occiput from prior injury, improving.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18719217", "visit_id": "N/A", "time": "2162-04-17 22:02:00"}

11908889-RR-34

## CLINICAL HISTORY: Pancreatic resection of presumed neuroendocrine tumor. ## FINDINGS: Intraoperative ultrasound was performed for Dr. to assess the surrounding structures about a rapidly enhancing mass lesion which was seen on prior CT examinations at the pancreatic body/tail. Via laparoscope, exophytic lesion arising from the inferior aspect of the pancreas near the tail is visualized and measured at approximately 1.4 cm x 0.8 cm in size and demonstrating marked vascularity. Arising from its superior margin towards the body of the pancreas is a prominent vascular structure. This appears distant from the main pancreatic duct, although the main duct is difficult to visualize due to its non-distended state. ## IMPRESSION: Intraoperative ultrasound guidance for Dr. pancreatic mass excision.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11908889", "visit_id": "28669753", "time": "2142-02-18 11:14:00"}

19235859-RR-23

## EXAMINATION: MR PITUITARY CONTRAST MR ## INDICATION: year old woman with a medial pituitary stalk mass// Please evaluate for change ## FINDINGS: Study is moderately degraded by motion. Within these confines: Again seen arising from or inseparable from the right more than left anterior aspect of the infundibulum, or possibly arising from the very superior aspect of the pituitary gland itself, is a rounded, circumscribed, mildly T2 hyperintense, T1 isointense to normal adenohypophysis, non- or minimally enhancing mass measuring up to 8 x 7 x 7 mm, unchanged in size since study of . Seen anteriorly and laterally adjacent (to the left) of the lesion is enhancing soft tissue which likely represents normal pituitary infundibulum. A more rounded, 3 mm focus of homogeneous enhancing tissue seen at the posterosuperior margin of the mass is also felt to represent normal, displaced infundibulum (see series 9, image 8 as well as series 8, image 9), unchanged in size. Inferior to the lesion, within the sella turcica, there is normal-appearing, homogeneously enhancing anterior pituitary gland. The neurohypophysis is normally located. The mass contacts and inserts mild upward mass effect on the optic chiasm, stable (6:8). The mass protrudes superiorly into the suprasellar cistern which otherwise remains patent at the right and left lateral aspects of the lesion. The cavernous intracranial carotid flow voids are normal. The cavernous sinus enhances normally. ## IMPRESSION: 1. Study is moderately degraded by motion. 2. Grossly stable approximately 8 mm homogeneous, mildly T2 hyperintense, non-enhancing or minimally enhancing rounded mass appearing to arise from the pituitary infundibulum or upper margin the pituitary in size and mass effect on optic chiasm. Differential considerations again include pituitary microadenoma arising from the superior aspect of the pituitary gland, Rathke's cleft cyst. If the 3 mm focus of enhancement at the posterosuperior margin of the mass represents an enhancing component of the mass rather than normally displaced pituitary infundibulum, differential includes craniopharyngioma, though this is less likely given the absence of calcifications of this lesion on prior contrast CT. Pituicytoma, germinoma, and lymphoma are additional differential considerations at are less likely given the enhancement pattern. Recommend attention on follow-up imaging. ## RECOMMENDATION(S): Grossly stable approximately 8 mm homogeneous, mildly T2 hyperintense, non-enhancing or minimally enhancing rounded mass appearing to arise from the pituitary infundibulum or upper margin the pituitary in size and mass effect on optic chiasm. Differential considerations again include pituitary microadenoma arising from the superior aspect of the pituitary gland, Rathke's cleft cyst. If the 3 mm focus of enhancement at the posterosuperior margin of the mass represents an enhancing component of the mass rather than normally displaced pituitary infundibulum, differential includes craniopharyngioma, though this is less likely given the absence of calcifications of this lesion on prior contrast CT. Pituicytoma, germinoma, and lymphoma are additional differential considerations at are less likely given the enhancement pattern. Recommend attention on follow-up imaging.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19235859", "visit_id": "N/A", "time": "2187-09-05 08:02:00"}

11775843-RR-24

## EXAMINATION: MRI CERVICAL AND THORACIC PT21 MR SPINE ## INDICATION: patient with multiple sclerosis, found down, status epilepticus, motor sensory and cognitive deficits. Evaluate for spinal cord lesions. ## FINDINGS: Study is severely degraded by motion. Cervical spine fat-suppressed imaging is nondiagnostic. Within these confines: ## CERVICAL: The alignment of the cervical spine is maintained. There are type 2 endplate degenerative changes at C5-C6. The vertebral body heights are preserved. Question C5-6 level cervical spinal cord signal abnormality versus artifact (see 04:11, . There is no evidence of abnormal enhancement. ## C2-C3: There is no spinal canal or neural foraminal narrowing. ## C3-C4: There is a central and right paracentral disc protrusion with annular fissure causing mild spinal canal stenosis without spinal cord compression. There is bilateral facet and uncovertebral joint arthropathy without significant neural foraminal narrowing. ## C4-C5: There is a disc bulge with ligamentum flavum thickening and bilateral facet and uncovertebral joint arthropathy without spinal canal stenosis. There is severe right and moderate left neural foraminal narrowing. ## C5-C6: There is central and paracentral disc protrusion with ligamentum flavum thickening and bilateral facet and uncovertebral joint arthropathy resulting in moderate spinal canal stenosis with severe right and moderate left neural foraminal narrowing. ## C6-C7: There is a disc bulge with ligamentum flavum thickening and bilateral facet and uncovertebral joint arthropathy resulting in mild spinal canal stenosis with mild left and no right neural foraminal narrowing. ## C7-T1: There is no spinal canal or neural foraminal narrowing. ## THORACIC: The alignment of the thoracic spine is maintained. There is no suspicious marrow replacing lesion. The spinal cord is normal in caliber and morphology without abnormal signal intensity. There is disc desiccation at T5-T6 with loss of intervertebral disc space. There is mild wedging of T6 and T7 vertebral bodies with a superior endplate Schmorl's node at T6. There is a T5-T6 disc protrusion indenting the ventral thecal sac. Otherwise, there is no spinal canal or neural foraminal stenosis. ## OTHER: The visualized L1 level demonstrates a compression fracture with approximately 75% loss of vertebral body height and suggestion of STIR hyperintense signal anteriorly, suggestive of relatively subacute compression fracture. There is mild retropulsion of the superior endplate indenting the ventral thecal sac without spinal canal stenosis or cord compression. There is no neural foraminal narrowing. Small left-sided pleural effusion is noted. ## IMPRESSION: 1. Study is severely degraded by motion, and fat-suppressed imaging is nondiagnostic. 2. Within limits of study, no definite abnormal enhancement. 3. Cervical spondylosis worse at C5-C6 with moderate spinal canal stenosis and moderate-to-severe multilevel neural foraminal narrowing as described above. 4. Question C5-6 level nonenhancing cervical spinal cord signal lesion versus artifact. 5. Extremely limited imaging of lumbar spine suggests L1 vertebral body compression fracture with bony retropulsion component. If clinically indicated, consider dedicated lumbar spine imaging when patient can tolerate exam. 6. Small left-sided pleural effusion. ## NOTIFICATION: The findings were discussed with , M.D. by , M.D. on the telephone on at 6:05 pm, 3 minutes after discovery of the findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11775843", "visit_id": "27756499", "time": "2148-12-23 09:21:00"}

18554398-RR-15

## INDICATION: with pneumonia, c/f volume overload. Evaluate for pulmonary edema. ## FINDINGS: Lung volumes are low. Increased opacification in the right hemithorax is similar to recent outside hospital chest radiograph and concerning for underlying pneumonia. There is mild prominence of the central pulmonary vasculature without evidence of overt edema. The cardiomediastinal silhouette is enlarged but stable. Probable small bilateral pleural effusions. No pneumothorax. Stable calcifications along the bilateral diaphragmatic surfaces compatible with prior asbestos exposure. ## IMPRESSION: 1. Increased opacification of the right lower hemithorax is concerning for a right middle lobe pneumonia. 2. Mild prominence of the central pulmonary vasculature without evidence of overt edema. 3. Probable small bilateral pleural effusions.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18554398", "visit_id": "28045280", "time": "2168-12-25 05:17:00"}

16134954-DS-22

## HISTORY OF PRESENT ILLNESS: This is a with PMHx of HIV (CD4 count was 422 , only presenting for wound evaluation of worsening skin lesions that are more consistently painful, larger and more numerous and pustular. The patient is a poor historian and collateral was obtained from Health chart review and discharge summary. Of note, patient originally at and thought to be folliculitis and was prescribed bactrim and cephalexin 4 days ago. Patient then went to the ED ( ) for skin lesions and found to have CAP. The lesions were biopsied but there was no infecting agent found in either pathology or culture. Pt was treated for strep. pneumonia with ceftriaxone and discharged on amoxicillin and naproxen. Patient reports he is taking two medications given to him by the hospital, though he can't name them. He also reports that he takes his HIV medications daily (adherent to medications, all pills arrive to home prepackaged). Productive cough and skin lesions improved throughout the course of the hospitalization at . Today he denies fever, nausea, vomiting, diarrhea, productive cough, abdominal pain, chills, sweats, or chest pain. The patient himself denies any medical history or any taking any medications. He reports he developed multiple occasionally painful nonpruritic erythematous lesions over his chest about 2 months ago. Over the past week a lesion over his sternum started to enlarge with surrounding erythema, warmth and drainage. Additionally, he reports a new lesion on the left side of his neck but the rest have improved. ## PAST MEDICAL HISTORY: HIV on HAART(CD4 322, VL 22 as of Dx Meningoencephalitis, Toxoplasmosis ( ) Cognitive Deficits Due Cerebrovascular Disease or Meningitis R-hemiparesis s/p CNS Toxo PCP ( ) Hx of Herpes Zoster Ophthalmicus Internal Hemorrhoids Coronary Artery Disease, LAD s/p coronary stent Hypothyroidism Anemia, Beta-Thal Hepatitis B (VL >38 million, Seizure d/o Hearing loss since childhood(communicates more by writing) Cataract Foot Pain Bilateral ## M: , alive and well, hx uterine ca ## F: deceased. old age Brother also healthy ## GENERAL: Alert, oriented, no acute distress ## HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, neck supple, JVP not elevated, no LAD ## CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops ## LUNGS: Clear to auscultation bilaterally, no wheezes, rales, rhonchi ## ABDOMEN: Soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding ## SKIN: numerous ~1cm oval atrophic plaques with purpuric center, some with overlying flaccid bullae on trunk, neck, left medial ankle, few follicular based pustules on back, upper sternum with large red/purple annular plaque with raised border and central/inferior ulceration with serous exudate, no oral lesions or nail changes, non blanching erythematous macules on bilateral lower extremities. ## EXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema ## NEURO: CNII-XII intact, strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. DISCHARGE EXAM ## GENERAL: Alert, oriented x 3, no acute distress ## HEENT: Sclera anicteric, MMM, oropharynx clear, no evidence of leukoplakia. Erythema at right upper gingiva which he says is painful. ## NECK: supple, JVP not elevated, no LAD ## LUNGS: Clear to auscultation bilaterally, no wheezes, rales, rhonchi ## CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops ## ABDOMEN: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ## EXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema ## SKIN: numerous ~1cm oval atrophic plaques with purpuric center, some with overlying flaccid bullae on trunk, neck, left medial ankle, few follicular based pustules on back, upper sternum with large red/purple annular plaque with raised border and central/inferior ulceration with serous exudate, no oral lesions or nail changes ## IMPRESSION: 1. Increased interstitial markings concerning for atypical pneumonia. 2. The sternum is not well assessed on this study. MR CHEST ## IMPRESSION: Superficial plaque-like lesion centered in the dermal and immediately subdermal layers of the anterior chest wall. Minimal interstitial edema/ enhancement in the subcutaneous fat below it. No fluid collection.No involvement of the underlying musculature or bone. MICROBIOLOGY ============ BCx , negative Wound culture No growth Tissue Time Taken Not Noted Log-In Date/Time: 7:22 pm ## TISSUE SOURCE: Skin biopsy r/o pox virus (molluscum). GRAM STAIN (Final : NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. ## ANAEROBIC CULTURE (PRELIMINARY): NO GROWTH. POTASSIUM HYDROXIDE PREPARATION (Final : NO FUNGAL ELEMENTS SEEN. ## FUNGAL CULTURE (PRELIMINARY): NO FUNGUS ISOLATED. ACID FAST SMEAR (Final : NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. ## ACID FAST CULTURE (PRELIMINARY): PENDING Time Taken Not Noted Log-In Date/Time: 7:22 pm ## TISSUE SOURCE: Skin biopsy r/o pox virus (molluscum). ## VIRAL CULTURE: R/O CYTOMEGALOVIRUS (Preliminary): No Cytomegalovirus (CMV) isolated. CYTOMEGALOVIRUS EARLY ANTIGEN TEST (SHELL VIAL METHOD) (Final : Negative for Cytomegalovirus early antigen by immunofluorescence. Refer to culture results for further information. 8:51 pm BLOOD CULTURE ( MYCO/F LYTIC BOTTLE) ## HIV VIRAL LOAD : 22 copies/ml BCx NGTD ## BRIEF HOSPITAL COURSE: BRIEF SUMMARY ============= Mr. is a pleasant with PMHx of HIV (CD4 count was 322 on , only presenting for wound evaluation of a large centrally located skin lesion on his chest. The patient reports that these lesions have been present for two months, and was seen at in for the same problem. At , they were biopsied, which results highly concerning for infection, although no organisms were seen on staining. During the current admission, the large chest lesion appeared cellulitic, so he was initially treated with vancomycin. Dermatology was consulted, with subsequent biopsy of the large lesion. ID was also consulted, and an extensive infectious workup was performed (most of which was pending at discharge). The antibiotics were discontinued prior to his discharge due to low likelihood of his lesion being a staph cellulitis. Biopsy results during this admission were again highly suspicious for infection, but nothing was seen in stain. Cultures pending at time of discharge. The patient was discharged to follow up with his PCP and infectious diseases as an outpatient. ACUTE ISSUES ============ #Skin lesions: The patient presented to the ED with a painful, large, red central chest lesion as well as several smaller non-painful lesions over his back, chest, arms, and legs (sparing palms and soles). He reports that these lesions had been present for two months, and he was previously seen at in for the same skin lesions (minus the new large lesion). At , he underwent biopsy of one of the small lesions, with results highly concerning for infection, although no organisms were seen on staining. Between that admission and the present admission, he developed a large painful chest lesion at the his chest. Given concern for cellulitis, he was initially treated with vancomycin. Dermatology was consulted, with subsequent biopsy of the large chest lesion. ID was also consulted, and an extensive infectious workup was performed, with nothing revealing found (some of which was pending at discharge, however). The antibiotics were discontinued a few days prior to his discharge due to low likelihood of his lesion being a staph cellulitis. Biopsy results during this admission were again highly suspicious for infection, but no organisms were seen on micro stain. Given the lack of findings, dermatology recommended adding PCR testing of the tissue for blasto, histo, coccioido, MTB, and atypical mycobacteria (pending at discharge). His pain was treated with oxycodone, and he was discharged to follow up with his PCP and infectious diseases as an outpatient to follow up his pending results. Please see labs section of the discharge summary for specific lab tests/findings. ## CHRONIC #HIV: Patient reports adherence to HAART regimen and has a history of multiple HIV related complications including CNS toxo, PCP PNA and herpes zoster opthalmicus. CD4 during this admission was 322, with HIV viral load of 22 copies/ml - continued HAART: Raltegravir 400 mg PO BID, RiTONAvir 100 mg PO BID, Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY, Darunavir 600 mg PO BID #Hypothyroidism - continued home levothyroxine #Beta-thalassemia - H/H stable #CAD - Continued home Metoprolol #GERD - continued home loratidine TRANSITIONAL ISSUES =================== - Culture results and several labs were pending at the time of discharge. Please follow these up as an outpatient - Please remove the patient's sutures on his chest lesion at his next PCP appointment on - At his next PCP visit, please ensure that the patient has made it to follow up with infectious diseases (scheduled for ## MEDICATIONS ON ADMISSION: The Preadmission Medication list is accurate and complete. 1. Aspirin 81 mg PO DAILY 2. Raltegravir 400 mg PO BID 3. RiTONAvir 100 mg PO BID 4. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 5. Darunavir 600 mg PO BID 6. Loratadine 10 mg PO DAILY 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Levothyroxine Sodium 50 mcg PO DAILY 9. Hydrocortisone Cream 1% 1 Appl TP BID ## DISCHARGE MEDICATIONS: 1. Aspirin 81 mg PO DAILY 2. Darunavir 600 mg PO BID 3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 4. Hydrocortisone Cream 1% 1 Appl TP BID 5. Levothyroxine Sodium 50 mcg PO DAILY 6. Loratadine 10 mg PO DAILY 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Raltegravir 400 mg PO BID 9. RiTONAvir 100 mg PO BID 10. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q4H:PRN pain RX *oxycodone-acetaminophen 5 mg-325 mg 1 tablet(s) by mouth q4-6h Disp #*15 Tablet Refills:*0 ## DISCHARGE INSTRUCTIONS: Dear Mr. , You were admitted to the hospital after you developed a red and painful spot on your chest as well as several other non-tender spots on your skin. You were treated with antibiotics initially, and underwent a biopsy to determine the cause of these spots. You were evaluated by your infectious disease physicians, who recommended several tests to help us figure out the cause of these. These results #### prior to your discharge, and you were discharged home to follow up with your primary care doctor, the infectious disease doctors, and a dermatologist (skin doctor). We wish you the best, Your Care Team

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16134954", "visit_id": "29037670", "time": "2128-08-03 00:00:00"}

13777050-RR-134

## HISTORY: Chronic bilateral subdural hematomas, evaluate for residual blood. Patient is post-op. ## NON-CONTRAST HEAD CT: Comparison is made to exam and MRI. Patient is noted to be status post left frontal craniotomy with indwelling extra-axial drain with near-complete resolution of previously identified mixed density subdural hematoma with only a small chronic appearing component noted inferiorly. There is expected post-operative pneumocephalus. No new regions of acute hemorrhage are identified. There is resolution of previously identified minimal rightward subfalcine herniation. The right subdural hematoma displays no significant interval change from prior exam. The appearance of the brain parenchyma and ventricular system is unchanged. Mild soft tissue swelling and expected subcutaneous emphysema is noted along the surgical site with the soft tissues and globes appearing otherwise unremarkable. Mucosal thickening involving the maxillary sinuses is stable. ## IMPRESSION: Status post drain placement along the left superior cerebral convexity with near-complete resolution of acute-on-chronic appearing left-sided subdural hematoma and resolved rightward subfalcine herniation. Unchanged appearance to predominantly chronic appearing right-sided subdural hematoma. No new regions of hemorrhage identified.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13777050", "visit_id": "21764468", "time": "2141-08-16 20:53:00"}

16669225-RR-79

## EXAMINATION: C-SPINE NON-TRAUMA VIEWS IN O.R. ## INDICATION: year old woman with central cord syndrome// eval cspine ## FINDINGS: Bony structures are severely demineralized, this markedly limits evaluation on radiographs. C1-C7 visualized on the lateral projection. There is mild anterolisthesis of C 2 on C3. There is severe multilevel degenerative disc disease from C3 through C7. No definite fracture seen. No destructive lytic or sclerotic bone lesion seen. Visualized portions of the lung apices are grossly clear. ## IMPRESSION: Evaluation is limited due to severe demineralization. Severe degenerative disc disease from C3 through C7. No definite fracture seen.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16669225", "visit_id": "N/A", "time": "2159-11-28 14:19:00"}

19497408-DS-17

## ALLERGIES: Patient recorded as having No Known Allergies to Drugs ## CHIEF COMPLAINT: Excessive thirst, urinary frequency, fatigue ## HISTORY OF PRESENT ILLNESS: Mr. is a year old male with no significant medical history who presents with 2 weeks of increased urinary frequency and excessive thirst. He says he has been urinating up to 50 x/day. He denies dysuria. He also describes "not feeling like himself" with increased fatigue and malaise. He also describes a decreased appetite accompanied by a 40-50 pound weight loss over the past month. He denies abdominal pain, n/v, diarrhea, constipation, sob, cp. He feels otherwise well. He denies depressive symptoms . In the ED, initial vs were: T P BP R O2 sat. Patient was given 5L NS and received IV KCl . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. All other review of systems are negative. ## FAMILY HISTORY: Mom and brother with diabetes ## GENERAL: Alert and oriented, appears fatigued with a blunted affect ## HEENT: Sclera anicteric, MMM, oropharynx clear. No lymphadenopathy. ## LUNGS: Clear to auscultation bilaterally, no wheezes, rales, ronchi ## CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops ## ABDOMEN: soft, non-tender, non-distended, bowel sounds hyperactive, no rebound tenderness or guarding, no organomegaly ## EXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema ## NEURO: Alert and oriented x 3. CNII-XII intact. No focal neurologic motor or sensory defecits. ## - EKG : Sinus rhythm. Left axis deviation. Possible left anterior fascicular block.J point elevation with early repolarization in the precordial leads may be anormal variant. No previous tracing available for comparison. ## # HYPERGLYCEMIA: Mr. arrived at the ED following symptoms of polydipsia and polyuria for two weeks and progressive fatigue and a 40 lb weight loss over the last month. He had a blood sugar in the 900s and urinary glucose over 1000 with trace ketones in the ED consistent with a new diagnosis of DM. He had no anion gap or metabolic acidosis, and was thus consistent with Hyperosmolar Hyperglycemic non-ketoacidosis. He was aggressively rehydrated with over 7L of normal saline in the ED and on the floor with 20 mEq KCl overnight bringing his glucose down to the 300s-400s by HOD#2. was consulted and recommended glargine 30 units/day with an insulin sliding scale at meals. His sugars remained in the 200-300s throughout HOD#2, but improved overnight in to the mid-high 100s. On HOD#3 his sugars spiked again to the 300s, and recommended increasing his Lantus to 36U daily, and increased his sliding scale. He also met with the nutritionist for diabetic diet teaching. His blood glucose levels subsequently normalized by discharge between 135-300. He was provided with insulin injection and sliding scale teaching by the nurses, and he was scheduled for a follow up the following week with . He was also advised to remain out of work as a for the until he is evaluated by . . #Social work: Mr. struggled to cope with his new diagnosis of diabetes. He often became tearful when discussing it. He met with social work here regarding his, and it was recommended that he follow up with the psychologists at . He was given their contact information . # ECG changes: An ECG performed in the ED on arrival showed ST vs. J point elevations in leads V3-V4 which were felt to be unconcerning for myocardial ischemia due to lack of reciprocal changes and the lack of cardiac symptoms. A repeat ECG was unchanged, and cardiac enzymes were negative x 2 (TropT and CK-MB). He never endorsed any chest pain or shortness of breath . # Shoulder pain: On the morning of , Mr. complained of new onset, throbbing shoulder pain ( ) that he felt was due to how he was sleeping on it. His symptoms persisted but were markedly improved with acetaminophen. ## DISCHARGE MEDICATIONS: 1. BD Insulin Pen Needle UF Mini 31 x Needle Sig: as directed Miscellaneous as directed. Disp:*300 needles* Refills:*0* 2. BD Ultra Fine Lancets Misc Sig: as directed Miscellaneous as directed. Disp:*300 lancets* Refills:*0* ## 3. GLUCOSTIX TEST STRIP SIG: as directed Miscellaneous as directed. Disp:*300 strips* Refills:*0* 4. Lantus Solostar 100 unit/mL (3 mL) Insulin Pen Sig: as directed Subcutaneous as directed: 36 units per day at breakfast or as otherwise directed by your physician. Disp:*12 pens* Refills:*0* 5. Humalog KwikPen 100 unit/mL Insulin Pen Sig: Three (3) boxes of 5 pens each (100 units per pen) Subcutaneous as directed: Please take four times per day as directed by sliding scale Disp:*3 boxes (5 pens per box, 100 units per pen)* Refills:*2* ## PRIMARY: Hyperosmolar Hyperglycemic Non-Ketoacidosis Diabetes Mellitus ## DISCHARGE INSTRUCTIONS: Mr. , You were admitted to the hospital because you were having increased urination, and you were found to have very high blood sugars consistent with a new diagnosis of diabetes. You were followed closely by our diabetes experts from who helped us to start your insulin while in the hospital. Your symptoms and blood sugar improved, but you will still require close follow up at as an outpatient. We also had our nutritionist see you in the hospital to give you some information on how to adjust your diet with the diabetes. We hope that you are able to make the changes they recommend. We also had our nurses teach you how to check your finger blood glucose levels and inject insulin. You were not taking any medications prior to coming to the hospital. However we have added the following diabetes medications which you should administer as you were taught: ## -LANTUS (GLARGINE): Inject 36 units each morning or as otherwise directed -Humalog insulin: Please check your sugars before each meal and give yourself humalog insulin as directed by your sliding scale as attached. Please note your follow-up appointments below. We have written prescriptions for the materials you will need to check your blood sugars and give your insulin.

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "19497408", "visit_id": "25833652", "time": "2176-04-27 00:00:00"}

18568321-RR-9

## EXAMINATION: CT abdomen pelvis with contrast ## INDICATION: year old man with unintentional weight loss, post prandial dyscomfort, no previous cancer screening// Please evaluate abd/pelv for mass/obstruction ## SINGLE PHASE SPLIT BOLUS CONTRAST: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Sequenced Acquisition 0.5 s, 0.2 cm; CTDIvol = 7.3 mGy (Body) DLP = 1.5 mGy-cm. 2) Stationary Acquisition 1.8 s, 0.2 cm; CTDIvol = 24.1 mGy (Body) DLP = 4.8 mGy-cm. 3) Spiral Acquisition 6.9 s, 44.9 cm; CTDIvol = 5.3 mGy (Body) DLP = 234.9 mGy-cm. Total DLP (Body) = 241 mGy-cm. ## LOWER CHEST: Visualized lung fields are within normal limits. Trace left pleural effusion. There is no evidence of pericardial effusion. ## HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesions. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder collapsed. ## PANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of hydronephrosis. Few small cortical cysts bilaterally, the larger is a left interpolar 1.1 cm. There is no perinephric abnormality. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The colon and rectum are within normal limits. The appendix is normal. ## PELVIS: The urinary bladder with Foley catheter balloon is almost empty . Minimal free fluid in the pelvis. ## REPRODUCTIVE ORGANS: The prostate is enlarged, 5 cm, and the seminal vesicles are unremarkable. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. ## BONES: There is no evidence of worrisome osseous lesions. ## SOFT TISSUES: The abdominal and pelvic wall is within normal limits. ## IMPRESSION: No evidence of malignancy. No evidence of obstruction, masses or lymphadenopathy. Minimal free fluid in the pelvis.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18568321", "visit_id": "29634611", "time": "2179-07-10 17:37:00"}

18035552-RR-23

## INDICATION: Fetal survey; known fibroids complicating pregnancy. ## LMP: . Transabdominal imaging shows a single live intrauterine gestation in transverse presentation. The placenta is fundal without evidence of previa. There are multiple fibroids present. The largest fibroid is located in the lower uterine segment more to the right measuring 9.6 x 5.3 x 5.9 cm. A second fibroid is seen posteriorly in the fundal region measuring 5.2 x 3.5 x 4.7 cm. No fetal morphologic abnormalities are detected. Views of the head, face, heart, outflow tracts, stomach, kidneys, cord insertion site, bladder, spine and extremities are normal. The following biometric data were obtained: ## EFW: 246 g. Compared to the prior exam there has been appropriate interval growth. ## IMPRESSION: Normal fetal survey. Multiple fibroids are present with the largest located in the lower right uterine segment. The placenta is in the fundus away from the fibroids. gb

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18035552", "visit_id": "N/A", "time": "2176-08-27 09:45:00"}

19798925-RR-50

## EXAMINATION: RENAL TRANSPLANT U.S. RIGHT ## INDICATION: year old woman with PMHx HCV/ ETOH cirrhosis c/b HRS and ESRD s/p simultaneous liver-kidney transplantation (CMV intermediate risk, PHS increased risk donor and hep C positive donor to hep C positive patient) on cyclosporine, MMF, c/b recurrent post transplant UTI with resistant E.coli and Klebsiella who presents due to increased Cr concerning for acute reaction.// transplant kidney US ## FINDINGS: The right lower quadrant 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 and no perinephric fluid collection. The resistive index of intrarenal arteries ranges from 0.72-0.79 within the elevated range. The main renal artery shows a normal waveform, with prompt systolic upstroke and continuous antegrade diastolic flow, with peak systolic velocity of 166 cm/sec. Vascularity is symmetric throughout transplant. The transplant renal vein is patent and shows normal waveform. ## IMPRESSION: Patent renal transplant vasculature with minimally elevated resistive indices of the intrarenal arteries compared to prior ultrasound. No hydronephrosis or perinephric fluid collections identified.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19798925", "visit_id": "20326081", "time": "2179-08-08 15:15:00"}

13693064-RR-21

## EXAMINATION: ultrasound examination of the left small finger ## INDICATION: year old man with left digit tendon rupture s/p repair x2// ? rupture vs adhesion of left digit FDP tendon ## FINDINGS: The patient is status post rupture and repair of the flexor digitorum profundus x2 (FDP). There has been partial excision of the flexor digitorum superficialis (FDS). The distal portion of the FDS is seen at the level of the MCP joint. It is not seen distal to this level compatible with partial excision. The FDP tendon is seen to attach normally to the distal phalanx. Adjacent post surgical changes are noted. The FDP tendon appears intact without evidence of re-tear. However, there is a large amount of scarring in the palmar soft tissues overlying the tendon at the level of the proximal middle phalanx. No significant increased vascularity. Upon dynamic imaging with passive flexion and extension at the PIP joint, the FDP tendon appears adherent to the adjacent soft tissues likely secondary to scarring/adhesions. ## IMPRESSION: Small finger FDP tendon appears adherent to the adjacent soft tissues likely secondary to scarring/adhesions. No evidence of tendon re-tear. Partial excision of the small finger distal FDS tendon to the level of the MCP joint.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13693064", "visit_id": "N/A", "time": "2147-10-14 13:17:00"}

13531814-RR-54

## INDICATION: Hip pain, for evaluation. ## REPORT: Bony mineralization is essentially normal. There is minor symmetric hip narrowing with some dependent superior joint space narrowing and a little osteophyte formation. There is a ? expansile ill-defined lucency with sclerotic border of the left inferior pubic ramus, probably reflecting a cyst or fibrous dysplasia, unchanged from the prior study. Dedicated hip views again show minor degenerative change. There is suggestion of some sclerosis of the femoral head, which may represent early avascular necrosis. MRI is suggested for further evaluation here. ## CONCLUSION: There is suggestion of perhaps some sclerosis of the right femoral head, suggesting early AVN. MRI is suggested to further evaluate. There are minor degenerative changes in both hips. Unusual appearance of the left pubic ramus. This may just be simple projectional change. The MR from is reviewed and there is a small subchondral cyst in that study, but no evidence of avascular necrosis and no specific abnormality of the pubic ramus either.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13531814", "visit_id": "N/A", "time": "2179-01-24 13:35:00"}

16400373-RR-11

## EXAMINATION: CT ABD AND PELVIS WITH CONTRAST ## NO PO CONTRAST; HISTORY: with right sided abdominal pain, nausea, please eval for appendicitis NO PO contrast // appendicitis ## SINGLE PHASE CONTRAST: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration. Oral contrast was not administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Stationary Acquisition 6.0 s, 0.5 cm; CTDIvol = 28.9 mGy (Body) DLP = 14.4 mGy-cm. 2) Spiral Acquisition 6.7 s, 52.6 cm; CTDIvol = 10.0 mGy (Body) DLP = 525.3 mGy-cm. Total DLP (Body) = 540 mGy-cm. ## LOWER CHEST: There is moderate bibasilar atelectasis. Mild lingular atelectasis is seen. There is no evidence of pleural or pericardial effusion. ## HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. Redemonstrated is a 1.8 x 1.6 cm right hepatic lobe cyst, unchanged compared to prior. There are numerous additional subcentimeter hypoattenuating hepatic lesions, which are too small to fully characterize, but likely represent hepatic cysts or biliary hamartomas. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. ## PANCREAS: The pancre2as has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. ## SPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesions. ## ADRENALS: The right and left adrenal glands are normal in size and shape. ## URINARY: The kidneys are of normal and symmetric size with normal nephrogram. There is no evidence of solid renal lesions or hydronephrosis. There is no perinephric abnormality. ## GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. The rectum is distended with air. The colon is within normal limits. The appendix is nondilated and contains air with no adjacent mesenteric fat stranding. ## PELVIS: The urinary bladder is distended but otherwise normal in appearance. The distal ureters are unremarkable. There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within normal limits. ## LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. No significant atherosclerotic disease is noted. There is persistent narrowing near the origin of the celiac axis with distal reconstitution. ## 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 evidence of appendicitis or other acute abdominopelvic abnormality. 2. Persistent narrowing near the origin of the celiac axis.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16400373", "visit_id": "N/A", "time": "2146-06-17 17:07:00"}

19858494-RR-84

## HISTORY: man with necrotizing pancreatitis, pancreatic duct disruption, here with increasing abdominal fluid, assess the pancreatic duct. ## FINDINGS: The liver is not nodular in contour and no focal liver lesions are seen. The portal vein and hepatic veins are patent. The hepatic arterial anatomy is conventional, however, the dynamic post-contrast phases are somewhat limited due to non-breathhold technique. The gallbladder is distended and contains sludge, but is otherwise unremarkable in appearance. The common bile duct measures 9 mm with transition in the pancreatic head to a more normal caliber common bile duct. No significant intrahepatic duct dilatation. The pancreas is diffusely abnormal and with decreased signal intensity on T1-weighted images, however, following contrast administration, the pancreatic parenchyma enhances normally. There is no convincing evidence of pancreatic necrosis on this study. The pancreatic duct appears to be patent and intact throughout its course, although it is narrowed in the central portion of the body of the pancreas. No duct disruption is identified. There are large peripancreatic necrotic fluid collections seen. The contents of these collections are moderately T1 hyperintense suggesting component of hemorrhagic material. A right-sided retroperitoneal collection has a drain in situ, and this collection is contiguous with the collection anterior to the pancreatic body. This is difficult to measure accurately because of the diffuse heterogeneity, but does not appear to have changed significantly compared to the the prior study. There is a left-sided loculated fluid collection in the retroperitoneum measuring 7.8 x 3.9 cm containing heterogeneous debris, unchanged compared to the prior CT. A fluid collection adjacent to the greater curve of the stomach measures 3.3 x 2.8 cm, also unchanged. The spleen is not enlarged, but is diffusely low in signal intensity on T2-weighted images and there is loss of signal on in-phase compared to out-of-phase T1-weighted images, suggesting with siderosis. The adrenal glands are unremarkable in appearance. There is mild right hydronephrosis with a dilated right ureter down to the level of the retroperitoneal collection. The kidneys are otherwise unremarkable. Vertebral body hemangioma in T8. Bilateral pleural effusions are unchanged, atelectasis or consolidation in the right lower lobe is incompletely evaluated on this study. A gastric tube is noted in adequate position. ## IMPRESSION: 1. No overt pancreatic duct disruption. 2. Changes of acute pancreatitis with multiple large intra-abdominal fluid collections containing hemorrhagic or necrotic debris, these are not changed significantly when compared to the prior study. No necrotic parenchyma identified. 3. Gallbladder sludge. 4. Bilateral pleural effusions with atelectasis or consolidation in the right lower lobe. 5. Possible splenic siderosis.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19858494", "visit_id": "27361663", "time": "2186-05-17 16:15:00"}

13665644-RR-43

The examination was performed on this lady as a 30-month followup following randomization into the TINSAL-CV trial, research account . The examination includes abdomen for liver fat, body fat, coronary artery calcium score and coronary arteriogram for measurement of calcified and noncalcified plaque. Imaging was performed using the Aquilion One CT scanner. ## ABDOMEN: Expanded views of the abdomen were reconstructed in the axial, sagittal and coronal planes. The liver was imaged Using 135 kVp. Using 135 kVp, the attenuation value for the left lobe was 61.1, right lobe 59.1 and spleen 49.7. Using the same factors in , the respective values were 59, 58, and 48 for the spleen. The spleen, gallbladder, kidneys, adrenals and pancreas are all normal. Mild degenerative changes are noted in the spine. ## CHEST: A stent is noted in the LAD and possibly a short stent in the diagonal. The lungs are clear. The pulmonary arteries and veins are normal with no evidence of emboli. There is no evidence of hilar adenopathy. ## CARDIAC: The cardiac images were acquired in a prospective gated fashion at 75% of the RR interval capturing the heart in a single beat and reconstructed on the Vitrea workstation. Metoprolol was not needed for heart rate control. 0.4 mg of nitroglycerin was given sublingually to dilate the coronary arteries. The detailed report of the cardiac findings is not included in the medical record because of the research nature but transmitted directly to the referring cardiologist. ## TOTAL RADIATION DOSE: The total effective radiation dose was 11.23 millisieverts with the cardiac portion contributing 3.43 millisieverts.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13665644", "visit_id": "N/A", "time": "2173-12-25 11:15:00"}

19005999-RR-66

## INDICATION: sarcoma // DO NOT MOVE, TO RESCHEDULE , rule out progression or new lesions. ## FINDINGS: There is a new intra-axial mass in the left parietal lobe, likely in the postcentral gyrus, measuring approximately 3.1 x 3.1 x 3.0 cm (AP, transverse, SI). The mass demonstrate peripheral intrinsic T1 hyperintensity, with central T1 hypointensity, as well as predominantly T2/FLAIR hyperintensity. There is associated surrounding vasogenic edema resulting in mild mass effect on the adjacent parenchyma. Additionally, the mass demonstrate diffusion restriction. The intrinsic T1 hyperintensity limits the evaluation of with the mass demonstrates enhancement are not. There is also a new small lesion in the body of the left corpus callosum that demonstrate T1 hypointensity, T2 and FLAIR hyperintensity, and diffusion restriction. It measures approximately 8 x 8 x 11 mm. There is is a new small enhancing lesion in left superior parietal lobule (10:99). This lesion also demonstrates T2/FLAIR hyperintensity and isointensity on T1 weighted images. There is stable redemonstration of postsurgical changes of right frontal craniotomy. There is no evidence of midline shift. The ventricles and sulci are normal in caliber and configuration. The vascular flow voids are grossly unremarkable. The dural venous sinuses are patent. Stable mucous retention cyst in the bilateral maxillary sinuses with associated mucosal thickening in the bilateral ethmoid air cells. The bilateral mastoid air cells are clear. No abnormal marrow signal. ## IMPRESSION: 1. New large hemorrhagic lesion with surrounding vasogenic edema in the left parietal lobe, and additional enhancing lesions in the a body of the left corpus callosum and left superior parietal lobules, raises concern for new metastatic disease, in keeping with patient history of sarcoma. 2. Stable postsurgical changes of right frontal craniotomy. 3. Moderate paranasal sinus disease as described above. ## NOTIFICATION: The impression and recommendation above was entered by Dr. on at 13:03 into the Department of Radiology critical communications system for direct communication to the referring provider.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19005999", "visit_id": "N/A", "time": "2147-03-01 09:10:00"}

17560931-RR-50

## HISTORY: with abdominal pain, dark stools // Ischemic colitis ## FINDINGS: The lung bases are clear. Limited imaging of the heart reveals no pericardial effusion or cardiomegaly. ## CT ABDOMEN: There are several small hypodense foci in the liver which are too small to characterize, for example 7 mm lesion superiorly in segment 8 (series 4, image 181), and 7 mm lesion superiorly in segment 4B (series 4b, image 183). On the arterial phase, there are several areas of transient perfusion abnormality, located at segment 6 (series 4 a, image 31), segment 4B (series 4 a, image 29), and segment 3 (series 4 a, image 27). If there is a persistent hyperdensity in segment 4B on venous phase likely representing a underlying hemangioma. The cause of the additional transient perfusion changes is not identified on this study. The portal and hepatic veins are patent. There is no intra or extrahepatic biliary dilatation. The gallbladder is normal. The pancreas enhances homogeneously. The spleen and adrenal glands are normal. The kidneys enhance and excrete contrast promptly. There are no concerning renal lesions. There is no retroperitoneal or abdominal adenopathy. No free air or free fluid is present. The stomach and intra-abdominal loops of small bowel are normal caliber and appearance. The appendix is visualized in the right lower quadrant appears normal. There is mild sigmoid diverticulosis without evidence of diverticulitis. ## CT PELVIS: The remainder of the bowel is normal. Minimal submucosal fat in the anteriorly in the bladder wall may be due to prior inflammatory episodes. (series 601b, image 81). There are metallic densities compatible with fiducial markers in the prostate. There is no free pelvic fluid. There is no inguinal or pelvic adenopathy. ## OSSEOUS STRUCTURES: No concerning osteoblastic or osteolytic lesion identified. A sclerotic focus in the left iliac bone measuring 1 cm is stable in size in appearance since . Osseous changes throughout the left ilium appear stable from and consistent with Paget's disease. ## CTA: The aorta contains calcified atherosclerotic plaque. There is conventional hepatic arterial anatomy. The celiac, superior mesenteric, bilateral renal and inferior mesenteric arteries are patent. Multifocal plaque in the bilateral iliac arterial system. , with mild narrowing of the bilateral common iliac and right external iliac arteries. There is severe, near occlusive focal narrowing of the mid left external iliac artery (series 4a, image 120). Inferior vena cava, superior mesenteric vein and superior mesenteric veins are patent. The portal vein is patent. ## IMPRESSION: 1. Normal bowel wall enhancement. The superior mesenteric and inferior mesenteric arteries are patent. 2. No active extravasation. 3. The left external iliac artery demonstrates focal near occlusive severe atherosclerotic stenosis (series 4a, image 120). 4. Mild sigmoid diverticulosis without evidence of diverticulitis. 5. Possible mild contrast reaction including itching of the face and neck as well as congestion. 6. Left hemipelvic Paget's disease. 7. Likely benign lesions in the liver may represent combination of cysts and hemangiomas, suggest further assessment with nonemergent ultrasound or MRI. ## NOTIFICATION: The possible mild contrast reaction was called immediately to Dr. by Dr. on at 12:54 . #7 of impression above was entered by Dr. on at 19:38 into the Department of Radiology critical communications system for direct communication to the referring provider.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17560931", "visit_id": "N/A", "time": "2162-05-30 12:13:00"}

12758384-RR-32

## INDICATION: AIDS, lymphoma, febrile neutropenia. Evaluate for source of infection. ## BONE WINDOWS: Sclerotic focus in the left intertrochanteric region again seen, possibly representing bone island. No new suspicious lytic or blastic lesion identified. ## IMPRESSION: 1. Multiple new subcentimeter nodular densities seen at the visualized lung bases. These are nonspecific in appearance, and possibly represent inflammatory or infectious etiology, although given patient's history, short interval three-month followup would be recommended to document resolution. 2. At least three hypoattenuating lesions seen within the liver, possibly cysts or hemangiomas, too small to characterize by CT. These could be further evaluated by ultrasound as clinically indicated. 3. Unchanged appearance of multiple cystic lesions within the kidneys and superior aspect of the spleen. Again, these are too small to characterize by CT, and if indicated, MRI could be helpful for further evaluation. 4. Improving splenomegaly. 5. Decrease in size of bilateral inguinal lymphadenopathy.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12758384", "visit_id": "N/A", "time": "2169-10-27 17:01:00"}

17542886-RR-17

NON-CONTRAST HEAD CT SCAN ## HISTORY: Left middle cerebral artery aneurysm rupture. Evaluate for ventricular size. ## FINDINGS: Comparison with the prior study performed 12 hours before reveals no appreciable change in the mildly dilated supratentorial ventricular system. The subarachnoid blood, distributed throughout the basal cisterns, as well, does not appear substantially changed. There is no new shift of normally midline structures. There remains effacement of the cerebral cortical sulci, likely a manifestation of mild cerebral edema. The surrounding osseous and soft tissue structures are unremarkable. ## CONCLUSION: Negligible interval change in appearance of study from examination, obtained 12 hours before the present examination.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17542886", "visit_id": "29012018", "time": "2180-09-02 08:12:00"}

18587826-RR-16

## HISTORY: with right sharp intermittent pain today // evaluate for torsion ## FINDINGS: The uterus is anteverted and measures 6.3 x 2.7 x 4.9 cm. The endometrium is homogenous and measures 1 mm. The ovaries are normal. A small amount of fluid is noted around the left ovary. There is a trace amount of free fluid in the pelvis. ## IMPRESSION: Normal appearance of the uterus and bilateral ovaries. A small amount of fluid is noted surrounding the left ovary and a trace amount of free fluid is seen in the pelvis, considered physiologic.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18587826", "visit_id": "N/A", "time": "2185-05-10 11:20:00"}

16969063-RR-87

## HISTORY: Left thyroid mass seen on a previous chest x-ray. ## FINDINGS: The right lobe of the thyroid is homogenous in echotexture and measures 44 x 20 x 16 mm. Note is made of a small hypoechoic nodule in the isthmus measuring 10 x 4 x 11 mm. There is a diffusely multinodular appearance to the enlarged left lobe of the thyroid with the inferior pole predominantly occupied by cystic nodules. A large heterogeneous nodule at the mid portion of the left lobe measures 39 x 35 x 84 mm and a large conglomerate of the cystic lesions at the lower pole of the left measures 38 x 37 x 33 mm. The nodules are predominantly hypovascular. ## IMPRESSION: Multinodular left thyroid with mixed solid and cystic components as detailed above. Given size, recommend biopsy for further evaluation. Note that the more cranial nodule on the left is likely more amenable to biopsy given its predominantly isoechoic material.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16969063", "visit_id": "24115526", "time": "2140-04-19 13:16:00"}

12411239-RR-23

## REASON FOR EXAMINATION: Followup of a patient after large uterine mass excision after massive fluid resuscitation. Portable AP chest radiograph compared to , obtained at 8:34 p.m. The ET tube tip currently is 3.6 cm above the carina, although note is made that the tip might impinge the right tracheal wall. The NG tube tip is in the stomach. The right internal jugular line tip is low in the right atrium approximately 3 cm below the cavoatrial junction. The heart size is normal. Prominence of the aortopulmonic window is again noted, unchanged and may represent the pulmonary hypertension or lymphadenopathy. The evaluation of lung parenchyma demonstrates minimal vascular engorgement but no overt failure. There is no appreciable pleural effusion. There is no pneumothorax. ## IMPRESSION: 1. No evidence of failure. Mild vascular engorgement. 2. Too low position of the right internal jugular line which should be pulled back for 3 cm to place it in distal SVC. 3. Bulging of the aortopulmonic window contour may be related to pulmonary artery or prominent lymphadenopathy. Evaluation with chest CT might be considered if clinically warranted. Findings discussed with Dr. the phone at the time of dictation.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12411239", "visit_id": "23028159", "time": "2163-02-23 04:23:00"}

12428510-RR-74

## FINDINGS: In the lumbar spine, an analysis of L1-L4 reveals a BMD of 1.154 g/cm2, equivalent to a T-score of -0.3 and a Z-score of 0.1. This is within normal limits. In comparison with the baseline study of , there has been a significant 2.5% increase in BMD. In the femoral neck region, the mean BMD is 0.829 g/cm2, equivalent to a T-score of -1.5 and a Z-score of -0.8. This is in the osteopenic range. In comparison with the baseline study, there has been a significant 12.7% decrease in BMD.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12428510", "visit_id": "N/A", "time": "2196-05-21 15:54:00"}

14042101-DS-5

## ALLERGIES: No Known Allergies / Adverse Drug Reactions ## CHIEF COMPLAINT: "Palpitations and shortness of breath". ## HISTORY OF PRESENT ILLNESS: y.o woman with past medical history significant for type II DM who presents to the hospital for palpitations and tachycardia. The patient reports that she has been having these episodes for over a year, where she feels palpitations that are associated with shortness of breath and fatigue. In the past these episodes would last approximately 10 minutes and occurred on average once a week. However, over the past week she has been having these episodes with increasing frequency with each episode lasting longer. Today, she went to her pcp for this problem and her longest episode yet, which was lasting for 2 hours during her time at her doctor's office. An ECG was performed at the office which found her to be in an SVT with rates as high as 170s. 911 was called and EMS arrived, who gave her two doses of adenosine 6mg and 12mg which broke the rhythm and reverted her to sinus. She has never lost consciousness. . In the emergency room, she was in sinus and received IV fluids. On arrival to the floor, the patient denied any chest pain or shortness of breath, however had another episode of tachycardia on the floor with sudden onset. An ECG was performed which showed retrograde p waves and no delta waves consistent with an AVNRT and this rhythm was converted to sinus by carotid massage. She remained CP free throughout. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. ## 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: none -PACING/ICD: none 3. OTHER PAST MEDICAL HISTORY: Retinopathy Depression severe for years, rendering her bedbound GERD occasional "bile duct obstruction causing nausea" ## FAMILY HISTORY: Parents with diabetes, history of stroke and AD in the family. No fhx of MI, arrythmia, or sudden cardiac death. ## VS: T 98 bp 120/72 p 73 rr 20 sat 99% on RA ## GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect appropriate. ## HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. No carotid bruits. ## CARDIAC: PMI located in intercostal space, midclavicular line. tachycardic, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. ## LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ## ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. ## EXTREMITIES: No c/c/e. No femoral bruits. ## SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. ## LEFT: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ 2+ At discharge: v/s 98.0 98.0 106/70 130->80 after carotid massage 18 gen: obese female in NAD eyes: PERRL, EOMI, anicteric ent: MMM neck: supple no JVD cv: tachycardic, no murmurs resp: ctab no w/r/c abd: +bs, soft, nt, mildly distended ext: wwp, trace LLE edema, DP 2+ bilat neuro: A&Ox3 psych: pleasant, mood appropriate ## CXR: Single frontal view of the chest was obtained. This study is slightly underpenetrated. Given this, no focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is mild pulmonary vascular congestion. The cardiac silhouette is not enlarged. The aorta is calcified and tortuous. IMPRESSION: Mild pulmonary vascular congestion. No focal consolidation seen. ## ECHO: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Physiologic mitral regurgitation is seen (within normal limits). The tricuspid valve leaflets are mildly thickened. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. No significant valvular abnormality seen. ## ECG: Regular narrow complex tachycardia of uncertain mechanism. Low QRS voltage. Diffuse ST-T wave changes. Findings are non-specific. Since the previous tracing of the same date regular narrow complex tachycardia has replaced sinus tachycardia. ## BRIEF HOSPITAL COURSE: yo woman with history of diabetes and hypertension presented with tachycardia and palpitations. ECG is consistent with SVT, most likely common AVNRT, responsive to adenosine and carotid massage. . #SVT: There was a short R-P interval on ECG making the differential common AVNRT, AVRT with a fast accessory pathway, or AT with PR delay. However, retrograde p-waves were consistent with AVNRT. The patient broke with adenosine in the ambulance and after carotid massage while inpatient. She has had repeated episodes that are recently more persistent and symptomatic. A TSH was normal. She was started on metoprolol to decrease the incidence of SVT. She was taught the Valsalva maneuver for breakthrough SVT despite metoprolol. An appointment was made for her with Dr. to discuss options for SVT treatment. . #Type 2 Diabetes: years in duration, and complicated by retinopathy. Metformin and glyburide were held while she was NPO, and a sliding scale of insulin was used for coverage. . #Hypertension: Stable. She notes history of hypertension to systolic 170's when not on medications. Metoprolol was added to her medication regimen. Her lisinopril dose was halved as a result. . #Depression: Notes year history of severe depression, now resolved. The patient denies being on any psychotropic medications currently. Mood appropriate. . #Constipation: Typically has regular bowel movements. TSH was within normal limits. She was given a bowel regimen. ## MEDICATIONS ON ADMISSION: metformin 500mg bid lisinopril 10mg daily glyburide dose uncertain zolpidem 5mg qhs vitamin B12 daily dose uncertain aspirin prn airplaine rides ## DISCHARGE MEDICATIONS: 1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 2. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 3. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day. 4. glyburide Oral 5. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 6. Vitamin B-12 Oral ## SECONDARY DIAGNOSIS: Hypertension, Diabetes mellitus, Depression ## DISCHARGE CONDITION: Hemodynamically stable, HR , no further arrhythmia since 9am . Ambulating without difficulty ## DISCHARGE INSTRUCTIONS: You were admitted to the hospital with palpitations and fatigue. Your symptoms were secondary to an abnormal heart rhythm which you have had in the past. We started you on a medication called metoprolol to slow your heart rate and try and prevent you from having this abnormal rhythm. Additionally, if you have this fast heart rate at home, you can try to bear down as if having a bowel movement as we discussed when you were int he hospital. Please also avoid caffeine and alcoholic beverages as this can increase the risk of the abnormal heart rhythm. You will also have a follow-up appointment with Dr. to discuss different ways including medications and a potential procedure to stop this rhythm. We made the following changes to your medications: 1. We started metoprolol 25mg PO twice daily 2. We decreased your lisinopril from 10mg to 5mg daily Please keep all of your follow-up appointments as below. Please call to schedule an ultrasound of the heart called an echocardiogram at . It was a pleasure taking care of you.

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14042101", "visit_id": "26779287", "time": "2168-09-30 00:00:00"}

15244599-RR-59

## EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 2 EXAMS ## INDICATION: year old woman with cirrhosis, SBP s/p Dobhoff placement // evaluate for dobhoff placement evaluate for dobhoff placement ## IMPRESSION: 2 CHEST RADIOGRAPHS SHOW REPOSITIONING OF THE ESOPHAGEAL FEEDING TUBE WITH THE WIRE STYLET IN PLACE FROM THE LOWER ESOPHAGUS TO THE GASTROESOPHAGEAL JUNCTION. IT WOULD STILL NEED TO BE ADVANCED ABOUT 8 CM TO MOVE THE APPROPRIATELY INTO THE STOMACH. MOST SIGNIFICANT INTERVAL CHANGE IS NEW LEFT PERIHILAR OPACIFICATION WHICH COULD BE LARGE SCALE PNEUMONIA OR ASYMMETRIC PULMONARY EDEMA, PARTICULAR IF PATIENT LIES ON HER LEFT SIDE. MILD CARDIOMEGALY IS ONLY A LITTLE LARGER TODAY THAN IT WAS ON . MODERATE RIGHT PLEURAL EFFUSION IS LARGER. THERE IS NO PNEUMOTHORAX.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15244599", "visit_id": "22612897", "time": "2170-08-05 17:59:00"}

14136035-RR-11

## INDICATION: Abdominal enlargement with pericardial effusion; evaluate for malignancy. ## ABDOMEN: Dependent atelectasis is mild. A moderate pericardial effusion is simple appearing. Punctate right breast calcifications are incompletely evaluated. A punctate hypoattenuating focus in segment 2 of the liver (3, 18) is too small to characterize, but believed to represent a cyst. The liver is otherwise unremarkable. The spleen and pancreas are within normal limits. There is mild thickening of both adrenal glands, without discrete nodule. Hypoattenuating foci in both kidneys likely represent cysts, although some are too small to characterize. There are no pathologically enlarged lymph nodes within the abdomen or pelvis. A portocaval node measures 9 mm in short axis. There is no ascites or bowel dilatation. Atheromatous change of the abdominal aorta and common iliac arteries is moderate. There is moderate circumferential wall thickening of the hepatic flexure. The terminal ileum appears unremarkable. ## PELVIS: The rectum, sigmoid colon, uterus and bladder are unremarkable. Multiple prominent parauterine vessels are noted. ## OSSEOUS STRUCTURES: Levoconvex lumbar scoliosis is mild, with associated multilevel degenerative changes. ## IMPRESSION: 1. Moderate simple-appearing pericardial effusion, of unknown etiology. 2. Thickening of both adrenal glands is most suggestive of adrenal hyperplasia. 3. Moderate circumferential thickening of the right hepatic flexure may be infectious or inflammatory in nature. However, neoplasm cannot be excluded and correlation with colonoscopy is recommended. The finding regarding the hepatic flexure and need for followup was entered into the critical results dashboard by at approximately 5:15 p.m. on .

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14136035", "visit_id": "N/A", "time": "2165-08-15 12:09:00"}

16041733-RR-50

## EXAMINATION: BILATERAL 2D SCREENING MAMMOGRAM AND 2D SYNTHESIZED VIEWS, 3D BREAST TOMOSYNTHESIS, INTERPRETED WITH CAD ## FINDINGS: Tissue density: B- There are scattered areas of fibroglandular density. ## RIGHT BREAST: There is no suspicious dominant mass, architectural distortion, or suspicious grouped microcalcifications within the right breast. ## LEFT BREAST: There is a 4.5 mm asymmetry within the lower central left breast posterior depth best seen on MLO tomosynthesis image 41 without definite correlate on CC images. There is no additional suspicious dominant mass, architectural distortion, or suspicious grouped microcalcifications within the left breast. ## RIGHT BREAST: No mammographic evidence of malignancy within the right breast. ## LEFT BREAST: 4.5 mm asymmetry lower central left breast for which additional imaging is required. ## RECOMMENDATION(S): Diagnostic mammogram left breast with possible ultrasound. ## NOTIFICATION: The mammography department will attempt to contact the patient to arrange for additional evaluation per department protocol; the patient will be sent a letter requesting her return and her clinician will be sent a copy of this report. ## BI-RADS: 0 Incomplete - Need Additional Imaging Evaluation.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16041733", "visit_id": "N/A", "time": "2173-12-18 13:08:00"}

11354329-DS-17

## ALLERGIES: Patient recorded as having No Known Allergies to Drugs ## MAJOR SURGICAL OR INVASIVE PROCEDURE: ERCP with sphincterotomy EUS with FNA ## CC: abd pain y/o M s/p lap chole in c/b post-op pancreatitis. MRCP at the time was normal. Re-presented in with nausea, vomiting, and abdominal pain. A CT scan showed inflammed pancreas w/ peripancreatic changes and enlarged body. No abscess, pseudocyst, or calcifications were noted. MRCP confirmed pancreatitis but was o/w unremarkable. The patient is being admitted for elective ERCP and CT-A of pancreas. ERPC showed pancreatic duct stricture mid body. No definite filling defects in CBD. Sphincterotomy performed. Patient with some mild post ERCP pain, but not significantly more than pre-ERCP pain. Epigastric, dull, non-radiating. No n/v. ## PAST MEDICAL HISTORY: 1. HTN 2. HLD 3. diverticular disease 4. Coronary artery disease s/p MI ## GEN: Well appearing, no acute distress, awake, alert, appropriate, and oriented x 3 ## SKIN: warm to touch, no apparent rashes. ## HEENT: No conjunctival pallor, no scleral jaundice, OP clear, no cervical LAD ## CV: RRR no audible m/r/g, pulse 2+, no edema ## ABD: soft, mild epigastric tenderness, bowel sounds wnl. ## NEURO: strength and sensation intact bilaterally. ## CT ABD/PANCREAS (PANCREAS PROTOCOL): 1. Subtle enlargement of pancreatic body with mild peripancreatic stranding, suggestive of residual pancreatitis, with edema being a potential cause of pancreatic ductal narrowing. Differential consideration includes autoimmune pancreatitis, although appearance is not classic. Clinical correlation with IgG4 level may be considered. Although no focal mass is seen, follow-up to resolution is recommended to exclude an underlying neoplasm. 2. No pancreatic mass. 3. Infrarenal chronic abdominal aortic dissections. ERCP Normal major papilla Cannulation of the biliary duct was successful and deep with a sphincterotome after a guidewire was placed. Contrast medium was injected resulting in complete opacification. The common bile duct, common hepatic duct, right and left hepatic ducts, biliary radicles and cystic duct were filled with contrast and well visualized. The course and caliber of the structures were normal with no evidence of extrinsic compression, no ductal abnormalities, and no filling defects A sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire for management of possible microlithiasis/sludge as a cause of his pancreatitis. Cannulation of the pancreatic duct was successful and deep with a sphincterotome after a guidewire was placed. Contrast medium was injected resulting in complete opacification A single stricture that was 10 mm long was seen at the main pancreatic duct in the body of the pancreas. This could be as a result of the recent pancreatitis, or due to a malignancy. Otherwise normal ercp to third part of the duodenum EUS An ill-defined mass / abnormal parenchyma was noted in the body of the pancreas - these changes were suggestive of focal acute pancreatitis, however a neoplasm could not be ruled out - FNA was performed. ## BRIEF HOSPITAL COURSE: male with recent pancreatitis was admitted for elective ERCP to find etiology of recent pancreatitis. He underwent an ERCP which revealed a stricture at the pancreatic duct, thought secondary to either pancreatitis or possibly malignancy. He underwent sphincterotomy in case cholelithiasis may have played a role in his pancreatitis. He also underwent CTA Pancreas, which did not reveal a pancreatic mass. EUS was also performed which revealed an abnormality in the pancreas, although again it was unclear if this represented pancreatitis or a pancreatic mass. FNA was taken, and the patient is to follow-up as an outpatient with the ERCP team regarding these results and further follow-up. He was continued on the rest of his home medications, with the exception of aspirin. He was recommended to hold aspirin for the next 7 days. ## MEDICATIONS ON ADMISSION: Lisinopril 20 daily, Atenolol 50 daily, Vicodin, Nexium 40 daily, Multivits, Lovastatin 20 daily, Diltiazem 12h ext mg bid, Naproxen, amiloride-hydrocholothiazide daily. ## DISCHARGE MEDICATIONS: 1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. ## 4. MULTIVITAMIN TABLET SIG: One (1) Tablet PO once a day. 5. Lovastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 6. Diltiazem HCl 60 mg Capsule, Sust. Release 12 hr Sig: One (1) Capsule, Sust. Release 12 hr PO twice a day. ## 7. AMILORIDE-HYDROCHLOROTHIAZIDE MG TABLET SIG: One (1) Tablet PO once a day. 8. Dilaudid 2 mg Tablet Sig: Tablet PO every four (4) hours as needed for pain for 5 days: This medication may make you drowsy. Do not drive or use heavy machinery until you know how this medication affects you. . Disp:*30 Tablet(s)* Refills:*0* 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as needed for constipation. 10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. ## SECONDARY DIAGNOSES: 1. Coronary Artery Disease 2. Hyperlipidemia 3. Hypertension ## DISCHARGE INSTRUCTIONS: You were admitted to the hospital for evaluation of your pancreatitis. You underwent a CT scan of your pancreas, ERCP, and endoscopic ultrasound, which all revealed pancreatitis. We are awaiting the final results of your biopsy, and Dr. will be in touch with you regarding your results. We have made the following changes to your medications: - aspirin: Please do not take this medication for one week after your procedure. You may restart this medication on . - senna / docusate: We would encourage you to take these stool softeners while you are on pain medication to help prevent constipation. - dilaudid: This is a pain medication. This medication may make you drowsy. Do not drive or use heavy machinery until you know this medication affects you.

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "11354329", "visit_id": "24058482", "time": "2156-07-28 00:00:00"}

10813891-RR-2

## INDICATION: female with early pregnancy, referred to assess dating. ## FINDINGS: Transabdominal and transvaginal ultrasound examinations were performed, the latter to better visualize the fetal sac. There is a single live intrauterine gestation with heart rate of 130 beats per minute. The crown-rump measures 6 mm which represents a gestational age of 6 weeks 3 days which corresponds satisfactorily to menstrual dating of 6 weeks 4 days. The ovaries are normal with a right sided hemorrhagic corpus luteal cyst. There is physiologic free fluid within the pelvis. ## IMPRESSION: Single live IUP with size equals dates.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10813891", "visit_id": "N/A", "time": "2174-12-15 14:43:00"}

18602000-DS-12

## HISTORY OF PRESENT ILLNESS: As per HPI by admitting MD: ## HPI(4): Ms. is a female with past medical history of ulcerative colitis w/ recent flare requiring high dose steroids, recent new stroke, Afib, who is admitted for recurrent fevers. The patient presented to the ED by recommendation from her GI doctor Dr. . She reports that starting abruptly yesterday, she developed urinary frequency and fevers to 101.6 at home. She had associated malaise and dysuria. She felt that it was similar to UTI's, which she has had many of. She is also complaining of ongoing abdominal pain that she has been having since her recent UC flare began. Of note, the patient was admitted from through for a UC flare and was treated with IV steroids and initiated on Remicade, and was discharged on prednisone 40 mg po daily with plans to follow up with GI to taper the steroids and continue remicade. At that time, she was also diagnosed with new Atrial fibrillation. After discussion with the patient and CHADS2VASC of only 2, as well as active bloody diarrhea, decision was made to hold anticoagulation. The patient was readmitted on with visual symptoms and diagnosed with new ischemic stroke, likely embolic from Afib. She was started on apixaban at that time. ## LABS: UA negative, UCX and BCx sent, WBC 19.6, hgb 10.8, phos 2.3, otherwise within normal limits. CXR, which I interpreted, showed no focal pneumonia or other obvious airspace disease. She was given one packet of neutral-phos Decision was made to admit for further workup. On arrival to the floor the patient has had no further fevers, her urinary frequency has improved, and she feels back to normal. She corroborated the above. She also reports that her bowel movements have been improving significantly, now just having about 2 nonbloody BM's daily (was as many as BM's w/ blood during her flare). ## ROS: Pertinent positives and negatives as noted in the HPI. All other systems were reviewed and are negative. ## PAST MEDICAL HISTORY: -Acute stroke , likely embolic from new Atrial fibrillation -Ulcerative colitis -Atrial fibrillation, diagnosed during admission for UC flare. -Hypertension - Esophagus -Raynaud's -Plantar fasciitis -Rosacea -Dry eye -Fibroid embolization -Fibroid removal -Cluster headaches ## FAMILY HISTORY: Mother and sister with HTN Maternal grandmother with stroke - stomach cancer ## VITALS: Afebrile and vital signs stable (see eFlowsheet) ## GENERAL: Alert and in no apparent distress ## EYES: Anicteric, pupils equally round ## ENT: Ears and nose without visible erythema, masses, or trauma. Oropharynx without visible lesion, erythema or exudate ## CV: Heart regular, no murmur, no S3, no S4. No JVD. ## RESP: Lungs clear to auscultation with good air movement bilaterally. Breathing is non-labored ## GI: Abdomen soft, non-distended, non-tender to palpation. Bowel sounds present. No HSM ## GU: No suprapubic fullness or tenderness to palpation ## MSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs ## SKIN: No rashes or ulcerations noted ## NEURO: Alert, oriented, face symmetric, gaze conjugate with EOMI, speech fluent, moves all limbs, sensation to light touch grossly intact throughout ## 97.7 PO BP: 115/74 HR: 61 RR: 18 O2 sat: 96% O2 delivery: RA Gen - well appearing, sitting up in bed HEENT - moist oral mucosa, PERRL - rrr, s1/2, no murmurs Pulm - CTA b/l, no w/r/r GI - soft, non tender, non distended, + bowel sounds Ext - no peripheral edema or cyanosis Skin - warm and dry, no rashes Psych - calm and cooperative ## DISCHARGE: ========== blood cultures with Strep species and blood cultures no growth to date ## NCHCT ( ): 1. Dental amalgam streak artifact limits study. The previously described subacute infarct at the right frontal semiovale and subcortical white matter are better demonstrated on MRI MRA dated . 2. No new large territory infarction or hemorrhage. 3. Atrophy, probable small vessel ischemic changes, and atherosclerotic vascular disease as described. ## CXR ( ): No acute intrathoracic findings, particularly, no findings concerning for pneumonia. ## CT A/P W/CONT ( ): 1. Wall thickening of the descending colon and distal transverse colon with mild inflammatory changes in the surrounding abdominal fat and peritoneal fascia consistent with acute colitis. 2. Featureless appearance of the descending colon and mild fatty infiltration of the wall is likely sequela of colitis. ## BRIEF HOSPITAL COURSE: female with past medical history of ulcerative colitis w/ recent flare ( ) requiring high dose steroids and initiation of remicade, recent diagnosis of afib with acute stroke (initiated on apixaban) admitted with fevers now found to have sigmoid abscess and GPC bacteremia. # Fevers: # GPC Bacteremia: # Sigmoid abscess: Initially unclear etiology so CT torso obtained and notable for ~2cm x 1cm abscess in the sigmoid colon also with PVT that is likely due to septic thrombophlebitis. Blood Cx positive for GPCs in pairs. ID consulted and recommended IV ceftriaxone 2g daily and PO flagyl TID, for an extended course of 6 weeks. Per discussion with radiologist, abscess not likely amenable to drainage due to size. She will be seen by ID as an outpatient for clinical monitoring. Case discussed with both ID and GI, will need a repeat CT scan as an outpatient to accurately determine duration of antibiotic therapy but planning for 6 weeks from discharge. A PICC line was placed before discharge. -Ceftriaxone 2g daily x 6 weeks -Metronidazole 500mg po TID x 6 weeks -Labs per OPAT recs -PICC lined placed # Ulcerative colitis: # Recent UC flare: She was initially on rectal mesalamine but in early had sigmoidoscopy showing diffuse inflammation so she was initiated on remicade and IV steroids, and eventually discharged on on prednisone 40mg daily with plan for outpatient remicaide and prednisone taper. Prednisone taper continued to 20mg at time of discharge with outpatient plan to stay on 20mg daily until seen by GI as an outpatient. If her steroids are not tapered further she should be evaluated for prophylactic calcium/vit D (already on GI ppx). # Atrial fibrillation: # Recent embolic stroke: Recently admitted for small R frontal infarct, likely due embolic from afib for which apixaban was initiated. Currently in NSR with well-controlled rates. CHADsVASC 3. Continued apixaban and metoprolol. covering MD discussed with neurology, does not need to be on atorvastatin as her CVA was embolic in setting of atrial fibrillation. Based on lipid profile, does not require statin based on ASCVD risk score. Additionally her LFT's are slightly elevated at the time of discharge so it is held for this reason as well. # Leukocytosis Likely in the setting of infection and now trending down appropriately. Still elevated but trend improved. Will need this followed as an outpatient ## # HTN: Was previously taking losartan which has been held due to normotension. # Low serum TSH without hyperthyroidism: TSH undetectable this admission and last but FT4 WNL, likely c/w nonthyroidal illness vs steroid effect. Needs repeat TFTs in weeks. ## # INFLUENZA PROPHYLAXIS: Tamiflu x 7 additional days # Chronic dry eye: Continue restasis # Transitional -TFTs weeks -CBC within the next week (part of OPAT labs) -Repeat LFTs within the next week (part of OPAT labs) -f/u with GI and ID as an outpatient to help determine duration of antibiotic treatment ## MEDICATIONS ON ADMISSION: The Preadmission Medication list is accurate and complete. 1. Metoprolol Succinate XL 200 mg PO DAILY 2. Omeprazole 20 mg PO DAILY 3. PredniSONE 40 mg PO DAILY 4. Restasis 0.05 % ophthalmic (eye) BID 5. Apixaban 5 mg PO BID 6. Estradiol 0.01 % (0.1 mg/gram) vaginal 1X/WEEK ( ) 7. Atorvastatin 40 mg PO QPM ## DISCHARGE MEDICATIONS: 1. CefTRIAXone 2 gm IV Q24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 g IV once a day Disp #*45 Intravenous Bag Refills:*0 2. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*120 Tablet Refills:*0 3. OSELTAMivir 75 mg PO DAILY Duration: 10 Days RX *oseltamivir 75 mg 1 capsule(s) by mouth once a day Disp #*7 ## CAPSULE REFILLS: *0 4. PredniSONE 20 mg PO DAILY RX *prednisone 20 mg 1 tablet(s) by mouth once a day Disp #*30 ## TABLET REFILLS: *0 5. Apixaban 5 mg PO BID 6. Estradiol 0.01 % (0.1 mg/gram) vaginal 1X/WEEK ( ) 7. Metoprolol Succinate XL 200 mg PO DAILY RX *metoprolol succinate 200 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 8. Omeprazole 20 mg PO DAILY 9. Restasis 0.05 % ophthalmic (eye) BID 10. HELD- Atorvastatin 40 mg PO QPM This medication was held. Do not restart Atorvastatin until your liver enzymes are checked and normalize ## DISCHARGE DIAGNOSIS: # sigmoid abscess # pylephlebitis # GPC bacteremia ## DISCHARGE INSTRUCTIONS: Dear Ms. , You were admitted to the hospital with fevers. You underwent an extensive infectious work-up, which revealed and abscess in your colon as well as bacteria in your blood. You were seen by our infectious doctors and require several weeks of antibiotics. You will continue treatment at home. Please have your thyroid function tests repeated in weeks. You will also need your liver enzymes and blood counts checked on a weekly basis as part of your antibiotic therapy. Please continue to take all medications as prescribed and follow up with all appointments as detailed below. We wish you the best. Sincerely, Your Team

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "18602000", "visit_id": "25967308", "time": "2135-11-11 00:00:00"}

14023173-RR-2

## INDICATION: male with history of MDS, myelodysplastic syndrome, diagnosed with bone marrow biopsy on when he was found to have fatigue, drop counts on CBC, refractory anemia and excessive blast, now transferring from for management and question of transformation to acute leukemia. ## FINDINGS: Lung bases demonstrate small bilateral basilar pleural effusions, greater on the right with basilar atelectasis. The remaining lungs are otherwise clear. The heart is normal in size. Sequela of anemia is noted within the heart on the non-contrast images. Mitral valve calcification is noted. The liver is normal in size. A focal hypodensity is noted within the hepatic lobe (2:24), incompletely characterized without IV contrast. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is distended. The spleen is normal. The pancreas is normal. The bowel is normal. Both adrenal glands are normal. Redemonstration of large subcapsular right-sided hematoma of the right kidney with stable to slight increase in size since comparison examination. This measures 8 x 8.5 x 11.4 cm in the AP, transverse and CC , previously 8 x 7.9 x 11 cm. There is redemonstration of the hyperdense fluid tracking into the right perirenal space and about the IVC. Trace amount of fluid is also noted tracking into the bilateral posterior pararenal spaces and left paracolic gutter as previously seen, without significant interval change. A stable hypodense lesion in the left kidney superior pole. Nephrolithiasis in the inferior pole of the left kidney. No significant retroperitoneal lymphadenopathy is noted. Moderate atherosclerotic disease of the abdominal aorta. ## CT PELVIS: Mild amount of hyperdense fluid is persistent in the presacral space, tracking from the above hematoma. Post-surgical changes in the lower pelvis are not clearly seen due to adjacent artifact from left hip prosthesis. ## BONES: Left total hip arthroplasty. Facet arthropathy and degenerative disc disease in lower lumbar spine and lower thoracic spine. ## IMPRESSION: Stable to minimal interval increase in size of the right subcapsular renal hematoma. However, there is stable amount of hematoma tracking into the retroperitoneum as described without significant interval change. An underlying mass is difficult to exclude on this non contrast examination. 6 month follow up MRI may be helpful for characterization; This time frame would allow for some resolution of the hematoma and would provide for better visualization of any underlying mass. The above findings were discussed with Dr. at 8:30 a.m. on . Additionally, the recommendation for awaiting 6 months for a follow up evaluation for MRI was discussed with Dr. at 5:30 pm

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14023173", "visit_id": "28467541", "time": "2151-04-23 21:37:00"}

19354547-RR-9

## EXAMINATION: BILAT LOWER EXT VEINS ## INDICATION: Evaluate for DVT in a patient with the lower extremity edema after fall. ## FINDINGS: There is normal compressibility, flow, and augmentation of the bilateral common femoral, femoral, and popliteal veins. Normal color flow and compressibility are demonstrated in the posterior tibial and peroneal veins on the left. The right calf veins are not particularly well assessed. There is normal respiratory variation in the common femoral veins bilaterally. No evidence of medial popliteal fossa ( ) cyst. ## IMPRESSION: No evidence of deep venous thrombosis in the right or left lower extremity veins.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19354547", "visit_id": "29104573", "time": "2135-07-09 17:57:00"}

17239250-RR-25

## EXAMINATION: CT ABD AND PELVIS WITH CONTRAST ## INDICATION: with epigastric pain and elevated lipase, assess for pancreatitis. ## LUNG BASES: The imaged lung bases are clear. The imaged portion of the heart is unremarkable. ## ABDOMEN: The liver enhances normally without focal concerning lesion. Main portal vein is patent. No biliary ductal dilation is seen. The gallbladder is normal. There is no biliary ductal dilation. There is mild peripancreatic fluid surrounding the pancreatic head and uncinate process which raises concern for acute pancreatitis. No evidence of complication. Pancreatic duct is not dilated. Spleen is normal. Adrenals are normal. Kidneys enhance and excrete normally. The stomach and duodenum appear normal. ## PELVIS: Loops of small bowel demonstrate no signs of ileus or obstruction. There is an entero-enteric anastomosis in the left mid abdomen which appears unremarkable. There is no secondary evidence for appendicitis. The colon is unremarkable. Urinary bladder is decompressed. The prostate is unremarkable. No pelvic sidewall or inguinal adenopathy. ## BONES: No worrisome lytic or blastic osseous lesion is seen. Transitional anatomy is noted with partial lumbarization of S1. ## IMPRESSION: Acute pancreatitis centered at the pancreatic head/uncinate process.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17239250", "visit_id": "27499286", "time": "2175-05-04 12:28:00"}

18121763-RR-34

## STUDY: Limited right upper quadrant ultrasound liver and gallbladder. ## INDICATION: HIV positive and rising LFTs. ## FINDINGS: The liver displays normal echotextural pattern without focal lesion detected. There is no intra- or extra-hepatic biliary ductal dilatation with the common bile duct measuring 3 mm. Limited views of the right kidney display no hydronephrosis or other abnormality. No gallbladder is visualized, consistent with history of previous cholecystectomy. The pancreas is unremarkable, although the tail is not well visualized secondary to overlying bowel gas. The main portal vein is patent with normal hepatopetal flow. The spleen is normal in size and echotexture, measuring 9.8 cm. ## IMPRESSION: Unremarkable limited right upper quadrant ultrasound.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18121763", "visit_id": "N/A", "time": "2178-01-13 13:15:00"}

15220389-RR-21

## INDICATION: woman with stable nodules right upper quadrant thought likely to represent complicated cysts which have demonstrated two-year stability by mammogram. Comparison is made to prior mammograms from and and ultrasound right breast and . BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM WITH COMPUTER-AIDED DETECTION: There are scattered fibroglandular densities. The partially circumscribed nodules and nodular asymmetries in the right upper outer breast, anterior/mid breast depth are unchanged for at least years with some of the nodules decreasing in size when compared to prior studies. There are scattered benign-appearing calcifications without suspicious groups. No new or spiculated mass, suspicious clusters of microcalcifications or architectural distortion. ## ULTRASOUND RIGHT BREAST: Targeted ultrasound of the upper outer right breast was performed. At 11 o'clock, 2 cm from the nipple, there is a complicated cyst measuring 9 x 8 x 9 mm, this demonstrates a fluid-debris level with no internal vascularity and is stable for one year. At 10 o'clock, 3 cm from the nipple, there are two further hypoechoic nodules, also likely representing complicated cysts. The larger of these has decreased in size from 12 x 11 x 10 mm to 9 x 11 x 7 mm compatible with a collapsing complicated cyst. The smaller nodule adjacent to this has decreased from 4 mm to 3 mm. Further subcentimeter scattered simple cysts are seen. No new or suspicious mass. ## IMPRESSION: Stable/decreased size of the circumscribed nodule/nodular asymmetries in the upper outer right breast, compatible with simple cysts. These have demonstrated three-year stability by mammography and two-year stability from prior ultrasound. The patient may resume annual screening one year. These results and recommendation were discussed with the patient who agrees with this plan. BI-RADS 2 - benign findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "15220389", "visit_id": "N/A", "time": "2183-12-04 09:04:00"}

11722506-RR-19

## HISTORY: Right knee and lower leg surgery with right lower leg and ankle pain, skin erythema along the anterior lower leg. ## FINDINGS: A lateral plate is seen fixating the proximal medial tibia with 2 proximal and 2 distal screws. Lucency is noted within the medial proximal tibia which is related to prior orthopedic procedure. Additionally, 2 screws are noted coursing through the lateral proximal tibia. No evidence of hardware loosening or failure is demonstrated. There are degenerative changes involving all 3 compartments of the knee, but most severe within the medial compartment with moderate joint space narrowing and osteophyte formation. Tiny suprapatellar joint effusion is noted. No acute fracture or dislocation is seen. Within the ankle and tibia and fibula, no acute fracture or dislocation is present. The ankle mortise is symmetric. The talar dome is smooth. Minimal spurring is noted at the tibiotalar joint. There is no focal lytic or sclerotic osseous abnormality. No radiopaque foreign bodies or subcutaneous gas is noted. ## IMPRESSION: No acute fracture or dislocation. No evidence of hardware complications.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "11722506", "visit_id": "N/A", "time": "2134-02-11 12:19:00"}

14588919-RR-65

## CLINICAL INFORMATION: woman with right flank pain, question stone. . ## LUNG BASES: The lung bases are clear without pleural or pericardial effusion. ## ABDOMEN: Evaluation of abdominal viscera is limited by lack of intravenous contrast. There is no intrahepatic biliary ductal dilatation. The gallbladder is normal appearing. The spleen is normal in size. The adrenals are normal in size bilaterally. Kidneys are normal in size and appearance bilaterally without surrounding inflammatory change. There is no renal calculus identified, nor hydronephrosis. No ureteral calculus is seen. There are no calculi seen within the bladder. The pancreas is unremarkable. The stomach is filled with ingested contents. Loops of small bowel are normal in caliber. The small-bowel mesentery appears normal. The aorta is normal in caliber along its course. ## PELVIS: The patient is status post appendectomy with surgical staple line seen at the level of the cecum. The pelvic organs, rectum, bladder, and colon all appear normal. There is no intraperitoneal free fluid or free air. There is no pelvic side wall lymphadenopathy. ## BONE WINDOWS: There is no concerning lytic or blastic osseous lesion. ## IMPRESSION: 1. No renal or ureteral calculus, or cause for acute right flank pain. No hydronephrosis. 2. Status post appendectomy.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "14588919", "visit_id": "N/A", "time": "2187-11-03 19:03:00"}

12501269-RR-224

## PROCEDURE: CT chest without contrast. ## REASON FOR EXAM: Evaluate for mass or post-obstructive pneumonia. ## FINDINGS: There is new multifocal ground-glass opacities throughout both lungs, worse in the right middle lobe, right lower lobe and left upper lobe in addition to multiple tiny centrilobular nodules, bronchiolectasis and mild airway thickening. Some of these centrilobular nodules are confluent in areas, for example in the right lower lobe (5.219). Linear atelectasis in the left lower lobe with mild bronchiectasis is the residua of consolidation on the previous CT. A large hiatal hernia raises the possibility of recurrent aspiration, particularly in the presence of a lower lobe bronchiectasis and recurrent consolidation. However, a concurrent atypical infection is also possible. Lymph node enlargement is slightly less than on the previous study and is now 10 mm in the paratracheal region, was 14 mm. A well-circumscribed nodule in the right lower lobe (4.133) is slightly larger than , was 12 mm, is now 13.8 mm, although the differences could be due to differences in technique. No new pulmonary nodules, pleural effusion, mass. Airways are widely patent to subsegmental levels bilaterally. The right main pulmonary artery is 27 mm, borderline enlarged. The aorta and heart size are normal with no pericardial effusion. Calcification in the aortic annulus and coronary arteries is moderate. Limited review of the upper abdomen is unremarkable except to note calcification in the abdominal aorta at the origin of the visceral arteries and fatty replacement of the pancreas. No destructive or sclerotic bone lesion is present. ## IMPRESSION: 1. Resolution of the left lower lobe consolidation with residual left lower lobe atelectasis and mild bronchiectasis. 2. New multifocal ground-glass opacities with mild bronchiolectasis and bronchiectasis, bronchial wall thickening and centrilobular nodules are likely due to a combination of recurrent aspiration--the patient has a moderate-to-large hiatal hernia--and concurrent atypical infection, probably viral. 3. Minimal increase in right lower lobe well-circumscribed nodule could be accounted for by differences in technique; follow up in one year would be prudent. 4. Diffuse triple vessel coronary artery and aortic valve calcification.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12501269", "visit_id": "23215128", "time": "2138-06-01 09:54:00"}

12716861-RR-96

## EXAMINATION: CT abdomen and pelvis ## INDICATION: year old woman with a history of diverticulitis status post sigmoid colectomy and diverting loop ileostomy status post ileostomy takedown . Now presenting with prior ostomy wound requiring dressing with packing and has constant pain lower right quadrant flanking prior ostomy site.// Please evaluate for source of right lower quadrant pain. ?Abscess, ## SINGLE PHASE SPLIT BOLUS CONTRAST: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## DOSE: Acquisition sequence: 1) Stationary Acquisition 2.5 s, 0.5 cm; CTDIvol = 12.0 mGy (Body) DLP = 6.0 mGy-cm. 2) Spiral Acquisition 4.2 s, 46.4 cm; CTDIvol = 10.1 mGy (Body) DLP = 469.1 mGy-cm. 3) Spiral Acquisition 0.8 s, 9.0 cm; CTDIvol = 4.8 mGy (Body) DLP = 42.7 mGy-cm. 4) Spiral Acquisition 0.8 s, 9.0 cm; CTDIvol = 4.8 mGy (Body) DLP = 42.7 mGy-cm. Total DLP (Body) = 560 mGy-cm. ## LOWER CHEST: The left lung base is clear. The right hemidiaphragm is elevated. ## HEPATOBILIARY: Liver is unremarkable. Cholelithiasis is again noted. ## PANCREAS: The pancreas is unremarkable. ## SPLEEN: The spleen is unremarkable. ## ADRENALS: The adrenal glands are unremarkable. ## URINARY: The kidneys are unremarkable. ## GASTROINTESTINAL: Post sigmoid colectomy with sigmoid sutures. New changes of ileostomy take down with mild soft tissue stranding and wall thickening around the anastomotic site are noted and could be postsurgical. No free air, fluid collection or extraluminal contrast to suggest leak. Stranding and a few foci of air are seen in the subcutaneous fat overlying the right lower quadrant, also expected post recent intervention. The appendix is unremarkable. ## PELVIS: The uterus and adnexa are unremarkable on CT for age. ## LYMPH NODES: There is no abdominal or pelvic lymphadenopathy. ## VASCULAR: Moderate atherosclerotic disease is noted. ## BONES: There are no aggressive bone lesions. There is mild retrolisthesis of L5 on S1. Severe compression deformity of L2 is unchanged. ## SOFT TISSUES: Redemonstration of ventral hernia containing nonobstructive loops of small bowel. ## IMPRESSION: Mild soft tissue stranding around the ileoileal anastomosis and within the subcutaneous soft tissues of the right lower quadrant, likely related to recent intervention. No drainable fluid collection or leak demonstrated.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12716861", "visit_id": "N/A", "time": "2138-08-30 14:27:00"}

17188320-RR-19

## EXAMINATION: ANKLE (AP, MORTISE AND LAT) RIGHT ## INDICATION: year old woman s/p R pilon ORIF and ex-fix// s/p R pilon ORIF and ex-fix s/p R pilon ORIF and ex-fix ## FINDINGS: The patient is status post open reduction internal fixation of markedly comminuted fractures of the distal right tibia and fibula. There has been interval placement of a lateral plate over the distal fibula with multiple screws as well as a syndesmotic screw. An external fixation device is also present. The alignment is overall near anatomic. A small butterfly fragment from the fibular fracture again projects over the syndesmoses. The mortise appears congruent on the provided nonweightbearing views and the talar dome is intact. No new fractures or evidence of hardware related complications. ## IMPRESSION: Status post open reduction internal fixation of the lower right leg as described above. No evidence of acute hardware related complications.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17188320", "visit_id": "20189092", "time": "2111-10-24 19:36:00"}

10108435-RR-188

## HISTORY: man with recent STEMI, GI bleed, and status post catheterization, now presenting with low blood pressure and hematocrit drop. Evaluate for possible retroperitoneal bleed. ## STUDY: CT abdomen and pelvis without contrast. MDCT images were acquired from the lung bases to the pubic symphysis. Multiplanar reformatted images are displayed in 5-mm slice thickness. ## CT ABDOMEN WITHOUT CONTRAST: In the visualized lung bases, there are mild-to- moderate dependent bibasilar atelectasis. There is trace amount of bilateral pleural effusion. The heart is within normal limits. There is a small amount of pericardial effusion. In the abdomen, the liver is without focal lesions. The gallbladder has tiny hyperdense foci in the dependent position (image 2a:25) but is otherwise normal. The stomach, duodenum, loops of small bowel, and colon are normal within the limits of the non-contrast study. The pancreas has small focal fatty changes, normal for age. The spleen, adrenal glands, kidneys are unremarkable. There is an IVC filter in the infrarenal vein position. There are multiple small venous varices in the retroperitoneum, consistent with a history of DVT and subsequent collateral venous varice formation. There is no discernable lymphadenapathy. There is no evidence of free fluid to suggest hematoma. There is no free air in the intra- abdominal cavity. ## CT PELVIS WITHOUT CONTRAST: The bladder is normally distended without focal abnormality. The prostate is normal in size. The colon and small bowel are normal. There is no discernable lymphadenopathy. There is no free fluid in the retroperitoneum. There is no free air in the pelvis. ## BONE WINDOW: There is an unchanged L1 anterior wedge deformity with evidence of mild retropulsion. The superior endplate deformity in L3 is also unchanged. There is multilevel disc narrowing with moderate-to-severe facet joint arthropathy and secondary degenerative changes especially in the lower lumber. The right SI joint is fused, and the left SI joint has significant narrowing with a small bone island in the left iliac bone. There are no suspicious blastic or lytic osseous lesions. There is vascular calcification in the descending aorta, common iliac arteries and splenic artery. The underlying soft tissues are unremarkable. ## INDICATION: 1. No evidence of retroperitoneal bleeding/hematoma. 2. IVC filter at the infrarenal vein position with evidence of collateral venous varice formation. 3. Unchanged deformity in L1 and L3 vertebral bodies. 4. Unchanged marked underlying degenerative diseases. The findings of the study have been communicated to the primary team, Dr. by phone at 1:30 p.m. on the date of the study.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10108435", "visit_id": "21874806", "time": "2184-04-25 12:20:00"}

16931484-RR-44

## INDICATION: year old man with abdominal aneurysm// follow up on AAA repair ## FINDINGS: The aorta measures 2.4 cm in the proximal portion, 2.7 cm in mid portion and 5.6 cm in the distal abdominal aorta. There has been interval increase in size of the known fusiform aneurysm now measuring up to 5.6 cm in maximal AP dimension (previously 4.2 cm in . There is moderate calcified atherosclerotic plaque. Wall-to-wall color flow is seen within the aorta with appropriate arterial waveforms. The common iliac arteries are aneurysmal. The right common iliac artery measures 1.7 cm and the left common iliac artery measures 1.5 cm. The right kidney measures 10.1 cm and the left kidney measures 10.8 cm. Limited views of the kidneys are without hydronephrosis. ## IMPRESSION: Interval increase in the size of the known fusiform aortoiliac aneurysm measuring up to 5.6 cm maximal AP (previously 4.2 cm in . ## NOTIFICATION: The findings were discussed with , by , on the telephone on at 10:55 am, 5 minutes after discovery of the findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16931484", "visit_id": "N/A", "time": "2204-02-12 10:02:00"}

10368757-RR-36

## EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD ## INDICATION: male with history of prior head trauma, presenting with persistent nasal drainage and headache. Concern for CSF leak. ## DOSE: Acquisition sequence: 1) Sequenced Acquisition 6.0 s, 20.0 cm; CTDIvol = 53.0 mGy (Head) DLP = 1,060.0 mGy-cm. Total DLP (Head) = 1,060 mGy-cm. ## FINDINGS: CT cisternogram study demonstrates expected hyperdensity within the sulci and cisterns. There is no evidence of contrast material outside the expected regions to suggest CSF leak. No evidence to suggest fistula. Again demonstrated are fractures involving the left frontal bone with persistent focal depression and bilateral nasal bone fractures again seen. The mastoid air cells are clear. ## IMPRESSION: 1. Expected filling within the sulci and cisterns without evidence to suggest CSF leak or fistula. 2. Again noted are nasal bone fractures and depressed left frontal bone fracture.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "10368757", "visit_id": "N/A", "time": "2115-01-07 13:27:00"}

12522208-RR-41

## INDICATION: year old man with memory loss with HTN, DM, and ESRD on dialysis// ? medial lobe atrophy or white matter disease. ## FINDINGS: There is no evidence of acute intracranial hemorrhage or acute territorial infarction. Ventricles and sulci are prominent secondary to age related involutional changes. Periventricular and deep subcortical T2/FLAIR white matter hyperintensities are likely sequelae of chronic microangiopathy. No diffusion abnormalities are detected. Chronic infarction is seen involving the right cerebellum with adjacent increased FLAIR signal abnormality likely secondary to gliosis, ocular ischemic changes identified in the right side of the pons (image 7, series 5, image 83, series 101). Symmetric bilateral hippocampal atrophy seen. Bilateral basal gangliar calcifications are seen. Mild mucosal sinus thickening is seen involving the ethmoid air cells. The remainder the visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Left replacement is identified in the right eye globe otherwise the orbits are unremarkable. The patient is status post right lens replacement surgery. The principal vascular flow voids are well preserved. ## IMPRESSION: 1. No acute intracranial abnormalities identified. Chronic microangiopathy. 2. Chronic infarction is seen involving the right cerebellum. 3. Symmetric bilateral hippocampal atrophy, may be secondary to age related involutional changes, however is a finding seen in the presence of dementia. 4. Lacunar ischemic change is identified towards the right side of the pons

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12522208", "visit_id": "N/A", "time": "2154-09-03 16:40:00"}

14550633-DS-21

## ALLERGIES: No Known Allergies / Adverse Drug Reactions ## MAJOR SURGICAL OR INVASIVE PROCEDURE: : Deceased donor kidney transplant ## HISTORY OF PRESENT ILLNESS: Ms. is a y/o speaking female with a medical history of ESRD on HD, CAD s/p CABG, PVD, HTN, DM2 who presents after being called in for renal transplant. She denies CP, SOB, n/v/abd pain. She feels well and overall had no complaints. ## PAST MEDICAL HISTORY: ESRD on HD (TuThSa) Failed left AVF Right AV graft created in Angioplasty of the right mid-graft and basilic vein at AV care on . CAD s/p CABG ( ) Myelodysplastic syndrome PVD DM2 HTN ## FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. ## HEENT: AT/NC, EOMI, PERRL, MMMs ## CARDIAC: RRR, S1/S2, III/VI SEM heard best at LUSB ## LUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles ## ABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding ## EXTREMITIES: Old LUE AV fistula w/o palpable thrill or murmur. RUE AV fistula also w/o palpable thrill or murmur. No overlying erythema or induration. Moving all extremities well, no cyanosis, clubbing or edema ## NEURO: A&Ox3. Moving all extremities equally. No focal deficits appreciated. ## BRIEF HOSPITAL COURSE: On , she underwent Deceased donor kidney transplant after receiving induction immunosuppression. Surgeon was Dr. . Please refer to operative report for complete details. Intraop, after the vascular anastomoses, the kidney reperfused, although was slow initially as the patient's blood pressure was in the . BP improved after decreasing sedation. A 19 drain was placed in the retroperitoneum. Postop, she was producing small amounts of urine. Immediately postop, potassium was elevated at 6.6. IV meds (insulin/dextrose)were administered with lowered potassium. Renal duplex demonstrated arterial waveforms slightly delayed acceleration time throughout. On postop day 1, urine output was still low and potassium was still elevated for which IV meds were readministed. Hemodialysis was then performed with lowering of the potassium. She continued to have low urine outputs. Hct was low (23 from postop day 1 and 2 units of prbc were administered with hct increase to 32.5. However, over the hospital course, hct decreased again to 20 on postop day 7. Another 2 units of PRBC were transfuse with hct increase to 27 which remained stable. She received a total of 4 doses of ATG (75mg each dose), steroids were tapered to off, cellcept was adjusted to 500mg qid for GI complaints and Prograf was started on postop day 3. Doses were adjusted daily per trough levels. BP was elevated in 160s. Home dose of Isosorbide was resumed and amlodipine was added. BPs improved with SBP in 140-120 range. Diet was advanced and tolerated. Glucoses were elevated in 200-300s. was conculted and insulin adjusted to Lantus and sliding scale humalog with improved control. JP drain was removed on . On , she complained of diarrhea. Stool was sent for c.diff and was negative. Cellcept was adjusted to 500mg qid. She was started on loperamide for diarrhea with resolution. Hemodialysis was performed on and then held for increasing urine output. It was also discovered on , that the patient was saving all of her urine for recording. After discussion with interpreter, she started to save urine and it was noted that she had made 1000+ cc for the day. Creatinine decreased to 4.9. Repeat renal duplex on showed increased resistive indices to 1.0 with no diastolic flow. Renal vein and artery were patent. No fluid collection was noted. She and her family received medication and transplant teaching via the interpreter. Meds were delivered. determined that patient had no needs. Caregroup was arranged. She was discharged to home in stable condition. HD was on hold pending f/u labs and urine output. Next lab draw on at lab 7 by 9am. Of note, her outpatient HD spot was given away therefore, she was given Lasix 80mg once on , and was to take another dose on (dose provided). ## MEDICATIONS ON ADMISSION: The Preadmission Medication list is accurate and complete. 1. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO DAILY 4. Doxazosin 1 mg PO HS 5. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 6. Lisinopril 20 mg PO DAILY 7. Metoprolol Succinate XL 100 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Omeprazole 20 mg PO DAILY 10. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 11. sevelamer CARBONATE 1600 mg PO BID 12. cilostazol 50 mg ORAL BID 13. Acetaminophen 650 mg PO Q8H:PRN pain 14. Furosemide 80 mg PO DAILY 15. Nephrocaps 1 CAP PO BID 16. Cinacalcet 30 mg PO DAILY 17. Cyanocobalamin 1000 mcg PO DAILY 18. Sodium Polystyrene Sulfonate 30 gm PO 1X/WEEK (MO) 19. FoLIC Acid 1 mg PO DAILY 20. Glargine 12 Units Bedtime Humalog 6 Units Breakfast Humalog 7 Units Lunch Humalog 2 Units Dinner ## DISCHARGE MEDICATIONS: 1. Acetaminophen 650 mg PO Q8H:PRN pain Maximum of 8 tablets(325mg tabs) per day 2. Amlodipine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO DAILY 5. cilostazol 50 mg ORAL BID 6. FoLIC Acid 1 mg PO DAILY 7. Omeprazole 20 mg PO DAILY 8. Mycophenolate Mofetil 500 mg PO QID 9. Nystatin Oral Suspension 5 ml PO QID 10. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 11. ValGANCIclovir 450 mg PO 2X/WEEK (WE,SA) This dose will be adjusted as kidney function improves 12. Cyanocobalamin 1000 mcg PO DAILY 13. Sodium Polystyrene Sulfonate 30 gm PO 1X/WEEK (MO) 14. Nephrocaps 1 CAP PO BID 15. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth q 4 hours Disp #*30 ## TABLET REFILLS: *0 16. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 17. LaMIVudine 25 mg PO DAILY RX *lamivudine [Epivir] 10 mg/mL 2.5 ml by mouth once a day Disp Milliliter Refills:*12 18. Glargine 10 Units Dinner Insulin SC Sliding Scale using HUM Insulin 19. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*3 20. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*60 ## TABLET REFILLS: *3 21. Metoprolol Succinate XL 50 mg PO DAILY 22. Tacrolimus 3 mg PO Q12H 23. Furosemide 80 mg PO ONCE Duration: 1 Dose take once on . Outpatient Lab Work 25. Outpatient Lab Work ## DISCHARGE DIAGNOSIS: ESRD s/p kidney transplant Delayed graft function Hepatitis B core Antibody positive ## DISCHARGE INSTRUCTIONS: Please call the transplant clinic at for fever (temperature of 101 or greater, chills, nausea, vomiting, diarrhea, constipation, inability to tolerate food, fluids or medications, increased abdominal pain, incisional redness, drainage or bleeding, dizziness or weakness, decreased urine output or dark, cloudy urine, swelling of abdomen or ankles, or any other concerning symptoms. You will have labwork drawn twice weekly as arranged by the transplant clinic at floor, , with results to the transplant clinic (Fax . (CBC, Chem 10, AST, T Bili, Trough Tacro level, Urinalysis). On the days you have your labs drawn, do not take your Tacrolimus until your labs are drawn. Bring your Tacrolimus with you so you may take your medication as soon as your labwork has been drawn. Follow your medication card, keep it updated with any dosage changes, and always bring your card with you to any clinic or hospital visits. You may shower. Allow the water to run over your incision and pat area dry. No rubbing, no lotions or powder near the incision. You may leave the incision open to the air. The staples are removed approximately 3 weeks following your transplant. No tub baths or swimming No driving if taking narcotic pain medications Avoid direct sun exposure. Wear protective clothing and a hat, and always wear sunscreen with SPF 30 or higher when you go outdoors. Drink enough fluids to keep your urine light in color. Your appetite will return with time. Eat small frequent meals, and you may supplement with Glucerna nutritional supplement. Check your blood sugars and blood pressure at home. Report consistently elevated values to the transplant clinic Do not increase, decrease, stop or start medications without consultation with the transplant clinic at . There are significant drug interactions with anti-rejection medications which must be considered in medication management following transplant Consult transplant binder, and there is always someone on call at the transplant clinic with any questions that may arise

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14550633", "visit_id": "21250797", "time": "2183-06-12 00:00:00"}

19919017-RR-11

## CLINICAL HISTORY: Left ovarian cyst. Evaluate for change or resolution. ## PELVIC ULTRASOUND: Comparison is made with the prior ultrasounds of and . Both transabdominal and transvaginal ultrasound were performed. A clear walled left ovarian cyst is again seen. No septations or projections are noted. The overall size is currently 7.9 x 8 x 3.7 cm, which probably comes to roughly the same volume as it was on the prior ultrasound, but is definitely larger than it was in . No other changes are seen since the prior ultrasound. There is a small amount of fluid in the cul-de-sac, probably less than it was in . ## IMPRESSION: Persistence of left ovarian cyst.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19919017", "visit_id": "N/A", "time": "2184-11-25 12:27:00"}

13546197-RR-20

## INDICATION: year old man with history of right arm swelling // ? destructive arthritis ## IMPRESSION: There is no significant joint effusion. No acute fractures or dislocations are seen. There is a large spur off of the olecranon at the expected attachment of the triceps tendon. Prominent soft tissue swelling seen suggestive of bursitis or hematoma. The spur demonstrates a fracture of the distal tip, age indeterminate. On the oblique view, there is a corticated density adjacent to the medial epicondyle which may represent a loose body or sequela of prior avulsion type injury. Spurring about the coronoid process is seen and consistent with osteoarthritis.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13546197", "visit_id": "N/A", "time": "2130-11-24 08:30:00"}

18092188-RR-74

## INDICATION: Status post wide excision for left breast papillary carcinoma, . The patient's daughter reports that Dr. a left breast mass. ## LEFT BREAST ULTRASOUND: Targeted ultrasound of the left outer breast at 3 o'clock demonstrates a dilated duct in the retroareolar region measuring 1.3 cm in length x 0.6 cm in diameter. This is without internal debris. The duct continues to be mildly dilated at least 6 cm from the nipple laterally. Other ducts are noted to be dilated at this location also. In addition, at 3 o'clock, 6 cm from the nipple, there is some intraductal echogenicity with a small fleck of calcification. This may represent internal debris however, a small solid lesion is not entirely excluded. In the more proximal duct, a few other calcifications are noted (3 o'clock, 2 cm from the nipple). ## IMPRESSION: The area of palpable concern corresponds to the area of dilated ducts at 3 o'clock. There is probable debris in the duct at 3 o'clock 6 cm from the nipple. In addition, the patient and her daughter and I discussed the possibility of a six month follow-up vs. an ultrasound- guided core biopsy. However, the patient will be seen by Dr. in the next few weeks, and the daughter, the patient and Dr. will decide future management. BI-RADS 3 - probably benign. Six-month followup mammogram and ultrasound is recommended at this time.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "18092188", "visit_id": "N/A", "time": "2176-02-03 15:39:00"}

16492132-RR-12

## HISTORY: male with large right-sided intracranial hemorrhage who is intubated not moving the left side, with abrasions on the left upper arm. ## STUDY: Two views of the left shoulder, two views of the left elbow. ## FINDINGS: Limited views of the shoulder showed no evidence of fracture. Dislocation cannot be definitively ruled out to the lack of an axillary or Y view. Degenerative changes are seen at the AC joint. Visualized portion of the left chest wall and lung appear unremarkable. The left elbow shows no fracture or dislocation. Two round well-corticated ossific densities are noted at the medial epicondyle, possibly the sequela of prior injury. A supracondylar process is incidentally noted within the distal humerus. ## IMPRESSION: No fracture of the elbow or shoulder, although limited assessment for shoulder dislocation. An axillary or Y view would be recommended to definitively exclude a shoulder dislocation.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "16492132", "visit_id": "23590130", "time": "2147-08-31 11:38:00"}

14994273-DS-5

## ALLERGIES: Patient recorded as having No Known Allergies to Drugs ## HISTORY OF PRESENT ILLNESS: y/o male with 6 prostate cancer. He had a 26 core prostate needle biopsy this afternoon with Dr. . He had rectal bleeding shortly after going home from the clinic this afternoon, and was brought to the ED by ambulance after feeling lightheaded with continuous rectal bleeding. He had a syncopal episode on admission to the ED. He denies nausea, vomiting, fevers, chills, chest pain, dyspnea, hematuria, urinary urgency, frequency. The patient had discontinued his aspirin one week prior to the biopsy as instructed. ## PAST MEDICAL HISTORY: HTN Hyperlipidemia Mild COPD/Asthma Colonic polyps ## FAMILY HISTORY: Father, mother: colon cancer ## VS: Afebrile, HR 65, BP 139/49, R 16, 100%RA NAD, A&Ox3, lying in Trendelenburg RRR, No respiratory distress ## GU: No active rectal bleeding on initial exam. On DRE, pressure and surgicel were applied to the prostate, and there was no active bleeding or clots after pressure applied. ## BRIEF HOSPITAL COURSE: On , the patient was admitted to Dr. service/SICU from the ED with rectal bleeding and syncope after prostate needle biopsy. In the ED, surgicel and pressure were applied to the prostate and the acute bleeding stopped. The patient was placed in and serial Hct's were checked. GI consult was requested by the ICU team, and they recommended Vit K for elevated INR 1.5. Cardiac enzymes were negative. On HD 2, the patient had several bloody bowel movements and remained in the ICU for monitoring. Hematocrits were stable at without transfusion on HD 2. On HD 3, the patient was seen by general surgery, who performed an anoscope. The anoscopy showed old clot, no active bleeding. Also on HD 3, the patient was transferred to the floor from the ICU in stable condition. Serial Hct's were monitored, which continued to be stable at . He received antibiotic prophylaxis, and he remained afebrile throughout his hospital stay. At discharge, patient denied pain, was tolerating a regular diet, ambulating without assistance, and voiding without difficulty. He denied chest pain, dyspnea, abdominal pain at discharge. He was given explicit instructions to call Dr. office to schedule follow-up appointment. ## DISCHARGE MEDICATIONS: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. Disp:*60 Capsule(s)* Refills:*2* ## DISCHARGE DIAGNOSIS: Rectal bleeding status post ultrasound guided prostate needle biopsy ## DISCHARGE INSTRUCTIONS: -Call Dr. ( ) to schedule follow up appointment. -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication, discontinue if loose stool or diarrhea develops. -If you have fevers > 101.5 F, abdominal pain, nausea or vomitting, bright red blood per rectum, call your doctor or go to the nearest emergency room.

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "14994273", "visit_id": "28784363", "time": "2141-04-17 00:00:00"}

12839027-RR-27

## HISTORY: female with removal of right chest tube. Assess for pneumothorax. Portable AP upright chest radiograph is compared to earlier the same day performed at 9:10 a.m. A minimal right apical pneumothorax is evident. Extremely tiny left apical pneumothorax is unchanged. Left chest tube remains in position. Right chest tube has been removed. The right IJ central venous catheter tip projects over the upper SVC, unchanged. Cardiomediastinal contours are stable. Lungs remain clear aside from minimal bibasilar atelectasis. ## IMPRESSION: Status post removal of right chest tube with tiny right apical pneumothorax. Unchanged tiny left apical pneumothorax.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "12839027", "visit_id": "27532902", "time": "2116-11-02 12:01:00"}

16864785-DS-12

## CHIEF COMPLAINT: advanced dementia with aggressive behavior ## HISTORY OF PRESENT ILLNESS: w/ history of dementia with aggressive behavior, frequent falls, neuropathy, hearing loss presenting from House for evaluation of aggressive behavior and possible psych placement. Patient with long history of severe dementia. Was admitted to in for dementia, aggressive behavior found to have positive UA though negative Urine culture, treated with 7 day abx course. Patient was seen by psych as inpatient and started on for assistance in managing aggressive behavior. Since returning to house last month, patient has continued to be aggressive while still on . Last night, patient hit private aid in the head x2 causing the private aid company to discontinue services. Patient also with intermittent incontinence of urine and stool recently which is new for her. In setting of ongoing violent/aggressive behavior, patient sent to ED for evaluation and possible psych placement as she can no longer be managed at house. In the ED, initial vs were: 0 98 72 125/61 18 100% ra Labs were remarkable for WBC 4.8 47%N, Hct 29.4 (bl , INR 1.1. UA with large 2 WBCs, no bacteria, with 5 Epis. CT Head showed hygroma/chronic Subdural hematoma. Patient was seen by neurosurgery who stated that this was chronic, no need for neurosurgical internvetion and that it was ok to continue ASA 325mg. CXR negative. Patient was given bactrim and risperidone. Urine culture sent. Seen by Psych who recommended UTI rx and restarting of depakote. Vitals on Transfer: 99.2 74 109/51 17 97% RA. On the floor patient reports she feels fine and is without complaints. Just wants to rest for the night. Per the nurse, earlier she had been up and walking around the floor, very calm and appreciative of others help. Review of sytems: not reliable due to patient's dementia ## PAST MEDICAL HISTORY: B12 deficiency, GERD, decreased hearing, hypercholesterolemia, hypertension, monoclonal gammopathy, thalassemia, osteopenia, neuropathy, advanced dementia, HLD, iron deficiency ## FAMILY HISTORY: Reviewed, not pertinent to this hospitalization ## ADMISSION: Vitals- 98.6, 139/60, 74, 18, 100%RA General- Alert, orientedx1-2, in no acute distress, pleasant and cooperative - Sclera anicteric, MMM, oropharynx clear Neck- supple, JVP not elevated, no LAD Lungs- Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV- Regular rate and rhythm, normal S1, S2, no murmurs, rubs, gallops Abdomen- soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU- no foley Ext- warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro- CNs2-12 intact, motor function grossly normal ## GEN: NAD, alert, not oriented (only knows first name) ## : anicteric sclera, EOMI, moist mucous membranes, clear oropharynx ## NECK: supple, JVP not elevated, no LAD ## CARDS: RRR, normal S1/S2, no murmurs, rubs or gallops ## PULM: CTAB; no wheezes, crackles, or increased work of breathing ## ABDOMEN: soft, NT/ND, +BS, no rebound/guarding ## EXT: warm and well perfused; 2+ pulses, no clubbing, cyanosis or edema ## NEURO: CN2-12 grossly intact, symmetrical muscle strength and sensation, no focal neurologic deficits. ## TECHNIQUE: Contiguous axial MDCT images were obtained through the brain without contrast. Axial images were reviewed in conjunction with coronal and sagittal reformats. ## FINDINGS: A predominantly hypodense subdural hemorrhage with a small hyperdense component is seen along the right parietal convexity, maximally measuring 1 cm from the inner table. There is no shift of normally midline structures. There is no evidence of edema or acute vascular territorial infarction. Prominent ventricles and sulci are compatible with age-related atrophy with dilated temporal horns of the lateral ventricles also suggesting medial temporal atrophy. Periventricular white matter hypodensities are nonspecific but likely reflect sequelae of chronic small vessel ischemic disease. The basilar cisterns are patent. Gray-white matter differentiation is preserved. No fracture is identified. Partially imaged paranasal sinuses, mastoid air cells, and middle ear cavities are clear. Globes are unremarkable. ## IMPRESSION: Chronic subdural hematoma along the right parietal convexity with a small acute component. ## BRIEF HOSPITAL COURSE: The patient is an year old female with advanced dementia with aggressive features, frequent falls, who was sent to from House with increased aggression. ## # DEMENTIA WITH AGGRESSIVE FEATURES: unclear eitology. Differential diagnoses include medication effect (reccent d/c of depakote), occult infection, pain/discomfort, head trauma, or progression of severe dementia. Chest x-ray and urine analysis were negative. Head CT does not show acute process, only chronic subdural hematoma, which is resolving. Most likely due to progression of dementia. The patient was re-started on depakote (125 mg TID; LFTs WNL). Memantine was d/c'd since there is no evidence that it increases the efficacy of donepezil and may cause GI symptoms. Tethers and lines were avoided and the patient was frequently re-oriented. She was treated with zyprexa for acute episodes of agitation and qhs. She was also calmed by . She was discharged to for further evaluation and management. ## # CHRONIC ANEMIA: likely due to a combination of B12 deficiency, iron deficiency, and thalassemia. HCT was at patient's baseline during admission. # B12 deficiency: the patient's B12 level was elevated compared with normal limits, so her B12 supplementation was decreased from 1000 to 750 mg QD. # Fe deficiency: continued home iron supplementation. # Hyperlipidemia: continued home statin. ## # CODE: Full code per # CONTACT: daughter, # HCP: (confirmed) # PENDING STUDIES AT TIME OF DISCHARGE: none # ISSUES TO DISCUSS AT FOLLOW UP: dementia ## MEDICATIONS ON ADMISSION: The Preadmission Medication list may be inaccurate and requires futher investigation. 1. Aspirin 325 mg PO DAILY 2. Calcium Carbonate 500 mg PO DAILY 3. Cetirizine 10 mg Oral daily 4. Citalopram 20 mg PO DAILY 5. Donepezil 10 mg PO DAILY 6. Ferrous Sulfate 325 mg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Memantine 5 mg PO DAILY 9. Simvastatin 20 mg PO DAILY 10. Cyanocobalamin 1000 mcg PO DAILY 11. Mirtazapine 15 mg PO HS 12. RISperidone 0.5 mg PO HS 13. RISperidone 0.25 mg PO DAILY 14. TraZODone 50 mg PO HS 15. TraZODone 25 mg PO Q6H:PRN agitation ## DISCHARGE MEDICATIONS: 1. Aspirin 325 mg PO DAILY 2. Calcium Carbonate 500 mg PO DAILY 3. Citalopram 20 mg PO DAILY 4. TraZODone 50 mg PO HS 5. Simvastatin 20 mg PO DAILY 6. RISperidone 0.25 mg PO DAILY 7. RISperidone 0.5 mg PO HS 8. Multivitamins 1 TAB PO DAILY 9. Mirtazapine 15 mg PO HS 10. Ferrous Sulfate 325 mg PO DAILY 11. Donepezil 10 mg PO DAILY 12. Cetirizine 10 mg Oral daily 13. TraZODone 25 mg PO Q6H:PRN agitation 14. Cyanocobalamin 750 mcg PO DAILY 15. Divalproex Sod. Sprinkles 125 mg PO TID 16. OLANZapine (Disintegrating Tablet) 5 mg PO QHS ## PRIMARY DIAGNOSIS: advanced demention with aggressive behavior Secondary diagnosis: neuropathy, hearing loss, B12 deficiency, anemia, hyperlipidemia ## ACTIVITY STATUS: Ambulatory - requires assistance or aid (walker or cane). ## DISCHARGE INSTRUCTIONS: Dear Ms. , It was a pleasure taking care of you during your recent admission to . You were admitted for aggression. You did not have any infections. You are being discharged to a facility for further care. Best wishes!

mimic

{"version": "mimic_iv", "note_type": "Discharge summary", "patient_id": "16864785", "visit_id": "24087345", "time": "2178-10-11 00:00:00"}

17418657-RR-17

## INDICATION: woman with abnormal uterine bleeding and fibroids; assess reasons for uterine bleeding and size, number, and location of fibroids. ## FINDINGS: The uterus is anteverted and measures 11 x 6.1 x 7.5 cm. Multiple uterine fibroids (at least 10 discrete) are demonstrated with submucosal, subserosal, and intramural components: The dominant fibroid on the left measures 3.4 x 3.3 x 4 cm. A dominant fibroid in the right uterine fundus has a submucosal component and measures approximately 2.7 x 2.5 x 2.7 cm (se 1b, im 72; se 1e, im 75). The endometrium is distorted by fibroids and slightly heterogenous. The endometrium measures up to 9 mm. An intrauterine device is malpositioned, low-lying in the cervix. The ovaries are normal. There is a small amount of simple-appearing free fluid. ## IMPRESSION: 1. Multiple uterine fibroids with one dominant 2.7-cm right fundal fibroid with submucosal component. 2. Malpositioned IUD, low-lying in the cervix. ## NOTIFICATION: The findings were discussed with , M.D. by , M.D. on the telephone on at 4:18 , 15 minutes after discovery of the findings.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17418657", "visit_id": "N/A", "time": "2133-01-15 13:54:00"}

17725368-RR-10

## EXAMINATION: CT CHEST/ABD/PELVIS W/ CONTRAST ## INDICATION: with triple pressor sepsis, transferred, unclear source // eval PNA, eval cholangitis, abdominal source. Additional clinical history was provided, which includes at the patient is severely neutropenic and has history of multiple prior bone marrow biopsies. ## HEART AND VASCULATURE: Pulmonary vasculature is well opacified to the segmental level without filling defect to indicate a pulmonary embolus. The thoracic aorta is normal in caliber without evidence of dissection or intramural hematoma. Mild cardiomegaly is noted. Otherwise, the heart, pericardium, and great vessels are within normal limits. No pericardial effusion is seen. ## AXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass. ## PLEURAL SPACES: No pneumothorax. Small pleural effusions are noted bilaterally. ## LUNGS/AIRWAYS: There are small bilateral pleural effusions and subjacent dependent atelectasis, although superimposed aspiration cannot be excluded. Additionally, the interlobular septae are diffusely thickened and there are diffuse regions of slight ground-glass opacity, concerning for mild pulmonary edema. The airways are patent to the level of the segmental bronchi bilaterally. An endotracheal tube is positioned with tip at the level of the carina, and oriented towards the right main bronchus. Retraction by approximately 2 cm would result in more optimal positioning. ## BASE OF NECK: Visualized portions of the base of the neck show no abnormality. ## HEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There are 3 hypodense foci within the left lobe of the liver, the largest of which measures up to 7 mm (2:103, 108), which may represent hepatic cysts or biliary hamartomas. There is no evidence of intrahepatic or extrahepatic biliary dilatation. There is moderate periportal edema and pericholecystic fluid which likely reflects aggressive hydration. The gallbladder is distended with probable mild wall thickening. No radiopaque gallstones. ## PANCREAS: The pancreas is atrophic and 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. There are 2 rounded cystic structures within the spleen, the larger of which measures up to 6.0 cm in diameter (601:85). Of note, the spleen appears malrotated. ## 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 an 8 mm hypodensity at the lower left renal pole (2:155), too small to characterize but likely representing a renal cyst. There is no evidence of solid renal lesions or hydronephrosis. There is no perinephric abnormality. ## GASTROINTESTINAL: The stomach is unremarkable. An enteric catheter is in place, with tip in the distal stomach. Small bowel loops demonstrate no signs of ileus or obstruction. There is mild thickening of the distal/terminal ileum. There is significant abnormality involving cecum with mural thickening, and extensive focal cecal pneumatosis (2:187). Additionally, there is poor definition of the medial wall of the cecum best seen on series 601, image 38, and there are several small foci of extraluminal gas within the mesentery. Findings raise concern for micro perforation. There is no portal venous gas or gas within branches of the superior mesenteric vein. The appendix is not visualized. There is no free intraperitoneal air. There is a small amount of intra-abdominal free fluid. ## PELVIS: The urinary bladder is decompressed with a Foley catheter and grossly unremarkable. There is a small amount of pelvic free fluid. ## REPRODUCTIVE ORGANS: There are several coarse calcifications within the uterus, which may represent degenerated, calcified fibroids. The bilateral adnexae are grossly within normal limits. ## LYMPH NODES: There is enlarged mesenteric lymph node in the right lower quadrant, measuring up to 1.1 cm in the short axis (601:46) and several additional smaller lymph nodes not meeting CT size criteria for pathologic enlargement. There is no retroperitoneal lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. ## VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease is noted. The celiac artery, superior mesenteric artery, superior mesenteric vein, portal vein are patent. There is no portal venous gas. ## BONES AND SOFT TISSUES: Within the right buttock deep to the right gluteus medius muscle there is a pocket of soft tissue gas which tracks along the fascial planes raising potential concern for necrotizing fasciitis (2:85). There is no evidence of worrisome osseous lesions or acute fracture. Mild anterolisthesis of L4 on L5. ## IMPRESSION: 1. Cecal thickening with pneumatosis may represent complications of typhlitis given history of severe neutropenia. Micro perforation is suspected. 2. Multiple foci of gas seen in tracking along the fascia between the right gluteus minimus and medius muscles. While necrotizing fasciitis is difficult to exclude, clinical correlation is advised given history of multiple prior intervention/bone marrow biopsies which may contribute to this appearance. 3. Mild pulmonary edema, small pleural effusions, small volume ascites, periportal edema may reflect aggressive hydration and fluid overload state. 4. Suboptimal position of the ET tube terminating at the carina requires retraction by 2-3 cm for more optimal positioning. 5. Significant lower lobe atelectasis, difficult to exclude a component of aspiration.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "17725368", "visit_id": "25311297", "time": "2138-07-23 19:20:00"}

13899364-RR-132

CT ABDOMEN AND PELVIS ## INDICATION: History of ovarian CA, abdominal pain. ## CT ABDOMEN: There is atelectasis noted within the inferior segment of the lingula. There are multiple small bilateral pulmonary nodules stable in size and number since prior imaging, consistent with known pulmonary metastatic disease. Small right basal pleural effusion, little bigger when compared to prior CT. No pericardial effusion noted. Again there are multiple ill-defined low-attenuation lesions noted within the liver consistent with diffuse hepatic metastases. The portal vein and visualized hepatic veins are patent. Gallbladder is normal. There are two low-density lesions identified within the spleen (series 2, image 19 and 14) stable. Incidental note is made of a gastric diverticulum (series 2, image 14). Both adrenal glands and kidneys are unremarkable. The pancreas is atrophic with no focal solid mass or cystic lesion identified. Again there is an aortocaval lymphadenopathy measuring 1.1 x 2.5 cm, previously 1.0 x 2.6 cm (series 2, image 26) and an aortocaval lymph node measuring 10 x 13 mm, previously 9 x 9 mm (series 2, image 35) unchanged when compared to prior imaging. No abnormally dilated or thickened small or large bowel loops in the visualized upper abdomen and no evidence for free fluid or omental deposits. ## CT PELVIS: No pelvic adenopathy or free fluid. There has been prior hysterectomy and bilateral salpingo-oophorectomy. Ileoanal anastomosis is noted which is unremarkable. The visualized bladder is unremarkable. ## CT OSSEOUS SKELETON: Again extensive sclerosis is noted in the L5 vertebral body and in the sacrum in the midline (series 3, image 43), stable and unchanged when compared to prior imaging. There is a convex scoliosis of the lumbar spine to the right with decreased intervertebral disc space height noted at the lower three lumbar vertebral levels. Unfused apophysis noted off the superior endplate of the L3 vertebral body. They are stable and unchanged when compared to prior CT. ## IMPRESSION: 1. Diffuse pulmonary, hepatic, and osseous metastases consistent with known primary ovarian neoplasm. 2. No cause for acute abdominal pain identified on CT. No abnormally dilated or thickened small or large bowel loop. No evidence for intra-abdominal collection.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13899364", "visit_id": "26548983", "time": "2171-05-02 16:33:00"}

19402233-RR-107

## INDICATION: Fall after turn of the head. R/O carotid stenosis // Syncope ## RIGHT: The right carotid vasculature has no atherosclerotic plaque. The peak systolic velocity in the right common carotid artery is 57 cm/sec. The peak systolic velocities in the proximal, mid, and distal right internal carotid artery are 54, 49, and 46 cm/sec, respectively. The peak end diastolic velocity in the right internal carotid artery is 20 cm/sec. The ICA/CCA ratio is 0.9. The external carotid artery has peak systolic velocity of 56 cm/sec. The vertebral artery is patent with antegrade flow. ## LEFT: The left carotid vasculature has no atherosclerotic plaque. The peak systolic velocity in the left common carotid artery is 88 cm/sec. The peak systolic velocities in the proximal, mid, and distal left internal carotid artery are 46, 49, and 29 cm/sec, respectively. The peak end diastolic velocity in the left internal carotid artery is 21 cm/sec. The ICA/CCA ratio is 0.5. The external carotid artery has peak systolic velocity of 62 cm/sec. The vertebral artery is patent with antegrade flow. ## IMPRESSION: Less than 40% stenosis bilaterally. No significant plaque noted.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "19402233", "visit_id": "N/A", "time": "2142-08-22 11:07:00"}

13100428-RR-6

## EXAMINATION: CT abdomen and pelvis ## INDICATION: with history of remote bariatric surgery, HF, afib, COPD presents with 6 months severe LUQ and left flank pain// evaluate for obstruction, abscess, etiology of LUQ and L flank pain ## SINGLE PHASE SPLIT BOLUS CONTRAST: MDCT axial images were acquired through the abdomen and pelvis following intravenous contrast administration with split bolus technique. Oral contrast was administered. Coronal and sagittal reformations were performed and reviewed on PACS. ## LOWER CHEST: Multiple calcified granulomas are noted in the left lower lobe. There is mild scarring and atelectasis noted also in the lower lungs. The imaged portion of the heart is unremarkable. There is a small hiatal hernia. There is atelectasis bilaterally at the bases. There is no evidence of pleural or pericardial effusion. ## HEPATOBILIARY: The liver enhances normally. No focal liver lesion. Main portal vein and central branches are patent. Notable intrahepatic and extrahepatic biliary ductal dilation may in part reflect prior cholecystectomy though clinical correlation is advised. No definite cause of obstruction is identified on CT. ## PANCREAS: Pancreas is atrophic though without focal lesion of concern or ductal dilation. ## SPLEEN: The spleen is normal. ## ADRENALS: Adrenals are slightly atrophic in appearance bilaterally. ## URINARY: The kidneys appear somewhat atrophic though enhance symmetrically and demonstrate prompt excretion. A nonspecific hypodensity in the lower pole left kidney is too small to characterize. ## GASTROINTESTINAL: Patient is status post gastric bypass surgery. Contrast is seen within the excluded stomach, compatible with a gastro-gastric fistula. Small large bowel loops demonstrate no signs of ileus or obstruction. The appendix is not visualized though there are no secondary signs of appendicitis. ## PELVIS: The urinary bladder and distal ureters are unremarkable. There is no free fluid in the pelvis. ## REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass is seen. ## 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: No worrisome bony lesion. ## SOFT TISSUES: Postsurgical changes are noted in the anterior body wall without frank hernia. ## IMPRESSION: 1. Status post gastric bypass surgery with probable gastrogastric fistula. 2. Slightly atrophic appearance of the kidneys. Please correlate clinically. 3. Status post cholecystectomy with prominent intrahepatic and extrahepatic biliary tree for which clinical correlation is advised.

mimic

{"version": "mimic_iv", "note_type": "Radiology", "patient_id": "13100428", "visit_id": "N/A", "time": "2136-03-09 15:32:00"}