ImranzamanML/Clinical_Documents_on_Syndromes_Disease

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IMPRESSION:

1. Hypervascularity of the left epididymis compatible with left epididymitis.

2. Bilateral hydroceles.
REASON FOR EXAM:

Aortic valve replacement. Assessment of stenotic valve. Evaluation for thrombus on the valve.

PREOPERATIVE DIAGNOSIS:

Atrial valve replacement.

POSTOPERATIVE DIAGNOSES:

Moderate stenosis of aortic valve replacement. Mild mitral regurgitation. Normal left ventricular function.

PROCEDURES IN DETAIL:

The procedure was explained to the patient with risks and benefits. The patient agreed and signed the consent form. The patient received a total of 3 mg of Versed and 50 mcg of fentanyl for conscious sedation and pain control. The oropharynx anesthetized with benzocaine spray and lidocaine solution.

Esophageal intubation was done with no difficulty with the second attempt. In a semi-Fowler position, the probe was passed to transthoracic views at about 40 to 42 cm. Multiple pictures obtained. Assessment of the peak velocity was done later.

The probe was pulled to the mid esophageal level. Different pictures including short-axis views of the aortic valve was done. Extubation done with no problems and no blood on the probe. The patient tolerated the procedure well with no immediate postprocedure complications.

INTERPRETATION:

The left atrium was mildly dilated. No masses or thrombi were seen. The left atrial appendage was free of thrombus. Pulse wave interrogation showed peak velocities of 60 cm per second.

The left ventricle was normal in size and contractility with mild LVH. EF is normal and preserved.

The right atrium and right ventricle were both normal in size.

Mitral valve showed no vegetations or prolapse. There was mild-to-moderate regurgitation on color flow interrogation. Aortic valve was well-seated mechanical valve, bileaflet with acoustic shadowing beyond the valve noticed. No perivalvular leak was noticed. There was increased velocity across the valve with peak velocity of 3.2 m/sec with calculated aortic valve area by continuity equation at 1.2 cm2 indicative of moderate aortic valve stenosis based on criteria for native heart valves.

No AIC.

Pulmonic valve was somewhat difficult to see because of acoustic shadowing from the aortic valve. Overall showed no abnormalities. The tricuspid valve was structurally normal.

Interatrial septum appeared to be intact, confirmed by color flow interrogation as well as agitated saline contrast study.

The aorta and aortic arch were unremarkable. No dissection.

IMPRESSION:

1. Mildly dilated left atrium.

2. Mild-to-moderate regurgitation.

3. Well-seated mechanical aortic valve with peak velocity of 3.2 m/sec and calculated valve area of 1.2 cm2 consistent with moderate aortic stenosis. Reevaluation in two to three years with transthoracic echocardiogram will be recommended.
INDICATIONS:

Chest pain, hypertension, type II diabetes mellitus.

PROCEDURE DONE:

Dobutamine Myoview stress test.

STRESS ECG RESULTS:

The patient was stressed by dobutamine infusion at a rate of 10 mcg/kg/minute for three minutes, 20 mcg/kg/minute for three minutes, and 30 mcg/kg/minute for three additional minutes. Atropine 0.25 mg was given intravenously eight minutes into the dobutamine infusion. The resting electrocardiogram reveals a regular sinus rhythm with heart rate of 86 beats per minute, QS pattern in leads V1 and V2, and diffuse nonspecific T wave abnormality. The heart rate increased from 86 beats per minute to 155 beats per minute, which is about 90% of the maximum predicted target heart rate. The blood pressure increased from 130/80 to 160/70. A maximum of 1 mm J-junctional depression was seen with fast up sloping ST segments during dobutamine infusion. No ischemic ST segment changes were seen during dobutamine infusion or during the recovery process.

MYOCARDIAL PERFUSION IMAGING:

Resting myocardial perfusion SPECT imaging was carried out with 10.9 mCi of Tc-99m Myoview. Dobutamine infusion myocardial perfusion imaging and gated scan were carried out with 29.2 mCi of Tc-99m Myoview. The lung heart ratio is 0.36. Myocardial perfusion images were normal both at rest and with stress. Gated myocardial scan revealed normal regional wall motion and ejection fraction of 67%.

CONCLUSIONS:

1. Stress test is negative for dobutamine-induced myocardial ischemia.

2. Normal left ventricular size, regional wall motion, and ejection fraction.
EXAM:

Single frontal view of the chest.

HISTORY:

Atelectasis. Patient is status-post surgical correction for ASD.

TECHNIQUE:

A single frontal view of the chest was evaluated and correlated with the prior film dated mm/dd/yy.

FINDINGS:

Current film reveals there is a right-sided central venous catheter, the distal tip appears to be in the superior vena cava. Endotracheal tube with the distal tip appears to be in appropriate position, approximately 2 cm superior to the carina. Sternotomy wires are noted. They appear in appropriate placement. There are no focal areas of consolidation to suggest pneumonia. Once again seen is minimal amount of bilateral basilar atelectasis. The cardiomediastinal silhouette appears to be within normal limits at this time. No evidence of any pneumothoraces or pleural effusions.

IMPRESSION:

1. There has been interval placement of a right-sided central venous catheter, endotracheal tube, and sternotomy wires secondary to patient's most recent surgical intervention.

2. Minimal bilateral basilar atelectasis with no significant interval changes from the patient's most recent prior.

3. Interval decrease in the patient's heart size which may be secondary to the surgery versus positional and technique.
INDICATION FOR STUDY:

Elevated cardiac enzymes, fullness in chest, abnormal EKG

and risk factors.

IMPRESSION:

1. Hypervascularity of the left epididymis compatible with left epididymitis.

2. Bilateral hydroceles.

REASON FOR EXAM:

Aortic valve replacement. Assessment of stenotic valve. Evaluation for thrombus on the valve.

PREOPERATIVE DIAGNOSIS:

Atrial valve replacement.

POSTOPERATIVE DIAGNOSES:

Moderate stenosis of aortic valve replacement. Mild mitral regurgitation. Normal left ventricular function.

PROCEDURES IN DETAIL:

The procedure was explained to the patient with risks and benefits. The patient agreed and signed the consent form. The patient received a total of 3 mg of Versed and 50 mcg of fentanyl for conscious sedation and pain control. The oropharynx anesthetized with benzocaine spray and lidocaine solution.

Esophageal intubation was done with no difficulty with the second attempt. In a semi-Fowler position, the probe was passed to transthoracic views at about 40 to 42 cm. Multiple pictures obtained. Assessment of the peak velocity was done later.

The probe was pulled to the mid esophageal level. Different pictures including short-axis views of the aortic valve was done. Extubation done with no problems and no blood on the probe. The patient tolerated the procedure well with no immediate postprocedure complications.

INTERPRETATION:

The left atrium was mildly dilated. No masses or thrombi were seen. The left atrial appendage was free of thrombus. Pulse wave interrogation showed peak velocities of 60 cm per second.

The left ventricle was normal in size and contractility with mild LVH. EF is normal and preserved.

The right atrium and right ventricle were both normal in size.

Mitral valve showed no vegetations or prolapse. There was mild-to-moderate regurgitation on color flow interrogation. Aortic valve was well-seated mechanical valve, bileaflet with acoustic shadowing beyond the valve noticed. No perivalvular leak was noticed. There was increased velocity across the valve with peak velocity of 3.2 m/sec with calculated aortic valve area by continuity equation at 1.2 cm2 indicative of moderate aortic valve stenosis based on criteria for native heart valves.

No AIC.

Pulmonic valve was somewhat difficult to see because of acoustic shadowing from the aortic valve. Overall showed no abnormalities. The tricuspid valve was structurally normal.

Interatrial septum appeared to be intact, confirmed by color flow interrogation as well as agitated saline contrast study.

The aorta and aortic arch were unremarkable. No dissection.

IMPRESSION:

1. Mildly dilated left atrium.

2. Mild-to-moderate regurgitation.

3. Well-seated mechanical aortic valve with peak velocity of 3.2 m/sec and calculated valve area of 1.2 cm2 consistent with moderate aortic stenosis. Reevaluation in two to three years with transthoracic echocardiogram will be recommended.

INDICATIONS:

Chest pain, hypertension, type II diabetes mellitus.

PROCEDURE DONE:

Dobutamine Myoview stress test.

STRESS ECG RESULTS:

The patient was stressed by dobutamine infusion at a rate of 10 mcg/kg/minute for three minutes, 20 mcg/kg/minute for three minutes, and 30 mcg/kg/minute for three additional minutes. Atropine 0.25 mg was given intravenously eight minutes into the dobutamine infusion. The resting electrocardiogram reveals a regular sinus rhythm with heart rate of 86 beats per minute, QS pattern in leads V1 and V2, and diffuse nonspecific T wave abnormality. The heart rate increased from 86 beats per minute to 155 beats per minute, which is about 90% of the maximum predicted target heart rate. The blood pressure increased from 130/80 to 160/70. A maximum of 1 mm J-junctional depression was seen with fast up sloping ST segments during dobutamine infusion. No ischemic ST segment changes were seen during dobutamine infusion or during the recovery process.

MYOCARDIAL PERFUSION IMAGING:

Resting myocardial perfusion SPECT imaging was carried out with 10.9 mCi of Tc-99m Myoview. Dobutamine infusion myocardial perfusion imaging and gated scan were carried out with 29.2 mCi of Tc-99m Myoview. The lung heart ratio is 0.36. Myocardial perfusion images were normal both at rest and with stress. Gated myocardial scan revealed normal regional wall motion and ejection fraction of 67%.

CONCLUSIONS:

1. Stress test is negative for dobutamine-induced myocardial ischemia.

2. Normal left ventricular size, regional wall motion, and ejection fraction.

EXAM:

Single frontal view of the chest.

HISTORY:

Atelectasis. Patient is status-post surgical correction for ASD.

TECHNIQUE:

A single frontal view of the chest was evaluated and correlated with the prior film dated mm/dd/yy.

FINDINGS:

Current film reveals there is a right-sided central venous catheter, the distal tip appears to be in the superior vena cava. Endotracheal tube with the distal tip appears to be in appropriate position, approximately 2 cm superior to the carina. Sternotomy wires are noted. They appear in appropriate placement. There are no focal areas of consolidation to suggest pneumonia. Once again seen is minimal amount of bilateral basilar atelectasis. The cardiomediastinal silhouette appears to be within normal limits at this time. No evidence of any pneumothoraces or pleural effusions.

IMPRESSION:

1. There has been interval placement of a right-sided central venous catheter, endotracheal tube, and sternotomy wires secondary to patient's most recent surgical intervention.

2. Minimal bilateral basilar atelectasis with no significant interval changes from the patient's most recent prior.

3. Interval decrease in the patient's heart size which may be secondary to the surgery versus positional and technique.

INDICATION FOR STUDY:

Elevated cardiac enzymes, fullness in chest, abnormal EKG

and risk factors.