ImranzamanML/Clinical_Documents_on_Syndromes_Disease

text stringlengths 0 4.02k

Normal flexor tendons within the carpal tunnel. There is mild thickening of the tendon sheaths and the median nerve demonstrates increased signal without compression or enlargement (series #3 image #7, series #4 image #7).

There are no pathological cysts or soft tissue masses.

IMPRESSION:

Partial tear of the volar and membranous components of the scapholunate ligament with an associated posttraumatic cyst in the lunate. There is thickening and laxity of the lunatotriquetral ligament.

Longitudinal split tear of the ECU tendon with tendinosis and severe synovitis.

Synovitis of the second dorsal compartment and tendon sheath thickening in the fourth dorsal compartment.

Tendon sheath thickening within the carpal tunnel with increased signal within the median nerve.
EXAM:

MRI LEFT SHOULDER

CLINICAL:

This is a 69-year-old male with pain in the shoulder. Evaluate for rotator cuff tear.

FINDINGS:

Examination was performed on 9/1/05.

There is marked supraspinatus tendinosis and extensive tearing of the substance of the tendon and articular surface, extending into the myotendinous junction as well. There is still a small rim of tendon along the bursal surface, although there may be a small tear at the level of the rotator interval. There is no retracted tendon or muscular atrophy (series #6 images #6-17).

Normal infraspinatus tendon.

There is subscapularis tendinosis with fraying and partial tearing of the superior most fibers extending to the level of the rotator interval (series #9 images #8-13; series #3 images #8-14). There is no complete tear, gap or fiber retraction and there is no muscular atrophy.

There is tendinosis and superficial tearing of the long biceps tendon within the bicipital groove, and there is high grade (near complete) partial tearing of the intracapsular portion of the tendon. The biceps anchor is intact. There are degenerative changes in the greater tuberosity of the humerus but there is no fracture or subluxation.

There is degeneration of the superior labrum and there is a small nondisplaced tear in the posterior superior labrum at the one to two o’clock position (series #6 images #12-14; series #3 images #8-10; series #9 images #5-8). There is a small sublabral foramen at the eleven o’clock position (series #9 image #6). There is no osseous Bankart lesion.

Normal superior, middle and inferior glenohumeral ligaments.

There is hypertrophic osteoarthropathy of the acromioclavicular joint with narrowing of the subacromial space and flattening of the superior surface of the supraspinatus musculotendinous junction, which in the appropriate clinical setting is an MRI manifestation of an impinging lesion (series #8 images #3-12).

Normal coracoacromial, coracohumeral and coracoclavicular ligaments. There is minimal fluid within the glenohumeral joint. There is no atrophy of the deltoid muscle.

IMPRESSION:

There is extensive supraspinatus tendinosis and partial tearing as described. There is no retracted tendon or muscular atrophy, but there may be a small tear along the anterior edge of the tendon at the level of the rotator interval, and this associated partial tearing of the superior most fibers of the subscapularis tendon. There is also a high-grade partial tear of the long biceps tendon as it courses under the transverse humeral ligament. There is no evidence of a complete tear or retracted tendon. Small nondisplaced posterior superior labral tear. Outlet narrowing from the acromioclavicular joint, which in the appropriate clinical setting is an MRI manifestation of an impinging lesion.
EXAM:

MRI orbit/face/neck with and without contrast; MR angiography of the head,CLINICAL HISTORY:

1-day-old female with facial mass.

TECHNIQUE:

1. Multisequence, multiplanar images of the orbits/face/neck were obtained with and without contrast. 0.5 ml Magnevist was used as the intravenous contrast agent.

2. MR angiography of the head was obtained using a time-of-flight technique.

3. The patient was under general anesthesia during the exam.

FINDINGS:

MRI orbits/face/neck: There is a pedunculated mass measuring 5.7 x 4.4 x 6.7 cm arising from the patient's lip on the right side. The mass demonstrates a heterogeneous signal. There is also heterogeneous enhancement which may relate to a high vascular tumor given the small amount of contrast for the exam. The origin of the mass from the upper lip demonstrates intact soft tissue planes.

Limited evaluation of the head demonstrates normal appearing midline structures. Incidental note is made of a small arachnoid cyst within the anterior left middle cranial fossa. The mastoid air cells on the right are opacified; while the left demonstrates appropriate aeration.

MR angiography of the head: Angiography is limited such that the vessel feeding the mass cannot be identified with certainty. The right external carotid artery is noted to be asymmetrically larger than the left, the phenomenon likely related to provision of feeding vessels to the mass. There is no carotid stenosis.

IMPRESSION:

1. The mass arising from the right upper lip measures 5.7 x 4.4 x 6.7 cm with a heterogeneous appearance and enhancement pattern. Hemangioma should be considered in the differential diagnosis as well as other mesenchymal neoplasms.

2. MR angiography is suboptimal such that feeding vessels to the mass cannot be identified with certainty.
CC:

Found unresponsive.

HX:

39 y/o RHF complained of a severe HA at 2AM 11/4/92. It was unclear whether she had been having HA prior to this. She took an unknown analgesic, then vomited, then lay down in bed with her husband. When her husband awoke at 8AM he found her unresponsive with "stiff straight arms" and a "strange breathing pattern." A Brain CT scan revealed a large intracranial mass. She was intubated and hyperventilated to ABG (7.43/36/398). Other local lab values included: WBC 9.8, RBC 3.74, Hgb 13.8, Hct 40.7, Cr 0.5, BUN 8.5, Glucose 187, Na 140, K 4.0, Cl 107. She was given Mannitol 1gm/kg IV load, DPH 20mg/kg IV load, and transferred by helicopter to UIHC.

PMH:

1)Myasthenia Gravis for 15 years, s/p Thymectomy,MEDS:

Imuran, Prednisone, Mestinon, Mannitol, DPH

IV NS

FHX/SHX:

Married. Tobacco 10 pack-year; quit nearly 10 years ago. ETOH/Substance Abuse unknown.

EXAM:

35.8F, 99BPM

BP117/72, Mechanically ventilated at a rate of 22RPM on !00%FiO2. Unresponsive to verbal stimulation. CN: Pupils 7mm/5mm and unresponsive to light (fixed). No spontaneous eye movement or blink to threat. No papilledema or intraocular hemorrhage noted. Trace corneal reflexes bilaterally. No gag reflex. No oculocephalic reflex. MOTOR/SENSORY: No spontaneous movement. On noxious stimulation (Deep nail bed pressure) she either extended both upper extremities (RUE>LUE)

or withdrew the stimulated extremity (right > left). Gait/Station/Coordination no tested. Reflexes: 1+ on right and 2+ on left with bilateral Babinski signs.

Normal flexor tendons within the carpal tunnel. There is mild thickening of the tendon sheaths and the median nerve demonstrates increased signal without compression or enlargement (series #3 image #7, series #4 image #7).

There are no pathological cysts or soft tissue masses.

IMPRESSION:

Partial tear of the volar and membranous components of the scapholunate ligament with an associated posttraumatic cyst in the lunate. There is thickening and laxity of the lunatotriquetral ligament.

Longitudinal split tear of the ECU tendon with tendinosis and severe synovitis.

Synovitis of the second dorsal compartment and tendon sheath thickening in the fourth dorsal compartment.

Tendon sheath thickening within the carpal tunnel with increased signal within the median nerve.

EXAM:

MRI LEFT SHOULDER

CLINICAL:

This is a 69-year-old male with pain in the shoulder. Evaluate for rotator cuff tear.

FINDINGS:

Examination was performed on 9/1/05.

There is marked supraspinatus tendinosis and extensive tearing of the substance of the tendon and articular surface, extending into the myotendinous junction as well. There is still a small rim of tendon along the bursal surface, although there may be a small tear at the level of the rotator interval. There is no retracted tendon or muscular atrophy (series #6 images #6-17).

Normal infraspinatus tendon.

There is subscapularis tendinosis with fraying and partial tearing of the superior most fibers extending to the level of the rotator interval (series #9 images #8-13; series #3 images #8-14). There is no complete tear, gap or fiber retraction and there is no muscular atrophy.

There is tendinosis and superficial tearing of the long biceps tendon within the bicipital groove, and there is high grade (near complete) partial tearing of the intracapsular portion of the tendon. The biceps anchor is intact. There are degenerative changes in the greater tuberosity of the humerus but there is no fracture or subluxation.

There is degeneration of the superior labrum and there is a small nondisplaced tear in the posterior superior labrum at the one to two o’clock position (series #6 images #12-14; series #3 images #8-10; series #9 images #5-8). There is a small sublabral foramen at the eleven o’clock position (series #9 image #6). There is no osseous Bankart lesion.

Normal superior, middle and inferior glenohumeral ligaments.

There is hypertrophic osteoarthropathy of the acromioclavicular joint with narrowing of the subacromial space and flattening of the superior surface of the supraspinatus musculotendinous junction, which in the appropriate clinical setting is an MRI manifestation of an impinging lesion (series #8 images #3-12).

Normal coracoacromial, coracohumeral and coracoclavicular ligaments. There is minimal fluid within the glenohumeral joint. There is no atrophy of the deltoid muscle.

IMPRESSION:

There is extensive supraspinatus tendinosis and partial tearing as described. There is no retracted tendon or muscular atrophy, but there may be a small tear along the anterior edge of the tendon at the level of the rotator interval, and this associated partial tearing of the superior most fibers of the subscapularis tendon. There is also a high-grade partial tear of the long biceps tendon as it courses under the transverse humeral ligament. There is no evidence of a complete tear or retracted tendon. Small nondisplaced posterior superior labral tear. Outlet narrowing from the acromioclavicular joint, which in the appropriate clinical setting is an MRI manifestation of an impinging lesion.

EXAM:

MRI orbit/face/neck with and without contrast; MR angiography of the head,CLINICAL HISTORY:

1-day-old female with facial mass.

TECHNIQUE:

1. Multisequence, multiplanar images of the orbits/face/neck were obtained with and without contrast. 0.5 ml Magnevist was used as the intravenous contrast agent.

2. MR angiography of the head was obtained using a time-of-flight technique.

3. The patient was under general anesthesia during the exam.

FINDINGS:

MRI orbits/face/neck: There is a pedunculated mass measuring 5.7 x 4.4 x 6.7 cm arising from the patient's lip on the right side. The mass demonstrates a heterogeneous signal. There is also heterogeneous enhancement which may relate to a high vascular tumor given the small amount of contrast for the exam. The origin of the mass from the upper lip demonstrates intact soft tissue planes.

Limited evaluation of the head demonstrates normal appearing midline structures. Incidental note is made of a small arachnoid cyst within the anterior left middle cranial fossa. The mastoid air cells on the right are opacified; while the left demonstrates appropriate aeration.

MR angiography of the head: Angiography is limited such that the vessel feeding the mass cannot be identified with certainty. The right external carotid artery is noted to be asymmetrically larger than the left, the phenomenon likely related to provision of feeding vessels to the mass. There is no carotid stenosis.

IMPRESSION:

1. The mass arising from the right upper lip measures 5.7 x 4.4 x 6.7 cm with a heterogeneous appearance and enhancement pattern. Hemangioma should be considered in the differential diagnosis as well as other mesenchymal neoplasms.

2. MR angiography is suboptimal such that feeding vessels to the mass cannot be identified with certainty.

CC:

Found unresponsive.

HX:

39 y/o RHF complained of a severe HA at 2AM 11/4/92. It was unclear whether she had been having HA prior to this. She took an unknown analgesic, then vomited, then lay down in bed with her husband. When her husband awoke at 8AM he found her unresponsive with "stiff straight arms" and a "strange breathing pattern." A Brain CT scan revealed a large intracranial mass. She was intubated and hyperventilated to ABG (7.43/36/398). Other local lab values included: WBC 9.8, RBC 3.74, Hgb 13.8, Hct 40.7, Cr 0.5, BUN 8.5, Glucose 187, Na 140, K 4.0, Cl 107. She was given Mannitol 1gm/kg IV load, DPH 20mg/kg IV load, and transferred by helicopter to UIHC.

PMH:

1)Myasthenia Gravis for 15 years, s/p Thymectomy,MEDS:

Imuran, Prednisone, Mestinon, Mannitol, DPH

IV NS

FHX/SHX:

Married. Tobacco 10 pack-year; quit nearly 10 years ago. ETOH/Substance Abuse unknown.

EXAM:

35.8F, 99BPM

BP117/72, Mechanically ventilated at a rate of 22RPM on !00%FiO2. Unresponsive to verbal stimulation. CN: Pupils 7mm/5mm and unresponsive to light (fixed). No spontaneous eye movement or blink to threat. No papilledema or intraocular hemorrhage noted. Trace corneal reflexes bilaterally. No gag reflex. No oculocephalic reflex. MOTOR/SENSORY: No spontaneous movement. On noxious stimulation (Deep nail bed pressure) she either extended both upper extremities (RUE>LUE)

or withdrew the stimulated extremity (right > left). Gait/Station/Coordination no tested. Reflexes: 1+ on right and 2+ on left with bilateral Babinski signs.