electronic access to lab results – an MRI reading, information overload!

I have access to my lab results (web interface to EPIC).

When is information too much information? I cannot possibly understand these results and if I search terminology on the Web I am likely to cause myself much anxiety, whereas a Physician might just say “all is ok”


Report: Minor straightening of the typical lumbar
lordosis.  Stature preserved.  Reactive marrow changes along the
superior endplate of L4.  Focal fatty marrow or hemangiomata in
the left paracentral L3 and L4 vertebral bodies.  Reactive
marrow
change and/or  focal fatty marrow in the left superior endplate
of T12.  Schmorl’s node defects bridging the T12-L1 and L2-L2
levels, and the superior endplates of L3 and L4.  Conus extends
down to the mid upper body of L1.  The descending cauda equina
normal.  Mildly complex fluid intensity mass affiliated with the
left kidney which shows relative thinning in the cortex and
what
appears to be a fluid filled distended proximal ureter.  Normal
appearing right kidney.  No bulky prevertebral soft tissue
masses
or adenopathy.  1.5 to 2 cm diameter fluid collection
immediately
adjacent to the right psoas margin on the lowest axial image
which may be fluid within bowel though another cystic/fluid
filled mass in the retroperitoneum is not excluded.

T12-L1: Mild disk desiccation and intervertebral space
narrowing.  Minor left paracentral annular bulge.  No
significant
mass effect on the central canal.  Minor asymmetric attenuation
of caudal margin of the exiting left neural foramen but with
preservation of perineural fat.

L1-L2: Minor annular bulge flattening the ventral margin of the
thecal sac.  No significant mass effect on the central canal.
Lateral recesses and neural foramina unencumbered.

L2-L3: Mild annular bulge flattens the ventral margin of the
thecal sac. Mild facet arthropathy.  Minor extension in the
caudal margins of both exiting neural foramina with proximal
attenuation of the perineural fat.

L3-L4: Minor annular bulge is present flattening the ventral
margin of the thecal sac.  Mild to moderate facet arthropathy
overall yielding a mild to moderate central canal stenosis
contributed in  part by borderline congenitally foreshortened
pedicles.  Attenuation of the caudal margins of both exiting
neural foraminal with proximal attenuation of perineural fat.

L4-L5: Mild disk desiccation.  Broad-based disk bulge flattens
the ventral margin of the thecal sac.  Mild to moderate facet
arthropathy.  Pedicles are also borderline foreshortened. There
is extension on he caudal margins of both exiting neural
foramina
with moderate bilateral neural foraminal stenosis.

L5-S1: Central annular bulge without  significant mass effect.
Mild facet arthropathy.  Minor extension of the caudal aspects
of
both exiting neural foramina but with preservation of perineural
fat.

IMPRESSION:
1. Mild broad-based bulges and spondylosis at L3-L4 and L4-L5 in
conjunction with borderline congenitally foreshortened pedicles
and mild to moderate facet arthropathy yielding mild to moderate
central canal, lateral recess and bilateral neural foraminal
stenoses.
2. Mild broad-based bulge in association with mild facet
arthropathy at L2-L3 yielding mild central canal and mild
bilateral neural foraminal attenuation.
3. Mild annular bulges at T12-L1 and L1-L2 but without
significant mass effect.
4. Central annular bulge at L5-S1 in association with facet
arthropathy but without significant mass effect on the central
canal but yielding mild bilateral neural foraminal attenuation.
5. Probable hydronephrosis and proximal hydroureter with
attenuation of native renal cortex, left kidney; ? longstanding
congenital ureteral pelvic junction obstruction.  Clinical and
urologic correlation recommended.  If this is de novo depiction
of this entity, then evaluation can begin with ultrasound or CT
to confirm.

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3 thoughts on “electronic access to lab results – an MRI reading, information overload!

  1. Pingback: Consumer! – shop for medical services…. « The HealthITBlog

  2. Yes information overload exists in medicine, and although folks may feel otherwise, this is why we (physicians, yes I am one) go to medical school to learn to interpret these things. i am all for patient access to records and results, but only in the context of having a conversation about what it all means. The problem on our end (physicians) is that depending on ones specialty, invasiveness, training, etc, these things can be interpreted differently. Since our health care system reimbures depending on what we do to you, there is a strong will to interpret results in the context of ‘doing something’ (IE surgery or medications) to fix these problems. Medicine’s ability to look inside without pain (ie lab work, diagnostic imaging) means we see a lot of ‘abnormal’ in the statistic sense, but not clinically relevent. Look at that report above-lots of ‘abnormals’ but the report can not tell us which one is the cause of the symptoms (if at all). i tell patients all the time that MRI images have lots of cool pictures, but don’t have an arrow pointing to the cause of the problem. That is what clinicians do (as opposed to radiologist that just look at pictures all do)

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