Patient Name: Marston, John J Patient ID: 247836 CT CT ABC AND PELVIS NO CONTRAST

301 Pages·2014·51.38 MB·English

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Montgomery
General Hospital
Med5tar HMlt/j
Patient Name: Marston, John J
Patient ID: 247836
Date of Birth: 02·18~1939
Age: 73 years
Gender: Male
Accesslcn Number: 1511670
Location: MGH
Referring Physician: Medical Associates Er
Study Date: 01~25·2013 09:31
Procedure Types: CT ABD AND PELVIS NO CONTRAST
Verified
CT CT ABC AND PELVIS NO CONTRAST
CUnic:al Indication: LOW BACK PAIN RADIATING DOWN THE LEFT LQWi,Ft EXTREMITY

CAT 4152 - CT ABD AND PELVIS NO CONTRAST OJ./25/2013 4384152 1511670

XMPRESSION:
1. BILATERA):., RENAL CALCULI WITHOUT ANY ~~TERAl, CALCULUS. NO EVIDENCE
OF HYDRONEPHROSIS.
2. SUBCAiNTlMETER LOW-DENSITY l,AiSION IN THE: RIGHT LOB£ OF THE LlVER,
RECOMMEND FOLLOW- UP EITHER WITH ULTRASOUND, CONTRAST ENHANCED CT OR R~,l?EAT
CT IN 3 MONTHS AS IS CLINICALLY APPROPRIATE.
3. ENLARGED PROSTATE.
4. CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH SCARRING AT THE LUNG BASES.
FULL RESULT!
'l'echniquel Serial axj.a,l tomograJ;lhic section.s through the abdomen and pel vi~
j
are obtained without the administration of contrast.
CT Abdomen Without Contrast, Urinary Stone Protocol~
Images through the lung bases demonstrate changes of COPD with scarring
bi h.terally.
There bilateral renal calculi, there are two calculi seen in the righe
ar\'.!l
kidney and one in 1:-he left kidn.ey, 1!~sy all' are -'Approximately 0.2 em j.n
size. No evid,ence of hydronephrosis. No calculus is seen in the 1,.l;reter~.
There is a 0.8 em low-density l®sion in the right lobe of the liver which is
Page 1 of 2
PAGE 02/02

Patient: John Marston 10: 247838 Study Date; 01·25·2013 09:31
not fully evaluateQ due to laok of cQucrast, it is located near tne
gall.bl~dder fossa. Follow-up is recommenQed with ultra$ound or. contr.ast
enhanoed CT or. with repeat CT in 3 months.
The sp Leen is unremarkel.ble.
Thill pancreas the adrenal gl.;!l.nds and the reeroper.i tioneum are 1.m.remar.Kable.
I I
Atherosclerotic calcification iJ> seen in the abdominal aorta. Th.ere is no
bowel obstruction.
CT Pelvis Without Contr~.sti Ur.inary Stone Protocol:
There j,s maz ked distention of the urinary bll:l.dder. There is no pelvic mass
or ascites. No calcul~s is seen in the distal ureters or in the urinary
bladder. The prostate g]'and is mildly enlarged. Multiple phleboliths are
noted in the pelvis.
Mukul Das MD
01-25"2013 09:43
Page 2of2
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ASSOCJ.ATES

COURTESY COpy TO:
Patient:
MARSTO" .TOH:\,
ARTHUR SCHOE.NGOLD MD OOB:
02/Hlf1939 Age: 73
18111 PRINCE PHILIP DR MRN:
no 128606 Sex: Male
STE
Phone #: [phone]
OLNEY, MD 20832 Accession: 2753931
DATE OF SERVICE: 01/3112013
EXAM: MRI LUMBAR SPINE WITHOUT CONTRAST
HISTORY: 73-year-old male with lumbar radiculopathy, particularly in the left leg.
TECHNIQUE: Sagittal T1- and T2-weighted images as well as axial T2-weighted images are performed
through the lumbar spine without the intravenous administration of contrast. In addition, sagittal STIR or
sagittal fat-suppressed T2-weighted sequence was also performed.
COMPARISON: Prior x-ray of the lumbar spine of 10/15/2008.
FINDINGS: Dextroscoliosis of lumbar vertebrae. Evidence of spondylolysis of pars interarticularis of LS
vertebra leading to grade I spondylolisthesis of L5 over S1 vertebral body. As a result, there is foraminal
stenosis noted bilaterally at LS-S1 level in craniocaudad dimensions leading to impingement of the right L5
nerve root in the foramen and encroachment on the left: LS nerve root in the foramen. Right foraminal
stenosis also identified at L3-L4 at L4-L5 levels secondary to osteophytic encroachment from the endplates
and facet joint causing impingement of the right L4 nerve root in the neural foramen.
At L 1-L2 level, mild bulge of the annulus identified causing flattening along the anterior border of the dural
sac. Hypertrophic changes noted in ligamentum flavum causing mild degree of narrowing of the dural sac
with bilateral lateral recess stenosis.
At L2-L3 level, mild bulge of the annulus identified without distortion ofthe dural sac.
At L3-L4 level, diffuse bulge of the disk identified encroaching along the anterior border of the dural sac.
Along with hypertrophic changes noted in ligamentum flavurn, there is a mild-to-moderate degree of
acquired central spinal canal stenosis with bilateral lateral recess stenosis worse on right side compared to
left with complete obliteration of the fat planes in the right lateral recess causing impingement of the right
L4 nerve root. Mild right foraminal stenosis with encroachment noted on the right L3 nerve root.
At L4-L5 level, diffuse asymmetrical bulge/protrusion of the disk identified lateralized to right side extending
in right lateral recess and in the right neural foramen encroaching on the anterior border of the dural sac,
along with bilateral lateral recesses worse on right side compared to left and extending in right neural
The attache!l document» contain l,"ntidcntiul health inr. ••. matron. If)'lIu believe ynu have received tl,is information in cr"IIr, please enntuct
the sender at. the phone number stilted ubovc nnd dcst. •.•• }' (tI •• nnt simpl~' Iliscal~l) the info.mnt.iun hnmediutely,
1d.\l81l~li<..: Resonance Imaging (T\,fRT). Opcri'l'v1RI • Computed Tomographv (CT). Nuclear Medicine
rET:CT. Marnmographye Hltrasound e l)EXA • f1uonl"'opy. Interveruionul e X-Ray
Providing JC{tdh)log.).' Services at
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01 ,:\F.Y
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Coutinucde Page 201'2
Patient: MARSTO:'\, .TOH:'\
DOB: 02118/1939 A~e: 73
MRN: 128606 Sex: Mille
Phone #: [phone]
Accession: 2753931
DATE OF SERVICE: 01/3112013
foramen causing encroachment on the right L4 nerve root. Along with hypertrophic changes noted in
ligamentum flavum and facet joint, there is moderately severe acquired central spinal canal stenosis,
At LS-S 1 level, pseudoprotrusion ofthe disk is lateralized more to the right side compared to the left in the
right lateral recess. No distortlon of the dural sac,
The remainder of the neural foramina show intact perineural fat planes. Conus medullaris is at its normal
location and appears to be within normal limits. Normal marrow signal activity of the vertebral bodies.
IMPRESSION: Lumbar spondylosis. Spondylolysis of pars interarticularis of L5 vertebra leading to
grade I spondylolisthesis with bilateral foraminal stenosis and impingement of the right L5 nerve
root in the neural foramen and encroachment on the left L5 nerve root in the neural foramen.
Acquired central spinal canal stenosis at L3-L4 and L4-L5 levels, and to a lesser extent at L 1-L2
level with right foraminal stenosis and impingement of the right L3 and L4 nerve roots in the
foramina.
Dilip Arwlndekar MD
Electronically Signed: 1/31/13 10:12 am
DA/jt
Referring Phys: Dr, KEVIN MCMAHON
Phone Number: 301-774-8958
The attached ('neuments contuin •. ,"onfitlcntial health infurrnatmu. If you hdievc, .YUtl have received t.his information in ern,.·, please cnntnct
the sender lit the phone number stated uhnvc 1I011.1(!stro)' (tin nnt. simply (lismnl) the informat.ion imm c ..tiutcly.
Magnetic R~'01l:I1",e 1"''''I:\;ng (MRT) • Open MRT. Computed Tomography (CT). Nuclear Medicine
Pf.T;CT. Muml11ography. Ultrasound 0 DEX;\ • Fluoroscopv .111ler\,enl;nnal. X-Ray
Providing Rm/io/Og), Services ai

nelhe.sd<l nOW1{~ Bowie Soulh Chevy Cha,~ Chnlnn Freder-ick
Frederick South Germantown Greenbelt I .eisure World
MCI\.fTC (\·mT) Olney Rockville ~i:~\'ell T .ocks Waldorf While Oak
T'-Ian 08 07: 13:36 2013 Page 2 of 3

ROBERT R.L. SMITH. M.D.
Medical Director

J.972810020842
SFECIMEN COLLECTED: 01/07/2013 08:04
COMPLETED REPORT: 01/08/2013 07:13

ARTHUR SCHOENGOLD,M.D. (R-78506) MARSTON,JOHN
STE '1'10 (K1,M 9813 SAILFISH TER
18111 PRINCE PHILIP DR ) MONTGOMERY VILLAGE,MD 20886
OLNEY MD 20832

DOB: 02/18/1939 PT/PH#: 1-301-987-2685 Acn: 1972810020842

Original report sent to ordering physician:
CARDIAC ASSOCIATES, CARDIAC ASSOCIATES, 18109 PRNC PHILIP DR #125, OLNEY, MD

CHEMISTRY:
AST ( 17 U/L 10-35 GLUCOSE-- 91 MG/DL ( 65-99
16 U/L 9-60 BUN------ 16 MG/DL( 7-25 )
ALT SGOT)
CREATININE 0.95 mg/dL(0.70-1.18)
(
BU/CR RATIO N /A ( 6-22 )
SGPT)
CALCIUM--- 9.9 MG/DL( 8.6-10.3)
SODIUM--- J.42 mmol/L( 135-146 )
POTASSIUM- 4.6 mmol/L( 3.5-5.3 )
CHLORIDE- 105 mmol/L( 98-110)
CO/2----- 26 mmo1/L( 21-33 )

CHOLESTEROL---------------------- 147 MG/DL ( 125-200
TRIGLYCERIDE--------------------- 111 MG/DL «150)

~or patients >49 years of age, the reference limit
for Creatinine is approximately 13 higher for people
identified as African-American.
Bun/Creatinine ratio is not reported when the BUN
and creatinine values are within normal limits.

*HDL CHOLESTEROL------------------ 3 MG/DL (> or = 40)
LDL CHOLESTEROL, CALCULATED------ 8 MG/DL «130)
8
7

SIGNA,URE
DAn: REPORn:D
rre "too"" reccr atorv .Ii..<iles were pertonrec Py ocesi Diaorostic~. 1901 SLlpl'"r Spnr o RoM. Baltlll'ore. MD 21227
200201 (41)

03/04/2012 07;40:55 PM Page 5 of 15

PATIENT: MARSTON, JOHN J
MR#: 247-836
BILLING #: 00022355812
SEX: M

DATE OF BIRTH: 02/18/1939
UNIT: 1 NOR0105A
CARDIOLOGY CONSULTATION

CONSULT REQUESTED BY: Hospitalist Service
DATE OF CONSULTATION: 03103/2012
REASON FOR CONSULTATION:
Presyncope and history of coronary disease.
HISTORY OF PRESENT ILLNESS:
The patient is a 73-year-old gentleman with a significant cardiac history of coronary
artery disease, status post CABG, who also has a known history of esophagitis, who
presented with a short episode of mild dizziness yesterday in association with a
headache. He did not have any nausea or vomiting. He did not have any chest
discomfort or shortness of breath. He currently has remained asymptomatic overnight
in observation with occasional episodes of mild sinus bradycardia with heart rates in the
40s to 50s. The patient denies any PND or orthopnea. He has not had any syncope at
home. His enzymes have ruled out. The patient, to his knowledge, has not had an
echo in some time. He is followed routinely by Dr. Tannenbaum. He has not had any
prior history of syncope or palpitations.
PAST MEDICAL AND SURGICAL HISTORY:
1. Significant for coronary artery disease, status post CABG in 1996.
2. Status post left heart catheterization in 2010 with resulting medical management.
3. Tobacco use.
4. Hypertension.
5. Sinus bradycardia.
6. Hypercholesterolemia.
7. Esophagitis.
ALLERGIES:
Morphine.
CU RRENT MEDICATIONS:
1. Pravastatin 40 mg p.o. at bedtime .
• CONSUL. TATION -
MEDSTAR MONTGOMERY MEDICAL. CENTER
ARTHUR SCHOENGOLD, M.D.
• ./o.vUI,,·,r;:7Ul.lia...1. ttecOrdS 03/04/2012 07:41:06 PM Page 6 of 15

MARSTON, JOHN J
PATIENT: 247-836
MR#: 2
PAGE #:

2. Pantoprazole 40 mg p.o. daily.
3. Eye drops.
4. Enalapril10 mg p.o b.i.d.
5. Atenolol 25 mg p.o. daily.
6. Aspirin 81 mg.
SOCIAL HISTORY:
He continues to smoke. He denies alcohol or drug use.
FAMILY HISTORY:
Negative for premature coronary disease.
REVIEW OF SYSTEMS:
Negative for nausea or vomiting, fever or chills, weight gain, weight loss, neurological
symptoms or rash. The rest of the 11-point review of systems is negative.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 140/54. Heart rate 68. Respirations are 20.
Temperature is 98.
HEENT: Extraocular movements are intact. Sclerae anicteric. Oropharynx clear.
Moist mucous membranes.
NECK: No JVP. No lymphadenopathy. No thyromegaly.
LUNGS: Clear to auscultation bilaterally, without increased respiratory effort.
HEART: Regular rhythm, without murmurs, rubs or gallops. PMI is nondisplaced.
ABDOMEN: Soft, nontender, and nondistended. Bowel sounds positive. No
hepatosplenomegaly.
EXTREMITI ES: No clubbing, cyanosis or edema. Range of motion is full.
SKIN: Warm and dry, without evidence of erythema or rashes.
NEUROLOGIC: Cranial nerves 2-12 intact. Sensation is intact to light touch.
PSYCHOLOGIC: Affect is appropriate. Alert and oriented x3.
LABORATORY DATA AND STUDIES:
Telemetry, reviewed by myself, does reveal some sinus bradycardia while sleeping, in
the 40s, but otherwise normal sinus with heart rates in the 60s to 80s. No AV block.
EKG revealed normal sinus rhythm without ST or T wave changes.
-CONSULTATION -
MEDSTAR MONTGOMERY MEDICAL CENTER
ARTHUR SCHOENGOLD, M.D.
03/04/2012 07:41:18 PM Page 7 of 15

MARSTON, JOHN J
PATIENT:
247-836
MR#:
3
PAGE #:

Labs revealed a negative troponin. Hematocrit is 40.9. White blood cell count is 9.37.
INR is 0.98. Electrolytes are a" normal. Creatinine is 0.82. TSH 1.74. HDL 35 and
LDL 78.
The patient also has a meningioma located on CT scan.
IMPRESSION:
1. Presyncopal event.
2. History of coronary disease, status post coronary artery bypass graft.
3. Tobacco use.
4. Sinus bradycardia.
At this point, the presyncopal event could be multifactorial. The patient has a 3.6 cm
right parietal meningioma, for MR of the brain.
RECOMMENDATIONS:
1. Okay to continue atenolol for now.
2. Okay to go home from a cardiovascular standpoint, as there does not appear to
be any high-risk arrhythmia or bradycardia at this point.
3. We will plan an echo and event monitor as an outpatient to determine whether or
not any medication changes or other interventions are needed and to determine
the etiology of the syncope. A loop recorder can be considered if the event
monitor is negative.
4. Follow up with Dr. Tannenbaum in 3 to 4 weeks.
5. Neurosurgery followup for the meningioma.
6. Discussed with Dr. Schoengold, his primary Cafe physician.
Pending Electronic Signature
SEAN BEINART, M.D .
• CONSULTATION-
MEDSTAR MONTGOMERY MEDICAL CENTER
ARTHUR SCHOENGOLD, MD.
CARDIAC PAGE 02/02
ASSOCI~T~S
Quest Quest Diagnostics Incorporated
Diagnostics
® R01H!.RT R.L. SMITIl. M.l).
1901 Sulphur SJ,'Irillg Roud - Baltimore. Marylund 21227-0580 M~j~ul Oitcclor
M~1I1 LabOtaltlry 411l-247-910(}· ,D.C. Area 30 H'i2J.6900
Out~idc M/lrylnnd j ·ROc'>-LAB-XCEL
1972a10018587
SPECIMEN COLLECTED: 01/31/2012 08;37
COMPLETED REPORT: 02/0l/2012 04:19
TANNENBAUM,ERIC (R-197281) MARSTO~,JOHN
CARDIAC ASSOCI~TES (K1,A) PATIENT IO:
18109 P~C PBXLIP DR #125 ~CCESSION #: 1~7281001S5S7
OLNEY, MD 20832 9813 SAILFISH TER
MONTGOMER.Y VILLAGE, MD 20886
, PATIENT PHONE#: [phone]
:.:,~,jl·""" ;~,'-' ;';l?~TIENT DeB: 0.2!lS/1~39
r A TrENT NAME DATE LAB NUMBER
1. \B H.FI'OI~
MARSTON, JOHN 01/31/2012 73 ,M ~2322706 I
CHEMISTRY: ..!2§L?JJ/U
AST----------------------~------- '2.D 17,,/.11/L 10-35
ALT-,.:.---------------------------- 2'2 16' ".oiL 9-60
i:' ,-
CHOLESTEROL---------------------- 132 149.yMG/DL ( l25-200
TRIGLYCERIDE-~-----------~----~~- \ 23 «150)
*HDL CHOLESTEROL-------~--~--~--~~ ,MG/DL (;:. or '"'
,;y.-:
LDL CHOLESTEROL, CALCULATED------ 3f, 6 MG/DL 40)
71.,. ',' 8',v',' " MG/DL «130)
Desir.-able range .dOO mg/dL for patien~s,~with9HD.;6r
diabetes and -:: 70 mg/dL for .diabetic pat~~tits,',;with,
known heart disease.
CHOLESTEROL/HDL 3.9 0.0-5,0
RATIO-----------~'

j
I

-:;-:;END OF REPORT - MARSTON,JOHN AB2322706 - TOTAL 1 l?AGE(S»>
(COMPLETED) 02/01/2012 04;20
DATE ~EPORTED