T1  Age 2 13    65-year-old

T2  Sex 14 19   woman

T3  Clinical_event 20 29    presented

E1  Clinical_event:T3 

T4  Sign_symptom 71 75  pain

E2  Sign_symptom:T4 

T5  Biological_structure 50 70  right upper quadrant

R1  MODIFY Arg1:T5 Arg2:E2  

T6  Date 77 94  Three years prior

E3  Date:T6 

T7  Disease_disorder 151 154    BCS

E4  Disease_disorder:T7 

#1  AnnotatorNotes E4   Budd-Chiari syndrome

T8  Detailed_description 140 150    idiopathic

R2  MODIFY Arg1:T8 Arg2:E4  

T9  Clinical_event 169 176  checkup

E5  Clinical_event:T9 

T10 Diagnostic_procedure 186 196    ultrasound

E6  Diagnostic_procedure:T10 

T11 Detailed_description 178 185    Doppler

R3  MODIFY Arg1:T11 Arg2:E6 

T12 Diagnostic_procedure 198 200    US

E7  Diagnostic_procedure:T12 

R4  IDENTICAL Arg1:E7 Arg2:E6   

T13 Sign_symptom 221 232    obstruction

E8  Sign_symptom:T13 

T14 Biological_structure 240 269    middle and left hepatic veins

R5  MODIFY Arg1:T14 Arg2:E8 

T15 Disease_disorder 305 318    thrombophilia

E9  Disease_disorder:T15 

A1  POLARITY E9 UNCERTAIN

T16 Medication 359 367  warfarin

E10 Medication:T16 

T17 Diagnostic_procedure 383 413    international normalized ratio

E11 Diagnostic_procedure:T17 

T18 Lab_value 414 429   between 2 and 3

E12 Lab_value:T18 

R6  MODIFY Arg1:E12 Arg2:E11    

T19 Clinical_event 513 520  consult

E13 Clinical_event:T19 

A2  POLARITY E13 NEG

T20 Duration 542 549    2 years

E14 Duration:T20 

T21 Date 448 469    after at least 1 year

E15 Date:T21 

T22 Detailed_description 477 491    non-compliance

R7  MODIFY Arg1:T22 Arg2:E10    

T23 Other_event 435 447 discontinued

E16 Other_event:T23 

#2  AnnotatorNotes E16  discontinued warfarin

T24 Sign_symptom 568 580    asymptomatic

E17 Sign_symptom:T24 

T25 Duration 589 601    past 3 years

E18 Duration:T25 

T26 Sign_symptom 675 679    pain

E19 Sign_symptom:T26 

T27 Frequency 662 674   intermittent

T28 Detailed_description 651 660    worsening

R8  MODIFY Arg1:T28 Arg2:E19    

R9  MODIFY Arg1:T27 Arg2:E19    

T29 Biological_structure 687 707    right upper quadrant

R10 MODIFY Arg1:T29 Arg2:E19    

T30 Diagnostic_procedure 767 787    Physical examination

E20 Diagnostic_procedure:T30 

T31 Sign_symptom 835 845    tenderness

E21 Sign_symptom:T31 

T32 Biological_structure 814 834    right upper quadrant

R11 MODIFY Arg1:T32 Arg2:E21    

T33 Sign_symptom 3262 3274  asymptomatic

E22 Sign_symptom:T33 

T34 Duration 3281 3287  1 year

E23 Duration:T34 

T35 Clinical_event 3291 3300    follow-up

E24 Clinical_event:T35 

T36 Medication 3240 3248    warfarin

E25 Medication:T36 

T37 Clinical_event 3216 3226    discharged

E26 Clinical_event:T37 

T38 Diagnostic_procedure 847 863    Laboratory tests

E27 Diagnostic_procedure:T38 

T39 Lab_value 873 888   mildly elevated

E28 Lab_value:T39 

T40 Diagnostic_procedure 889 898    bilirubin

E29 Diagnostic_procedure:T40 

T41 Lab_value 900 909   2.2 mg/dL

E30 Lab_value:T41 

T42 Diagnostic_procedure 915 922    albumin

E31 Diagnostic_procedure:T42 

T43 Lab_value 923 930   deficit

E32 Lab_value:T43 

T44 Lab_value 932 941   2.38 g/dL

E33 Lab_value:T44 

R12 MODIFY Arg1:E32 Arg2:E31    

R13 MODIFY Arg1:E33 Arg2:E31    

R14 MODIFY Arg1:E30 Arg2:E29    

R15 MODIFY Arg1:E28 Arg2:E29    

T45 Diagnostic_procedure 948 958    Child-Pugh

E34 Diagnostic_procedure:T45 

T46 Diagnostic_procedure 960 962    CP

E35 Diagnostic_procedure:T46 

R16 IDENTICAL Arg1:E35 Arg2:E34 

T47 Lab_value 974 975   8

E36 Lab_value:T47 

R17 MODIFY Arg1:E36 Arg2:E34    

T48 Diagnostic_procedure 977 1010   Model for End-Stage Liver Disease

E37 Diagnostic_procedure:T48 

T49 Diagnostic_procedure 1012 1016  MELD

E38 Diagnostic_procedure:T49 

R18 IDENTICAL Arg1:E38 Arg2:E37 

T50 Lab_value 1028 1030 11

E39 Lab_value:T50 

R19 MODIFY Arg1:E39 Arg2:E37    

T51 Diagnostic_procedure 1032 1041  Rotterdam

E40 Diagnostic_procedure:T51 

T52 Lab_value 1052 1056 0.15

E41 Lab_value:T52 

R20 MODIFY Arg1:E41 Arg2:E40    

T53 Diagnostic_procedure 1062 1087  BCS-TIPS prognostic index

E42 Diagnostic_procedure:T53 

T54 Diagnostic_procedure 1089 1100  BCS-TIPS PI

E43 Diagnostic_procedure:T54 

R21 IDENTICAL Arg1:E43 Arg2:E42 

T55 Lab_value 1112 1115 6.3

E44 Lab_value:T55 

R22 MODIFY Arg1:E44 Arg2:E42    

T56 Diagnostic_procedure 1137 1156  computed tomography

E45 Diagnostic_procedure:T56 

T57 Detailed_description 1119 1136  contrast-enhanced

R23 MODIFY Arg1:T57 Arg2:E45    

T58 Diagnostic_procedure 1158 1160  CT

E46 Diagnostic_procedure:T58 

R24 IDENTICAL Arg1:E46 Arg2:E45 

T59 Sign_symptom 1220 1232  hepatomegaly

E47 Sign_symptom:T59 

T60 Sign_symptom 1238 1249  hypertrophy

E48 Sign_symptom:T60 

T61 Diagnostic_procedure 3314 3330  laboratory tests

E49 Diagnostic_procedure:T61 

T62 Medication 2296 2314    conscious sedation

E50 Medication:T62 

T63 Diagnostic_procedure 3127 3136  recovered

E51 Diagnostic_procedure:T63 

T64 Lab_value 3137 3149 uneventfully

E52 Lab_value:T64 

T65 Sign_symptom 3195 3199  pain

E53 Sign_symptom:T65 

A3  POLARITY E53 NEG

T66 Biological_structure 3185 3194  abdominal

R25 MODIFY Arg1:T66 Arg2:E53    

T67 Date 3203 3206  2 d

E54 Date:T67 

R26 MODIFY Arg1:E52 Arg2:E51    

T68 Diagnostic_procedure 3347 3361  liver function

E55 Diagnostic_procedure:T68 

T69 Lab_value 3340 3346 normal

E56 Lab_value:T69 

R27 MODIFY Arg1:E56 Arg2:E55    

T70 Diagnostic_procedure 3375 3377  US

E57 Diagnostic_procedure:T70 

T71 Detailed_description 3367 3374  Doppler

R28 MODIFY Arg1:T71 Arg2:E57    

T72 Date 3403 3435  1, 3, 6, and 12 mo postprocedure

E58 Date:T72 

T73 Sign_symptom 3448 3460  patent shunt

E59 Sign_symptom:T73 

T74 Diagnostic_procedure 3466 3468  CP

E60 Diagnostic_procedure:T74 

T75 Diagnostic_procedure 3482 3486  MELD

E61 Diagnostic_procedure:T75 

T76 Diagnostic_procedure 3500 3509  Rotterdam

E62 Diagnostic_procedure:T76 

T77 Diagnostic_procedure 3530 3541  TIPS-BCS PI

E63 Diagnostic_procedure:T77 

T78 Lab_value 3479 3480 5

E64 Lab_value:T78 

T79 Lab_value 3497 3498 8

E65 Lab_value:T79 

T80 Lab_value 3520 3524 0.12

E66 Lab_value:T80 

T81 Lab_value 3552 3555 6.1

E67 Lab_value:T81 

R29 MODIFY Arg1:E64 Arg2:E60    

R30 MODIFY Arg1:E65 Arg2:E61    

R31 MODIFY Arg1:E66 Arg2:E62    

R32 MODIFY Arg1:E67 Arg2:E63    

T82 Diagnostic_procedure 3557 3559  CT

E68 Diagnostic_procedure:T82 

T83 History 1526 1556   no preceding history of trauma

T84 Clinical_event 2198 2205    brought

E69 Clinical_event:T84 

T85 Nonbiological_location 2213 2243    interventional radiology suite

R33 MODIFY Arg1:T85 Arg2:E69    

T86 Therapeutic_procedure 2316 2334 Portal vein access

E70 Therapeutic_procedure:T86 

T87 Date 1621 1639  3 years previously

E71 Date:T87 

T88 Sign_symptom 1174 1188  non-visualized

E72 Sign_symptom:T88 

T89 Biological_structure 1189 1218  middle and left hepatic veins

R34 MODIFY Arg1:T89 Arg2:E72    

T90 Diagnostic_procedure 3039 3070  portosystemic pressure gradient

E73 Diagnostic_procedure:T90 

T91 Diagnostic_procedure 3072 3075  PPG

E74 Diagnostic_procedure:T91 

R35 IDENTICAL Arg1:E74 Arg2:E73 

T92 Lab_value 3081 3090 decreased

E75 Lab_value:T92 

T93 Lab_value 3096 3103 19 mmHg

E76 Lab_value:T93 

T94 Lab_value 3107 3113 8 mmHg

E77 Lab_value:T94 

R36 MODIFY Arg1:E75 Arg2:E73    

R37 MODIFY Arg1:E76 Arg2:E73    

R38 MODIFY Arg1:E77 Arg2:E73    

A4  TREND E19 INC

T95 Sign_symptom 732 765    associated or alleviating factors

E78 Sign_symptom:T95 

A5  POLARITY E78 NEG

T96 Biological_structure 1257 1269  caudate lobe

T97 Sign_symptom 1271 1283  splenomegaly

E79 Sign_symptom:T97 

T98 Sign_symptom 1293 1311  venous collaterals

E80 Sign_symptom:T98 

T99 Biological_structure 1285 1292  hepatic

R39 MODIFY Arg1:T99 Arg2:E80    

T100    Sign_symptom 1328 1336  aneurysm

E81 Sign_symptom:T100 

T101    Detailed_description 1319 1327  saccular

R40 MODIFY Arg1:T101 Arg2:E81   

T102    Biological_structure 1352 1388  extrahepatic portal vein main branch

T103    Distance 1399 1415  3.2 cm in height

T104    Area 1420 1447  2.5 cm × 2.4 cm in diameter

R41 MODIFY Arg1:T102 Arg2:E81   

R42 MODIFY Arg1:T103 Arg2:E81   

R43 MODIFY Arg1:T104 Arg2:E81   

T105    Sign_symptom 1466 1474  aneurysm

E82 Sign_symptom:T105 

T106    Disease_disorder 1509 1512  BCS

E83 Disease_disorder:T106 

T107    Disease_disorder 1550 1556  trauma

E84 Disease_disorder:T107 

A6  POLARITY E84 NEG

T108    Diagnostic_procedure 1596 1598  US

E85 Diagnostic_procedure:T108 

T109    Detailed_description 1588 1595  Doppler

R44 MODIFY Arg1:T109 Arg2:E85   

T110    Sign_symptom 1669 1676  ascites

E86 Sign_symptom:T110 

A7  POLARITY E86 NEG

T111    Sign_symptom 1689 1697  bleeding

E87 Sign_symptom:T111 

A8  POLARITY E87 NEG

T112    Biological_structure 1680 1688  variceal

R45 MODIFY Arg1:T112 Arg2:E87   

T113    Therapeutic_procedure 1733 1737 TIPS

E88 Therapeutic_procedure:T113 

#3  AnnotatorNotes E88  Transjugular intrahepatic portosystemic shunt

T114    Sign_symptom 1772 1783  obstruction

E89 Sign_symptom:T114 

T115    Biological_structure 1749 1763  hepatic venous

R46 MODIFY Arg1:T115 Arg2:E89   

T116    Detailed_description 1764 1771  outflow

R47 MODIFY Arg1:T116 Arg2:E89   

T117    Sign_symptom 1806 1810  pain

E90 Sign_symptom:T117 

A9  TREND E90 INC

T118    Disease_disorder 1827 1840  complications

E91 Disease_disorder:T118 

A10 POLARITY E91 MAYBE_POS

T119    Sign_symptom 1848 1856  aneurysm

E92 Sign_symptom:T119 

T120    Sign_symptom 1886 1894  aneurysm

E93 Sign_symptom:T120 

T121    Therapeutic_procedure 1863 1878 direct approach

E94 Therapeutic_procedure:T121 

A11 POLARITY E94 NEG

T122    Sign_symptom 1979 1991  hypertension

E95 Sign_symptom:T122 

T123    Biological_structure 1972 1978  portal

R48 MODIFY Arg1:T123 Arg2:E95   

T124    Therapeutic_procedure 1997 2011 stent-grafting

E96 Therapeutic_procedure:T124 

A12 POLARITY E96 UNCERTAIN

T125    Sign_symptom 2103 2114  obstruction

E97 Sign_symptom:T125 

T126    Sign_symptom 2130 2143  thrombophilia

E98 Sign_symptom:T126 

T127    Biological_structure 2080 2094  hepatic venous

T128    Detailed_description 2095 2102  outflow

R49 MODIFY Arg1:T128 Arg2:E97   

R50 MODIFY Arg1:T127 Arg2:E97   

T129    Diagnostic_procedure 2381 2392  fluoroscopy

E99 Diagnostic_procedure:T129 

T130    Diagnostic_procedure 2398 2409  portography

E100    Diagnostic_procedure:T130 

T131    Biological_structure 2356 2374  right hepatic vein

R51 MODIFY Arg1:T131 Arg2:E70   

T132    Sign_symptom 2428 2436  aneurysm

E101    Sign_symptom:T132 

T133    Detailed_description 2419 2427  saccular

R52 MODIFY Arg1:T133 Arg2:E101  

T134    Biological_structure 2452 2468  main portal vein

R53 MODIFY Arg1:T134 Arg2:E101  

T135    Sign_symptom 2505 2515  thrombosis

E102    Sign_symptom:T135 

T136    Biological_structure 2480 2504  intrahepatic portal vein

R54 MODIFY Arg1:T136 Arg2:E102  

T137    Severity 2470 2479  extensive

R55 MODIFY Arg1:T137 Arg2:E102  

T138    Sign_symptom 2539 2546  varices

E103    Sign_symptom:T138 

T139    Biological_structure 2527 2538  splenorenal

T140    Severity 2521 2526  small

R56 MODIFY Arg1:T139 Arg2:E103  

R57 MODIFY Arg1:T140 Arg2:E103  

T141    Therapeutic_procedure 2627 2638 stent-graft

E104    Therapeutic_procedure:T141 

T142    Detailed_description 2587 2610  polytetrafluoroethylene

T143    Detailed_description 2612 2617  ePTFE

R58 IDENTICAL Arg1:T143 Arg2:T142   

R59 MODIFY Arg1:T142 Arg2:E104  

T144    Detailed_description 2619 2626  covered

R60 MODIFY Arg1:T144 Arg2:E104  

T145    Detailed_description 2578 2586  expanded

T146    Detailed_description 2563 2577  10-mm diameter

R61 MODIFY Arg1:T145 Arg2:E104  

R62 MODIFY Arg1:T146 Arg2:E104  

T147    Detailed_description 2640 2652  Fluency Plus

T148    Detailed_description 2654 2709  Bard Peripheral Vascular, Tempe, Arizona, United States

R63 MODIFY Arg1:T147 Arg2:E104  

R64 MODIFY Arg1:T148 Arg2:E104  

T149    Biological_structure 2735 2758  liver parenchymal tract

R65 MODIFY Arg1:T149 Arg2:E104  

T150    Therapeutic_procedure 2774 2785 stent-graft

E105    Therapeutic_procedure:T150 

T151    Biological_structure 2795 2817  main portal vein trunk

R66 MODIFY Arg1:T151 Arg2:E105  

T152    Sign_symptom 2831 2839  aneurysm

E106    Sign_symptom:T152 

A13 POLARITY E105 NEG

T153    Sign_symptom 2881 2889  obstruct

E107    Sign_symptom:T153 

A14 POLARITY E107 NEG

T154    Biological_structure 2908 2928  portal vein branches

R67 MODIFY Arg1:T154 Arg2:E107  

T155    Diagnostic_procedure 2941 2952  portography

E108    Diagnostic_procedure:T155 

T156    Sign_symptom 3005 3013  aneurysm

E109    Sign_symptom:T156 

A15 TREND E109 DEC

T159    Sign_symptom 3582 3590  aneurysm

E111    Sign_symptom:T159 

A16 TREND E111 DEC

T160    Distance 3616 3632  2.4 cm in height

T161    Area 3637 3664  2.0 cm × 1.9 cm in diameter

R69 MODIFY Arg1:T160 Arg2:E111  

R70 MODIFY Arg1:T161 Arg2:E111  

T162    Date 3668 3678  3 mo after

E112    Date:T162 

T163    Therapeutic_procedure 3679 3683 TIPS

E113    Therapeutic_procedure:T163 

T164    Distance 3726 3742  1.9 cm in height

T165    Area 3747 3774  1.6 cm × 1.5 cm in diameter

T166    Date 3778 3784  1 year

E114    Date:T166 

R71 MODIFY Arg1:T164 Arg2:E111  

R72 MODIFY Arg1:T165 Arg2:E111  

*   OVERLAP E1 E2

R73 AFTER Arg1:E2 Arg2:E3   

*   OVERLAP E3 E4 E5 E6 E8 E9 E10 E11

R74 BEFORE Arg1:E11 Arg2:E16    

*   OVERLAP E16 E15

R75 BEFORE Arg1:E15 Arg2:E13    

*   OVERLAP E13 E14

R76 BEFORE Arg1:E14 Arg2:E17    

*   OVERLAP E17 E18

R77 BEFORE Arg1:E18 Arg2:E19    

*   OVERLAP E19 E78 E20 E21 E27 E34 E37 E40 E42 E45 E72 E47 E48 E79 E80 E81 E82 E83

R78 SUB_PROCEDURE Arg1:E29 Arg2:E27 

R79 SUB_PROCEDURE Arg1:E31 Arg2:E27 

R80 MODIFY Arg1:T96 Arg2:E48    

R81 AFTER Arg1:E83 Arg2:E84 

*   OVERLAP E84 E85 E71

R82 BEFORE Arg1:E71 Arg2:E86    

*   OVERLAP E86 E87 E88 E89 E90 E91 E92 E94 E95 E96 E97 E98 E69 E50 E70 E99 E100 E101 E102 E103 E104 E105 E106 E107

#4  AnnotatorNotes E96  this was not considered but was later performed anyway

R83 BEFORE Arg1:E107 Arg2:E108  

R84 BEFORE Arg1:E73 Arg2:E51    

R85 BEFORE Arg1:E51 Arg2:E53    

*   OVERLAP E53 E54

R86 BEFORE Arg1:E54 Arg2:E26    

*   OVERLAP E26 E25

R87 BEFORE Arg1:E25 Arg2:E22    

*   OVERLAP E22 E23 E24 E49 E55 E57 E58 E59 E60 E61 E62 E63 E68 E111

T157    Sign_symptom 2969 2981  patent shunt

E110    Sign_symptom:T157 

*   OVERLAP E108 E110 E109 E73

R68 AFTER Arg1:E111 Arg2:E112   

*   OVERLAP E112 E113

R88 BEFORE Arg1:E113 Arg2:E114