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What would be the most appropriate dx?

  1. #1
    Default What would be the most appropriate dx?
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    CT SCAN OF THE ABDOMEN WITHOUT CONTRAST:
    CT SCAN OF THE PELVIS WITHOUT CONTRAST:
    CT SCAN MULTIPLANAR REFORMATIONS:

    History: The patient has a morphine pump in place. The patient is notresponding to pain medication. Evaluation for integrity of themorphine pump mechanism.

    High-resolution CT scan of the abdomen and pelvis was done withmultiplanar reformations. Prior to the study Dr. Vallejo had injectedradiopaque contrast into the pump.

    There is radiopaque contrast seen in the thecal sac. This suggestspatency of the catheter and pumping mechanism.

    There is no extravasation of contrast. Some contrast is also notedwithin the morphine pump device as well.

    Morphine pump catheter is located normal in the thecal sac.

    There is suggestion of decompressive lumbar laminectomy at L4-L5 andL5-S1 level. There is suggestion of significant spinal stenosis atL3-L4 level due to broad-based disc herniation.

    No other significant abnormality is seen on this limited examinationfocused on the morphine pump mechanism.

    There is sigmoid diverticulosis but no gross evidence ofdiverticulitis is seen.

    Impression: Suggestion of spinal stenosis at L3-L4 level. Nomyelographic block is seen since radiopaque contrast is seen to thelevel of the conus. There is no disruption or obstruction of themorphine pump catheter. Small amount of contrast is also seen in themorphine pump. Clinical correlation is advised.

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
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    Quote Originally Posted by Kimberley View Post
    CT SCAN OF THE ABDOMEN WITHOUT CONTRAST:
    CT SCAN OF THE PELVIS WITHOUT CONTRAST:
    CT SCAN MULTIPLANAR REFORMATIONS:

    History: The patient has a morphine pump in place. The patient is notresponding to pain medication. Evaluation for integrity of themorphine pump mechanism.

    High-resolution CT scan of the abdomen and pelvis was done withmultiplanar reformations. Prior to the study Dr. Vallejo had injectedradiopaque contrast into the pump.

    There is radiopaque contrast seen in the thecal sac. This suggestspatency of the catheter and pumping mechanism.

    There is no extravasation of contrast. Some contrast is also notedwithin the morphine pump device as well.

    Morphine pump catheter is located normal in the thecal sac.

    There is suggestion of decompressive lumbar laminectomy at L4-L5 andL5-S1 level. There is suggestion of significant spinal stenosis atL3-L4 level due to broad-based disc herniation.

    No other significant abnormality is seen on this limited examinationfocused on the morphine pump mechanism.

    There is sigmoid diverticulosis but no gross evidence ofdiverticulitis is seen.

    Impression: Suggestion of spinal stenosis at L3-L4 level. Nomyelographic block is seen since radiopaque contrast is seen to thelevel of the conus. There is no disruption or obstruction of themorphine pump catheter. Small amount of contrast is also seen in themorphine pump. Clinical correlation is advised.
    I have never seen this...checking a morphine pump with CT scans, seems like they could have used fluoro. In any case, I think I would use ICD9 V53.09 (fitting/adjustment of other devices related to the nervous system...)
    You might also use the diverticulosis as a second dx.


    HTH
    Danny L. Peoples
    CIRCC,CPC

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