Dale: 121112015 Tirne:9:09:28 AM

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ST. DAVID 1 S GEORGETOWN HOSPITA

2000 SCENIC DRIVE
GEORGETOWN, TX 78626

#:
#:

Name: BABU, JOSE

Phys: Fields,Esther L DO
DOB: 10/29/1983
Age: 32
Sex: M
Acct: V00084049616 Loc: V.236 A
Exam Date: 11/30/2015 Status: ADM IN
Radiology No: OV242422
Unit No: V000242422

EXAMS:
045109306 CTA CHEST FOR PE

HISTORY:

sob, tumor .

COMPARISON: 11-24-2015
TECHNIQUE: During rapid intravenous contrast injection, CT
angiographic acquisition was performed. Images were acquired in the
axial plane and reformatted in the coronal plane. MIP images were
submitted from the scanning console.
CTA CHEST: There is a right chest Port-A-Cath in place
AORTA: The thoracic aorta is of normal caliber with no evidence of
aneurysm or dissection.
GREAT VESSELS: Visualized portions of the brachiocephalic, right
subclavian, right carotid, left carotid and left subclavian arteries
appear unremarkable.
PULMONARY VESSELS: Visualized portions of the pulmonary arteries are
patent and unremarkable in appearance. No evidence for pulmonary
embolic disease is noted.
CT CHEST:
Within the interval, there is been interval placement of a tunneled
right pleural catheter which courses through the pleural space; there
is mild increased right pleural fluid with severe loculation which is
again noted. There is no significant improvement to the aeration of
the right lung; in fact there is apparent decreased aeration of the
right lung ~hen compared to prior exam.
is no_ significant interval change to the extensive tumor
involvement in the right hemithorax. There is increased interstitial
markings likely representing carcinomatosis.
Within the left lung, there is a stable 14 mm pulmonary nodule in the
left upper lobe along with smaller subcentimeter nodules in the left
lower lobe which measure up to 8 mm suspicious for metastatic disease.
A small left pleural effusion is noted.
Ther~

There is no significant change to the conglomerate mediastinal

lymphadenopathy. A small pericardia! effusion is noted ..
OSSHOUS S~UCTURES AND SOFT TISSUES: There are no suspicious lytic or
blastic bone lesions
PAGE

Signed Report

(CONTINUED)

Dce:12/112015 nme~:10:12 AM

51. Dlllids He&lhCa'e

ST. DAVID'S GEORGETOWN HOSPITA

2000 SCENIC DRIVE
GEORGETOWN, TX 78626

Name: BABU,JOSE
Phya: Fields,Esther L DO
DOB: 10/29/1983
Age: 32
Sex: M
Acct: V00084049616 Loc: V.236 A
Exam Date: 11/30/2015 Status: ADM IN
Radiology No: OV242422
Unit No: V000242422

EXAMS:
045109306
~ CHEST FOR PE
<Continued>
IMPRESSION:
1. No CT evidence of pulmonary embolic disease
2. Mild decreased aeration of the right lung field likely on the
basis of a mildly worsening loculated pleural effusion. Otherwise
significant interval change.
I have asked the Radiologist Assistant to call these results on
11-30-2015 9:32 PM.

** Electronically Signed by M.D. DAVID QUINTANA **

on 11/30/2015 at 2133
**

**

Reported and signed by: DAVID QUINTANA, M.D.

CC: Dekeratry,Dominic Rodolfo; Downie,Benjamin Joel;

Fields,Esther Lynn
Dictated Date/Time: 11/30/2015 (2121)
Technolqgist: SWALLOW,TROY
Transcribed Date/Time: 11/30/2015 (2121}
Transcr~ptionist: TRAN.DFT
Electronic Signature Date/Time: 11/30/2015 (2133)
Orig Print D/T: S: 11/30/2015 (2134)
BATCH NO: N/A
PAGE

Signed Report

no

Status Date: tli22/20rfrF2~:%

Approved By: Shirley, Kathy, NP
Status: Approved

iM

Austin Radiological Association

Patient:
Patient
DOB:
Patient
Gender:
Patient
MRN:
At the
Request

BABU, JOSE

Exam:

CT CHEST HIGH RESOLUTION WITHOUT

CONTRAST

10/29/1983

Exam Date:

11/17/2015 9:49:00 AM

Exam
Accession:

22581268

2181578

Exam Status: F

DOWNIE, BENJAMIN

Phone:

(512)763-3850

Of:

CT CHEST HIGH RESOLUTION WITHOUT CONTRAST: 11/17/2015

HISTORY: Secondary malignant neoplasm of unspecified lung, encounter for antineoplastic chemotherapy, malignant
neoplasm of connective and soft tissue of trunk, unspecified, worsening cough and shortness of breath, evaluate for
interstitial changes.
COMPARISON: PET/CT 03/13/2015
TECHNIQUE: High-resolution chest CT was performed without intravenous contrast in the supine and prone positions.
Dynamic expiratory images were obtained.
CHE5T:
LUNGS: The airways are patent. Development of extensive compressive atelectasis obscuring detail of the right lower lobe,
related to a massive right pleural effusion. 1.8 x 1.5 em right upper lobe nodule, previously 2.4 x 2.2 em.
The other previously described medial right upper lobe nodule is not clearly seen, possibly encompassed by the right
paratracheal mediastinal mass/adenopathy (discussed below).
Other right lower lobe nodules are also not seen given extensive compressive atelectasis of the right lung. 10 x 9 mm
cavitary left upper lobe nodule (series 2, image 17), previously less than 5 mm. 10 x 8 mm lingular nodule (series 2, image
31, previously 18 x 13 mm. 4.1 x 2.8 em left lower lobe infrahilar mass, previously 3.5 x 2.3 em. 1.9 x 1.1 em left lower
lobe nodule (image 45), previously 2.0 x 1.8 em.
No bronchiectasis, bronchial wall thickening, septal thickening or pulmonary fibrosis is present.
MEDIASTINUM AND HILUM: The heart and great vessels are within normal limits.
3.9 x 3.0 em right paratracheal mass, abutting the SVC and right s'.lprahilar region. There is no evidence of pericardia!
effusion. Right chest port with catheter tip to the distal SVC.
PLEURAL SPACE: Development of a large right pleural effusion. Mass effect with shift of the heart and mediastinum to the
left of midline. New pleural-based lesions are present along the diaphragmatic pleura on ~he right. For instance, 2.3 x 1.7
em (series 2, image 52) and 2.8 x 1.5 em medially (series 2, image 49), consistent with pleural metastases.
UPPER ABDOMEN: The visualized appearance of the upper abdomen is unremarkable.
LYMPH NODES: Right paratracheal mediastinal/suprahilar mass as discussed above. No obvious additional adenopathy
identified within the chest without contrast material.
OSSEOUS STRUCTURES AND SOFT TISSUES: No destructive lesions.

IMPRESSION:
Progressive disease with new right pleural metastases and development of a massive right pleural effusion and
compcessive at~lectasis of the right lung.
New right paratracheal mediastinal adenopathy. Increase in size of left lower lobe infrahilar mass. Mixed response to the
other bilateral pulmonary nodules as discussed above with increase in some nodules and decrease in others.

https://araris.ausrad.com/dxview/PowerPrint.aspx?Version=ARA&Username=VUpton&...

11117/2015

Status Date: ll/22120r?rf:t9~~ ~

Approved By: Shirley, Kathy, NP
Status: Approved
No evidence of chronic interstitial disease.
Results discussed with BENJAMIN J DOWNIE, MD on 11/17/2015 10:07 AM.
John Barkley, MD
Electronically Signed: 11/17/2015 10:11 AM

https://araris.ausrad.com/dxview/PowerPrint.aspx?Version=ARA&Username= VUpton&...

11/17/2015

"''

n. ,.,. 11 nono1" 'J<71l<

~M

Approved By: De La 0, Dariela, Bil ~g

Status: Appro ed
St. David's Georgetown Hospital
A Facility of St. David's Medical Center
2000 Scenic Drive * Georgetown, Texas 78626
(512) 943-3000

PATIENT:
BABU,JOSE
ACCT#;
V00084038271
DATE OF BIRTH: 10/29/83
SEX:

MED REC#:
ROOM#:
LOCATION:
PT STATUS:
ADM DATE:
DIS DATE:

ATTENDING PHYS:Dekeratry,Dominic R
REPORT TYPE:
CONSULTATION

DATE OF CONSULTATION:

MD

V000242422
V.ICU215-1
V.ICU
ADM IN
11/17/15

11/20/2015

Initial COn$ultation
CHIEF COMPLAINT:
Sarcoma and malignant pleural effusion.
HISTORY OF PRESENT ILLNESS:
Mr. Babu is a 32-year-old male with rhabdomyosarcoma involving the testes as
well as lungs and was admitted to the hospital mid week with worsening shortness
of breath and a large right sided pleural effusion was taken for drainage,
cryotherapy and talc pleurodesis with a chest tube still in place. His cough
has improved significantly and his tachycardia has improved as well, the latter
with the addition of some steroids yesterday after the patient was found to have
evidence of a potential adrenal insufficiency. He is more comfortable at
bedside and hemodynamically more stable. He is still coughing some, but he got
some sleep last night and he is grateful for this.
His chest tube was TPA
yesterday.
PAST MEDICAL HISTORY:
1. Metastatic rhabdomyosarcoma and has presented with malignant pleural
effusion despite ongoing gemcitabine taxane therapy in clinic.
2.
Seizure disorder.
CURRENT MEDICATIONS:
Include Keppra, hydrocortisone, Lortab and morphine p.r.n.
ALLERGIES:
No known.
FAMILY HISTORY:
Negative for sarcoma.
SOCIAL HISTORY:
The patient is married and has a little one at home.
He works in IT.
Indian citizen and is here temporarily on a work visa.

He is an

REVIEW OF SYSTEMS:
GENERAL: See above in the history of present illness.
SKIN: No reported skin, hair, nail changes.
No reported itching, rashes,
PATIENT NAME: BABU,JOSE

Austin Net~ork PCI **LIVE**

ACCOUNT#: V00084038271

(PCI: OE Database COCGTH)

Run: 11/20/15-14:03 by DELAO,DARIELA R

Page 1 of 3

Status Date: 11120/2015 2:37:03 PM

Approved By: De La 0, Dariela, Billing
Status: Approved
sores, lumps nor moles.
HEENT: No reported trauma, no reported visual changes, blurriness or itching.
No reported hearing loss, tinnitus, vertigo, earache. No reported rhinorrhea,
stuffiness, sneezing, itching, allergy nor epistaxis.
NECK: No reported swelling, mass, nor goiter.
LYMPHATIC: No reported anterior or posterior cervical, supraclavicular,
axillary nor inguinal lymphadenopathy.
CHEST: See above in the history of present illness.
CARDIAC: See above in the history of present illness.
BREASTS: No reported masses, lumps/bumps, skin changes, nor discharge.
GASTROINTESTINAL: No reported abdominal pain, nausea/vomiting, diarrhea,
constipation, change in stool color or bleeding nor jaundice.
GENITAL: No reported discharge, bleeding nor pain.
URINARY: No reported change in urinary output, frequency, hesitancy, hematuria,
nocturia nor incontinence.
EXTREMITIES: No reported weakness, pain nor swelling.
NEUROLOGIC: No reported focal paralysis, change in mental status, seizures,
headaches, loss of sensation, numbness, tingling, tremors nor vertigo.
PSYCHIATRIC: No reported change in mood, anxiety nor memory.
HEMATOLOGIC:
See above in the history of present illness.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 98.5, pulse 96, respiratory rate 19, blood pressure
1.00/50.
GENERAL: The patient is a pleasant 32-year-old male in less distress than he
has been historically, breathing more comfortably in the ICU.
BREASTS: Deferred.
NEUROLOGIC: Deferred.
CHEST: The patient has diminished breath sounds at the right base still with
chest.tube insertion site that is clean, dry and intact.
LABORATORY DATA:
Hemoglobin is up to 7.2g/dL from 6.4 previously, BUN and creatinine 1.0 and 1.
yesterday.
IMPRESSION AND PLAN:
Mr. Babu is a 32-year-old male with a metastatic rhabdomyosarcoma with testes,
inguinal and lung involvement now with biopsy proven pleural based involvement
who presented with malignant pleural effusion and has undergone local
intervention under the care of Dr. Dekeratry and Dr. Lester, whose efforts are
appreciated. His chest tube is still in place, but he is more comfortable. His
anemia is multifactorial in etiology, potentially secondary to a component of
marrow hypoplasia from history of heavy chemotherapy exposure, though the
patient is also acutely ill and likely lost some blood at the time of his
procedure. As a~ outpatient, we will need to transition the patient's
chemotherapy to a more active regimen and he has an appointment scheduled at MD
Anderson the first week of December. We will use their anecdotal experiences as
well to help here as the patient has now progressed through 2 separate regimens.
I appreciate the efforts of the ICU and pulmonary team and we ~11 continue to
follow along with you.
Please call with any questions.
Benjamin

Downie, M.D.

DDT:l-1/20/2015 0822
PATIENT NAME: BABU,JOSE

ACCOUNT#: V00084038271

Austin Network PCI **LIVE** (PCI: OE Database COCGTH)

Run: 11/20/15-1.4:03 by DELAO,DARIELA R

Page 2 of 3

Status Date: 11/20/2015 2:37:03 PM

Approved By: De La 0, Dariela, Billing
Status: Approved
TDT:11/20/2015 0928
Trans By: AT/TTS
Job #: 2654803
Copies To:
Authenticated by Benjamin Joel Downie MD On 11/20/2015 12:12:46 PM

Report #:

1120-0025

Electx:onically Signed by Benjamin J Downie, MD on 11/20/l5 at 1213

ACCOUNT#: V0008403827l

PATIENT NAME: BABU,JOSE

Austin Network PCI **LIVE**

(PCI: OE Database COCGTH)

Run: ll/20/15-14:03 by DELAO,DARIELA R

Page 3 of 3

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