Lumbar spine MRI. He says: Impression - ?quiet? degenerative changes.
Posted By: PoodleLady on 2008-12-30
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Subject: Lumbar spine MRI. He says: Impression - ?quiet? degenerative changes.
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CT L-spine: he says "small amount of degenerative s/l AIR
Subject: CT L-spine: he says "small amount of degenerative s/l AIR
"Small amount of degenerative s/l AIR collection demonstrated within the L3-4 facet joint." Have never heard of this before and cannot document. Help?
MRI lumbar spine
Subject: MRI lumbar spine
Once again, I am trying to make sense of the hospital radiology reports. Noncontrast MRI of lumbar spine shows a clonus ending posterior to L1. It does not sound right to me. clonus does not make sense but I do not type much radiology. Anyone have a clue what else it could be? It does sound like he is saying clonus.??? Thanks
A lumbar spine x-ray.....see inside
Subject: A lumbar spine x-ray.....see inside
Says...
There is diffuse osteopenia. Patient is status-post posterior fusion of L3-L4. Hardware in good position. There is mild degenerative disc disease with small anterior osteophyte formation in L2-L5 with diminished L4-L5 disc space. Alignment of vertebral bodies is preserved. No ____ is seen.
The blank sounds like, and I may be WAY OFF, sclenostasis...there is definitely the stasis and pretty sure the scle part...Please help!!!
MRI of the lumbar spine without contrast (please sm)
Subject: MRI of the lumbar spine without contrast (please sm)
showed s/l *Mobic* type 1 degenerative changes in the anterior-superior corner of L4. Thanks.
MRI of lumbar spine term (sm)
Subject: MRI of lumbar spine term (sm)
would a radiologist say *the corners of the spinal cord* are at L1...
is corners correct?
thoric and lumbar spine?
Subject: thoric and lumbar spine?
Visibly associated with progressive kyphotic deformity of the""thoric and lumbar spine"", with an with attendant cervical lordosis.
Is this right or should it be thoracic and lumbar spine?
lumbar spine in the cord s/l *glioscar*??? nm
Subject: lumbar spine in the cord s/l *glioscar*??? nm
nm
endometrial ablation lumbar spine? !
Subject: endometrial ablation lumbar spine? !
Under past surgical history the doctor dictates endometrial ablation lumbar spine both in 1998 and 2003. What is she trying to say? I do not see any association between an endometrial ablation and the lumbar spine. Any ideas?
lumbar spine "beana probe was inserted and all
Subject: lumbar spine "beana probe was inserted and all
Thank you
Plain lumbar spine films. See inside.
Subject: Plain lumbar spine films. See inside.
Little rule I learned a long time ago:
1. Plain as in "plain Jane", no make up, not dressed up and no where to go. So plain x-rays are those who are not augmented by any special dye or anything else such an arthrogram or MRI.
2. Plane as in a space between. A plane for dissection - a place or space to cut into.
MRI of the lumbar spine is limited because of s/l fer-bon-ganic artifact, which is SM
Subject: MRI of the lumbar spine is limited because of s/l fer-bon-ganic artifact, which is SM
obscuring the spine above L4.
This would be incorrect. The 'L' levels of spine refer to the lumbar area,
Subject: This would be incorrect. The 'L' levels of spine refer to the lumbar area,
x
I do not appreciate any obvious s/l levique changes in the cervical, thoracic or lumbar spine.
Subject: I do not appreciate any obvious s/l levique changes in the cervical, thoracic or lumbar spine.
coned-down view...is this a radiograph of the thoracic or lumbar spine???
Subject: coned-down view...is this a radiograph of the thoracic or lumbar spine???
TX
Anyone heard of a NAFA brace for fracture of the lumbar spine? thanks. nm
Subject: Anyone heard of a NAFA brace for fracture of the lumbar spine? thanks. nm
Chiropractic word help. S/l bluos test is positive for the lumbar spine.
Subject: Chiropractic word help. S/l bluos test is positive for the lumbar spine.
is there a Dessler or Tessler scan showed a T score of -3 in the lumbar spine?
Subject: is there a Dessler or Tessler scan showed a T score of -3 in the lumbar spine?
Lumbar spine film: s/l the "TIP U LATING" joints unremarkable
Subject: Lumbar spine film: s/l the "TIP U LATING" joints unremarkable
Completely normal lumbar spine films. He's being speedy dictator tonight.
herniated disc of her lumbar spine with s/l suporsis.. I dont hear scoliosis
Subject: herniated disc of her lumbar spine with s/l suporsis.. I dont hear scoliosis
. ,
The lower convex curve in the lumbar spine was to the right, and the lower convex thoracic region to
Subject: The lower convex curve in the lumbar spine was to the right, and the lower convex thoracic region to the left
Is how I would do it.
I hear lumbar. So would it make sense as: Posture has decreased lumbar lordosis
Subject: I hear lumbar. So would it make sense as: Posture has decreased lumbar lordosis
s/l quiet matter?
Subject: s/l quiet matter?
There are moderately enlarged (Virchow-Robin) spaces within the hemisphere (quiet) matter
I shoulda kept quiet; you ROCK! ;) nm
Subject: I shoulda kept quiet; you ROCK! ;) nm
nm
Never keep quiet, I am many times far from right and all input is mega-helpful!
Subject: Never keep quiet, I am many times far from right and all input is mega-helpful!
C-spine, L-spine, T-spine, unless client allows
Subject: C-spine, L-spine, T-spine, unless client allows
degenerative? nm
Subject: degenerative? nm
x
could it be degenerative changes? nm
Subject: could it be degenerative changes? nm
x
Maybe degenerative
Subject: Maybe degenerative
I would say either degenerative arthritis or...
Subject: I would say either degenerative arthritis or...
has developed some arthritis.
Could it just be something like neuro-degenerative?
Subject: Could it just be something like neuro-degenerative?
degenerative scoliosis? nm
Subject: degenerative scoliosis? nm
x
Nope -- not degenerative.
Subject: Nope -- not degenerative.
He says degenerative all the time, this is not the same at all.
DJD - Degenerative Joint Disease
Subject: DJD - Degenerative Joint Disease
nm
"C-spine" (cervical spine) ??
Subject: "C-spine" (cervical spine) ??
degenerative/degenerating? narrowing? just a guess...NM
Subject: degenerative/degenerating? narrowing? just a guess...NM
cervical degenerative disk disease?
Subject: cervical degenerative disk disease?
x
s/l Norwood degenerative type disorder (sm)
Subject: s/l Norwood degenerative type disorder (sm)
doc has very strong accent. patient being treated for urology services at clinic - catheterization. patient is trach dependent and G-tube dependent.
Thanks for any help on this!
also, where ever it is it showed degenerative disk disease
Subject: also, where ever it is it showed degenerative disk disease
super imposed on degenerative arthritis and
Subject: super imposed on degenerative arthritis and
? scoliosis of the lumbar region.
Help with IMPRESSION
Subject: Help with IMPRESSION
Should this be dictated like this?
1. Hyponatremia, rule out subdural hematoma.
OR
1. Hyponatremia.
2. Rule out subdural hematoma.
impression
Subject: impression
type it with a semicolon in between.
Impression
Subject: Impression
Hi Shirl -
Hang in there, this will be old hat to you after a while. Radiology reports are usually pretty standard. Same phrases/terms used by all radiologists.
Some usual headings in a radiology report are:
CLINICAL INDICATION: or INFORMATION: or HISTORY, or variations of any of these.
FINDINGS: or RESULTS:
IMPRESSION: or OPINION:
Start adding the common phrases, like "lung markings" and all the various possible headers as above, to whatever word expander program you have. You'll be flying through reports in no time!
Impression
Subject: Impression
In the impression the doctor says the patient probably has a small perforation of his colonic cancer.
Impression
Subject: Impression
Status post laceration, rigth wrist with repair of partial tear to the s/l FC or FCE tendon.
orhopedic word help degenerative change at s/l asicrominally?
Subject: orhopedic word help degenerative change at s/l asicrominally?
degenerative changes of the acetabular cercele/sir-seal region. Tx.
Subject: degenerative changes of the acetabular cercele/sir-seal region. Tx.
Ever heard of chronic degenerative chair of the supraspinatus
Subject: Ever heard of chronic degenerative chair of the supraspinatus
I tried to get change out of it, but just can't. Would tear make sense?
Working on new ortho doc and he is giving me fits. Also, in the x-ray, he says:
Left shoulder, three views, supraspinatus s/l mantaplee demonstrates type 3 acromion.
Thanks! About ready to pull out my hair.
Knee MRI: Degenerative signal s/l impress? Can't find this anywhere.
Subject: Knee MRI: Degenerative signal s/l impress? Can't find this anywhere.
she may say it again in impression if you haven't got there. nm
Subject: she may say it again in impression if you haven't got there. nm
IMPRESSION prob
Subject: IMPRESSION prob
I have a problem under impression  ...
"D: IMPRESSION: Occipital neuralgia probable acute gastroenteritis"
question: how will I transcribe that? coz Occipital neuralgia is not related to "probable acute gastroenteritis" isn't it? or possibly there was a 2 impression. one, is occipital neuralgia and secondly, acute gastroenteritis?... What's the meaning by the dictator?
NOTE: but the dictator did not dictate any numbering.... 
Assessment or Impression
Is it an AAMT rule to automatically number the diagnoses in the Assessment or Impression of an H&P or soap even if the dictator does not? TIA!
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