CONTACTS
SUBJECTS
Knee Injury ER Examination Xray Favorable Right Recurrance Hiking Se
2203 -
2203 - ..
2204 - Summary/Objective
2205 -
220501 - Follow up ref SDS 20 0000. ref SDS 19 0000.
220502 -
220503 -
220504 -
220505 -
220507 - ..
2206 -
2207 -
2208 - Progress
2209 -
220901 - Went to Radiology on 2nd floor.
220903 - ..
220904 - The attendant found the order for MRI on knees and feet, which was
220905 - entered by Doctor Thuillier in Orthopedics on 171227 0915. ref SDS 24
220906 - E54H
220908 - ..
220909 - Went down hall to radiology preparation room.
220911 - ..
220912 - The attendant provided a form to fill out.
220914 - ..
220915 - Had about 10 minute wait.
220917 - ..
220918 - The MRI tech arrived, Jonus. He was kind to remember me from prior
220919 - MRI scans, on 160805 0800. ref SDS 20 4260 At that time, Jonus did
220920 - tests on both knees, and the brain, reported in another record on
220921 - 160805 0845, ref SDS 21 B68H Worked with Jonus again for follow up
220922 - MRI on brain, which ultimately Bella did on 160817 0800. ref SDS 22
220923 - MX82
220925 - ..
220926 - Today, Jonus did MRI on knees first, and started with the right knee.
220928 - ..
220929 - VA medical records Internet address...
220930 -
220931 - https://www.myhealth.va.gov/
220932 -
220938 -
220940 - ..
220941 - Right Knee Radiologist Report MRI Most Severe Injury
220942 -
220943 - Follow up ref SDS 20 FZ5L.
220944 -
220945 - VA MRI scan file is stored in...
220946 -
220947 - F:\05\00003\SM\CC\AGMJ\20160805-080000\mri_knees\GEARView.exe
220949 - ..
220950 - Note: cannot run gearview.exe in Windows 10 Enterprise; run in
220951 - Windows 7, or try "Windows' Program Compatibility Troubleshooter"...
220952 -
220953 - http://www.laptopmag.com/articles/set-compatibility-mode-windows-10
220954 -
220956 - ..
220957 - VA radiologist report is stored in...
220958 -
220959 - F:\05\00003\SM\CC\AGMJ\20160805-080000\mhv_WELCH_20160809_1259.txt
220961 - ..
220962 - Procedure/Test Name: MRI KNEE W/O GAD
220963 - Date/Time Exam Performed: 05 Aug 2016 @ 0815
220964 - Ordering Location: San Francisco CA VAMC
220965 - Requesting Provider: GRACE,TREVOR R
220966 - Reasons for Study: RIGHT KNEE MRI WITHOUT CONTRAST
220967 - Clinical History:
220968 - CONCERN FOR ACUTE WORSENING RIGHT MEDIAL MENISCUS TEAR
220969 -
220970 - 1. Does the patient have one of the following
220971 - devices?: No
220972 -
220973 - 1. cardiac pacemaker
220974 - 2. cardiac defibrillator
220975 - 3. implanted device or pump
220976 - 4. neurostimulator
220978 - ..
220979 - 2. Has this patient had surgery for a brain
220980 - aneurysm?:No
220982 - ..
220983 - 3. Will this patient need sedation?: No
220984 -
220985 - Sedation orders are the responsibility of the ordering
220986 - provider and should be placed at the time of imaging
220987 - request.
220989 - ..
220990 - 4. Is there anything within this patient that you are unsure
220991 - about in regards to MR safety?: (foreign body, metal
220992 - object, etc): No
220994 - ..
220995 - If yes, please put in a short description below:
220997 - ..
220998 - 5. Performing Location: San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121
220999 - Radiologist: SRINIVASAN,RAMYA
221000 - --------------------------------------------------------------------------
221002 - ..
221003 - 6. RADIOLOGY REPORT
221005 - ..
221006 - Report: MRI OF THE RIGHT KNEE
221008 - ..
221009 - 7. CLINICAL HISTORY: Chronic knee pain with history of medial
221010 - meniscus tear on prior MRI, now with acute injury.
221012 - ..
221013 - 8. COMPARISON: Radiographs 7/20/2016, MRI 5/4/2016
221015 - ..
221016 - 9. TECHNIQUE: Using a 3 Tesla magnet, multiplanar/ multisequence
221017 - imaging was performed of the right knee without contrast
221018 - administration.
221020 - ..
221021 - 10. FINDINGS:
221022 -
221023 - 1. MENISCI:
221024 -
221025 - Medial meniscus with interval progression of complex tear
221026 - involving the posterior horn and body.
221028 - ..
221029 - Large radial tear involving the posterior horn, with 4 mm
221030 - transverse gap, and associated extrusion and intrasubstance
221031 - degeneration of the medial meniscus at the level of the
221032 - body.
221034 - ..
221035 - Longitudinal horizontal tear involving the posterior horn
221036 - and body.
221038 - ..
221039 - Lateral meniscus is intact.
221040 -
221042 - ..
221043 - 2. CRUCIATE LIGAMENTS:
221044 -
221045 - Anterior cruciate ligament is intact.
221047 - ..
221048 - Posterior cruciate ligament with abnormal morphology,
221049 - similar to prior, consistent with prior injury.
221050 -
221052 - ..
221053 - 3. COLLATERAL LIGAMENTS:
221054 -
221055 - Medial collateral ligament thickening with small focus of
221056 - ossification in the proximal fibers, consistent with remote
221057 - injury.
221059 - ..
221060 - Fluid signal in the soft tissues adjacent to the
221061 - superficial component of the MCL, consistent with grade
221062 - 1 sprain.
221064 - ..
221065 - MCL deep meniscofemoral component with complete tear,
221066 - progressed from prior.
221068 - ..
221069 - Lateral stabilizing structures including the iliotibial
221070 - band, fibular collateral ligament, and biceps femoris
221071 - tendon are intact.
221073 - ..
221074 - Popliteus tendon intact, however edema within the
221075 - popliteus muscle consistent with low-grade strain.
221076 -
221078 - ..
221079 - 4. EXTENSOR MECHANISM/ FAT PADS:
221080 -
221081 - Quadriceps and patellar tendons are intact. Hoffa's,
221082 - quadriceps and pre-femoral fat pads are within normal
221083 - limits.
221084 -
221086 - ..
221087 - 5. PATELLOFEMORAL JOINT:
221088 -
221089 - Alignment at the patellofemoral joint is anatomic. Medial
221090 - patellofemoral ligament with T2 signal hyperintensity at
221091 - its femoral attachment, consistent with sprain. Patellar
221092 - cartilage intact. Trochlear cartilage with high-grade
221093 - thinning and fissuring involving the central and medial
221094 - aspect of the trochlea.
221095 -
221097 - ..
221098 - 6. OSSEOUS AND CHONDRAL STRUCTURES:
221099 -
221100 - New subchondral insufficiency fractures involving the
221101 - central weightbearing aspect of the medial femoral condyle,
221102 - as well as the posterior aspect of the medial tibial
221103 - plateau, with surrounding bone marrow edema.
221105 - ..
221106 - Redemonstrated additional subchondral insufficiency
221107 - fracture at the posterior meniscal weightbearing aspect of
221108 - the medial femoral condyle, with interval resolution of
221109 - surrounding bone marrow edema, and new adjacent focal
221110 - chondral thinning. Small tricompartmental osteophytosis.
221111 -
221113 - ..
221114 - 7. MISCELLANEOUS:
221115 -
221116 - Moderate suprapatellar joint effusion. Tiny popliteal
221117 - cyst. There are no intra-articular bodies. Feathery edema
221118 - in the vastus medialis and VMO, consistent with strain.
221119 - Edema also in the lateral head of the gastrocnemius,
221120 - consistent with low-grade strain.
221121 -
221123 - ..
221124 - 11. Impression:
221125 -
221126 - 1. Interval progression of complex tear involving the posterior
221127 - horn and body of the medial meniscus.
221128 -
221129 - 2. New subchondral insufficiency fractures involving the medial
221130 - femoral condyle and the adjacent medial tibial plateau.
221132 - ..
221133 - 3. Grade 1 MCL sprain.
221134 -
221136 - ..
221137 - 12. Impression points #1,2 communicated with referring provider
221138 - Dr Grace by Dr Colby via secure email on 8/5/2016 at 12:00
221139 - PM.
221141 - ..
221142 - 13. The images were personally reviewed by Ramya Srinivasan
221143 - MD who agrees with the above interpretation.
221145 - ..
221146 - Primary Diagnostic Code:
221147 -
221148 -
221150 - ..
221151 - After completing the scan of the right knee, Jonus scanned the left
221152 - knee...
221153 -
221155 - ..
221156 - Left Knee Radiologist Report MRI Less Severe Injury
221157 -
221158 - Follow up ref SDS 20 193K.
221159 -
221160 - VA radiologist report is stored in...
221161 -
221162 - F:\05\00003\SM\CC\AGMJ\20171229-081700\mhv_WELCH_20180105_1434.txt
221163 -
221165 - ..
221166 - Procedure/Test Name: MRI KNEE W/O GAD
221167 - Date/Time Exam Performed: 29 Dec 2017 @ 0817
221168 - Ordering Location: San Francisco CA VAMC
221169 - Requesting Provider: THUILLIER, DANIEL U
221170 - Reasons for Study: see attached req
221171 - Clinical History:
221172 -
221173 - 1. Does the patient have one of the following
221174 - devices?: No
221175 -
221176 - 1. cardiac pacemaker
221177 - 2. cardiac defibrillator
221178 - 3. implanted device or pump
221179 - 4. neurostimulator
221181 - ..
221182 - 2. Has this patient had surgery for a brain
221183 - aneurysm?:No
221185 - ..
221186 - 3. Will this patient need sedation?: No
221187 -
221188 - Sedation orders are the responsibility of the ordering
221189 - provider and should be placed at the time of imaging
221190 - request.
221192 - ..
221193 - 4. Is there anything within this patient that you are unsure
221194 - about in regards to MR safety?: (foreign body, metal
221195 - object, etc): No
221197 - ..
221198 - If yes, please put in a short description below:
221200 - ..
221201 - 5. Performing Location: San Francisco CA VAMC 4150 CLEMENT STREET, SAN FRANCISCO 94121
221202 - Radiologist: WEINSTEIN, STEFANIE
221203 - --------------------------------------------------------------------------
221205 - ..
221206 - 6. RADIOLOGY REPORT
221208 - ..
221209 - Report: MRI OF THE LEFT KNEE
221211 - ..
221212 - 7. CLINICAL HISTORY: see attached req
221214 - ..
221215 - 8. COMPARISON: COMPARISON: 8/5/2016 (previous Radiographs 12/16/2015)
221217 - ..
221218 - 9. TECHNIQUE: Using a 3 Tesla magnet, multiplanar/ multisequence
221219 - imaging was performed of the left knee without contrast
221220 - administration.
221222 - ..
221223 - 10. FINDINGS:
221224 -
221225 - 1. MENISCI:
221226 -
221227 - Unchanged complete degenerative tearing of the medial
221228 - meniscus and partial tearing of the lateral meniscus
221229 - with extrusion of the body with intrasubstance
221230 - degeneration.
221232 - ..
221233 - Seems conflicting - 170929 1010 biomechanics review by Mark Wachter,
221234 - CEO On-the-Run, reported normal gait, possibly indicating recovery
221235 - from prior findings on 151215, of early lift off on left foot due to
221236 - long-standing osteoarthritis in left knee - indicating recovery with
221237 - PRP treatment from severe injury decades earlier. ref SDS 23 VW50
221239 - ..
221240 - 2. CRUCIATE LIGAMENTS:
221241 -
221242 - [...unchanged...]
221243 - Complete tear of the anterior cruciate ligament.
221245 - ..
221246 - [...unchanged...]
221247 - Posterior cruciate ligament is intact.
221248 -
221250 - ..
221251 - 3. COLLATERAL LIGAMENTS:
221252 -
221253 - The medial collateral ligament including
221254 - its superficial and deep components are intact.
221256 - ..
221257 - Fibular collateral ligament with subtle T2 signal
221258 - consistent with degeneration and unchanged.
221260 - ..
221261 - Lateral stabilizing structures including the iliotibial
221262 - band, fibular collateral ligament, and biceps femoris
221263 - tendon are intact.
221265 - ..
221266 - The popliteus tendon and muscle are within normal
221267 - limits.
221269 - ..
221270 - 4. EXTENSOR MECHANISM/ FAT PADS:
221271 -
221272 - Quadriceps and patellar tendons are intact.
221274 - ..
221275 - Possible improvement - prior MRI on 160805 reported "Distal quadriceps
221276 - tendon with mild tendinosis," and also " There is mild edema in the
221277 - quadriceps fat pad." see the record on 160805 0800. ref SDS 20 ZG6H
221279 - ..
221280 - MRI Left Knee on 171229 continues...
221281 -
221282 - Again noted is scarring in Hoffa's fat pad with
221283 - micrometallic susceptibility artifact which may be
221284 - related to prior surgery.
221286 - ..
221287 - Hoffa's, quadriceps and pre-femoral fat pads are within
221288 - normal limits.
221290 - ..
221291 - 5. PATELLOFEMORAL JOINT:
221292 -
221293 - Alignment at the patellofemoral joint is anatomic.
221295 - ..
221296 - Medial and lateral patellofemoral ligaments are intact.
221298 - ..
221299 - Full-thickness cartilage loss involving the median
221300 - ridge and lateral facet of the patella.
221302 - ..
221303 - Full-thickness chondral loss throughout the trochlea,
221304 - with adjacent subchondral marrow edema, minimally
221305 - decreased compared to prior.
221307 - ..
221308 - Improvement - prior MRI on 160805 0800. ref SDS 20 HH95
221310 - ..
221311 - MRI Left Knee on 171229 continues...
221312 -
221313 - 6. OSSEOUS AND CHONDRAL STRUCTURES:
221314 -
221315 - No evidence of fracture.
221316 -
221317 - Bone marrow signal is within normal limits.
221319 - ..
221320 - Unchanged extensive chondral defects in the knee.
221321 - Full-thickness chondral defect involving the central
221322 - aspect of the medial femoral condyle.
221324 - ..
221325 - For some reason the radiologist Doctor Weistein does not present
221326 - current measurements to compare with prior measurement of "5 x 8 mm
221327 - diameter", reported on 160805 0800, ref SDS 20 FI4L - saying
221328 - "unchanged" may imply the measurement is unchanged, thus no increased
221329 - degenration.
221331 - ..
221332 - MRI Left Knee on 171229 continues...
221333 -
221334 - High grade fissuring involving the posterior
221335 - weightbearing aspect of the lateral femoral condyle and
221336 - lateral tibial plateau.
221338 - ..
221339 - Subchondral cystic change in the medial and lateral
221340 - tibial plateaus. Tricompartmental osteophytosis.
221342 - ..
221343 - 7. MISCELLANEOUS:
221344 -
221345 - No significant joint effusion.
221347 - ..
221348 - Possible improvement - prior MRI on 160805 reported "Small
221349 - suprapatellar joint effusion," reported on 160805 0800. ref SDS 20
221350 - ZG89
221352 - ..
221353 - No mention in this report of "Prepatellar soft tissue edema," reported
221354 - on 160805 0800. ref SDS 20 FI67
221356 - ..
221357 - MRI Left Knee on 171229 continues...
221358 -
221359 - No popliteal cyst.
221361 - ..
221362 - There are no intra-articular bodies.
221364 - ..
221365 - Musculature again demonstrates atrophy and edema within
221366 - the vastus lateralis, and feathery edema in the vastus
221367 - medialis and medial/lateral heads of the gastrocnemius
221368 - muscles.
221370 - ..
221371 - 11. Impression:
221372 -
221373 - 1. Similar appearance of severe tricompartmental
221374 - osteoarthritis and chondral defects as described.
221375 -
221376 - 2. Extensive complete degenerative tearing of the medial
221377 - meniscus and partial tearing of the lateral menisci,
221378 - unchanged.
221380 - ..
221381 - 3. Chronic complete tear of the anterior cruciate ligament
221382 - is similar to prior.
221384 - ..
221385 - The images were personally reviewed by Stefanie Weinstein
221386 - MD who agrees with the above interpretation.
221388 - ..
221389 - Primary Diagnostic Code:
221391 - ..
221392 - Radiologist's impression of no change in left knee condition after PRP
221393 - treatment on 170726, and then hiking 2,326 miles, shown in mileage
221394 - spreadsheet correlating hiking with HDL cholesterol...
221395 -
221396 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
221398 - ..
221399 - This indicates no further degenertion, and slight improvements in
221400 - "chondral loss throughout the trochlea, with adjacent subchondral
221401 - marrow edema, minimally decreased," per above, ref SDS 0 M75N
221402 - Possible improvements "Quadriceps and patellar tendons are intact,"
221403 - ref SDS 0 ZG6H,
221405 - ..
221406 - Does, however, this record reconcile clinical results of no pain in
221407 - left knee without taking Glucosamine Chondroitin since the date
221408 - getting PRP injections on 170726, and while hiking 2,326 miles??
221409 -
221410 -
221411 - ********************
221413 - ..
221414 - After completing MRI scans on both knees, Jonus said he can do the
221415 - knees immediately, rather than wait until 1500, which was scheduled by
221416 - Caroline on 171227 0915. ref SDS 24 PQYS
221418 - ..
221419 - He dissasembed the MRI setup so the patient could take a 10 minute
221420 - break to go notify Kathy in the waiting area, that scans for the feet
221421 - will procede immediately.
221423 - ..
221424 - Did this, and then returned to Radiology MRI area.
221426 - ..
221427 - MRI on feet is reported in another record today, on 171229 0900.
221428 - ref SDS 25 HQ5O
221429 -
221430 -
221431 -
221432 -
221433 -
221434 -
221435 -
221436 -
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221438 -
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221441 -
2215 -