LABORATORY EXAMINATION

Significance or
Examination Done Date Results Normal Values Relevance to
Patient’s Condition

Urinalysis April 20, 2009

Transparency cloudy Clear
Pus cells 15-20 0-8
RBC many 0-5

Complete Blood Count May 1, 2009

(CBC)
RBC count 3.89 4.60-5.20

Differential count
Segmenters 0.68 0.55-0.65
Eosinophils 0.01 0,02-0.05

Roentgenological Report: April 12, 2009

Examination: Chest AP Supine / Abdomen Upright & Supine

Roentgenological Findings:

CHEST:

 The lung fields are clear.

 The cardiac shadowis not enlarged in its transverse diameter.

  The aorta, diaphragm & other chest structures are unremarkable.

*SUMMARY:

Essentially normal chest findings.

*ABDOMEN:

A metallic object (bullet) is seen in the right hemiabdomen at the level between L1 & L2 vertebral bodies.

No evidence of opaque calculus.

No abnormal soft tissue mass.

Gas-filled bowel loops noted with fecal residues in the colon.

Suspicious “lucency” noted beneath the right hemidiaphragm (presence of air).

No air-fluid levels in the upright film.

The bony structures are unremarkable.

Roentgenological Report: April 18, 2009

Examination: Chest Supine

Roentgenological Findings:

 Re-examination of the chest taken April 18, 2009

 The cardiac shadow is enlarged in this supine position with accentuation of the pulmonary vasculatures.

 Hazed densities observed in both hilar-perihilar areas.

 Sign of pulmonary congestion / edema and / or pneumonic process.

 Other chest structures are unremarkable.

 Clinical correlation is suggested.