[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 15-year-old boy presented to Fujian Medical University with giant scrotal elephantiasis and swelling of both lower extremities. The penoscrotal edema began fifteen years earlier, soon after his birth, and it resulted in bilateral lower extremity edema with the penis becoming buried by the scrotum. His scrotal size was massive, and for the past 5 years, the glans penis was not visible nor palpable (Fig. a–c). He had undergone circumcision 13 year earlier and had no history of travel in filariasis-endemic areas. There was also no family history of scrotal elephantiasis or known genetic disorders.
Upon examination, the patient had a massively enlarged scrotum, with a volume of approximately 16 cm × 13 cm × 7 cm. The anatomical structures and urethral orifice were visible as a deep depression on the scrotum. Both lower extremities exhibited generalized swelling, which was especially noticeable on his ankles. His thigh circumference was 52 cm on the left and 56 cm on the right.
Tissue biopsy of the lower extremities was performed 13 years earlier and revealed lymphangioma and connective tissue hyperplasia. A urinary system ultrasound examination was performed 14 months prior to presentation at our hospital, which confirmed diseased subcutaneous scrotal soft tissues with no abnormalities in the bilateral testicular morphology and blood supply. The results of lower limb lymphoscintigraphy demonstrated that the lymphatic drainage of the lower extremities was obviously tardy. The development of bilateral inguinal and iliac lymph nodes was obviously tardy (Fig. ). The lower limbs and anterior pelvic position was imaged after injecting with the tracer (99mTc-SC) subcutaneously between the first and second toes. The images demonstrated that the lymphatic drainage in both lower extremities were unclear. In the early stage, the images showed that the bilateral inguinal and iliac lymph nodes were blurred, which was obvious on the left side. The concentration of imaging agent (99

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 4.5-month-old female presented to hospital with a 2-day history of watery diarrhea and fever developed in the 12 hours before admission. The infant was reported to have had 10 watery stools over the previous 24 hours, during which she became quite unsettled, crying a lot, whilst drinking half her usual amount of liquids. There was no history of vomiting.
Her medical history revealed delivery at term via emergency cesarean section due to severe fetal distress, with a birth weight of 2910 g. Her Apgar score was 0-1 at one and five minutes, respectively, after delivery requiring tracheal intubation and transfer into neonatal intensive care unit. She was put into induced coma and active hypothermia for 72 hours. The infant was extubated on the fourth day of life, followed by reestablishment of enteral nutrition by day 5. She was fed exclusively on formula milk from birth. An MRI performed on day 5 showed signs of severe hypoxic-ischemic encephalopathy. Followup after discharge was very irregular and the infant did not receive any vaccines up until the current hospitalization episode. Her weight curve was a reason for concern; indeed, her weight two weeks before the current admission to hospital was 4390 g.
On the day of presentation, physical examination revealed an alert but irritable and ill-appearing infant with a temperature of 39.9°C, heart rate between 170 and 190 beats/min, respiratory rate between 40 and 80 breaths/min, blood pressure of 102/55 mmHg, and oxygen saturation by pulse oximetry of 100%. The child's weight at admission into hospital was 3990 g, meaning she lost 10% of the previous reported weight. The skin was pale grey, tenting skin turgor, dry lips and dry buccal mucosa, normal looking eyes but reduced tears, soft fontanele, and capillary refill time of 3 seconds. The urine output was also decreased. Heart and lung examination were normal except for tachycardia; the abdomen

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
An 83-year-old man underwent surgical excision of a malignant peripheral nerve sheath tumor (MPNST) at the right knee at another hospital and was then referred to our hospital for further chemotherapy. Three months after the start of chemotherapy, the patient complained of severe pelvic and low back pain. A PET CT was performed which showed multiple bony lesions with a variable (moderate to high) degree of metabolic activity raising suspicion that these were metastases. The lesions, however, had a very unusual appearance and evolution as seen on CT.
Initially, the lesions presented as small rounded lytic lesions with a well-defined sclerotic margin (Figure ). They exhibited a rapid growth but the initial appearance of central lysis and surrounding sclerotic margin was preserved. Follow up PET CT scan was performed after seven weeks to evaluate the response to chemotherapy. It revealed a second concentric band (halo) around some of the lesions. This band (halo) had a ground-glass appearance and was surrounded by a second sclerotic rim. This rim was thinner and less sharply demarcated than the more central rim (Figure ). The multiple lesions were in different phases of evolution and as such had a different appearance at any given time.
Presence of multiple lesions, a known primary tumor and moderate to high uptake of FDG tracer on PET scan (Figure ) suggested metastatic disease, despite the unusual appearance of the lesions.
Other bony metastases were also evident on CT. Some were entirely sclerotic and a few had an ill-defined lytic appearance. Collapse of a vertebral body and fracture of the upper endplate of another vertebra due to metastases were also present.
Bone biopsy of a lesion with the above described doughnut appearance located in the left pubic bone was performed. A biopsy was obtained in the central lytic area and another biopsy in the peripheral halo (Figure ). Histological evaluation of both the samples showed infiltration of bone marrow by malignant s

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 58-year-old woman presented with acute memory disturbance and headache. During the afternoon of the day of presentation, she did not have any complaints while she was at work. After finishing work, she drove home. By the time she arrived at her home, she developed a headache and nausea. Her husband noticed that her memory was severely disturbed and called an ambulance.
In the emergency department, she complained of headache and nausea but denied any visual disturbances. Her blood pressure was 187/100 mmHg, and her pulse rate was 77 beats per min. The remainder of the physical examination was normal. Neurologically, she was alert and oriented with respect to place and person but disoriented with regard to time. She was unable to acquire new information and to recall the events that occurred during the same or previous day. She repeatedly asked the same questions. Her remote and working memories were intact, and she showed no loss of personal identity. Her speech and reasoning were intact. There was no visual field defect, and the other neurological examinations were normal.
Her laboratory tests, including those of the cerebrospinal fluid, were normal, and her brain magnetic resonance image (MRI) () was interpreted as normal. She was suspected of having a diagnosis of TGA. However, because we were concerned about her high blood pressure along with the headache and nausea, we treated her hypertension with nicardipine, observed her in the emergency ward, and planed a follow-up MRI looking for punctate high intensity spots in hippocampus on diffusion-weighted images (DWIs), the diagnostic finding for TGA. Subsequently, over the next 9 h, her blood pressure returned to normal, and her amnesia improved. She no longer had nausea. By the next morning, her amnesia had completely resolved, although there was a gap in her memory during the episode. The DWIs () of the brain MRI on the same day were normal, but the fluid attenuation inversion recovery (

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 45-year-old woman presented to her gynecologist with 6 months of increasing abdominal cramping and marked distention despite a 35-pound intentional weight loss. She denied other systemic or gastrointestinal symptoms. Her medical history was notable for in vitro fertilization resulting in twin pregnancy 7 years prior. She was otherwise healthy with a body mass index of 27 and not taking any medications. Physical examination was remarkable for a non-tender, but firm and distended abdomen with palpable findings suspicious for a large mass. Lower extremity edema was not identified in either leg suggesting that the mass was not compressing the iliac veins and likely superior to the pelvis. All laboratory testing, including serum hCG, was within normal limits.
Computed tomography (CT) scan of the abdomen and pelvis revealed a large heterogeneous, hypodense mass measuring 27 cm x 20 cm x 13 cm with irregular, central solid-enhancing components (Fig. a, b). Based on cross-sectional imaging, the mass appeared distinct from the uterus, without associated ascites or lymphadenopathy. An ultrasound-guided core biopsy demonstrated an admixture of mature adipocytes and spindle cells. Immunohistochemical staining showed diffusely positive for smooth muscle actin, desmin, and estrogen receptor, but was negative for HMB-45 (Fig. c–g). Taken together with the imaging findings, the histopathological characteristics confirmed a diagnosis of lipoleiomyoma.
Given the symptomatic nature of the mass, the patient underwent exploratory laparotomy to resect the tumor. Upon entering the peritoneum, the mass was immediately identified and encompassed most of the abdominal cavity. The tumor appeared to originate below the inferior border of the stomach with attachments to the mesentery and omentum and displaced the transverse colon into the pelvis. The tumor was well vascularized with feeding arteries from the mesentery and a large draining vessel to the superior mesenteric vein. Grossly, the t

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 51 year old man presented to the ED for the third time in 2 weeks with complaints of flank pain and hematuria. He had complained of left sided flank pain during the initial 2 visits. During the first visit, the patient was diagnosed to have renal colic. X-ray KUB did not show any renal stone. He was treated symptomatically with analgesia and discharged. During the second visit with complaints of persistent left flank pain despite taking analgesia given at discharge, he was admitted to the emergency observation ward for pain management. Bedside ultrasound done then was noted to have mild left sided hydronephrosis. He was pain free at the end of the observation and was then discharged with analgesia and an outpatient follow-up with the urology department. He was also scheduled to have an outpatient computed tomography scan of the kidneys, ureters, and bladder (CT KUB). However, 2 days before the scheduled CT, he represented to the ED with right sided flank pain since morning on the day of his visit. The pain radiated to the right groin and was associated with hematuria. He was not passing blood clots. He denied any other complaints of fever, weight loss, vomiting, diarrhea, or constipation. He had a past medical history of hypertension, diabetes mellitus, and hyperlipidemia. He had previous surgeries for appendicectomy and cholecystectomy.
His vital signs were stable. There was tenderness over the right flank on physical examination. There was also a palpable tender mass measuring about 5x5cm over the right lumbar region. There was no renal angel tenderness. Bedside ultrasound in the ED showed an appearance of a 6 cm cystic lesion around the inferior pole of the right kidney with internal echogenicity within the cyst. The provisional diagnosis was a bleeding renal cyst versus a tumor. Blood tests done in the ED showed a mildly elevated white cell count 12.64 × 10(9), hemoglobin of 14 gm/dL, and creatinine of 109 Umol/L.

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
We present a case of a 52-year-old man who presented to our outpatient clinic complaining of a painful lump in his left lateral abdominal wall. The patient noticed the development of a small nodule about one year ago, and he also stated that the lump was gradually increasing in size. The patient did not refer any previous abdominal trauma or any further pathologies. Palpation revealed a 4 × 5 cm nodular mass protruding through the left upper lateral abdominal wall. The mass was firm, tender, and not fix to the skin of the abdominal wall.
Computed tomography (CT) scan of the abdomen with contrast revealed a 32 × 45 mm cystic mass located between the external and internal oblique muscles (). Abdominal Magnetic Resonance Imaging (MRI) demonstrated a well-circumscribed 4 × 5 cm cystic mass, arising in the abdominal wall. The lesion was hyperintense on T2 (), and fat-suppressed sequences suggested cystic degeneration (). Clinical appearance and radiological findings were not specific for a particular entity. Our differential diagnosis included a chronic haematoma or a cystic tumor of the abdominal wall.
The patient underwent total resection of the mass under local anaesthesia (). The choice of local anaesthesia was based on the patient's preference, the small size of the tumor, and the fact that it was located at the abdominal wall. During the operation, the tumor was intermuscular and found between the external and the internal oblique muscle. The mass was not strongly attached to the surrounding tissues and was easily mobilised and excised in healthy margins. He was discharged the following day in excellent clinical condition.
Macroscopic examination of the resected specimen revealed a well-circumscribed nodular mass measured 6.5 × 4.5 × 3.5 cm (). Histopathology findings were characterized by interlacing bundles of spindle cells of varying cellularity and peripheral lymphoid cuffs (Figures –).
The neoplastic cells were immunoreactive with S-100 protein () and vimentin

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
The patient was a 10-year-old boy with a 1-year history of a restrictive eating disorder with agitation during meals. He had no noteworthy developmental history. He showed body image distortion and obsessive fears of being fat, but he did not exhibit depressive mood, hallucinations, or delusions. Physical examination was normal with the exception of emaciation. Laboratory investigations, echocardiography, head computed tomography (CT), chest CT, and abdominal CT demonstrated no abnormality. In September 2009, he was hospitalized because he was refusing all meals and his weight had fallen from 26 kg to 22.8 kg (71% of ideal body weight [IBW] for his height of 134.2 cm). We consequently started enteral feeding. He gained 7 kg and maintained his weight; however, he became agitated during enteral feeding and continued to refuse to eat. We started olanzapine for the body image distortion and agitation during meals but discontinued it in December 2009 because of over-sedation.
In April 2010, we started risperidone 1 mg/day. Thereafter, the agitation during enteral feeding and his complaints based on body image distortion diminished. After 1 month (6 months after hospitalization), he resumed meals. No side effects of risperidone were observed and his growth was good in the month after it was started. However, we stopped risperidone in June 2010 at his mother's request. One month after doing so, the patient's abnormal eating behaviors deteriorated and he stopped eating meals. In July 2010, we resumed risperidone 1 mg/day and his abnormal eating behaviors diminished. One month later, he resumed meals. No side effects were observed and his growth was good during the next two months. However, after this period he refused risperidone because he believed it was making him fat. His abnormal eating behaviors deteriorated again, and after one month he again stopped eating. In October 2010, we started RLAI 12.5 mg/2 weeks, as he refused to take risperidone orally but accepted the in

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
Mrs D was a 36-year-old female patient diagnosed with metastatic triple negative breast cancer (stage T4b N3 M1). The patient had undergone 7 cycles of chemotherapy before being referred to and managed by the pain and palliative care team. Metastases had spread to her cervico-dorsal, lumbar and sacral vertebrae and bilateral pelvic bones. On presentation to the pain control out patients department (OPD) she had severe pain in her head and neck, and was admitted to the inpatient palliative care unit for analgesic titration and control of nausea and vomiting.
The patient was already on anti-sickness medication (Ondansetron); further management of nausea and vomiting included the introduction of a proton pump inhibitor (Pantoprazole) as well as advice on diet and patterns of eating.
The management of the patient's pain was more complex, and can be framed in the context of total pain [].[]
Physical pain control was managed as per the WHO pain ladder.[] The patient was already on step 3 of the ladder, so her morphine dose was increased from 20 mg every 4 h to 30 mg every 4 h. Due to her head and neck pain, an MRI was done. This was discussed at a cross-disciplinary meeting with the radiologists to clarify what the progression of the disease was and what would be the most appropriate way to move forward with management. Although the progression of disease was such that treatment was no longer an option, a decision to give radiotherapy was taken as a palliative measure in order to prevent spinal cord compression and its complications, as well as to relieve pain and preserve function.[] As an adjunct to this, the physiotherapists provided advice on movements of the head and neck, and also a neck brace.
The patient's social problems had started when she first fell ill. She had to leave her job of making clothes and therefore lost some of the family income. Her brother and husband were also missing

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
34 years old patient, Gravida 6 Parity 3, previous 2 miscarriages (18 weeks & 12 weeks), was seen first at 23 weeks 4 days of pregnancy. She had undergone previous 3 cesarean sections and an evacuation of retained products of conception by curettage in 2013 for partial hydatidiform mole. At 27 weeks 5 days, she was admitted for vaginal bleeding. On further evaluation by ultrasound (), the diagnosis of placenta percreta was made (later confirmed by MRI). At 29 weeks, she had constipation with 2 episodes of urinary retention and she was put on continuous bladder drainage. She developed urinary tract infection and treated with appropriate antibiotics based on culture sensitivity. She continued to have repeated bouts of vaginal bleeding of varying amounts and severe constipation from 31 weeks of gestation.
At 32 weeks 4 days, patient underwent cystoscopy, which had shown signs of cystitis with no definite infiltration. She underwent classical cesarean section under combined anesthesia (Epidural + General). The umbilical cord was tied near insertion and the placenta was left in situ because there was no spontaneous separation. Then, the uterus was closed. Prophylactic temporary bilateral internal iliac artery balloons were inserted and inflated earlier. Uterine artery embolization was performed post cesarean section and selective angiograms confirmed adequate positioning. The patient required large volume of particles and still had incomplete embolization with the lower part of the uterus still showing some unblocked branches on both sides.
Post-operatively, she was transferred to labor ward and within 4 hours, she developed clinical features of pulmonary embolism (PE). Some of her symptoms included drop in O2 saturation to 81%, tachycardia, chest pain, peripheral cyanosis, and signs of respiratory distress. Then, she was transferred to ICU and was initiated on heparin infusion. On chest X-ray, she had no atelectasis, pneumothorax, or pleural effusion. An immediate CT sc

[Assistant]
ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A female patient aged 58 years presented to a tertiary cancer care unit with a history of bleeding from the vagina and low back ache since 4 months. On clinical evaluation, patient’s general condition was good, and per vaginal examination revealed a cervical growth with left parametrial involvement not up to the pelvic wall. Biopsy of the cervical growth showed a nonkeratinizing squamous cell carcinoma []. Her cystosigmoidoscopy was normal. Final diagnosis was carcinoma of the cervix, FIGO – International Federation of Gynecology and Obstetrics – stage 2B. The patient received external beam radiotherapy 50 Gy/27 fractions followed by high dose rate intracavitary brachytherapy (3 sessions each of 7 Gy) from October 31, 2008, to January 23, 2009. The patient was cured on clinical and radiological evaluation and was on regular follow-up.
Four months after the treatment, on follow-up evaluation the patient gave a history of lump in the left breast. On examination, a lump measuring 8 × 7 cm was palpable in the upper outer quadrant of the left breast with no evidence of skin or chest wall invasion. Mammographically, a high-density mass with ill-defined margins was noted in the upper outer quadrant; no calcification was noted. On ultrasonographic correlation, the mass was hypoechic with internal vascularity. Tru-Cut biopsy of the lump was done and histopathological examination showed features suggestive of an infiltrating ductal carcinoma with negative estrogen and progesterone receptors. Her primary site was clinically evaluated and was normal. A diagnosis of breast carcinoma as second primary was made and the evaluation was initiated on the same lines.
As a part of metastatic work-up and to know the status of the primary carcinoma, a positron emission tomographic scan was done which showed uptake in the left breast and left lung. Her bone scan and ultrasonography (USG) of the abdomen were normal. Chemotherapy for metastatic breast carcinoma was planned. The patient recei

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 45-year-old male was admitted to the emergency department with complaints of acute onset severe abdominal pain and vomiting for three days. He was earlier evaluated and treated at a local hospital where he was kept on conservative management with insertion of nasogastric tube for 24 hours. But his symptoms were further aggravated with increased bouts of vomiting; as a result he was referred to our institute for further management. The patient had no history of similar attack in the past. He did not report any fever, dysuria, and change in bowel habit or hematochezia. There was no history of any comorbid illness, past surgical intervention, or trauma. On general examination, pulse rate was 98/minute and blood pressure was 130/80 mm of Hg. Patient was afebrile and tachypneic. Abdominal distension and tenderness were detected on abdominal examination. Bowel sounds were decreased. Digital rectal examination was normal. Rest systemic examination revealed no abnormality. Abdominal radiography in the upright position showed dilated small intestinal loops with multiple air-fluid levels suggesting intestinal obstruction. Ultrasonography of the abdomen revealed gaseous distension of the bowel loops. Routine blood investigations were within normal limit.
The patient was planned for exploratory laparotomy in view of acute intestinal obstruction. On laparotomy, a loop of ileum was found to enter the retroperitoneum through a hernia gate (defect of 2.5 cm) located lateral to the sigmoid colon in the left paracolic gutter (Figures and ). The small intestinal loop was incarcerated at the neck of the hernia sac which was reduced after widening the hernia gate. The segment of intestine was found to be viable after reduction for which resection was not required. The hernia gate was closed with nonabsorbable interrupted suturing (). There was no malrotation of the gut. Postoperative recovery was uneventful and the patient was discharged on the sixth postoperative day. He is now on fo

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 12-year-old female patient reported to the Department of Periodontics, People's College of Dental Science and Research Centre, Bhopal, with a history of swelling in the upper lip and gums since last six years. Patient gave history of trauma during playing six years back, which resulted in laceration of upper lip, for which a local doctor was consulted. This was followed by appearance of swelling in the upper lip which increased gradually in size and was constant since the last two years. Patient also gave a history of swelling and spontaneous bleeding from the gums, because of which she refrained herself from oral hygiene maintenance.
Intra oral examination showed generalized gingival hyperplasia with maxillary arch with a typical bluish purple gingiva at the interdental areas of 11 and 21; associated with grade I mobility Also, localized gingival enlargement was present in relation with mandibular incisors and canine [Figures –]. Generalized bleeding was observed at slightest provocation of gingiva. No abnormalities were detected on general systemic examination, and hematological investigations which included a coagulation profile. Orthopantomogram was also inconclusive [].
Periodontal treatment which was initiated with phase I therapy using hand instruments resulted in spontaneous brisk bleeding which was difficult to control. The bleeding site was suctioned and severe hemorrhage was controlled by digital pressure which took no less than 20 to 25 minutes. Because of the severe nature of hemorrhage encountered, some type of vascular abnormality was suspected and the patient was referred to physician for opinion.
Ultra sonography of the upper lip was performed which showed marked thickening of upper lip with multiple dilated vascular channels in the submucosal layer of upper lip. Dilated and enlarged arteries were seen with marked increase in systolic and diastolic flow predominantly on left side of midline. The findings were suggestive of post traumatic AVM [].
A

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 70-year-old male patient was presented to us with a huge swelling measuring 35 cms in greater dimension arising anteriorly from the neck more on the left side which was hanging up to the umbilicus (). The swelling was painless, slow growing and had acquired the present size in approximately 20 years. There was no history of treatment in the past. Patient was completely asymptomatic, except for ulceration of the overlying skin. On palpation, the swelling was smooth, painless and non-tender. Skin over the swelling was stretched, shiny and showed ulceration over the lower most part. There was no lymphadenopathy or any other palpable mass.
ENT examination of the patient was normal. Thyroid hormonal evaluation showed no abnormality. On ultrasound, the “mass” was iso-echoic with subcutaneous fat. It laid in front of the left lobe of the thyroid which was normal in size and echogenicity and moved freely with swallowing under the mass. The mass appeared to have an ill-defined capsule with several thin echogenic septa seen coursing through the substance of the mass. The ultrasound findings were suggestive of a soft tissue lesion. Computed tomography (CT) scan of the neck showed a hypodense mass in the left side of the neck with fat density, measuring 17×9 cm with multiple internal septations.
It originated in the left anterior triangle of the neck and extended up to the upper chest cavity. The mass was seen to be causing mild pressure effects with displacement of left parapharyngeal and oropharyngeal spaces. The trachea and the major vessels were displaced to the right and both the lobes of the thyroid seemed normal. Findings were suggestive of a soft tissue lesion possibly lipoma. A fine needle aspiration was performed and samples were taken from multiple levels of the swelling for adequate and representative cytological material.
All cytological smears yielded mature adipose tissue fragments. In view of ultra-sonographic finding and CT evaluation, a diagnosis of giant su

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
The patient is a 24-year-old male, Igbo by tribe, and an undergraduate, resident in Enugu, Southeast Nigeria. He was referred from the Enugu State University Teaching Hospital staff clinic on account of persistent hiccups of 4 days and confusion of 2 days' duration. The patient was in apparent good health until about 14 days before presentation when he was involved in a road traffic accident, in which he sustained minor blunt injuries, bruises, and lacerations but no fractures. On presentation, he was seen, admitted, and managed by the General Surgical Unit of University of Nigeria Teaching Hospital, Enugu, Nigeria. Four days into the hospital admission in the surgical unit, he developed progressive weakness and worsening of the body pain, and hiccups which became so severe that the patient could not eat without fear of discomfort. As a result of the weakness, he was unable to walk around or bath himself. Two days later, the patient developed nausea and recurrent vomiting, which smothered on until he developed progressive confusion and altered sleep pattern. The patient later developed facial puffiness which was closely followed by bilateral swelling of the legs. The leg swelling progressed to the thigh; he had no associated fever or seizures. His urine volume was noticed to have reduced and a collected urine sample turned dark brown after 6 h. There was no history of hematuria or frothy urine. He had no bleeding from any orifice. There was no history of hypertension or diabetes mellitus. He had no known risk factor for muscular disease from history obtained, and there is no family history of muscular disease.
Physical examination revealed an acutely ill-looking young male. He was in respiratory distress, was afebrile (temperature 37.1°C), not pale, and not anicteric. There was no significant peripheral lymphadenopathy. He had bilateral pitting lower limb edema. Asterixis was present.
The significant observations on examination of

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 41 years old Egyptian male with an unremarkable past medical or surgical history presented to the King Saud medical city emergency department, with two days history of abdominal pain, associated with nausea, vomiting, and abdominal distention. The pain was colicky and started gradually without any bowel motion or flatus for two days. The drug and family history was unremarkable. Patient had tachycardia, with normal blood pressure and oxygen saturation of 100 % in room air. The abdomen was found to be distended and tender all over with an empty rectum by digital rectal examination (DRE). Upright chest and abdominal X-ray showed multiple air fluid levels with no air under the diaphragm (). CT abdomen showed a dilated proximal small bowel loop and a picture of SBO at distal ileal loops (). The patient resuscitated with intravenous (IV) fluids and kept nil per os (NPO). A nasogastric tube was inserted, and the patient was shifted to the operating room. Laparoscopic exploration showed dilated small bowel loops with collapsed distal ileum and an inflammatory band was found 20 cm from ileocecal junction originating from a small bowel diverticulum with no palpable intraluminal masses (). The inflammatory band was present at the distal part of the diverticulum and was adhered to a small bowel segment leading to obstruction. The band was released, and wedge resection of the diverticulum was performed at its base by gastrointestinal anastomosis (GIA) on healthy tissue, about 2 cm from the inflamed segment, which is a standard surgical approach for MD. The postoperative period was uneventful. The patient was initially kept at regular surgical floor bed and then discharged on the second postoperative day, when he passed good bowel motion. The histopathology result on follow up visit showed MD with Schistosoma infection, most likely by Schistosoma mansoni. The patient was referred afterwards to the infectious disease department for initiation of praziquantel, which is the drug

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
This is a case of a 25 years old Malay girl with learning disability and no significant past medical history, who started noticing a sacral mass since August 2015. The mass was painless and gradually increasing in size. The family members of this patient brought her to a traditional healer. They did not seek any medical treatment until late 2017. By this time, the mass over the sacrum was extremely large. Family members claimed the mass was preventing the patient from lying down flat supine. The patient was also unable to ambulate for the past 2 years. Hence, she was bedbound most of the time. It was difficult for her to sit on the wheelchair. She also felt tired to move because the mass was quite heavy. The family members claimed when the patient was lying down flat, she had to flex her hips and knees to achieve a more comfortable position. In addition, she often slept either in prone position or in supine with multiple pillows below her body. The mother also claimed over the last 2 months, the patient’s body had been getting thinner despite her physical weight was increasing due to the increase in size of the sacral mass. The patient had been passing stool and urine in pampers. There was no past medical history and no family history of cancer. Socially, the patient lived with her mother and siblings. The mother was the main care taker. Her father passed away 10 years ago because of heart attack. The patient previously attended a special needs school, but she stopped going to school since 2015 after developing the sacral mass.
This patient was managed in the Southern Region referral centre for Orthopaedic Oncology in Malaysia. On clinical examination in the Orthopaedic Oncology ward, the patient appeared cachexic, she had slightly pale conjunctiva, but she was not dysmorphic. Vital signs were Blood Pressure 142/90, Pulse Rate 98 beats per minute and Temperature 37 degrees Celsius. There was a large mass 40 cm × 30 cm

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 59-year-old woman presented to our outpatient clinic complaining of a small indolent tumor on the tip of the nose which was slowly progressing in size. She did not mention any other symptoms ().
The clinical examination showed a nodule measuring about eight millimeters which was located on the upper border of the right nostril where the medial crus of the alar cartilage bends to reach the lateral crus. There was an additional subcutaneous expansion towards the tip of the nose and the columella. The lesion was hemispherical, immobile, sharply demarcated, nonirritated, and indolent. Further head and neck examination including laryngopharyngoscopy and cervical sonography did not reveal any other disorder.
The absence of irritation was not consistent with an acute infection. Because of the sharp demarcation, the smooth surface, and the lack of ulceration a primary malignancy was also unlikely. For a better diagnostic classification a histopathological diagnosis was necessary. Using local anesthesia we performed an excision biopsy. Via a small incision, a complete resection of the tumor and its surrounding capsule was possible. Crossing the midline, the lesion expanded into the subcutaneous tissue between the medial walls of the alar cartilages. However, the tumor did not macroscopically infiltrate the surrounding structures. After primary closure and uncomplicated postoperative wound healing the local status was cosmetically unremarkable.
The histopathological examination revealed fibrous connective tissue which was partly covered by an intact nondysplastic squamous epithelium. The corial connective tissue was infiltrated by nonkeratinizing squamous cells with pleomorphism of size and nuclei. These findings corresponded to a moderately differentiated squamous cell carcinoma ().
The clinical and histopathological findings, especially the nodular form, the intact epithelium covering the lesion, and the missing infiltration, were not consistent with a primary malignancy

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
Our patient is a 53-year-old male who worked as a coal miner. In spring of 2017, he noticed enlarging scalp nodules and right hip pain. He also complained of fatigue but was otherwise asymptomatic. Because of the hip pain and nodules, he came to the emergency department where a CT scan showed an enlarged right frontal scalp mass that measured about 4 cm (). MRI also revealed a right frontal scalp mass and extensive vasogenic edema localized to the right frontal lobe with a 5 mm midline shift at the foramen of Monroe (). A subsequent CT chest, abdomen, and pelvis was performed and showed a lytic lesion in his ilium and a single enlarged right hilar lymph node (not shown). A follow-up nuclear medicine bone scan demonstrated multiple areas of increased uptake concerning for metastasis (). One of the largest areas was in the right frontal scalp. After discussion with the patient and the need for a definitive diagnosis, he was consented for subtotal resection of the right frontal scalp mass.
He was taken to the operating room where a right frontal scalp incision was performed for subtotal resection of likely metastatic cancer. The mass was primarily located within the right frontal scalp but extended through the skull into the right frontal cortex. It did not however appear to be involved with the brain parenchyma. The resection consisted of removing scalp mass and taking a core biopsy from the specimen. Histopathology of the biopsy showed a diffuse and monotonous infiltrate composed of small cells with irregular nuclei, condensed chromatin and inconspicuous nucleoli (). On immunohistochemistry, the cells are CD20 positive B-cells and co-express CD10 and Bcl-2 but do not express CD3, 5, 23, 43 and cyclin D1 (). CD21 was present highlighting a disrupted follicular dendritic cell meshwork. Ki-67 proliferation rate was low (less than 20%). By flow cytometry, a dim kappa light chain-restricted B-cell population was identified expressing CD10. The FISH assay revealed t(14;

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 55-year-old male patient reported to our institution with a complaint of pain and swelling in the lower right jaw region for the past 3 months, which was increasing in size. No history of trauma was elicited. Extraoral examination revealed a nontender, diffuse, hard swelling of size 6 cm × 2.5 cm on the right side of the jaw extending 2 cm from the midline till 2 cm anterior to the angle of the mandible. Paresthesia was present in the same region. Intraoral examination revealed a swelling in the vestibular region which was soft, fluctuant and nontender.
Radiographic examination revealed a well-defined unilocular radiolucency of size 3.5 cm × 4 cm having irregular margin extending from 43 to 46 region. Another well-defined radiolucency of size 2.5 cm × 2.5 cm was seen on the left parasymphysis region extending up to 35 region []. Both the lesions were enucleated and specimens were sent for histopathological examination.
Histopathological examination of the lesion on the left side of the jaw showed multinodular proliferation of spindle-shaped and cuboidal cells. Numerous scattered duct-like structures were also seen which were lined by cuboidal to columnar cells and lumen filled with eosinophilic material exhibiting characteristic histological findings of AOT.
Histopathological examination of the lesion on the right side presented unusual features. The lesion showed a large cystic lumen surrounded by odontogenic epithelium, predominantly cuboidal cells showing ductal or glandular pattern []. Numerous follicles lined by cuboidal and columnar cells with centrally placed stellate reticulum-like cells with thin rim of eosinophilic material were seen []. Anastomosing cords of epithelial cells with peripheral tall columnar cells intermingled with areas of spindle-shaped cells were also seen []. Supporting connective tissue was highly vascular containing large areas of extravasated red blood cells, few chronic inflammatory cells and numerous multinucleated giant cells peri

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 25-year-old Korean male was admitted due to 3 days′ history of hematochezia. Two weeks earlier, he had visited the outpatient clinic due to intermittent dull left lower quadrant pain and loose stool of 3 months′ duration. He had mild exertional dyspnea. Faint pansystolic murmur was audible along his left sternal border. A firm tender mass of 3–4 cm in size was palpable at his left lower abdomen. Colonoscopy revealed a small pedunculated polyp on the cecum and another small sessile polyp on the sigmoid colon The two polyps were removed with polypectomy. The mucosal folds were hypertrophic and the lumen was slightly narrow over a long segment of the sigmoid colon. Histologic examination of the removed polyps revealed lymphoid polyps. Mucosal biopsy from the narrow segment of the sigmoid colon disclosed only mild infiltration of chronic inflammatory cells.
On admission, his vital signs were stable. Hemoglobin was 11.0g/dl. Upper GI endoscopy was unremarkable. Colonoscopy revealed a small shallow ulceration at the previous polypectomy site on the cecum, and any evidence of recent bleeding could not be noted. Four days later, he experienced mild hematochezia again without any significant change in blood pressure and heart rate. Urgent sigmoidoscopy revealed fresh blood up to the splenic flexure, but the bleeding point was not clear.
Selective inferior mesenteric arteriography demonstrated abnormal vasculature involving the sigmoid and distal descending colon without active bleeding (). Echocardiography and right cardiac catheterization demonstrated a ventricular septal defect with Qp/Qs ratio of 1.99. On the next day of the cardiac catheterization, he experienced a sudden massive lower GI bleeding and became hypotensive. On urgent laparotomy, a long abnormally hard thickened colonic segment with dilated tortuous vasculature involving the distal descending colon, sigmoid colon and upper rectum was found. Segmental colectomy, including the involved segment, was done. Pos

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 28-year old woman was free climbing with her boyfriend near Gunnison, Colorado. Both were wearing a helmet and a harness for safety. The girl had 20 years of experience of rock climbing, being taught early tricks by her father at the age of 8 years. The ascent consisted of three pitches of 90-100 feet (ca. 30 m) each. The climbing distance was defined by the climbing rope which had been fixed at a defined length. The girl took the lead on the third pitch, to a total height of 300 feet (ca. 90 m). After securing the anchor at that height, the rope - which was lacking a security knot - slid through her harness. She then fell a total of 300 feet, with a first impact at 200 feet onto a flat rock surface, and a further fall for about 100 feet. Based on this falling height, the velocity at the time of impact is estimated around 75-80 mph. Her boyfriend witnessed the entire fall, climbed back down and provided first aid at the scene. The patient was awake and moaning, but not responsive to verbal or painful stimuli. She was intubated at the scene and transported to a local level IV trauma center, where she was resuscitated and transfused with 4 units of packed red blood cells (PRBC). Due to ongoing hypotension and transfusion requirements, a decision was made for transfer to our regional level 1 trauma center. On arrival, the patient was intubated and sedated. She was hypotensive, with systolic pressures in the 80s. She was successfully resuscitated with crystalloids and blood products, using a standardized institutional massive transfusion protocol with point-of-care thrombelastography-guided resuscitation [,]. The patient was managed according to the ATLS guidelines for initial assessment and management, and by our institutional "damage control" protocols, including the initial spanning external fixation of femur shaft fractures [,

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 21-year-old woman presented to the surgery outpatient department (OPD) with clinical history of right upper abdominal lump for 6-7 years, which was gradually increasing in size. It was associated with dull aching type of pain, which was on and off in nature. There was no history of fever, weight loss, altered bowel habits, or urinary symptoms. Her menstrual history was within the normal limits. There was no history of twin birth or teratoma in the family. Her general physical examinations were within the normal limits. On abdominal examination, as done in surgery OPD, there was a lump involving the right upper quadrant of the abdomen. It had ill-defined margins with soft to firm consistency and irregular surface. It was not moving with respiration. On evaluation, beta-human chorionic gonadotropin (β-HCG), alpha fetoprotein (AFP), and routine blood investigations were found within the normal limits. For further diagnostic evaluation, ultrasonography (USG) was done. Prior imaging examinations were not done in this patient. USG showed a large, ill-defined heterogeneous mass in the right side of the abdominal cavity adjacent to the liver, having multiple hypoechoic areas and echogenic structures with no internal vascularity. With inconclusive diagnosis, she was admitted in surgery ward for further evaluation.
Later, contrast enhanced CT scan of the abdomen and pelvis revealed a large heterogeneous retroperitoneal mass in the right side of the abdomen, measuring approximately 22.5 × 14.1 × 12.5 cm having cystic areas, fat attenuating areas, foci of calcifications, malformed skeletal parts resembling long bones, ribs and vertebrae, and heterogeneous soft tissue fetal components. Soft tissue components showed minimal peripheral enhancement. The mass was lying predominantly in the posteroinferior aspect of the right lobe of the liver causing its displacement anteriorly and to the left side and extending superiorly up to D8 vertebral body causing superior displacement of t

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 46-year-old Javanese woman presented with urinary incontinence following an abdominal hysterectomy with bilateral salpingectomy 3 months earlier. She is a housewife with no history of routine drug use and no prior history of hypertension, diabetes, allergies, or other chronic disease. She does not smoke tobacco and does not consume alcohol.
A physical examination revealed that her general condition was good and her vital signs were: blood pressure 112/74 mmHg, heart rate 89 beats per minute, respiratory rate 18 times per minute, and temperature 36.6 °C. There were no abnormalities in her chest and abdomen, or in musculoskeletal and neurological examinations. In a genitalia examination using a speculum, we identified fistulae above her vagina wall that were 1 cm in size. All laboratory findings (that is, complete blood count, liver functions, renal functions, and urine analysis) were within normal limits.
After discussion with our patient regarding the risks and benefits of an open abdominal procedure and laparoscopic approach, we discussed the similarities and differences between the two procedures were her. We chose surgical management using laparoscopic approach with the considerations that it could facilitate precise dissection, offer good visualization, and be minimally invasive, thereby enabling faster recovery.
Our patient was placed in the lithotomy position and received general anesthesia. A cystoscopy was performed to confirm the fistulae orifice and a stent was inserted into the fistulae tract from her bladder to her vagina. A tamponade was inserted into her vagina up to the vaginal apex, to be able to identify the vagina and prevent loss of pneumoperitoneum. A transperitoneal approach was performed with trocars distributed as follows: The camera was placed through a 12 mm port with 30° down lens located superior to the umbilicus. Two ports for the surgeon were placed on the right side (Fig. ).
She had adhesions; therefore, adhesiolysis was performed, us

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 31-year-old male presented to the Department of Periodontics, Manipal College of Dental Sciences, Manipal, India, with recurrent swelling and pain in the maxillary anterior teeth over the previous 6 months. The pain was dull and slightly increased whenever he used that particular tooth for biting. The patient had fair oral hygiene and was otherwise healthy.
On examination, the maxillary right central incisor was found to have a 5 mm pocket mesiolabially and a 6 mm pocket mesiopalatally. The tooth was noncarious and was slightly extruded and proclined []. The incisal edge in the center of the tooth had a notch (abraded). The tooth showed no evidence of fracture and was not tender on percussion. There was no abnormal mobility. The incisal edges of the lower right and left central incisors also showed notching.
Radiographic evaluation revealed the presence of a vertical defect [] mesial to the right central incisor. An orthopantomogram revealed no periodontal involvement of any other tooth in the arch. When the clinical findings were correlated to the radiographic findings, it was evident that the cause of such localized destruction was either trauma or an endodontic-periodontic lesion. Since the tooth was not discolored and not tender on percussion, we sought for history of possible trauma.
Enquiries related to his work as an electrician revealed that he often used his incisors to strip the outer rubber coating off electrical wires. He would hold the wire between his maxillary anterior and mandibular anterior teeth and pull the wire, thus removing the outer tubing and exposing the tungsten core.
In view of the localized destruction and the recurrent attacks of periodontal abscess, it was evident that the lesion was related to his occupation. Based on the history and the clinical and radiographic findings, we made a diagnosis of chronic periodontal abscess.
The relationship between the recurrent attacks of periodontal abscess and periodontal destruction and his profe

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
An 80-year-old female presented to our health service with one month history of acutely worsening abdominal distention and pain, on a background of six months of non-specific gastrointestinal symptoms which was investigated with an abdominal ultrasound that did not detect any abnormality. Relevant medical history includes vaginal hysterectomy secondary to fibroids, type 2 diabetes mellitus, hypothyroidism, hypercholesterolaemia and hypertension.
On history, the main symptoms were abdominal distention and pain with no features of bowel obstruction. The vital signs were within normal limits. On examination, the abdomen was grossly distended with focal tenderness in the upper abdomen. There was a palpable cystic mass which appears of pelvic origin, however, the gynaecological examination was normal.
Routine laboratory investigations were normal. Tumour markers, including CA 125, CA 15-3, CA 19-9 and CEA, were all within normal limits.
A contrast-enhanced CT scan of the abdomen and pelvis was performed, which revealed a large intra-peritoneal cyst measuring 21 × 25 × 26 cm3, containing simple fluid (Fig. ). There were a few thin septations along the periphery with no appreciable nodular or soft tissue components within. The origin of the cyst was not able to be determined due to gross displacement of surrounding viscera. There was associated splaying of the bowel loops without resultant bowel obstruction. No pathologically enlarged abdominal, pelvic or inguinal lymph nodes were noted and there was no vascular compromise. On pelvic ultrasound, the majority of the lesion appeared simple cystic in nature. There was no obvious internal colour flow. Both ovaries were identified and appeared separate from the cyst.
A laparotomy was performed to resect the cyst for diagnostic and therapeutic purposes (Figs and ). The cyst was noted to originate from the sigmoid mesocolon. No other viscera required resection. The patient made an uneventful recovery.
Macroscopically, there was a

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 53-year-old female presented to the ED with six days of nausea and vomiting. She also noted feeling progressively weak with xerostomia and lower abdominal pain for several days prior to presentation. Further history revealed that she was a previous vegetarian who over the prior 22 days was attempting to lose weight by eating solely meat and eggs. She reported a 17-pound weight loss over the time period and noted that she was consuming only minimal carbohydrates. She took no medications and denied chronic alcohol use.
Her vitals upon arrival were as follows: temperature 97.1 degrees Fahrenheit, heart rate 77 beats per minute, respiratory rate 16 breaths per minute, blood pressure 160/106 millimeters of mercury, and oxygen saturation 97% on room air. She weighed 73 kilograms with her stated height of 5 feet 6 inches and had a body mass index of 26. The physical exam revealed dry mucous membranes and a benign abdominal exam.
The patient was given two liters (L) of normal saline intravenously (IV) and four milligrams of ondansetron IV for nausea. Labs were drawn due to a concern for abnormal electrolytes as well as her change in diet. Labs revealed an anion gap acidosis with ketosis ().
In the ED she received antiemetics, two L of normal saline and an infusion of D5NS at 150 cubic centimeters (cc) an hour, and her symptoms greatly improved. By the time she was admitted to the hospital, her gap had closed to a level of 12. She continued to receive an infusion of 5% dextrose in normal saline (D5NS) at 150 cc an hour as well as insulin subcutaneously on a sliding scale after admittance to the hospital. Her anion gap remained within the normal limits while in the hospital and her insulin was discontinued. After returning to a normal diet, her glucose remained stable and she was discharged after three days with only potassium supplement prescriptions. Since discharge

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 28-year-old male was referred to the department of oral and maxillofacial surgery for evaluation and management of a left facial mass. He had no other medical problems and no known food or drug allergies. At the age of 15 years, he noticed a mass on his left cheek eminence, which was excised and was told that it was a sebaceous cyst. Three years later, he had a local recurrence of the facial mass that was surgically excised again showing the same pathology. A third recurrence in the same area occurred 4 years later and was excised with the overlying skin. However, at this time the pathology specimen proved to be pilomatrixoma. The mass recurred again few years later and has been growing slowly over the past 3 years prior to presentation.
Clinical examination of the face showed a firm, nontender mass infiltrating the overlying skin of the left buccal subunit measuring about 5 × 3 cm. The overlaying skin had bluish discoloration (). There was no limitation of the mandibular range of motion. Cranial nerve exam was grossly intact. The neck was supple with no palpable masses or cervical lymphadenopathy. Intraoral exam was unremarkable.
Another incisional biopsy was done under local anesthesia, which confirmed the diagnosis and ruled out malignant transformation. A contrast enhanced magnetic resonance imaging (MRI) study showed a heterogeneously enhancing mass in the subcutaneous tissues overlying the left platysma muscle at the level of the mandible (). The adjacent musculature and bone marrow maintained their normal signal intensity. The mass was surgically excised including the overlying skin with a safety margin of 1 cm. About 6 × 5 cm skin was marked over the pilomatrixoma and was included in the specimen. The incision was carried through the skin, subcutaneous tissues, and the superficial musculoaponeurotic system (SMAS). The buccal and marginal mandibular branches of the left facial nerve were identified and preserved. The resulting cheek defect measured about 6

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 59-year-old female patient with a diagnosis of locally advanced invasive ductal carcinoma of the left breast was referred for a staging CT scan of the abdomen and pelvis. The scan was done using a Philips Brilliance 64 slice multidetector CT scanner. Nonionic contrast media (Ultravist 300) in a volume of 100 mLs were administered via pressure injector at a rate of 3.5 mL/min. The liver was found to be normal; however, she had evidence of metastases to the spleen, several vertebrae, and the pelvis.
An incidental finding of abnormal arterial branching was noted at the upper abdominal aorta (Figures and ). The left gastric artery originated directly from the anterior surface of the abdominal aorta shortly after it entered the abdomen through the diaphragmatic hiatus. Thereafter, it followed its normal course along the lesser curvature of the stomach. At the level of the first lumbar vertebra, there was a large arterial trunk originating from the anterior surface of the aorta, consistent with the celiacomesenteric trunk described by Ishigami et al. []. After coursing 2.5 cm, the celiacomesenteric trunk bifurcated into the superior mesenteric artery and the coeliac trunk that was unusually long and tortuous (). The splenic artery coursed to the left over the superior mesenteric artery and vein toward the splenic hilum where it divided into segmental arteries to supply the spleen in normal fashion. The left hepatic took an early origin directly off the common hepatic artery and travelled up toward the hilum in a plane superficial to the portal vein but in a more medial position than usual. The right hepatic artery took its origin from the distal gastroduodenal artery behind the pancreatic head to course superiorly in the free end of the gastroduodenal ligament, posterolateral to the portal vein. The bile ducts were normal in calibre and were not well visualized on CT scans. At the hepatic hilum, the left and right hepatic arteries branched in the usual fashion to supply

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 56-year-old male presented initially to the plastic surgery clinic with a right thumb lesion that had been present for approximately 2 years, and underwent a wide excision with flap closure. Final pathology revealed invasive porocarcinoma, measuring 1.3 cm, with positive margins and dermal lymphatic involvement, and consisted of nests and cord of atypical, mitotically active epithelial cells involving ulcerated epidermis, dermis, and subcutis without bone involvement. The cells exhibited marked nuclear pleomorphism and focal comedonecrosis. Some epithelial nests contained luminal structures, a distinguishing feature between porocarcinoma and squamous cell carcinoma (). Lymphovascular invasion was prominent and extended beyond the main tumor mass to involve the proximal margin.
Within weeks of his original surgery, the patient developed a new nodular recurrence at the suture line and subsequently underwent a partial amputation at the distal interphalangeal joint demonstrating persistent porocarcinoma with lymphatic involvement. At that time, a palpable right axillary node was detected and fine-needle aspiration was positive for malignant cells.
A complete metastatic workup revealed no evidence of distant disease, and he underwent a radical axillary lymph node dissection including nodal levels 1–3; 2/28 nodes were positive with the largest node measuring 3.7 cm. Given the burden of nodal disease, he went on to receive 4800 cGy in 20 fractions of adjuvant axillary external beam radiation.
Surveillance CT scans at 6 months post lymph node dissection did not reveal any evidence of new metastatic disease; however; within 7 months of surgery, he developed multiple cutaneous lesions with a papular, cystic appearance, located on the right hand and chest ().
A biopsy confirmed metastatic porocarcinoma. A re-staging CT did not demonstrate any visceral metastasis. Given the new diagnosis of cutaneous metastasis, he was then treated with palliative intent carboplatin and pacli

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 72-year-old Caucasian female patient was referred to the respiratory clinic with a 6-month history of exertional breathlessness. She gave a history of yearly chest infections, particularly in winter months. She, however, had no history of childhood respiratory problems or any significant respiratory symptoms during her adult life. She had a 30-pack-year smoking history but she quit 25 years prior to presentation. She worked as a nursing auxillary at a local hospital and had no prior asbestosis. She was on a 1 mg maintenance dose of prednisolone for polymyalgia rheumatica. Otherwise, she had no significant medical condition and was not on any regular medications. Her exercise tolerance was unlimited and she enjoyed a good health.
Her O2 saturation was 95% on room air and her spirometry showed obstructive pattern with FEV1 1.14L (55%), FVC 2.09L (83%) and FEV1/FVC ratio 54%.
An initial chest radiograph 2 years prior to presentation suggested an increased radiolucency of the left lung but this was not investigated further (). Serial CXRs 2 years later showed a relatively unchanged appearance of the left hemithorax with progressively increased opacification in the periphery of the middle and lower zones, and accompanying reduction in lung volume, on the right side ().
The patient underwent a contrast-enhanced CT of the chest in view of the repeated chest infections and lack of complete resolution to rule out the possibility of an adenocarcinoma in situ or endobronchial lesion, respectively. Cross-sectional imaging was also carried out to assess the possibility of an underlying bronchiectasis in the presence of the recurrent chest infections and to further assess the interstitial changes seen on the CXR on the right side.
Her CT showed hypoplastic left pulmonary artery (; arrow), attenuated peripheral pulmonary artery branches on the left (: arrows), hyperinflated left lung with air trapping and cystic bronchiectasis of the lingua and left lower lobe (). Features

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 24-year-old woman with a 6-month history of swelling in the left floor of her mouth was referred to our institution. Although she experienced slight difficulty in swallowing, she did not experience pain or tongue paralysis. Her medical and family histories were unremarkable.
Intraoral examination revealed a well-defined 3.5 × 3 × 2 cm-sized solid, spherical submucosal nodule adjacent to the sublingual gland; the nodule was covered with light bluish smooth mucus (Fig. ). The patient experienced slight pain when pressure was applied to the tumor. Mobility and sensory functions of the tongue were normal, and no lymphadenopathy in the submandibular region was detected on palpation. All relevant laboratory test results were normal. Enhanced computed tomography revealed a 2.8 × 1.8 × 2.1 cm-sized well-defined, solid, heterogeneous nodule that did not appear to involve the mandible (Fig. ). In addition, a three-dimensionally reconstructed image showed a nodular lesion occupying the left floor of the mouth with abundant blood flow (Fig. ). No enlarged lymph nodes were found in the submental or submandibular regions.
The initial clinical impression was a benign salivary gland tumor, dermoid cyst, or benign connective tissue neoplasm. The patient was scheduled for surgery via an intraoral approach. First, an elliptical incision was made around the periphery of the sublingual gland through only the oral mucosa, and a full-thickness tissue flap was prepared along the lingual aspect of the sublingual gland. After the sublingual gland was freed from its surrounding tissue with blunt dissection, a well-circumscribed tumor without capsular extension was found beneath the body of the sublingual gland and located above the submandibular gland duct and lingual nerve. The submandibular gland duct and lingual nerve were carefully freed from the tumor surface, and the complete tumor was excised along with the sublingual gland (Fig. ). The tissue sample was fixed with 10% formalin and s

[Assistant]
ICD-10-CM Coding based on findings:
Assign appropriate ICD-10-CM codes for all documented findings. Primary diagnosis first, then secondary findings. Verify with clinical context before finalizing.


[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
Susan is a 51-year-old woman. As an adolescent, she developed scoliosis. Working as a hairstylist when she was 18 or 19, she began to have severe pain in her hands, making her work very difficult. She had carpal tunnel surgery on her right hand which provided temporary relief. Her symptoms slowly returned and she continued to have intense pain and difficulty with her daily activities. Seeking relief from her symptoms, she received treatment from chiropractors and Chinese medicine practitioners with no significant benefit. She also tried yoga and swimming but depending on the yoga movements or swimming strokes, she began to have more pain.
When she was in her early forties, she began to have weakness in the lower half of her body. Her legs would frequently give out on the stairs, causing her to fall. Control of her bladder and bowel function also began to deteriorate. She had an MRI, and based on the results, she was scheduled for emergency surgery to stabilize her cervical spine and relieve spinal cord compression. She was informed that it would be an outpatient surgery and she would be home the same day.
In May 2011, Susan had a 6-level cervical spine fusion to stabilize her spine and relieve pressure on her spinal cord. When she woke up, she realized something was wrong. The entire right side of her body was paralyzed. What was supposed to be an outpatient surgery with a return home the same day ended up being an 8-week hospital and rehabilitation stay to learn how to walk again.
In August 2012, a second surgery was performed with the goal of pain relief. However, she reported her pain was significantly worse afterwards. She would receive weekly injections for pain relief that she reports would only marginally decrease her pain for about one week. She was also taking high doses of medication for nerve pain relief which she also reports provided marginal benefit. She had areas of heightened sensitivity on her legs where a bed sheet or even

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 75-year-old woman with no significant medical history presented with abdominal pain for one week. She was tender in the left costovertebral angle and had frequent voiding symptoms without gastrointestinal problems. Routine urinary analysis showed many red blood cells and 20-29 white blood cells per high power field of microscopy indicating renal stone disease. Other laboratory tests were unremarkable. Chest computed tomography (CT) was performed for evaluation of a nodular lesion in the right lower lung field that was detected on routine chest radiography leading to the incidental discovery of a low-density lesion in the left hepatic lobe. While she was admitted to the hospital for treatment of left renal stone disease, further evaluation of the incidental low-density lesion in the left hepatic lobe was performed. Ultrasonography (US) of the upper abdomen demonstrated a 3.1 cm-sized mixed-echoic nodular lesion in segment IV with a hyperechoic rim (). The right portion of the lesion was anechoic (solid arrow) while the left was hyperechoic. An abdominal CT scan revealed a lobulated mass with a cystic component in the right portion of the mass and delayed enhancement in the left which was thought indicate solid component (). Magnetic resonance imaging (MRI) of the liver was performed for further evaluation of the mass. The right side of the mass was seen as low signal intensity while the left side was enhanced on gadolinium-enhanced T1-weighted image (), thus matching to the CT features. However, T2-weighted images showed bright high signal intensity throughout the whole lesion () suggesting that the lesion was composed of aggregated cysts rather than solid tissue. For confirmative diagnosis, the patient underwent gun biopsy using US-guidance, the results of which demonstrated microscopic findings of a sponge-like lesion composed of microscopic cysts lined by attenuated cells resembling those in normal lymphatic ducts (). In addition, the lining cells showed stainin

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 52-year-old Korean male underwent distal gastrectomy for stomach cancer in 1999. Pathology report revealed early gastric cancer. Adjuvant treatment was not offered to the patient. The patient had multiple serious comorbidities including end-stage renal disease, for which patient was on hemodialysis and liver cirrhosis, which was associated with underlying viral hepatitis. The patient underwent regular surveillance with esophagogastroduodenoscopy (EGD) biannually. The patient was also under surveillance with serum alpha fetoprotein, liver function panel, and either ultrasonography or computed tomography (CT) scan of the liver following the Korean national guideline for high-risk patients with hepatocellular carcinoma. There were no signs of recurrence as of November 2016 when the patient had both EGD and CT. On July 2017, the patient visited the emergency room due to a sudden onset of melena. Emergency EGD revealed a 2 cm sized nodular mass in the greater curvature with bleeding (Figure ). Biopsy report showed moderately differentiated adenocarcinoma, identical to initial pathologic diagnosis. Stomach CT revealed a 2-cm sized cancer in the remnant stomach. Primary lesion on CT was suspicious for muscularis propria invasion. However, there was no evidence of lymph node or distant metastasis. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed diffuse hypermetabolism in the stomach without evidence of metastasis elsewhere (Figure ).
Remnant total gastrectomy was planned for this clinically staged T2N0 recurrent stomach cancer. On open laparotomy, however, severe adhesion was found. Due to high risk of incomplete resection and bleeding risk due to multiple comorbidities, further surgical exploration was not sought. The attending medical oncologist recommended against palliative chemotherapy. The underlying rationale was that the risk of adverse events from the anticipated treatment, including fatal hepatic failure, outweighed the survival benefit. After m

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 76-year-old woman with no relevant past medical history suffered a CA with asystole after collapsing in a shopping mall and falling down a few steps. Spontaneous pulse was recovered after 15 min of advanced resuscitation manoeuvres. She was sedated with propofol, intubated and transferred to the emergency room. The first electrocardiogram (ECG) after hospital admission following adrenaline injection 1 mg was sinus rhythm (). Pupils were symmetric, miotic, and reactive to light. Brainstem reflexes were preserved. Response to pain was absent except for withdrawal in the left foot. Plantar cutaneous responses were neutral.
The patient was admitted to the coronary care unit because of suspected cardiogenic CA and a hypothermia protocol was initiated. Acute myocardial infarction or other cardiac disorders were not diagnosed as the troponin curve was negative, angiography ruled out significant coronary lesions and echocardiography was normal. A thoracic computed tomography (CT)-scan ruled out pulmonary thromboembolism. There was no intracranial haemorrhage or other abnormalities on brain CT-scan.
On the 4th day post-CA, propofol was stopped but the patient remained in coma. Pupils were miotic and reactive. Other brainstem reflexes were preserved. Motor response to pain was absent. An EEG recorded diffuse delta–theta slowing with frequent irregular bilateral frontal sharp waves every 2–10 s. Median nerve SSEP demonstrated bilateral absence of thalamocortical N19 response and bilateral irregular low-amplitude cervicomedullary junction N13 waves with preserved peripheral potential (Erb point response) ().
On the 5th day after CA, a brain magnetic resonance imaging (MRI) showed absence of acute hypoxic–ischaemic lesions but an upper cervical spinal cord injury was unexpectedly noticed. A cervical MRI confirmed a fracture with luxation of the odontoid with severe cervical spinal cord hyperintensity (). The cervical spinal cord was immobilized and an orthopaedic consultation

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
The patient in this case was an otherwise healthy 6-year-old male who presented to the emergency room with a right elbow deformity from an injury sustained while playing football. He reported being tackled and falling back, leading to a direct impact onto his flexed right elbow. Examination demonstrated his right arm to be neurovascularly intact despite having a closed gross deformity at the elbow joint. X-ray evaluation revealed an anteromedial elbow dislocation with fracture of the radial head (). Two attempts were made at closed reduction in the emergency room under ketamine sedation with no appreciable reduction or improvement in alignment. Given the lack of success with closed reduction, the decision was made to take the patient to the operating room urgently for closed versus open reduction and possible fixation. Once under general anesthesia and with muscle relaxation employed, another closed reduction maneuver was attempted again with no success (). A direct posterior approach to the elbow was then performed with exposure carried around to the subcutaneous border of the ulna. It was noted that the olecranon apophysis remained in its anatomic position despite the ulna being anteriorly dislocated. Interestingly, the proximal ulna was found to be buttonholed through the anterior joint capsule, thus preventing reduction of the joint. The radial head was also noted to have an angulated Salter-Harris II fracture which was realigned with direct pressure application. No epicondylar fracture was noted with direct inspection. Once the entrapped proximal ulna was freed from the anterior capsule, it was easily reduced into its anatomic position (). Braided suture was used to reattach the olecranon apophysis to the proximal ulna through two drill holes in a figure of eight fashion. Final clinical exam and fluoroscopy images through a full range of motion revealed stable reduction of both the elbow joint and olecranon apophysis. The patient was splinted for approximately

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
We present a case of a 58-year-old female patient with a large recurrent ventral hernia. Six years before, the patient had been operated on for the umbilical hernia, with the simple repair without a mesh. The patient was an active smoker who suffered from morbid obesity with a body mass index of 43 kg/m2 and COPD as comorbidities relevant for this case report.
The patient was introduced to the surgeon during hospitalization at the gastroenterology department where a diagnostic workup due to a clinical picture of chronic small bowel obstruction was conducted. While taking the anamnesis, the patient reported frequent abdominal cramps, swelling, and pain in the area of the hernia that had intensified in the last few weeks. The physical examination revealed a large irreducible ventral hernia in the lower abdomen that was quite painful on palpation, but soft and, at that time, without signs of incarceration or strangulation. Taking into account the clinical picture with threatening hernia incarceration, the surgeon did not opt for preoperative optimization of the patient in terms of smoking cessation and starting a weight loss program but made an indication for semielective surgery.
On operative procedure, greater omentum, part of the transverse colon, and a cluster of small bowel loops with signs of chronic obstruction were found as hernial content. After adhesiolysis hernial content was reduced into the abdominal cavity. Hernial defect measuring about 7 cm in diameter and about 15 cm in the vertical line with significant rectus diastase in the supraumbilical part of the abdomen was revealed. Using the Rives-Stoppa technique a wide retromuscular space was created. Lateral dissection boundaries of this space were perforating neurovascular bundles in the area of the lateral edges of the rectus muscle on both sides. The posterior fascia was easily closed using also a portion of the hernia sac to bridge the defect between the posterior rectus sheaths. A 30 × 25 cm polypropy

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 31-year-old female presented for a routine clinic visit with her primary care physician and was found to have an elevated blood pressure of 150/100 that was sustained on repeat measurement. Upon further questioning, the patient reported history of elevated blood pressure readings over the past 7 years and was lost to follow-up. Past medical history was significant for migraine headaches and the patient had no past surgical history. Current medications included rizatriptan and ibuprofen were used as needed for headaches, approximately 2–3 times per year, and levonorgestrel IUD for contraception. Family history was notable for maternal and paternal grandparents with hypertension and mother with hypothyroidism. The patient was a nonsmoker with occasional alcohol use. BMI was 19. Physical exam was unremarkable.
24-hour ambulatory blood pressure monitoring was performed and confirmed the diagnosis of hypertension. Due to the patient's age, a secondary hypertension workup was initiated. Laboratory evaluation included complete blood count, basic metabolic panel, and thyrotropin that showed no abnormalities; plasma aldosterone and renin were within normal limits at 2.9 and 1.069, respectively; urinalysis showed 1+ protein with protein/creatinine ratio 0.44. Renal ultrasound was performed and showed presence of left accessory renal artery and the appearance of bilateral renal vein congestion. Bilateral main renal arteries showed no signs of stenosis. Renal CT with contrast was recommended for further evaluation of renal vasculature due to appearance of renal vein congestion and showed ostial stenosis of the left accessory renal artery (Figures –). In addition, compression of the left renal vein between aorta and superior mesenteric artery was also noted, consistent with nutcracker syndrome (Figures and ).
The cause of hypertension in this 31-year-old female was suspected to be due to stenosis of the left accessory renal artery that was identified on imaging. Interventional

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 53-year-old man manual worker with a 13-year history of gout in his right hallux presented to his general practitioner with right knee pain, stiffness, and giving way with no history of trauma. He had been taking allopurinol for 11 years. He drank 10 to 12 units of alcohol per week and his body mass index was 24.4. On examination, he had anterior knee pain and crepitus was felt from the patellofemoral joint. He had a range of motion from 0 to 90 degrees.
A magnetic resonance imaging (MRI) was performed and reported a grossly abnormal patella tendon showing heterogenous characteristics with areas of architectural distortion and altered signal in all sequences. The appearances were not typical for a tendinosis but more in keeping with findings seen in gout (
).
The patient was commenced on anti-inflammatory medication in addition to his regular allopurinol and referred to an orthopaedic knee surgeon. At assessment, he was found to be significantly compromised by his knee. He was unable to ride a pushbike, walk with his dog, or even get out of a chair. Plain films showed calcification within his patellar tendon (
).
A multidisciplinary discussion with rheumatology and radiology consultants confirmed that the likely diagnosis was a tophaceous gouty deposit within the patella tendon. His uric acid level was 560 μmol/L (above the target of <300 μmol/L set by the British Society for Rheumatology [BSR])
and estimated glomerular filtration rate was 52 mL/min. He was referred to rheumatology who advised increasing the dose of allopurinol. A subsequent ultrasound (US) scan showed the superficial fibers of the patellar tendon relatively intact, but within the deep fibers, there were multiple hyperechoic areas with distortion of the tendon architecture. There was no significant cyst. A computed tomography (CT) scan demonstrated a markedly thickened patellar tendon with areas of mineralization within the tendon itself (
). He was seen in a

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 46-year-old male presented to the outpatient department with a complaint of pain and swelling in his upper right back tooth region since 15 days. The patient gave a history of pain in relation to 14 and 15 for which he underwent inadvertent root canal therapy, followed by apicectomy and extraction of 12, 3 weeks earlier at a local dental hospital. Posttreatment, the pain and swelling did not subside which lead the patient to revisit his local dental surgeon, where he was advised to undergo biopsy.
On extraoral examination, there was a significant facial asymmetry caused by an approximately 5 cm × 4 cm mass involving the right maxilla. No pulsations were detected, and overlying skin was normal in color. Intraorally, an ulceroproliferative mass of 4 cm × 5 cm in its greatest dimension was observed protruding from the gingivobuccal sulcus from 15 to 11 tooth region obliterating the vestibule. The lesional mass was reddish, firm in consistency, with ulcerated surface and tender on palpation. The lesional mass extended around the upper gingival area near right central incisor to right first premolar, completely masking the associated tooth surface and also obliterating the gingivo buccal sulcus. There was no evidence of tooth mobility and pus discharge []. The computed tomography scan of the paranasal sinus revealed an enhancing mass lesion in the right gingivobuccal sulcus and nasolabial fold extending into maxillary sinus, with destruction of anterior wall of the sinus, and erosion of the alveolar margin []. Right cervical lymphadenopathy was observed with 6–20 mm right Level IB and IIA. A provisional diagnosis of soft-tissue tumor was given. The differentials included nodular fasciitis, malignant peripheral nerve sheath tumor (MPNST), fibrosarcoma, and rhabdomyosarcoma.
An incisional biopsy was subsequently performed and subjected to histopathological examination. On microscopic examination, the hematoxylin and eosin-stained sections exhibited loose, hypercellular s

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ICD-10-CM Coding based on findings:
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[System] You are a radiology coding specialist. Given a radiology report or clinical note, extract the ICD-10-CM codes for all findings.

[User]
RADIOLOGY NOTE:
A 69-year-old man was referred for treatment of a massive infected tumor situated in the left lumbar region, 12 months after left nephrectomy for squamous cell carcinoma of the kidney. On clinical examination the mass was located on the lobotomy scar and measured 15 cm ().
The abdomino-pelvic CT scan showed a mass in the left lumbar region, measuring 95 × 75 × 65 mm and invading the 11th rib. This mass extends to the ipsilateral latissimus dorsi muscle which seems to be invaded in the lower part and to the iliopsoas muscle ().
The biopsy revealed a squamous cell carcinoma. Recurrence of the renal tumor was evoked, and surgery was indicated.
The tumor was removed through a circular incision, section of the lower insertion of the latissimusdorsi, the quadrates lumborum, the iliopsoas, and the two obliquus muscles. The peritoneal cavity was opened. The distal part of the 11th rib was removed with a pleural wound which was repaired. The excised tissues included also a nodule located at the superiorpart of lobotomy scar, and a second one was situated in the left retrocolic area (Figures and ).
The LD outline was marked as well as its upper limit. The paraspinal perforators were outlined about 5 cm from the midline, and the penetration of the perforators through the muscle was estimated about 9 cm from the vertebral column (). No Doppler ultra soundor arteriography was performed (not available in the center). All the benchmarks were taken based on the literature.
An oblique incision was made from 10 cm down to the axilla to the defect. The LD was identified (). The thoracodorsal artery, vein, and nerve were exposed, tied off and then detached (). After section of its humerus insertion, the LD was harvested carefully in order to preserve the segmental pedicles.
We found three large perforators originating from the ninth,

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ICD-10-CM Coding based on findings:
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