CONTACTS
SUBJECTS
Knee Injury ER Examination Xray Favorable Right Recurrance Hiking Se
2203 -
2203 - ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 19 0000. ref SDS 17 0000.
220502 -
220503 -
220504 -
220505 -
220506 -
220508 - ..
2206 -
2207 -
2208 - Progress
2209 -
220901 - Went to Radiology on 2nd floor.
220902 -
220903 - Talked to Phylis. This is her last day on the job. She retires
220904 - today. Congratulated her on a long career, and wished her well in
220905 - retirement.
220907 - ..
220908 - She found the order for MRI on knees, which was entered by Doctor Dang
220909 - and Betty in Orthopedics on 160727 0930. ref SDS 19 0J61
220911 - ..
220912 - Explained there should be an order for MRI on brain.
220914 - ..
220915 - Phylis checked further and found the order for MRI on brain.
220917 - ..
220918 - Went down hall to radiology preparation room.
220920 - ..
220921 - An attendant installed an IV needed to apply contrast for MRI on
220922 - brain.
220924 - ..
220925 - Had about 10 minute wait.
220927 - ..
220928 - The MRI tech arrived.
220930 - ..
220931 - We discussed the order for performing the 2 MRI orders.
220933 - ..
220934 - MRI on both knees was ordered on 160727 0930. ref SDS 19 0J65
220936 - ..
220937 - MRI on brain was ordered on
220939 - ..
220940 - The tech explained the MRI studies should be done first because the
220941 - MRI on the brain requires contrast. If the MRI on the brain is done
220942 - first, then the contrast required for that study will interfere with
220943 - performing an accurate MRI on the knees, and therefore require
220944 - returning on another day for those studies.
220946 - ..
220947 - The tech assured that doing the MRI on the knees, and then on the
220948 - brain, will result in completing the MRI on the brain by 1000.
220950 - ..
220951 - This timing seems adequate for transmitting the files to Doctor Vora
220952 - at Stanford Neuroscience later today.
220954 - ..
220955 - Therefore did MRI on knees first.
220957 - ..
220958 - VA medical records Internet address...
220959 -
220960 - https://www.myhealth.va.gov/
220961 -
220967 -
220969 - ..
220970 - Right Knee Radiologist Report MRI Most Severe Injury
220971 -
220972 -
220973 - VA MRI scan file is stored in...
220974 -
220975 - F:\05\00003\SM\CC\AGMJ\20160805-080000\mri_knees\GEARView.exe
220977 - ..
220978 - Note: cannot run gearview.exe in Windows 10 Enterprise; run in
220979 - Windows 7, or try "Windows' Program Compatibility Troubleshooter"...
220980 -
220981 - http://www.laptopmag.com/articles/set-compatibility-mode-windows-10
220982 -
220984 - ..
220985 - VA radiologist report is stored in...
220986 -
220987 - F:\05\00003\SM\CC\AGMJ\20160805-080000\mhv_WELCH_20160809_1259.txt
220989 - ..
220990 - Procedure/Test Name: MRI KNEE W/O GAD
220991 - Date/Time Exam Performed: 05 Aug 2016 @ 0815
220992 - Ordering Location: San Francisco CA VAMC
220993 - Requesting Provider: GRACE,TREVOR R
220994 - Reasons for Study: RIGHT KNEE MRI WITHOUT CONTRAST
220995 - Clinical History:
220996 - CONCERN FOR ACUTE WORSENING RIGHT MEDIAL MENISCUS TEAR
220997 -
220998 - 1. Does the patient have one of the following
220999 - devices?: No
221000 -
221001 - 1. cardiac pacemaker
221002 - 2. cardiac defibrillator
221003 - 3. implanted device or pump
221004 - 4. neurostimulator
221006 - ..
221007 - 2. Has this patient had surgery for a brain
221008 - aneurysm?:No
221010 - ..
221011 - 3. Will this patient need sedation?: No
221012 -
221013 - Sedation orders are the responsibility of the ordering
221014 - provider and should be placed at the time of imaging
221015 - request.
221017 - ..
221018 - 4. Is there anything within this patient that you are unsure
221019 - about in regards to MR safety?: (foreign body, metal
221020 - object, etc): No
221022 - ..
221023 - If yes, please put in a short description below:
221025 - ..
221026 - 5. Performing Location: San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121
221027 - Radiologist: SRINIVASAN,RAMYA
221028 - --------------------------------------------------------------------------
221030 - ..
221031 - 6. RADIOLOGY REPORT
221033 - ..
221034 - Report: MRI OF THE RIGHT KNEE
221036 - ..
221037 - 7. CLINICAL HISTORY: Chronic knee pain with history of medial
221038 - meniscus tear on prior MRI, now with acute injury.
221040 - ..
221041 - 8. COMPARISON: Radiographs 7/20/2016, MRI 5/4/2016
221043 - ..
221044 - 9. TECHNIQUE: Using a 3 Tesla magnet, multiplanar/ multisequence
221045 - imaging was performed of the right knee without contrast
221046 - administration.
221048 - ..
221049 - 10. FINDINGS:
221050 -
221051 - 1. MENISCI:
221052 -
221053 - Medial meniscus with interval progression of complex tear
221054 - involving the posterior horn and body.
221056 - ..
221057 - Large radial tear involving the posterior horn, with 4 mm
221058 - transverse gap, and associated extrusion and intrasubstance
221059 - degeneration of the medial meniscus at the level of the
221060 - body.
221062 - ..
221063 - Longitudinal horizontal tear involving the posterior horn
221064 - and body.
221066 - ..
221067 - Lateral meniscus is intact.
221068 -
221070 - ..
221071 - 2. CRUCIATE LIGAMENTS:
221072 -
221073 - Anterior cruciate ligament is intact.
221075 - ..
221076 - Posterior cruciate ligament with abnormal morphology,
221077 - similar to prior, consistent with prior injury.
221078 -
221080 - ..
221081 - 3. COLLATERAL LIGAMENTS:
221082 -
221083 - Medial collateral ligament thickening with small focus of
221084 - ossification in the proximal fibers, consistent with remote
221085 - injury.
221087 - ..
221088 - Fluid signal in the soft tissues adjacent to the
221089 - superficial component of the MCL, consistent with grade
221090 - 1 sprain.
221092 - ..
221093 - MCL deep meniscofemoral component with complete tear,
221094 - progressed from prior.
221096 - ..
221097 - Lateral stabilizing structures including the iliotibial
221098 - band, fibular collateral ligament, and biceps femoris
221099 - tendon are intact.
221101 - ..
221102 - Popliteus tendon intact, however edema within the
221103 - popliteus muscle consistent with low-grade strain.
221104 -
221106 - ..
221107 - 4. EXTENSOR MECHANISM/ FAT PADS:
221108 -
221109 - Quadriceps and patellar tendons are intact. Hoffa's,
221110 - quadriceps and pre-femoral fat pads are within normal
221111 - limits.
221112 -
221114 - ..
221115 - 5. PATELLOFEMORAL JOINT:
221116 -
221117 - Alignment at the patellofemoral joint is anatomic. Medial
221118 - patellofemoral ligament with T2 signal hyperintensity at
221119 - its femoral attachment, consistent with sprain. Patellar
221120 - cartilage intact. Trochlear cartilage with high-grade
221121 - thinning and fissuring involving the central and medial
221122 - aspect of the trochlea.
221123 -
221125 - ..
221126 - 6. OSSEOUS AND CHONDRAL STRUCTURES:
221127 -
221128 - New subchondral insufficiency fractures involving the
221129 - central weightbearing aspect of the medial femoral condyle,
221130 - as well as the posterior aspect of the medial tibial
221131 - plateau, with surrounding bone marrow edema.
221133 - ..
221134 - Redemonstrated additional subchondral insufficiency
221135 - fracture at the posterior meniscal weightbearing aspect of
221136 - the medial femoral condyle, with interval resolution of
221137 - surrounding bone marrow edema, and new adjacent focal
221138 - chondral thinning. Small tricompartmental osteophytosis.
221139 -
221141 - ..
221142 - 7. MISCELLANEOUS:
221143 -
221144 - Moderate suprapatellar joint effusion. Tiny popliteal
221145 - cyst. There are no intra-articular bodies. Feathery edema
221146 - in the vastus medialis and VMO, consistent with strain.
221147 - Edema also in the lateral head of the gastrocnemius,
221148 - consistent with low-grade strain.
221149 -
221151 - ..
221152 - 11. Impression:
221153 -
221154 - 1. Interval progression of complex tear involving the posterior
221155 - horn and body of the medial meniscus.
221156 -
221157 - 2. New subchondral insufficiency fractures involving the medial
221158 - femoral condyle and the adjacent medial tibial plateau.
221160 - ..
221161 - 3. Grade 1 MCL sprain.
221162 -
221164 - ..
221165 - 12. Impression points #1,2 communicated with referring provider
221166 - Dr Grace by Dr Colby via secure email on 8/5/2016 at 12:00
221167 - PM.
221169 - ..
221170 - 13. The images were personally reviewed by Ramya Srinivasan
221171 - MD who agrees with the above interpretation.
221173 - ..
221174 - Primary Diagnostic Code:
221175 -
221176 -
221177 -
221178 -
221180 - ..
221181 - Left Knee Radiologist Report MRI Less Severe Injury
221182 -
221183 -
221184 - VA radiologist report is stored in...
221185 -
221186 - F:\05\00003\SM\CC\AGMJ\20160805-080000\mhv_WELCH_20160809_1259.txt
221187 -
221189 - ..
221190 - Procedure/Test Name: MRI KNEE W/O GAD
221191 - Date/Time Exam Performed: 05 Aug 2016 @ 0808
221192 - Ordering Location: San Francisco CA VAMC
221193 - Requesting Provider: KING, BETTY C
221194 - Reasons for Study: R/O nemiscus tear
221195 - Clinical History:
221196 - post trauma
221197 -
221198 - 1. Does the patient have one of the following
221199 - devices?: No
221200 -
221201 - 1. cardiac pacemaker
221202 - 2. cardiac defibrillator
221203 - 3. implanted device or pump
221204 - 4. neurostimulator
221206 - ..
221207 - 2. Has this patient had surgery for a brain
221208 - aneurysm?:No
221210 - ..
221211 - 3. Will this patient need sedation?: No
221212 -
221213 - Sedation orders are the responsibility of the ordering
221214 - provider and should be placed at the time of imaging
221215 - request.
221217 - ..
221218 - 4. Is there anything within this patient that you are unsure
221219 - about in regards to MR safety?: (foreign body, metal
221220 - object, etc): No
221222 - ..
221223 - If yes, please put in a short description below:
221225 - ..
221226 - 5. Performing Location: San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121
221227 - Radiologist: SRINIVASAN,RAMYA
221228 - --------------------------------------------------------------------------
221230 - ..
221231 - 6. RADIOLOGY REPORT
221233 - ..
221234 - Report: MRI OF THE LEFT KNEE
221236 - ..
221237 - 7. CLINICAL HISTORY: R/O meniscus tear
221239 - ..
221240 - 8. COMPARISON: COMPARISON: Radiographs 12/16/2015
221242 - ..
221243 - 9. TECHNIQUE: Using a 3 Tesla magnet, multiplanar/ multisequence
221244 - imaging was performed of the left knee without contrast
221245 - administration.
221247 - ..
221248 - 10. FINDINGS:
221249 -
221250 - 1. MENISCI:
221251 -
221252 - Medial meniscus with degenerative tearing involving its
221253 - entirety.
221255 - ..
221256 - Lateral meniscus with degenerative tearing involving
221257 - the posterior root and horn, extrusion of the body with
221258 - intrasubstance degeneration, and diminutive/degenerated
221259 - appearance of the anterior horn.
221261 - ..
221262 - [On 170929 1010 biomechanics review by Mark Wachter,
221263 - CEO On-the-Run, reported normal gait, possibly
221264 - indicating recovery from prior findings on 151215,
221265 - of early lift off on left foot due to long-standing
221266 - osteoarthritis in left knee - indicating recovery
221267 - with PRP treatment from severe injury decades
221268 - earlier. ref SDS 20 VW50
221270 - ..
221271 - 2. CRUCIATE LIGAMENTS:
221272 -
221273 - Anterior cruciate ligament with complete tear.
221275 - ..
221276 - Posterior cruciate ligament is intact.
221277 -
221279 - ..
221280 - 3. COLLATERAL LIGAMENTS:
221281 -
221282 - The medial collateral ligament including its
221283 - superficial and deep components are intact.
221285 - ..
221286 - Fibular collateral ligament with abnormal T2 signal
221287 - consistent with degeneration.
221289 - ..
221290 - Iliotibial band and biceps femoris tendon are intact.
221292 - ..
221293 - Scarring in the posterolateral corner consistent with
221294 - prior injury.
221296 - ..
221297 - The popliteus tendon and muscle are within normal
221298 - limits.
221299 -
221301 - ..
221302 - 4. EXTENSOR MECHANISM/ FAT PADS:
221303 -
221304 - Distal quadriceps tendon with mild tendinosis.
221306 - ..
221307 - There is mild edema in the quadriceps fat pad.
221309 - ..
221310 - Patellar tendon is intact.
221312 - ..
221313 - Scarring in Hoffa's fat pad, with micrometallic
221314 - susceptibility artifact possibly related to prior
221315 - surgery..
221316 -
221318 - ..
221319 - 5. PATELLOFEMORAL JOINT:
221320 -
221321 - Alignment at the patellofemoral joint is anatomic.
221323 - ..
221324 - Medial patellofemoral ligament with signal abnormality
221325 - consistent with prior injury, however no full-thickness
221326 - tear.
221328 - ..
221329 - Lateral patellofemoral ligament is intact.
221331 - ..
221332 - There is full-thickness cartilage loss involving the
221333 - median ridge and lateral facet of the patella.
221335 - ..
221336 - Full-thickness chondral loss throughout the trochlea,
221337 - with adjacent subchondral marrow edema.
221338 -
221340 - ..
221341 - 6. OSSEOUS AND CHONDRAL STRUCTURES:
221342 -
221343 - No evidence of fracture.
221345 - ..
221346 - Full-thickness chondral defect involving the central
221347 - non-meniscal weightbearing aspect of the medial femoral
221348 - condyle, measuring 5 x 8 mm diameter.
221350 - ..
221351 - High grade fissuring involving the posterior
221352 - weightbearing aspect of the lateral femoral condyle and
221353 - lateral tibial plateau.
221355 - ..
221356 - Subchondral cystic change in the medial and lateral
221357 - tibial plateaus. Tricompartmental osteophytosis.
221358 -
221360 - ..
221361 - 7. MISCELLANEOUS:
221363 - ..
221364 - Small suprapatellar joint effusion.
221366 - ..
221367 - Prepatellar soft tissue edema.
221369 - ..
221370 - No popliteal cyst.
221372 - ..
221373 - There are no intra-articular bodies.
221375 - ..
221376 - Musculature demonstrates fatty atrophy and edema within
221377 - the vastus lateralis, and feathery edema in the vastus
221378 - medialis and medial/lateral heads of the gastrocnemius
221379 - muscles.
221380 -
221382 - ..
221383 - 11. Impression:
221384 -
221385 - 1. Severe tricompartmental osteoarthritis.
221386 -
221387 - 2. Extensive degenerative tearing of the medial and
221388 - lateral menisci.
221390 - ..
221391 - 3. Chronic complete tear of the anterior cruciate
221392 - ligament. PCL is intact.
221394 - ..
221395 - The images were personally reviewed by Ramya Srinivasan MD who
221396 - agrees with the above interpretation.
221398 - ..
221399 - Primary Diagnostic Code:
221400 -
221401 -
221402 -
221403 -
221404 -
221405 -
221406 -
221407 -
221408 -
221409 -
221410 -
221411 -
221412 -
221413 -
221414 -
221415 -
221416 -
221417 -
221418 -
221419 -
221420 -
2215 -