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1...Kaiser should submit the date of the test and the language in the
2...How do "multiple abnormalities involving the left lung,
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SUBJECTS
Lung Cancer Lymph Nodes Medical Chart Primary Care Physician Says Va
1703 -
1703 - ..
1704 - Summary/Objective
1705 -
170501 - Follow up ref SDS 79 0000. ref SDS 78 0000.
170502 -
170503 -
170504 -
170505 -
170507 - ..
170508 - Lung Cancer Lymph Nodes Patient Requests Clarification Medical Chart
170509 -
170510 - Follow up ref SDS 79 NM6G, ref SDS 70 Z84Y.
170511 -
170512 - Background on the Medical Chart associating cancer with lungs
170513 - beginning on 061208, ref SDS 64 1248, is set out in the record on
170514 - 070112. ref SDS 79 NM6G At that time on 07112, Millie submitted a
170515 - letter to the doctor, ref DIP 15 6A6G, asking for clarification and
170516 - support in the record. ref SDS 79 N93H
170518 - ..
170519 - Millie received ref DRT 1 0001 from the primary care physician
170520 - responding to the letter, ref DIP 15 6A6G, submitted to Kaiser on
170521 - 070112 asking about reports in the Medical Chart that associates
170522 - cancer with lungs. ref SDS 79 N93H
170524 - ..
170525 - The doctor says in the letter to Millie...
170526 -
170527 - Several CT reports over the past few years speak to the
170528 - presence of small pulmonary nodules involving the right lung.
170529 - They are <5 mm so unlikely to be picked up in PET scans.
170530 - ref DRT 1 0001
170532 - ..
170533 - Complete image test history (CT, PET, MRI, Xray) is listed in the
170534 - record on 070102. ref SDS 75 1Y8G
170536 - ..
170537 - Kaiser should submit the date of the test and the language in the
170538 - report that identifies nodules in the right lung are cancer.
170540 - ..
170541 - Why is there no mention of cancer in the left lung, based on the CT
170542 - test for 051005, ref SDS 0 1N9O, and the CT test on 041230?
170543 - ref SDS 0 HK73, and in the test reported on 041104. ref SDS 0 2K8L
170545 - ..
170546 - At this time, lay review finds numerous references to nodules in
170547 - "lungs" and "lobes," and to pulmonary "masses"; there are no findings
170548 - nor impressions of cancer, as follows...
170549 -
170550 - Type Date Received Source
170551 -
170552 - 1. CT 070326 reported on 070329........... ref SDS 81 5S6L
170554 - ..
170555 - Findings...
170556 -
170557 - Lungs
170558 -
170559 - The previously described 4 very small 2-3mm nodules are
170560 - all stable. No new lung nodules identified. no
170561 - interstitial disease. Scarring in the left apex is
170562 - stable.
170564 - ..
170565 - Small nodules stable for 4 years does not sound like lung
170566 - cancer.
170567 -
170569 - ..
170570 - 2. PET/CT 061227 reported on 070102........... ref SDS 75 1Y8G
170572 - ..
170573 - No entry for "lung"
170575 - ..
170576 - Does the fact that no nodules are reported in this test
170577 - show that prior nodules are now gone? Does this indicate
170578 - that treatments for breast cancer has cured or otherwise
170579 - treated lung cancer?
170581 - ..
170582 - 3. CT 060930 reported on 061012........... ref SDS 55 284J
170583 -
170584 - No entry for "lung"
170586 - ..
170587 - Exam was technically adequate to determine presence of a
170588 - pulmonary embolism.
170590 - ..
170591 - There are filling defects within the subsegemental branches
170592 - of the right lower lobe pulmonary arteries. ref SDS 55 294Q
170594 - ..
170595 - Left apical bronchiectasis and fibrotic scarring consistent
170596 - with radiation changes are stable. Calcified right middle
170597 - lobe pulmonary nodule. No new pulmonary nodules or masses.
170598 - ref SDS 55 2955
170600 - ..
170601 - Kaiser notified the patient on 061002 about recurrence of
170602 - pulmonary embolism. ref SDS 53 MI5I If findings in the
170603 - test report also diagnose lung cancer, why wasn't the
170604 - patient notified of this additional malady?
170605 -
170607 - ..
170608 - 4. CT 060505 reported on 060523........... ref SDS 42 E355
170609 -
170610 - There are entries for "lung"...
170611 -
170612 - Minimal reticular opacities within the left apex not
170613 - significantly changed from the prior exam. 3 mm nodule
170614 - within the right upper lobe (image 21) unchanged from the
170615 - prior exam as well. 4 mm nodule within the right middle
170616 - lobe adjacent to the major fissure (image 37) unchanged
170617 - from the prior exam. No definite lung nodules noted on the
170618 - left. ref SDS 42 00HQ
170620 - ..
170621 - There is no indication nor "impression" of lung cancer
170622 - shown in the report. ref SDS 42 014T
170623 -
170625 - ..
170626 - 5. PET/CT 051005 reported on 051007........... ref SDS 35 WJ6G
170627 -
170628 - Compared to the prior PET examination 021218, the
170629 - previously identified multiple abnormalities involving the
170630 - left lung apex, the left 11th rib, and the left axillae and
170631 - L5 are not noted on today's study. ref SDS 35 IE5R
170633 - ..
170634 - There is no indication nor "impression" of lung cancer
170635 - shown in the report. ref SDS 35 L66M
170637 - ..
170638 - How do "multiple abnormalities involving the left lung,
170639 - relate to Kaiser's report today on nodules only in the
170640 - right lung? ref SDS 0 DU9M Are "abnormalities" different
170641 - from "nodules," i.e., are nodules normal, rather than
170642 - abnormal?
170644 - ..
170645 - 6. CT 050530 reported on 050610........... ref SDS 30 G75L
170646 -
170647 - No entry for "lung"
170649 - ..
170650 - 7. CT 050325 reported on 050422........... ref SDS 29 G75L
170651 -
170652 - There is a finding...
170653 -
170654 - No new lung nodules. ref SDS 29 WJ8J
170655 -
170656 - There is no indication nor "impression" of lung cancer
170657 - shown in the report. ref SDS 29 HX99
170659 - ..
170660 - This suggests there are existing nodules in the lungs that
170661 - are not new, and there is no indication of cancer
170662 - associated with existing lung nodues, which would require
170663 - express findings.
170665 - ..
170666 - 8. CT 041217 reported on 041230........... ref SDS 25 G75L
170667 -
170668 - There is a finding...
170669 -
170670 - No new nodules seen in either lung. ref SDS 25 PV6L
170671 -
170672 - This suggests there are existing nodules in both lungs that
170673 - are not new, rather than only the right lung cited in
170674 - Kaiser's letter today, per above, ref SDS 0 DU9M, and there
170675 - is no indication of cancer associated with existing lung
170676 - nodues, which would require express findings.
170678 - ..
170679 - 9. CT 041103 reported on 041104........... ref SDS 21 WV7H
170680 -
170681 - There is a finding....
170682 -
170683 - Images in the lung windows show subcentimeter pulmonary
170684 - nodules on image #34, #35 and #43, within the right middle
170685 - lobe and right lower lobe. There are increased
170686 - interstitial markings in the left upper lobe and lingui
170687 - which may be due to therapeutic changes. ref SDS 21 QP7X
170689 - ..
170690 - There is no indication nor "impression" of lung cancer
170691 - shown in the report. ref SDS 21 RC47
170693 - ..
170694 - Do interstitial markings in the left upper lobe and lingui
170695 - indicate cancer based on standard of nodules in the right
170696 - lung? ref SDS 0 DU9M
170698 - ..
170699 - 10. CT 040921 reported on 041005........... ref SDS 19 NL4N
170700 -
170701 - There is a finding....
170702 -
170703 - The lungs are unchanged, free of new nodules, infiltrates
170704 - or masses. There are no pleural effusions. There are no
170705 - hilar or mediastinal masses seen. The heart is normal in
170706 - size. ref SDS 19 NL4O
170708 - ..
170709 - There is no indication nor "impression" of lung cancer
170710 - shown in the report. ref SDS 19 WW79
170712 - ..
170713 - 11. CT 040710 reported on 040811........... ref SDS 17 H85S
170714 -
170715 - There is a finding....
170716 -
170717 - Again noted is scar tissue in the left lung apex. There is
170718 - a 2 mm nodule in the right middle lobe just anterior to the
170719 - major fissure (image #37), unchanged. There are no other
170720 - pulmonary nodules. ref SDS 17 WW68
170722 - ..
170723 - There is no indication nor "impression" of lung cancer
170724 - shown in the report. ref SDS 17 WW79
170726 - ..
170727 - 12. CT 040410 reported on 040416........... ref SDS 12 HX4K
170728 -
170729 - There is a finding....
170730 -
170731 - There is stable left apical interstitial septal change.
170732 - The lungs are otherwise clear, free of infiltrates or
170733 - masses. There are no pleural effusions. There are no
170734 - hilar or mediastinal masses seen. ref SDS 12 EH50
170736 - ..
170737 - There is no indication nor "impression" of lung cancer
170738 - shown in the report. ref SDS 12 7M63
170740 - ..
170741 - 13. CT 040307 reported on 040318........... ref SDS 11 LK5L
170742 -
170743 - There is a finding....
170744 -
170745 - Stable areas of scaring are again seen in the left lung
170746 - apex. There is a tiny subpleural calcified nodule again
170747 - seen in the right upper lobe. There are a few small
170748 - subpleural nodules in the right middle lobe without
170749 - significant change in appearance. There is no evidence of
170750 - new pulmonary nodule. There is no evidence of pleural
170751 - effusion. ref SDS 11 YB4K
170753 - ..
170754 - There is no indication nor "impression" of lung cancer
170755 - shown in the report. ref SDS 11 GJ69
170757 - ..
170758 - 14. CT 031031 reported on 031205........... ref SDS 9 IG9K
170759 -
170760 - There is a finding....
170761 -
170762 - There is a punctate calcified granuloma in the right upper
170763 - lobe on image #22. There are stable noncalcified pulmonary
170764 - nodules in the right middle lobe on image #38. There are
170765 - no new pulmonary nodules. There are no pleural effusions.
170766 - ref SDS 9 GW4P
170768 - ..
170769 - There is no indication nor "impression" of lung cancer
170770 - shown in the report. ref SDS 9 GJ69
170772 - ..
170773 - 15. CT 030626 reported on 030710........... ref SDS 8 AL6N
170774 -
170775 - There is a finding....
170776 -
170777 - Lung windows show stable, parenchymal interstitial
170778 - opacities at the left apex and ventral, subpleural lingula.
170779 - There is a tiny, stable, non-calcified 3mm pulmonary nodule
170780 - in the peripheral right middle lobe (image #42) closely
170781 - associated with the major and minor fissure. No other
170782 - pulmonary parenchymal nodules are detected. No hilar,
170783 - mediastinal or right axillary adenopathy is identified. No
170784 - pleural lesions are detected. The heart is normal in size.
170785 - ref SDS 8 WS4K
170787 - ..
170788 - There is no indication nor "impression" of lung cancer
170789 - shown in the report. ref SDS 8 GJ69
170791 - ..
170792 - 16. CT 030428 reported on 030508........... ref SDS 7 LK5L
170793 -
170794 - There is a finding....
170795 -
170796 - There are no pulminary nodules. There is no significant
170797 - mediastinal or hilar adenopathy. ref SDS 7 VM7W
170799 - ..
170800 - There is no indication nor "impression" of lung cancer
170801 - shown in the report. ref SDS 7 GJ69
170803 - ..
170804 - 17. PET 021218 reported on 030109........... ref SDS 6 LK5L
170805 -
170806 - There is a finding....
170807 -
170808 - Otherwise new is a hypermetabolic finding at the 11th rib
170809 - on the left and relatively linear hypermetabolic finding at
170810 - the left apical lung. ref SDS 6 7G6G
170812 - ..
170813 - There is no indication nor "impression" of lung cancer
170814 - shown in the report. ref SDS 6 GJ69
170816 - ..
170817 - 18. PET 020529 reported on 020603........... ref SDS 4 0001
170818 -
170819 - The actual report is not in the patient's record, which
170820 - reports discussion with the doctor that makes no references
170821 - to lung cancer.
170822 -
170823 -
170824 -
170825 -
170826 -
170827 -
170828 -
1709 -