Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Dyspnea at rest, anasarca. Left subcutaneous likely be an ICD unchanged in position. Cardiomegaly, about the same. Scarring in the right upper lobe. Atelectasis and dense airspace opacity in the right lower lobe present previously, about the same.

Output: Cardiomegaly without specific signs of pulmonary edema. Dense opacities in the right lower lobe were present previously; if patient has a history of Amiodarone use, this may be a manifestation of Amiodarone pulmonary toxicity and should be correlated with the dosing record.


Instruction: Generate impression based on medical findings.

Input: Chest pain and vomiting question complications of Bochdalek hernia. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Minimal atelectasis or scarring at the right lung base. No visible expansion of known small right Bochdalek hernia. No pneumothorax or visible pneumomediastinum. Right posterior mediastinal faint opacity similar to localizer image on the CT of 1/19/2016 and correlates with a mildly prominent suprahepatic IVC.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: post op, eval ETT, lung fields History: s/p CABG, MVR Status post median sternotomy with chest tubes but no pneumothorax.The lungs are better expanded than on the prior study and edema has near resolved.ET tube tip approximately 5 cm above the carina.IABP catheter distal tip projects over the aortic arch.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

Output: No complication of recent surgery, with improved pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Intubated History: Intubated Status post median sternotomy for aortic and mitral valve repair.Nonspecific pulmonary opacities suggestive of edema with pleural effusions and retrocardiac atelectasis.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter tip in right pulmonary artery.

Output: Postop edema and pleural effusions with no pneumothorax. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with COPD presents with wheezing. Cardiomediastinal silhouette is within normal limits. Tortuous aorta. Atherosclerotic calcifications.Non-specific mild interstitial changes, presumably chronic. No focal consolidation, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.New pleural effusion and elevated diaphragm on portable study, repeat PA/lateral. Persistent low lung volumes. Persistent right lower lobe opacity, compatible with a moderate to large pleural effusion with overlying atelectasis/consolidation. Left basilar atelectasis. Cardiomediastinal silhouette is incompletely evaluated.

Output: Low lung volumes with persistent moderate to large pleural effusion with overlying atelectasis/consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: r/o Pneumothorax ; shortness of breath, status post thoracentesis Cardiomediastinal silhouette is unremarkable. Interval decrease in right pleural effusion. No evidence of pneumothorax. No focal pulmonary opacity.

Output: Interval decrease in right pleural effusion without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: eval lung fields History: eval lung fields Bilateral pleural effusions and basilar opacities are unchanged.Right jugular catheter removed.Left subclavian pacemaker, leads unchanged in position.

Output: Unchanged pleural effusions and basilar opacities suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: preop History: preop Unremarkable cardiac and mediastinal silhouette. Focal scarlike opacity at the left base and no acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: shortness of breath History: shortness of breath New basilar atelectasis which may be from aspirated secretions or mucous plugging.Elsewhere, the lungs are unremarkable.Status post median sternotomy, heart size normal..Left subclavian ICD, leads unchanged in position.

Output: New basilar atelectasis which could be from aspirated secretions or mucous plugging, although the differential diagnosis includes pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: PNA, effusion History: Resp Insufficiency requiring bipap, extubated to Hi Flo NC NG tube tip in distal esophagus. Other support hardware stable.Persistent peripheral focal opacity in right lower lung zone likely pneumonia or aspirate. Infarct is less likely though may appear similarly.

Output: Persistent peripheral focal opacity in right lower lung zone likely pneumonia or aspirate. Infarct is less likely though may appear similarly


Instruction: Generate impression based on medical findings.

Input: Reason: lung nodule on esophagram History: lung nodule on esophagram Focal airspace opacity in the medial segment of the right middle lobe, suggestive of infection.A nodular opacity projected over the left upper lobe is consistent with calcified costal cartilage, best demonstrated on the energy subtraction views.Unremarkable cardiac and mediastinal silhouette.

Output: Focal airspace opacity in the right middle lobe, nonspecific but compatible with infection. Follow-up chest radiograph is recommended within the next 3 months.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for PNA History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval of line placement History: picc deep in R atrium, pulled back 4cm Interval retraction of right PICC with tip at the cavoatrial junction. No specific evidence of infection or edema. Unchanged cardiomediastinal silhouette. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: Right PICC tip at the cavoatrial junction.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pacemaker History: s/p pacemaker New pacemaker device with leads projected in the area of the right atrium and right ventricle. The atrial lead is directed towards the atrial free wall.No pneumothorax or other complications.

Output: New pacemaker device with no complications.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval for pulmonary infiltrate History: chest pain, sickle cell Stable cardiomediastinal silhouette. Mild retrocardiac interstitial thickening, which may be accentuated by technique. No focal pulmonary opacity. Surgical clips overlie the left upper abdomen.

Output: No specific evidence of acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Reason: swan History: swan Swan-Ganz catheter tip in the right descending pulmonary artery.Globular cardiomegaly with no specific evidence of pulmonary edema or infection.

Output: Swan-Ganz catheter in appropriate position.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: Emergent intubation History: Emergent intubation Status post median sternotomy with multiple chest tubes but no pneumothorax.Slight worsening of pulmonary opacities consistent with edema and pleural effusions. ET tube tip approximately 3 cm above the carina.Right jugular Swan-Ganz catheter tip in main pulmonary artery.

Output: ET tube tip approximately 3 cm above the carina. Slight worsening of pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: dyspnea History: dyspnea Interval increase in cardiac size and widening of the mediastinum may be related to vascular congestion.Marked tortuosity of aorta.Decreased lung volumes mild basilar atelectasis.No focal areas of consolidation.No large pleural effusions.Multiple surgical clips identified in right upper abdomen.

Output: Interval increase in cardiac size with widened mediastinal compared to the prior exam. This may represent vascular congestion. No specific evidence of infection or edema. Recommend upright PA and lateral views for better evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: evidence of infection History: fever Right IJ line, unchanged. Low lung volumes. Left greater than right bibasilar opacities again noted. No large pleural effusion or pneumothorax. Heart is at the upper limit of normal. No pneumothorax.

Output: Increase in left basilar opacity which may represent atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: pulmonary edema? Pleural effusion History: shortness of breath Large lung volumes consistent with COPD.Status post sternotomy for CABG.No specific evidence of infection or edema.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.History of right pleural effusion status post Pleurx. Interval placement of a right Pleurx catheter in the right lung base. A right pleural effusion appears slightly increased compared to the prior exam. Probable scarring in the left lung and loculated left effusion appear unchanged.Median sternotomy hardware and surgical clips noted.

Output: Interval placement of right Pleurx catheter with slight increase in a right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: rule out pneumonia History: yellow phlegm Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pre-op left atrial myxoma History: NA Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Moderate thoracolumbar scoliosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 59 year old female with chronic cough when lying flat. No focal airspace opacities. Small linear scar like opacities compatible with previous infection. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Small linear scar like opacities compatible with previous infection. No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Status post biventricular implantation and lead extraction. Interval extraction of left subclavian ICD, with a left chest wall drain in place. A new right subclavian ICD has been placed with leads in the right atrium and right ventricle as well as a branch of the coronary sinus. Additionally, there are radiopaque objects projecting over the left upper quadrant near the base of the heart which are of unclear etiology, correlate with surgical history for intentional or unintentional objects.

Output: No acute pulmonary abnormality. Unknown objects project over the left upper quadrant, it is unclear whether these are intentional or unintentional objects and should be correlated with surgical history.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male status post stem cell transplant with neutropenic fever. Evaluate for source. This examination is limited by the absence of intravenous contrast.CHEST:LUNGS AND PLEURA: A few scattered micronodules are unchanged. No new suspicious nodules or masses. No evidence of pulmonary infection. No pleural fluid.MEDIASTINUM AND HILA: Right jugular central venous catheter, tip in the SVC. Mild coronary artery calcifications. The cardiac size is normal. Small pericardial effusion is stable. No evidence of pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN: LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subtle fatty infiltration of the mesenteric and intraperitoneal fat, especially surrounding loops of bowel, with diffusely thickened walls. These findings are suspicious for graft-versus-host disease.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The bowel within the pelvis is diffusely thickened, most likely due to graft-versus-host disease.BONES, SOFT TISSUES: Just medial to the right iliac bone and adjacent to the iliacus muscle, as seen on axial image 165/257, the previously described soft tissue lesion is much smaller. The appearance is nonspecific and could represent fluid, hematoma or inflammation.OTHER: No significant abnormality noted

Output: New diffuse bowel wall thickening and subtle intraperitoneal fatty infiltration. This most likely due to graft-versus-host disease.Small pericardial effusion is stable. No evidence of pneumonia. Right pelvic abnormal soft tissue density seen previously is smaller.No perianal abscess.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old, with right hilar mass, increasing CEA. History of fibrotic lung disease. LUNGS AND PLEURA: Interstitial thickening and fibrosis, most severe in the upper lobes, with traction bronchiectasis and subpleural honeycombing has progressed slightly in the interval.A few scattered micronodules are unchanged. MEDIASTINUM AND HILA: Numerous enlarged superior mediastinal, prevascular, pretracheal, and subcarinal lymph nodes are evident, many of which demonstrate central low attenuation suggestive of necrosis. A reference right superior mediastinal lymph node measures 1.5 x 1.7 cm on axial image 9/87. A large right hilar mass is contiguous with a large precarinal mass. The hilar component measures 3.4 x 4.1 cm on axial image 37/87, while the precarinal component measures 4.0 by 2.7 cm on axial image 29/87. Although the prior examination is limited by lack of IV contrast, most of these lesions are new or have significantly increased in size. The large hilar/precarinal mass displaces the SVC anteriorly while encasing and narrowing in the right upper lobe pulmonary artery branches.The cardiac size is normal. No pericardial fluid. Coronary artery calcifications are noted. Significant aortic atherosclerotic disease with calcification and mural thrombus is also seen.CHEST WALL: Moderate dextroscoliosis.UPPER ABDOMEN: Punctate splenic hypodensity, too small to characterize.

Output: 1.Right hilar mass and mediastinal lymphadenopathy highly suspicious for a primary lung malignancy. 2.Chronic interstitial fibrosis of indeterminate etiology, most likely UIP (usual interstitial pneumonia), has progressed slightly.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: sob, COPD, eval for PNA History: sob, COPD, eval for PNA Sternotomy sutures noted. Thoracic aortic endograft and right carotid stent unchanged in position.The cardiomediastinal silhouette is stable from prior examinations.There are bilateral linear scarlike opacities in the peripheral lingula and lower lobes. Additionally, there is pleural scarring in the left costophrenic angle.

Output: No evidence of acute pneumonia or edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female evaluate for staging, upper urothelial cancer, status post left nephrectomy CHEST:8mm nodule in the apical segment of the right lower lobe on image number 38, series number 5. Left apical scarring.No evidence of mediastinal adenopathy.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Focal mild intrahepatic ductal dilatation the hepatic dome is unchanged. No focal lesions.SPLEEN: New payor fro enhancing fluid collection around the spleen. It measures 2.9 x 1.6 cm image number 19, series number 5. A small amount of free fluid around the spleen.PANCREAS: UnremarkableADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Collection in the left nephrectomy bed extending to the perisplenic area as described in the spleen section.Small right renal lesions.RETROPERITONEUM, LYMPH NODES: Postsurgical changes along the left para-aortic space and left psoas muscle. Previously described lymph nodes cannot be visualized due to these postsurgical changes and may have been excised.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Artifacts from the left hip prosthesis limits ultimately evaluation of the pelvis.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval left nephrectomy. Fluid collection in the left nephrectomy bed extending superiorly around the spleen. Peripheral enhancement of this collection suggests an abscess.Right lower lobe nodule. Metastatic lesion cannot be excluded.Dr. O'Donnell was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female 79 years old Reason: pulmonary edema, pneumonia? History: chest pain, shortness of breath Left subclavian ICD unchanged.The cardiomediastinal silhouette with cardiomegaly and tortuous aorta are unchanged.Bibasilar linear opacities compatible with subsegmental atelectasis. Small right pleural effusion, new. No pneumothorax.

Output: Mild edema and small pleural effusions compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Status post laparoscopic nephrectomy, now complains of pleuritic chest pain. Normal cardiac silhouette. Low lung volumes with bibasilar subsegmental atelectasis, likely postsurgical in etiology. No focal airspace opacity or pleural effusion.

Output: Basilar subsegmental atelectasis, likely postsurgical in etiology, without superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for pulmonary edema, PNA History: Shortness of breath Moderate cardiomegaly with a tortuous ectatic aorta, unchanged.Mild interstitial opacity and septal lines at the bases consistent with interstitial edema.Small amounts of loculated fluid in the pleural fissures, slightly decreased from previous.No sign of pneumonia.

Output: CHF with interstitial edema and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Pulmonary edema or pneumonia? Shortness of breath. Low normal lung volumes. No signs of pulmonary edema or pneumonia. Bilateral paratracheal opacity statistically most likely a goiter but incompletely assessed by plain film.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old. Catheter from a right arm extending to the right axilla.No significant cardiopulmonary abnormalities.

Output: Catheter tip in the right axillary vein.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: tobacco history, lul opacity, Arizona travel, + coccidioidomycosis History: see above Left mid lung periphery ill-defined opacity suggestive of lung cancer.Elsewhere, the lungs are unremarkable.Heart size normal.

Output: Probable lung cancer, although given the history coccidiomycosis is in the differential diagnosis. Short-term follow-up after treatment and a baseline CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 62 years old Male. Reason: CF exacerbation admission: evaluate for interim changes History: CF exacerbation. There is a new patchy opacity with probable cavity in the right upper lobe. There is interval decrease in right upper perihilar opacity. Stable right lower parahilar opacity and left perihilar opacities. Diffuse the interstitial changes are stable in both lungs. The cardiac silhouette is normal.

Output: New patchy opacity in the right upper lobe with probable cavity. Multifocal patchy opacities in both lungs and diffuse interstitial changes as described above.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of CHF exacerbation. Pacemaker unchanged in position.Median sternotomy hardware noted.Stable cardiomegaly.Redemonstration of left upper lobe rounded opacity contiguous with the aortic knob retrospectively correlating with a pseudoaneurysm on CT angiogram (7/31/2015).No new focal airspace opacities.No pleural effusion or pneumothorax.

Output: Redemonstration of left apical opacity retrospectively correlating with pseudoaneurysm on CT angiogram.No specific evidence of infection or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female status post left lower lobe superior segmentectomy and left upper lobe apical posterior segmentectomy for stage I b adenocarcinoma. Personal history of breast and esophageal carcinoma. CHEST:LUNGS AND PLEURA: Stable postsurgical changes in the left upper lobe. New ill defined nodule seen in left upper lobe, measuring 11 x 7 mm in axial dimension (series 5, axial image 21).Previously noted soft tissue mass at surgical site is smaller.Subcentimeter pulmonary nodule seen in right lung (series 5, image 48), unchanged from prior exam (series 5, image 48).MEDIASTINUM AND HILA: Gastric pull up, unchanged. No evidence of mediastinal adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Right adrenal mass, unchanged since 2006, favoring a benign etiology.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Focal cystic lesion pancreatic neck image 80 unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral wall hernia containing nonobstructed large bowel and mesenteric fat.BONES, SOFT TISSUES: Degenerative changes of the spine.

Output: New indeterminate left upper lobe lung nodule may be further evaluated by PET scan.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of right upper lobe pulmonary nodule now with unexplained weight loss. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Patient's known right upper lobe nodule has increased in size with spiculated borders and now measures 16 x 11 mm. This nodule has ground glass opacity and suspicious for a primary bronchogenic carcinoma such as bronchoalveolar carcinoma. Another subcentimeter nodule in the right upper lobe on image number 39, series number 4.MEDIASTINUM AND HILA: Enlarged thyroid with calcifications and multiple nodules. Multiple upper mediastinal adenopathy. There referenced pretracheal lymph node measures 15 x 11 mm on image number 28, series number 4. Additional prevascular adenopathy is also present.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Large mass arising from the gallbladder measures 8.2 x 7.2 cm image number 117, series number 4 suspicious for gallbladder carcinoma. Periportal edema, more prominent in the right lobe. The mass extends to the hepatic hilum. The soft tissue density around the hepatic arteries and the portal vein at the hepatic hilum may represent vascular encasement. Very prominent porta hepatis adenopathy. There referenced node measures 1.9 x 1.6 cm.Multiple scattered subcentimeter hypodensities in the liver which are not significantly changed from previous chest CT dated 3/7/2006, although the entire liver was not included in that study. Some of these subcentimeter lesions are too small to actually characterize but more likely represent cysts.Small amount of fluid around the liver with some stranding of the adjacent peritoneum. Extension to the extrahepatic peritoneum is likely. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. There referenced left third lymph node measures 11 x 13 mm image number 109, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: Bilateral bladder diverticula near the UV junctions.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large hepatic mass highly suspicious for gallbladder carcinoma with possible extension outside the liver and invasion of the hilar vessels. Extensive porta hepatis adenopathy and borderline enlarged retroperitoneal lymph nodes. Multiple sub-centimeter lesions in the liver which are too small to accurate characterize but more likely represents cyst.Right upper lobe ground glass opacity nodule with spiculated borders and minimal interval increase in size, suspicious for a primary bronchogenic carcinoma.


Instruction: Generate impression based on medical findings.

Input: Reason: 60 yo female w/ history of smoldering myeloma now newly dx symptomatic myeloma; assess for lytic lesions History: 60 yo female w/ history of smoldering myeloma now newly dx symptomatic myeloma; assess for lytic lesions Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No visible lytic lesions.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 59 year female with rheumatoid arthritis, SLE presenting with bilateral PEs and progressive renal failure. Assess for neoplasia or metastases in the setting of massive PE's and a cardiac mass on TTE The examination is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: Mild honeycombing is identified. Small bilateral pleural effusions are identified along with dependent air space opacities, most likely due to atelectasis.MEDIASTINUM AND HILA: Visualization of the cardiac chambers suggests anemia. Minimal pericardial effusion. Small mediastinal lymph nodes are seen, not pathologically enlarged by CT criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Enlarged left lobe and caudate lobe with a small right lobe can be seen with cirrhosis. No nodularity is seenGallbladder wall thickening is seen. Hyperdense material within the gallbladder suggests vicarious excretion of contrast from a previous examination/procedure.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Calcification in the right adrenal gland due to prior hemorrhage or infection.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild ascites.PELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small bilateral pleural effusions with associated atelectasis. Mild ascites with possible early cirrhotic morphology. Gallbladder wall thickening, previously noted. Hyperdense material within the gallbladder suggest recent use of contrast media.


Instruction: Generate impression based on medical findings.

Input: 50 year old with TE non-Hodgkin's lymphoma. Evaluate disease status. CHEST:LUNGS AND PLEURA: Linear atelectasis in the right lung base appear stable.MEDIASTINUM AND HILA: No significant abnormality noted. Subcentimeter precarinal nodes stable.CHEST WALL: Multiple lytic and sclerotic vertebral metastases are again noted through the thoracic spine. Partial Collapse of T9 vertebral body is again noted. Dedicated thoracic spine MRI may be helpful for further evaluation.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple para-aortic lymph nodes. Reference left para-aortic lymph node measures 17 x 10 mm (image 86; series 3), unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previous described subcutaneous nodules have regressed.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Vertebral body metastases are stable. Subcutaneous nodules have regressed. Retroperitoneal lymph nodes stable.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Status post left upper lobectomy. Three left-sided chest tubes are unchanged in position. Persistent left midlung opacity noted. Skin staples project over the left hemithorax. Right basilar subsegmental atelectasis. There is improvement in the previously seen small apical pneumothorax. Displaced left rib fractures again noted.

Output: Postsurgical changes from left upper lobectomy with persistent left midlung opacity, which may represent loculated fluid and hematoma surrounding the surgical site. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Status post line placement and tube withdrawal. Sepsis. Low endotracheal tube with tip 1 cm above the level of the carina.Enteric tube extends to the stomach but the tip is beyond the caudal margin of the film.Left Pleurx catheter unchanged in positionModerate pleural effusions bilaterally, slightly increased in volume.Interval worsening of extensive airspace opacities throughout the right lung which may reflect pneumonia and/or worsening of metastatic disease. Opacities in the left lung not substantially changed.

Output: Low endotracheal tube. Worsening airspace opacities in the right hemithorax may reflect infection and/or worsening metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Hypotension and low grade fever. Normal heart size. Lobular contour to the right hilum and infrahilar region.No additional air space opacities, pleural fluid or pneumothorax.

Output: Lobular contour right hilum/infrahilar region. Correlation with erect PA and lateral chest radiographs are recommended to exclude lymphadenopathy or a mass.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: Interval Eval and R/o Pneumothorax History: S/p pleurodesis Status post right apical resection.Chest tube removed with no pneumothorax or other significant abnormality.

Output: No pneumothorax following right chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: pre-procedure study per EP service History: as above Borderline cardiac enlargement. Vasculature is normal. Left basilar opacity can represent infection, aspiration or chronic interstitial change, which is difficult to interpret without the availability of prior films.No pneumothorax.

Output: Nonspecific left basilar opacity which can represent infection, aspiration or chronic interstitial change.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: 75 yod CLL s/p MRD, h/o GVHD, and rcurrent lung infection History: nasal conjestion , cough and mild SOB Linear interstitial abnormality with scarring as noted on prior CT. No new opacity to suggest infection.

Output: Linear interstitial abnormality with scarring as noted on prior CT. No new opacity to suggest infection.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: edema History: sob Interval progression of basilar opacities and pleural effusions.ICD leads stable.Stable cardiomegaly.

Output: Progression of lower lobe opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: med sternal chest pain History: chest pain Small lung volumes.Mild cardiomegaly.No acute abnormality.

Output: Mild cardiomegaly and small lung volumes, otherwise unremarkable. The mediastinal width is normal for age and technique.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Chest pain, evaluate for widened mediastinum Tortuous aorta. Borderline enlarged cardiomediastinal silhouette.Layering right pleural effusion. No pneumothorax.Patchy airspace opacities bilaterally.Left upper lobe calcified granuloma.

Output: Moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Pleural effusions. Right jugular dual-lumen catheter is very low in position, terminating at or near the level of the suprahepatic IVC, consider repositioning.Dobbhoff tube has been advanced and can be followed to the stomach, but the tip is beyond the caudal margin of the radiograph.Right subclavian catheter can be followed to the right atrium.Left subclavian dual-chamber pacemaker unchanged.Large layering pleural effusions with associated atelectasis. Nonspecific retrocardiac opacity on the left.

Output: Very low position of right jugular catheter which terminates at or near the expected level of the suprahepatic IVC. No significant change in large pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Chest pain status post fall. No acute cardiopulmonary abnormalities. No evidence of rib fracture or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Shortness of breath History: Shortness of breath Mild basilar interstitial opacities suggestive of edema with small pleural effusions.Focal left pleural thickening or pleural fluid, but no obvious underlying bone erosion.Heart size mildly enlarged.Right jugular catheter, tip in SVC.

Output: Mild interstitial edema and small pleural effusions versus pleural scarring.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: FemaleReason for Study: Reason: Pre-Operative Evaluation History: SOB Status post right mastectomy and placement of an implant.Surgical clips noted in the right axilla.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.Degenerative changes in the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Swan History: Sesn Stable position support devices. No change in basilar opacities and bilateral effusions. No pneumothorax.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Check for pneumothorax 3-lead left subclavian ICD appears new with lead tips in expected location. Mild cardiomegaly with distinct changes suggesting more asymmetric right heart enlargement.Lungs are clear other than mild streaky density suggesting possible minimal aspiration, greater in the upper lobes. Consider serial imaging

Output: ICD placed


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: et tube positioning Endotracheal tube terminates approximately 4 cm from the carina. Left greater than right basilar opacities again noted. Small pleural effusions, as before. Unchanged heart size.

Output: No substantial change in left greater the right basilar opacities consistent with aspiration, pneumonia, atelectasis, and/or edema. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: FemaleReason for Study: Reason: h/o respiratory failure History: h/o respiratory failure There is moderate cardiac enlargement.Decreased lung volumes with mild basilar atelectasis.No focal areas of consolidation.No large pleural effusions.

Output: There is cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval for dissection History: cp Mild cardiomegaly with a tortuous aorta but no specific evidence of dissection.No specific evidence of infection or edema.

Output: Mild cardiomegaly and a tortuous aorta, otherwise unremarkable. Reference should be made to a CT angiogram performed prior to this study.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for infiltrate History: cough Moderate cardiomegaly.Equivocal edema.No specific evidence of infection.Metallic linear density projected over the right axilla unchanged.

Output: Cardiomegaly, and equivocal evidence of edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Evaluate for right parotid lymph node. Right facial paralysis. Images through skull base and sinuses are unremarkable.Examination demonstrates multiple small normal-appearing, nonenhancing lymph nodes bilaterally in the parotid, carotid, submandibular, submental and posterior cervical spaces. No evidence of a mass or pathologic lymphadenopathy is identified. The airway and vasculature are patent. The thyroid glands appear normal. A lucency is seen in the C3 vertebral body, likely representing degenerative change.Limited view of the chest is unremarkable.

Output: No evidence of mass or pathologic lymphadenopathy in the soft tissues of the neck.


Instruction: Generate impression based on medical findings.

Input: Reason: CP, SOB History: above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: FemaleReason for Study: Reason: hx pna in early jan but also fluid overload with last XR showing ?infiltrate underlying fluid, now sp diuresis so please re-eval RLL infiltrate History: SOB Extensive right lung air space opacities and pleural effusions similar to the prior exam.Mild basilar atelectasis.No new pulmonary is noted.Stable cardiomediastinal silhouette with atherosclerotic changes of aorta.

Output: No significant interval change in extensive air space opacities in the right lung and bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: 91 F s/p cardiac arrest - line placement History: see above Endotracheal tube tip terminates approximately 3 cm above the carina. Interval placement of right jugular catheter with tip in the SVC. No pneumothorax.Stable cardiac and mediastinal silhouettes.Bibasilar atelectasis. No new pulmonary opacities.Small bilateral pleural effusions.

Output: Right jugular catheter tip in SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Bilateral pleural effusion.VIEW: Chest AP (one view) 02/26/15, 0549 One left and two right chest tubes are present. Left upper extremity PICC tip is in right atrium.Right lower lobe is slightly better aerated however opacities persist in the right hemidiaphragm is silhouetted. Left hemidiaphragm remains silhouetted. Upper lobes are well aerated. Cardiac silhouette size cannot be evaluated.

Output: Slight improvement in right base opacity. Unchanged left lower lobe opacity.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of endometrial cancer and new right lower quadrant pain CHEST:LUNGS AND PLEURA: Right thyroid nodules unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right hypodense lesion, too small to accurate characterize but is most likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No evidence of recurrent mass in the pelvis. Soft tissue density in the right pelvis, best seen image number 164, series number 3 likely represents unopacified small bowel segments. There is a clinical concern for recurrence MRI of the pelvis may be helpful.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post hysterectomy.Hypodense focus in the right side of the pelvis likely represents unopacified small bowel segments, however, there is a clinical concern for residual/recurrent disease pelvic MRI may be helpful for clarification.


Instruction: Generate impression based on medical findings.

Input: Reason: icu patient, O2 requirements History: continued O2 requirements Right jugular catheter and NG tube unchanged.Bilateral nonspecific opacities consistent with consolidation, atelectasis and pleural effusions, larger on the right.No new findings.

Output: Pleural effusions, consolidation atelectasis with no appreciable change since the previous exam.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: ? worsening pneumothroax History: shortness of breath and hypotension Moderate right hydropneumothorax has mildly decreased in size, with the apex of the lung approximately 14 mm from the chest wall.Pleural catheter again seen projecting over the right lung base.Persistent underlying consolidation/atelectasis of the right lung base.The left lung is clear.

Output: Interval decrease in size of right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: r/o PNA, Acute process History: A-traumatic sensation of "soft ball" in lung The cardiomediastinal silhouette is normal in size. NextNo focal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: The 26-year-old female with pain and chest radiating to back. Rule out PE. PULMONARY ARTERIES: Generally adequate technical quality with no sign of pulmonary embolism.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.Normal aortic caliber.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Surgical clips in the gallbladder bed.

Output: No sign of pulmonary embolism or other significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: PICC placement History: PICC Left upper upper extremity PICC tip terminates in the SVC. Multiple surgical clips project over the chest wall.There is no focal consolidation, pleural effusion or pneumothorax. The cardiac and mediastinal contours are within normal limits for size.

Output: Left upper extremity PICC tip terminating in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: rule out infiltrates, confirm tube position History: ICH, coma, intubation Lungs hypoinflated. Nonspecific basilar opacities, likely subsegmental atelectasis. ET tube tip 2 cm above carina. NG tube tip in stomach.

Output: ET tube tip 2 cm above carina.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with rectal carcinoid tumor CHEST:LUNGS AND PLEURA: Emphysema. Interval increase in the size of the small lung nodules, predominantly on the right side. Index nodule now measures 7-mm in diameter in the right lower lobe adjacent to the fissure image number 61, series number 10.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Extensive liver metastases please see most of the liver is again noted. Index mass and other metastases are increased in size within the interval. Index mass in the right lobe now measures 6.7 x 6.7 cm on image number 96, series number 9.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cyst in the left upper pole is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Index left pararectal mass has significantly increased in size and now measures 4.7 x 4.1 cm on image number 187, series number 9.BONES, SOFT TISSUES: New sclerotic lesions in the left iliac bone and right sacrum consistent with metastatic disease.OTHER: No significant abnormality noted.

Output: Interval increase in the size of the lung and liver metastases and perirectal adenopathy.New bone metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Evaluate lung fields for pna, evidence of obstructive lung dz History: Wheezing Slightly flat diaphragms may indicate mild COPD.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: Slight flattening the diaphragms may indicate COPD, but there is no evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: Left pneumothorax. Pleural space opened during reduction of PEH History: dyspnea Low lung volumes.Left basilar effusion and atelectasis with left hemithorax volume loss.No pneumothorax.Unremarkable cardiomediastinal silhouette.

Output: Left basilar effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out aspiration History: altered mental status Normal heart size with a moderately tortuous calcified aorta compatible with age.Elevated left hemidiaphragm with overlying opacity compatible with atelectasis and nonspecific consolidation, slightly increased compared to previous. This may be secondary to aspiration.

Output: Increased left basilar opacity which may be related to aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: worsening consolidation or effusion? History: worsening hypoxia, work of breathing, and chest pain Patient has been extubated. Feeding tube terminates within the proximal aspect of stomach. Unchanged left-sided PICC No substantial change in diffuse pulmonary opacities given differences in inspiration. Pleural effusions and basilar atelectasis again noted, right greater than left. Unchanged cardiomegaly. No pneumothorax.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration. Pleural effusions and basilar atelectasis again noted. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male CLL restaging. Please is bidimensional measurements. Index lesions compared to February 2009 CT. No IV contrast- oral contrast only please. CHEST:LUNGS AND PLEURA: Multifocal areas of subtle ground glass opacities bilaterally more on the right than on the left could be related to chemotherapy or less likely infection. No nodules. No effusions.MEDIASTINUM AND HILA: There is dramatic decrease in all lymph nodes to the point where comparing specific lymph nodes is nearly impossible as they are essentially resolved. Largest discrete node in the left axilla seen on series 2 image 25 measures 10.5 x 6.3 mm. Residual of the node in front of the right main bronchus is seen on series 3 image 39 measures 6.3 x 2.3 mm. There are no pathologically enlarged nodes anywhere in the chest. The retrocrural nodes are resolved and not measurable.Minimal vascular calcification a normal amount of pericardial fluid is redemonstrated.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Hyperdense lesion likely cyst left upper pole.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Portacaval node is resolved and not measurable.The retroperitoneal nodes resolved and not measurable.Atherosclerotic changes aorta and branch vessels redemonstrated.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted; none of the previously measured nodes are measurable.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Patchy ground glass opacities in the lungs. Correlate clinically.Resolution of adenopathy. No pathologically enlarged nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Patient status post cholecystectomy

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for free air History: epigastric pain, duodenal carcinoid Small lung volumes with heart size at the upper normal. Mediastinal widening, unchanged from previous, consistent with lipomatosis.Basilar opacity consistent with atelectasis and nonspecific consolidation which may be related to aspiration. Multiple bullet fragments projected over the right upper quadrant of the abdomen.No sign of pneumoperitoneum.

Output: Basilar atelectasis and consolidation. No free air.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: collapsed L lung? History: collapsed L lung? New moderate left pleural effusion with left basilar atelectasis. Scarring or atelectasis at the right lung base. Query mild pulmonary edema. Unchanged heart size. Dense aortic calcification again noted. No pneumothorax.

Output: New moderate left pleural effusion with left basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Large lung volumes with no significant change in the amount of pleural fluid in the left pneumonectomy space. Left-sided postsurgical rib deformities. Hyperinflation of the native right lung, which is clear. The heart is not visualized, shifted into the left hemithorax.

Output: No significant change in the appearance of the chest following left pneumonectomy.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: s/p TECAB Intra-aortic balloon pump terminates over the aortic arch. Low lung volumes makes detailed cardiopulmonary assessment difficult. Left pleural parenchymal scarring again noted. No new focal pleural parenchymal opacity. No pneumothorax.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Right lung biopsy question pneumothorax. 32 mm right apical pneumothorax, referring clinical service is aware.Left upper lobe cavitary lesion not well visualized.Mass in the right lower lobe partially obscured by the hilum. Airspace opacity in the right lower lobe is new and may reflect aspirated blood products or secretions post biopsy.

Output: 3.2 cm right pneumothorax. Airspace opacities in the right lower lobe are new and could reflect aspirated blood products. Short-term follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: is there pul edema History: sob, dry cough. History esrd. History cad with stent Ill-defined opacity developing inferolateral to the right hilum, a thoracic CT recommended for follow-up.Elsewhere, the lungs are unremarkable without evidence of edema or pneumonia.Heart size normal, the aorta tortuous.Left jugular catheter, tip at cavoatrial junction.

Output: Right infrahilar opacity, thoracic CT recommended.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male. Neuroendocrine tumor follow-up CHEST:LUNGS AND PLEURA: Few micronodules unchanged.MEDIASTINUM AND HILA: Postsurgical changes superior mediastinum. Small nonpathologic mediastinal nodes. Mild prominence proximal esophagus. Coronary artery calcification. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is been no arterial phase on any of the recent scans. The arterial phase demonstrates too numerous to count small hyperattenuating lesions throughout the liver particularly in the dome consistent with metastases.Using portal phase the compared to the February 19 study the hypoattenuating lesion in the dome and left lobe series 11 image 85 is larger. Several of the other lesions as either stable or larger. This would suggest possible progression of disease in the liver.SPLEEN: Hypertrophied accessory spleen. Main body spleen is been surgically resected. Appearance is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Porta hepatis node series 11 image 102. Irregularly-shaped gastrohepatic ligament node series 11 image 100 measures 2.6 x 2 cm approximately unchanged although measurement slightly larger. Other nodes are also visually stable. measures 2.5 x 2.2 cm, unchanged.BOWEL, MESENTERY: Massive diffuse nodular thickening stomach redemonstrated, unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered small lytic foci in the iliac wings are unchanged. No new sites of disease.OTHER: No significant abnormality noted

Output: Possibly new lesions in the liver or increased in size. Other scattered disease as detailed above is stable. Numerous lesions are visualized only on the arterial weighted phase in which there is no recent comparison.


Instruction: Generate impression based on medical findings.

Input: 37-year-old with Swan-Ganz catheter. Right jugular Swan-Ganz catheter tip at the level of the right interlobar pulmonary artery. Life Vest components project over the thorax, obscuring the underlying parenchymaBasal opacities suggestive of atelectasis and either alveolar edema or aspirate, slightly improved in the right and stable on the left.Cardiomegaly unchanged allowing for differences in position.

Output: Swan-Ganz catheter tip at the level of the right interlobar pulmonary artery. Worsening basal pulmonary opacities suggestive of atelectasis with either alveolar edema or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: SOB History: SOB New interstitial opacities suggestive of edema versus aspiration, particularly in the right lower lung zone.Heart size normal.Upper lobe emphysema.Left subclavian catheter, tip in SVC.

Output: New pulmonary opacities consistent with edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: as above Cardiomegaly with bilateral opacity compatible with edema, atelectasis and moderate pleural effusions. Catheter tip in the SVC.No new findings.

Output: Findings consistent with CHF with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: s/p R apical chest tube History: s/p R apical chest tube There is a new left apical catheter at the apex of the left pleural space. The size of the known left apical pneumothorax has minimally decreased in the interval. Left chest tube previously noted is unchanged in position.Low lung volumes and advanced interstitial fibrosis of both lungs is unchanged.Stable position of additional support apparatus.

Output: Interval placement of an additional left apical pleural catheter. The left apical pneumothorax has slightly decreased in size. Attention on follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Screen for infection prior to chemotherapy History: none No significant cardiopulmonary abnormality.Right PICC, tip in the SVC.

Output: No significant abnormality. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Shortness of breath, epigastric pain. Evaluate for CHF. Signs of pulmonary venous hypertension. Left upper lobe predominant heterogeneous opacities may represent asymmetrical pulmonary edema. Associated small bilateral pleural effusions consistent with history of congestive heart failure. No pneumothorax.Severe cardiomegaly.

Output: Findings suggestive of asymmetric pulmonary edema. Attention on follow-up chest radiographs.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Desaturation Right internal jugular chest port catheter terminates in the SVC.Redemonstration of a nodular right lower lobe opacity. No specific evidence of edema or new opacity to suggest infection. No large pleural effusion or pneumothorax. Moderate cardiomegaly is unchanged.Electronic device projects over the upper abdomen.

Output: Right lower lobe nodular opacity without evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer No cardiopulmonary abdomen. Left PICC line removed since prior study

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: Patient with SOB and decreased breath sounds on the left s/p left first rib resection History: SOB, Decreased breath sounds on the left Diminished lung volume with increased basilar opacities and pleural effusions left worse than right.No pneumothorax.Status post left rib resection.

Output: Diminished lung volume with increased opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: ? pna History: productive cough Scarlike opacity again noted at the right apex. Question mild biapical pleural parenchymal scarring and subpleural cystic change. Prominent osteophyte formation again noted in the lower thoracic spine. No pleural effusion or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Dyspnea, history of LVAD. Left basilar opacity with blunting of the left costophrenic angle consistent with atelectasis/scarring, similar to previous examination. Low lung volumes. Right lung remains well aerated.Marked cardiomegaly.LVAD, median sternotomy hardware, and C-ring mitral annuloplasty unchanged in position. Pacemaker leads terminate in right atrium and right ventricle.

Output: Left atelectasis/scarring similar to previous study.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with history of shortness of breath/COPD. Large lung volumes compatible COPD. Calcified and tortuous aorta. Large goiter causing leftward tracheal deviation. No focal air space opacities or pleural effusions.

Output: Stable cardiopulmonary appearance with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Mild asthma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: monitor pleural effusions - 73 yo multiple myeloma s/p massive RP bleed with persistent leukocytosis, altered mental status History: altered mental status, leukocytosis, pleural effusion, recent massive hemorrhage Right central venous catheter and enteric tube unchanged.Redemonstration of a catheter extending to the right lateral aspect of the T10 vertebrae.Cardiac enlargement with pleural effusions and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.Redemonstration of scoliosis of thoracolumbar spine with evidence of prior kyphoplasties.

Output: Stable cardiopulmonary appearance with pleural effusions and basilar consolidation/atelectasis. No new pulmonary opacities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: moved ETT 3cm inferior, please assess positioning History: none ET tube tip approximately 4 cm above the carina.Cardiopulmonary monitoring and support devices, unchanged. Small lung volumes with no gross abnormalities.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: r/o PNA History: SOB, fevers Basilar airspace opacities could be infection or aspiration.Mild cardiomegaly noted.Small pleural effusions identified.

Output: Mild cardiomegaly and basilar opacities suggestive of infection or aspiration. Small pleural effusions are noted on the lateral view.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: evaluate for pneumonia History: cough, fever. Now resolving Cardiac silhouette is normal in size. Calcified aortic arch.Increase AP diameter of the chest with flattening of the hemidiaphragms suggesting hyperinflation. Bibasilar interstitial/linear opacities likely sequela of remote atypical infection or aspiration with bronchiectatic changes. No focal consolidation or pneumothorax.

Output: 1.No evidence of acute cardiopulmonary abnormality.2.Bibasilar linear opacities likely sequela of remote atypical infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male; 68 years old. Reason: rule out infection History: fever, leukocytosis , ams Stable cardiac and mediastinal silhouettes.No focal airspace opacities to suggest infection. Stable biapical scarring.New enteric tube with tip in stomach and side-port at the GE junction.

Output: 1. No evidence of pneumonia. 2. Enteric tube side-port at GE junction; recommend advancing 5 cm.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#1 Interval extubation.Diffuse right lung pleural parenchymal fibrosis again noted most consistent with restrictive allograft syndrome in the setting of previous remote right lung transplant. No significant pneumothorax.

Output: Interval extubation. Stable radiographic appearance compared to prior


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Dyspnea, ET tube. Endotracheal tube tip less than 15 mm above the expected level of the carina.Enteric tube looped in the stomach.Lung volumes remain low normal. Atelectasis and patchy airspace opacity in the left lower lobe and lingula about the same.

Output: Low endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: 87yoM multifocal PNA, increased WOB History: as above No change in diffuse pulmonary opacities are relative sparing of the left upper lung zone. Stable pleural effusions and bibasilar opacities. Stable heart size. No pneumothorax.

Output: No substantial change compared to previous study. Diffuse pulmonary opacities consistent with edema and/or multifocal pneumonia with bibasilar opacities and pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female status post robotic left upper lobectomy. Postop follow-up. Left hemithorax postsurgical volume loss with scarring of the left lung base.No focal pulmonary consolidation or pleural effusion. No significant pneumothorax.Small opacities near the anterior left 3rd and 4th ribs of uncertain etiology and may be correlated with dedicated bone-technique rib films if the patient has pain in these areas.

Output: Left hemithorax postsurgical volume loss. No visible signs of localized recurrence by plain film. Subtle left 3rd and 4th rib opacities could be artifact and may be confirmed by rib series if the patient has pain.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: impella History: impella Endotracheal tube terminates 4 cm superior to carina. Stable position of impella device and the femoral Swan-Ganz catheter.Persistent moderate pulmonary edema with right greater than left pleural effusions. No pneumothorax.

Output: Stable position of impella device.


Instruction: Generate impression based on medical findings.

Input: Reason: AM CXR History: AM CXR. Generalized abdominal pain. Chest tubes on the left with no pneumothorax.Diffuse bilateral pulmonary opacity compatible with edema.Findings on the right consistent with previous thoracoplasty.ET tube tip approximately 4 cm above the carina.

Output: Findings compatible with pulmonary edema with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Previously large pneumothorax, now status post thoracentesis with residual small apical pneumothorax. Evaluate for interval change. Stable large left pleural effusion and small left apical pneumothorax.Mild scarring at the right costophrenic angle.

Output: Stable left pleural effusion and apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: eval lines and lung fields History: respiratory failure Support devices are unchanged in appearance, including biventricular assist devices.There is near complete opacification of the left hemithorax, with progressive atelectasis of the left lung. Although a large left pneumothorax is not visualized, this has been present on previous imaging; a loculation of gas at the left apex may be present in the pleural space. Right-sided opacities have slowly progressed over the last 2 days, suspicious for edema and subsegmental atelectasis. No significant pneumothorax.

Output: Near complete opacification of the left lung secondary to progressive atelectasis and pleural fluid and/or blood accumulation. A small loculation of gas within the left apical pleural space (hydropneumothorax) may be present .


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: intubated, interval exam History: see above The endotracheal tube is high with the cuff at the cords. Advancement is recommended. The remaining support devices are unchanged in position.Mild cardiomegaly with left ventricular enlargement. Lungs and pleural spaces remain clear. No pneumothorax.

Output: Tracheostomy tube cuff is at the cords. Advancement is recommended.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with dysphagia to solids and liquids. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. There was no evidence of esophagitis. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. No hiatal hernia was identified. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. The 13 mm barium tablet passed freely. There was no specific evidence of an esophageal web, bar or zenker's diverticulum.Limited views of the stomach and duodenum are unremarkable.FLUORO TIME: 7 minutes 34 secondsENTRANCE DOSE: 288.7 mGy

Output: Unremarkable esophagram.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: Evaluate for increased w/u breathing. C/f pulmonary edema History: dyspnea Left-sided ICD and right PICC line unchanged. Increasing interstitial/air space opacities particularly in the upper lung zones are compatible with edema or aspiration.Basilar atelectasis and pleural effusion similar to the prior exam.

Output: Increased pulmonary opacities particularly in the upper lung zones compatible with edema and/or aspiration. Stable basilar atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Intubation. Endotracheal tube remains low, with tip approximately 1.5 cm above the expected level of the carina.Linear areas of scarring or atelectasis unchanged

Output: Low endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Reason: 72 yo male with history of MM; pre-auto SCT evaluation History: evaluate Normal heart size with tortuous aorta. Coronary artery stents in place.Mild basilar scarring but no acute pulmonary abnormalities. Multiple bilateral rib fracture deformities and multiple vertebral compression fractures consistent with multiple myeloma.Radiopaque material consistent with a previous vertebroplasty level of T10.

Output: Multiple skeletal abnormalities consistent with multiple myeloma. No acute pulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: SOB, tachypneic History: see above Bilateral pleural effusions, right greater than left with associated atelectasis. Stable cardiomediastinal silhouette. No significant change of right basilar opacities.

Output: Bilateral pleural effusions and basilar opacities, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: intubated, interval change? ETT? History: as above ET tube and right IJ venous catheter and are unchanged.Stable cardiomediastinal silhouette with elevation of the left hemidiaphragm.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip 5 cm above the carina. Right IJ venous catheter with its tip extending retrograde in the right subclavian vein.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Evaluate for pneumonia and follow-up on sarcoidosis. Persistent cough and white phlegm. Mild cardiomegaly, unchanged. Prominence of the central pulmonary vasculature.Scoliosis.Asymmetric interstitial abnormality, greater in the right lung, about the same. Septal thickening as well as pleural thickening noted in the right lower lobe costophrenic angle region, but no pleural fluid.Right upper quadrant surgical clips.

Output: Stable asymmetric chronic fibrotic appearing interstitial lung disease in the right lung which is atypical for sarcoidosis, but no specific evidence of a superimposed pneumonia. Consider thoracic CT to exclude alternate diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Chest pain x 4 h and SOB evaluate for CHF exacerbation. Left subclavian pacemaker leads unchanged in position. Please note that the ventricular lead is directed cranially, not in the ventricular apex. Normal heart size. Atherosclerotic calcification of the thoracic aorta noted. No pneumothorax or focal airspace opacity. Scarring adjacent to anterior vertebral osteophytes noted. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed..

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: pneumonia? History: cough, chest pain Surgical clips project over the left breast shadow and right axilla.The cardiomediastinal silhouette is unchanged. Left basilar opacity may be consistent with pneumonia. Bilateral pleural effusions. No pneumothorax.

Output: Left basilar opacity may be consistent with pneumonia. Subsequent CT chest for more in-depth discussion.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Evaluate for pneumonia History: DKA The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. Low lung volumes.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: 57 old female with ovarian cancer CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Small pleural-based nodularities in the posterior aspect of the right lower lobe are nonspecific.MEDIASTINUM AND HILA: Pretracheal lymph node is slightly enlarged measuring 18 x 11 mm image number 27, series number 4. Precarinal lymph node is stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes involving the left lobe of the liver with persistent small perihepatic fluid.SPLEEN: Splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very minimal increase in the size of the pretracheal lymph node, otherwise stable findings.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: SOB ?pleural effusion on left; hx DLBCL History: SOB Complete opacification of left hemithorax with rightward mediastinal shift consistent with a large pleural effusion and/or mass. Multiple skinfold on the right.

Output: Complete opacification of left hemithorax with rightward mediastinal shift consistent with a large pleural effusion and/or mass.


Instruction: Generate impression based on medical findings.

Input: 38-year-old female with history of cough, shortness of breath, and SLE. Cardiomediastinal silhouette is unremarkable. Stable blunting of the left costophrenic angle, from epicardial fat-pad seen on prior CT. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Hypertension and tachycardia. Normal heart size. No focal airspace opacity, pleural fluid or pneumothorax. Areas of sclerosis in the scapulae and humeral heads suspicious for skeletal infarct.Mild pectus excavatum.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Lower extremity Swan-Ganz catheter, IABP marker unchanged.Low lung volumes.Nonspecific basilar opacities unchanged.No large pleural effusion. No pneumothorax.Stable cardiomediastinal silhouette.

Output: Stable support devices and nonspecific basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: S/P bilateral lung txp History: SOB There is post bilateral lung transplants with evidence of a clamshell sternotomy.Stable cardiomediastinal silhouette.Minimal basilar scarring/discoid atelectasis.No focal airspace opacities.No pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Fluid overload, check balloon pump Swan-Ganz has been advanced, tip projects into the right middle lobe, just beyond the takeoff of the upper lobe.ICD unchangedModerate cardiomegaly with nonspecific pulmonary changes representing possible mild edema

Output: Swan-Ganz repositioned


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: Evaluate for infiltrates, other causes of hypoxia History: Hypoxia ET tube has been removed.Left IJ venous catheter with its tip in the SVC.Decreased lung volumes with stable cardiac enlargement.Basilar atelectasis.No new pulmonary opacities identified.

Output: Interval extubation. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Previously described metastatic mass involving the left pleural space is slightly smaller now measuring 2.9 by 2.2 cm, image number 59, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 5 x 4 . 4-cm mass in the right suprarenal region on image number 114, series number 3, unchanged. Mass in the midpole of the right kidney is also unchanged, measuring 5.4 x 4 .6 cm, image no. 127, series number 3.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left-sided fat-containing posterior lateral herniaOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Minimal decrease in the left subpleural space mass, otherwise, no significant change in the patient's known other masses


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.ET tube advanced 3 cm assess position. ETT tip less than 2 cm above the level of the carina.Right jugular catheter and NGT unchanged in position.Large pleural effusions with associated atelectasis and consolidation about the same.Presumed intrathecal contrast material projects over the spine.

Output: ETT tip less than 2 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Bilateral lung transplant. Bilateral chest tubes similar in position.Improved size of left pneumothorax, now with maximal pleural separation from the chest wall of 12 mm.Improved size of right pneumothorax, now with maximal pleural separation from the chest wall of 15 mm.Small pleural effusions. Minimal basal atelectasis also improved.Subcutaneous emphysema.Left subclavian introducer terminates at the left clavicular head level.

Output: Improving pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: balloon pump eval History: balloon pump eval Support devices unchanged with IABP marker in the distal aortic arch.Stable marked cardiac enlargement with mild basilar edema/atelectasis.No new pulmonary opacities identified.

Output: IABP marker in the distal aortic arch. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: look for pulm edema, received 4L IVF in OR History: above Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Mild left-sided pleural thickening and/or effusion again noted. Unchanged cardiomegaly. No pneumothorax.

Output: No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with metastatic base of tongue cancer status post chemotherapy. Evaluate disease and compare to previous exam. CHEST:LUNGS AND PLEURA: Paraseptal and centrilobular upper lobe emphysema, unchanged. Previously noted 3-4 mm subpleural right upper lobe nodule is stable to smaller, now with cental lucency. Left upper lobe nodule on axial image 47/116 measures 8 x 10mm, previously 10 x 10 mm. Left upper lobe subpleural nodule on axial image 40/116 has decreased in size and does not reliably measurable.MEDIASTINUM AND HILA: Cardiac size is normal. No pericardial effusion. Ectasia of the ascending aorta is unchanged. Aortic atherosclerotic calcifications noted. Small mediastinal and right retrocrural lymph nodes unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney is absent.PANCREAS: Pancreatic calcifications and dilatation of the main pancreatic duct compatible with chronic pancreatitis. Progression of several small cystic lesions and peripancreatic lymph nodes is noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node measures 1.9 x 3.0 cm on axial image 108/143 and has increased in size from prior exams (this lesion was incompletely visualized on the most recent examination, but on the exam of 7/9/08, it measured approximately 1.6 x 1.8 cm). Retroperitoneal lymphadenopathy on the right is more prominent. Scattered small mesenteric nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Pulmonary nodules stable to smaller as described above.2.Progression of retroperitoneal lymphadenopathy.3.Progression of several small cystic pancreatic lesions as well as peripancreatic lymph nodes is noted. This is of unclear significance given lack of activity on the recent PET CT, but an indolent neoplastic process cannot be ruled out. A dedicated pancreatic CT is recommended in conjunction with the patient's next follow-up examination.4.5.


Instruction: Generate impression based on medical findings.

Input: Male 3 days old Reason: Is there an esophageal perforation History: air on previous xrayVIEW: Chest and abdomen: AP (2 views) 7/31/2015 at 1327 hours. ET tube tip is below thoracic inlet. Central line tip is at the right subclavian vein. Left-sided chest tube unchanged.Cardiac silhouette size is normal. Left-sided tension pneumothorax development with persistent right lung diffuse haziness. Retroperitoneal pneumoperitoneum and bilateral inguinal hernias.

Output: Interval tension pneumothorax development as described.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: s/p left thoracentesis History: none Left-sided pleural effusion has decreased in size. Decreased left basilar atelectasis. No pneumothorax. Unchanged cardiomegaly. No new focal lung consolidation.

Output: Decreased size of left-sided pleural effusion without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: sepsis, intubated History: sepsis intubated Endotracheal tube tip at the level of the carina. Enteric tube with tip overlying the very proximal stomach and sidehole at the level of the distal esophagus. Right subclavian port catheter again seen with undulating course underneath the right clavicle.Cardiac silhouette is again enlarged. Bilateral interstitial and nodular densities again seen with significant worsening in left upper paramediastinal and retrocardiac opacity likely atelectasis and pleural effusion.

Output: 1.Endotracheal tube tip at the level of the carina. Partial retraction by 2 to 3 cm is recommended.2.Enteric tube with proximalmost sidehole at the level of distal esophagus. Further advancement recommended.3.Interval worsening in left upper paramediastinal and retrocardiac opacities likely atelectasis and pleural effusion with or without component of consolidation/aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval for edema History: sob Cardiomegaly, with pulmonary vascular redistribution.New right pleural effusion with overlying atelectasis.No specific evidence of edema, however.

Output: Cardiomegaly with a right pleural effusion likely a manifestation of CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 81-year-old female with cough. Evaluate for pneumonia. Enlargement of the left ventricle, unchanged. Tortuous aorta.Minimal chronic appearing basilar opacities consistent with scarring. No focal lung opacity or pleural effusion.Moderate degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 86 years old Reason: pneumonia? History: altered mental status No focal airspace opacity suggest infection.No pleural effusion or pneumothorax.The heart is top normal in size.

Output: No acute cardiopulmonary abnormality, no specific evidence of infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Lung evaluation Single left-sided chest tube is unchanged in position. Subcutaneous emphysema of the left lateral chest wall.Postsurgical and degenerative changes to the right shoulder are seen, unchanged. Posterior left eighth and ninth rib fractures.Cardiomediastinal silhouette is is unchanged.Left retrocardiac opacity is unchanged. No large pleural effusions. No pneumothorax.

Output: Persistent left lower lobe opacity. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Shortness of breath, chest pain, history of asthma and CHF Single AICD lead within the right ventricle.Stable cardiomegaly.Increased small left and moderate right pleural effusion with underlying atelectasis and new fluid within the minor fissure.No pneumothorax.

Output: Cardiomegaly and increased pleural effusions consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: assess ett tube position History: s/p intubation Right mainstem intubation. New perihilar opacities. Unchanged heart size. No acute bony abnormality.

Output: Endotracheal tube terminates in the right mainstem bronchus. This has been pulled back on more recent chest radiographs.New perihilar pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: eval for RUL bleeding History: Eval for bleeding Right greater than left basilar opacities, unchanged. Unchanged heart size. No pneumothorax.

Output: Unchanged right greater than left basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: swan History: Swan Moderate cardiomegaly without acute edema.Right jugular Swan-Ganz catheter tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Moderate cardiomegaly without edema. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: 30 year-old male with lung cancer status post chemotherapy. Compare to outside exams. CHEST:LUNGS AND PLEURA: Left upper lobe heterogenous mass extending into the mediastinal fat (series 3 image 26) measures 6.4 x 4 cm in axial dimension (unchanged from prior), but with increased consolidation from prior. Few bilateral pulmonary nodules, new or slightly increased in size from prior, highly concerning for metastasis. Largest nodule in the left base (series 5 image 54), measures 11 x 9 mm (previously 4 x 3 mm). Small left effusion, similar to prior. Elevation of the left hemidiaphragm may indicate phrenic nerve injury. MEDIASTINUM AND HILA: Right paratracheal lymph node (series 3 image 26) measures 15 mm in short axis dimension, unchanged from prior.No cardiomegaly or pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal hypoattenuating lesion (series 3 image 86) measures 24 x 12 mm (previously 18 x 12 mm), compatible with FDG-avid metastatic disease on recent PET.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter lesion with peripheral sclerosis in the L3 vertebral body, unchanged from prior, favors benign lesion. OTHER: No significant abnormality noted.

Output: Progression of metastatic disease with new/increasing pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma. Please evaluate for response to treatment. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Nonenlarged mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodense lesion at the junction of segments 4 and IVb measures 3 x 2 .2 cm, unchanged from prior examination, however cannot exclude metastatic disease. Other lesions in the liver likely represent hemangiomas and cysts and are unchanged in size and number. Hemangioma in the left lobe measures 15 x 12 mm.SPLEEN: Splenic artery aneurysm measuring 1.9 cm, unchanged.PANCREAS: At least two hypodense, fluid density well-defined lesions, one in the tail of the pancreas measuring 2.7 x 1.4 cm and otherwise in the body measuring 7 mm are unchanged. No evidence of pancreatic main duct dilatation. Further evaluation of these lesions with M.R.C.P. is recommended.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral hypodense lesions within the renal sinus, likely represent renal sinuses. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Portacaval adenopathy is stable measuring 2.7 x 2.5 cm on image number 103/217. No new adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Changes secondary to previous hernia operation. Previously described small collection in the anterior abdominal wall has resolved.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate. Correlation with PSA is recommended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable hepatic lesions. One of the lesions is still suspicious for metastases despite stable size.Multiple cystic lesions in the pancreas. A cystic neoplasm cannot be excluded. Further evaluation with M.R.C.P. is recommended.Stable likely metastatic portacaval adenopathy.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: icu Large partially loculated right pleural effusion with a pigtail catheter in place. Smaller left effusion with underlying nonspecific airspace opacity in the left lower lobe. No new findings.

Output: Bilateral pleural effusions, greater on the right with a pigtail drain in place, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: Reason: 91 y/o with post cardiac arrest hypoxemia History: sob ET tube tip approximately 3 cm above the carina. Left subclavian catheter tip in the right atrium.Bilateral diffuse airspace opacity, suggestive of pulmonary edema with retrocardiac left lower lobe atelectasis and consolidation.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Evaluate for syncope. Stable cardiomediastinal silhouette.No acute focal airspace opacity, pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with colon cancer CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules are again identified, some of these have decreased and others have slightly increased in size. Reference left posterior upper lobe nodule measures 6 x 6 mm, previously 10 x 9 mm. A few these nodules demonstrate cavitation/pseudo-cavitation. MEDIASTINUM AND HILA: Mildly enlarged supraclavicular and mediastinal lymph nodes remain.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderately severe bilateral hydroureteronephrosis, slightly increased. Bilateral renal hypodensities persist.RETROPERITONEUM, LYMPH NODES: Several mildly prominent retroperitoneal lymph nodes are identified, slightly increased in size. For reference purposes, one of these measures 15 x 10 mm (series 3; image 123), previously 12 x 11 mm. Soft tissue infiltration at the root of the mesentery which encases the SMA and SMV has significantly increased and causes narrowing of the SMVBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: The urinary bladder is greatly distended and demonstrates a thickened wall, not significantly changedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of a metastatic disease involving the mesenteric root, causing narrowing of the SMV. Mild increase of retroperitoneal adenopathy.Fluctuation in size of bilateral pulmonary metastases with stable supraclavicular and thoracic adenopathy.Slightly increased moderately severe bilateral hydroureteronephrosis. The prostate gland remains enlarged-please correlate clinically.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: new sob, History: sob Mild bibasilar subsegmental atelectasis or scarring. Mild to moderate cardiomegaly. Aortic atherosclerosis, as before.Bilateral shoulder degeneration.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: rib fx? ptx? History: fall, chest pain Previous right IJ central catheter is no longer present.No displaced rib fracture is identified. Relatively low lung volumes without pneumothorax or evidence of contusion. Heart size is normal.

Output: No displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59 yo F w/ L sided upper abdominal/lower chest pain, eval for infiltrate vs rib fracture History: see above Cardiac silhouette is normal. No focal infiltrate, pleural effusion or pneumothorax. No definite evidence of rib fracture.

Output: Unremarkable examination. Limited evaluation for rib fractures.


Instruction: Generate impression based on medical findings.

Input: Leukocytosis and angioedema. Nondiagnostic lateral radiograph due to low lung volumes and body habitus. No effusion.Normal cardiomediastinal silhouette.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Minimal mild interstitial changes bases of uncertain significance given mild decreased lung volumes. Although possibly chronic in nature, aspiration or even a viral infection cannot entirely be excluded. Mild bronchial wall thickening is also observed. No effusions.The cardiac and mediastinal contours are within limits given mild scoliosis

Output: Nonspecific mild enlargement interstitial change both bases. See the differential provided above


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: sob Unremarkable cardiac and mediastinal silhouette. 11 mm left upper lobe nodule, previously shown to be stable and likely benign CT scans.No sign of CHF or pneumonia.

Output: No acute abnormalities.