Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: Infiltrates History: fever Central venous catheter terminates just above the cavoatrial junction. Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: FemaleReason for Study: Reason: cough History: cough, crackles The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.AVR POD 1 evaluate lung fields. Lung volumes slightly decreased. Basal atelectasis. Interval extubation. Other hardware and devices similar in position. No pneumothorax. Pleural effusions, similar to previous. Gaseous distention of the stomach.

Output: Low lung volumes with basal and dependent atelectasis. Gaseous distention of the stomach.


Instruction: Generate impression based on medical findings.

Input: 32 year-old female with metastatic colon cancer. Please evaluate disease status. CHEST:LUNGS AND PLEURA: 1.2 x 1.0 cm nodule in the right lower lobe is larger on image number 54, series 4. Other scattered subcentimeter nodules are also unchanged.MEDIASTINUM AND HILA: Soft tissue encasing the right lower bronchus is larger measuring 2.1 x 1.9 cm image number 44, series number 3. Large left thyroid nodule. CHEST WALL: No significant abnormality noted. Venous access device on the right, in the expected position.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted. Splenule at lower pole. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Sided hydronephrosis and hydroureter unchanged RETROPERITONEUM, LYMPH NODES: Index left para-aortic adenopathy measures 1.0 x 1.5 cm at axial image 113/209 and is larger compared to the previous study. Other retroperitoneal lymph nodes are slightly smaller along the left para-aortic space. These likely make the left ureter and causes left hydronephrosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post 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: Interval increase in the size of the retroperitoneal lymph nodes. Lung nodule and mediastinal soft tissue density are larger. Left-sided hydronephrosis is unchanged.


Instruction: Generate impression based on medical findings.

Input: 35-year-old female with history of CLL, status post cell transplant CHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: Index prevascular lymph node is enlarged and now measures 1.4 x 1.6 cm on image number 25, series number 3. Other mediastinal lymph nodes are also slightly increased in size.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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index portacaval lymph node measures 2 x 0.6 cm, slightly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerosis involving the left iliac wing.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval near increase in the size of the index lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old. Reason: sickle cell crisis with mild chest pain: assess for acute chest History: chest pain Left chest port, tip near the cavoatrial junction.The cardiac and mediastinal silhouette is within normal limits.No focal airspace opacity. No pleural effusions.Surgical clips overlie the upper abdomen.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: is there any infiltrate History: sickle cell , chest pain Mild cardiomegaly with basilar scarring, compatible with sickle cell disease.Skeletal findings consistent with sickle cell disease and evidence of previous splenectomy.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Worsening bronchiectasis History: SOB, cough, last month, now resolved Unremarkable cardiac and mediastinal silhouette. Bronchial thickening and subsegmental atelectasis in the right perihilar region compatible with bronchiectasis and bronchial mucous plugging.Complete left lower lobe atelectasis, unchanged.Blunting of both costophrenic angles compatible with small effusions and/or scarring.

Output: Bronchiectasis and left lower lobe atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Dobbhoff placement Dobbhoff extends into the distal esophagus. Left jugular catheter, ICD and underlying cardiopulmonary appearance are otherwise similar given differences in technique and penetration

Output: Dobbhoff tube placed into the distal esophagus


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: swan placement History: swan placement Right Swan-Ganz catheter terminates in the distal SVC.. ICD pacer leads are unchanged from prior examination.Right pleural effusion and right basilar opacities are not significantly changed from prior examination, compatible with edema. Unchanged cardiomegaly. No pneumothorax.

Output: Right Swan-Ganz catheter terminates in the distal SVC, recommend advancement.


Instruction: Generate impression based on medical findings.

Input: Reason: Confirm NG tube placement History: as above Enteric tube tip overlies the gastric body. Dilatation of multiple loops of bowel, compatible with known severe generalized ileus, not significantly changed. Please refer to concomitant chest radiograph for detailed thoracic findings. The pelvis is excluded from the field-of-view.

Output: Enteric tube tip overlies the gastric body. Stable severe generalized ileus.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Evaluate ETT and lung fields post CABG. IABP marker unchanged in position projecting over the proximal descending thoracic aorta. Endotracheal tube tip 4 cm above the level of the carina.Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level. Bilateral basal chest tubes and mediastinal drains in place.A stimulator device projects over the lower thoracic spine.Sternotomy hardware has been placed, comprised of several wires and plate/screw fixation devices.No pneumothorax or signs of pulmonary edema.Minimal subsegmental atelectasis at the lung bases.Possible small pleural fluid collections.

Output: ETT tip 4 cm above carina. No signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: 53yo F s/p chest biopsy, evaluate for pneumothorax History: as above No sign of pneumothorax or other acute change.Focal opacity in the left base as previously characterized by CT scan.No new findings.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: weakness, nausea History: weakness, nausea Heart size upper normal with a tortuous aorta. Mild basilar scarring, unchanged. No significant interval change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old. Reason: effusion? PNA? History: sob Mild cardiomegaly, unchanged.Unchanged pulmonary opacities, some of which appear chronic with pleural thickening and pleural effusions.No pneumothorax.Right jugular introducer catheter tip in the SVC.Mediastinal drains are unchanged.Status post median sternotomy with multiple surgical clips in the mediastinum.

Output: Cardiomegaly with unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: FU bronch History: none No change in patchy airspace and interstitial opacities in the upper lobes. No evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Shortness of breath, hypoxia, evaluate volume status Right chest wall single-lumen port tip at the cavoatrial junction. Low lung volumes and atelectasis without focal pulmonary opacity or pleural effusion. Heart size is within normal limits.

Output: Low lung volumes and atelectasis without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Pneumothorax. Right pleural drain again noted. Small loculated right lateral inferior pneumothorax again noted. Otherwise, no substantial difference compared to last study.

Output: Right pleural drain again noted. Small loculated right lateral inferior pneumothorax again noted.


Instruction: Generate impression based on medical findings.

Input: Central line placement Limited exam with portable positioning and motion. Questionable mild nonspecific cardiomegaly without additional discrete cardiopulmonary abnormality. Right jugular catheter extends up to the origin junction . No immediate associated postprocedural complications. A superimposed radiopaque wires also projected over the left neck and mediastinum of uncertain position function

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o infection History: crackles, fever, cough, h/o HD Left lower lung zone opacity consistent with atelectasis has improved although not resolved.Small right pleural effusion with adjacent atelectasis unchanged.Heart size upper normal.No reliable evidence of infection or edema.

Output: Improving left lung atelectasis, with no new findings. New reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 49 years old Male. Reason: Rule out any acute cardiopulmonary process as cause of new onset A flutter History: Atrial Flutter. There is a mass in the right hilum and the right upper lobe with right upper lobe atelectasis. The cardiac silhouette is normal. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Right hilar mass with right upper lobar atelectasis, suspicious for lung cancer. Suggest PET/CT for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: Evaluate heart failure History: heart failure Iatrogenic devices are unchanged. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Mild anterior wedging the lower thoracic vertebral body with associated kyphosis.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Evaluate PICC position. Interval placement of left PICC with tip in the left brachiocephalic vein. Unchanged cardiomegaly and low lung volumes with left greater than right interstitial opacities. These appear to have slightly progressed from prior exam. Other support hardware is unchanged. The previously visualized air collection in the left midlung zone is partially obscured on this examination.

Output: Interval placement of left PICC with tip in the left brachiocephalic vein. Otherwise, largely unchanged examination. Please see same day chest CT for further findings concerning esophageal perforation.


Instruction: Generate impression based on medical findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is moderate vertebral body height loss especially anteriorly of L1, with mild associated bandlike abnormal signal using STIR hyperintensity along the area of compression. There is mild disc narrowing at L4-L5 and L5-S1 with associated disc desiccation. There is also prominent disc desiccation at T12-L1. The vertebral body and disk heights are otherwise well-maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.At T12-L1, there is a trace disc bulge with minimal retropulsion of the compressed superior endplate without stenosis.At L1-L2, there is no significant disk pathology or stenosis.At L2-L3, there is a trace disc bulge as well as mild bilateral facet arthropathy. There is minimal bilateral foraminal narrowing.At L3-L4, there is a trace disc bulge and left greater than right facet arthropathy and ligamentum flavum thickening. There is mild-moderate left and minimal right foraminal narrowing.At L4-L5, there is a trace disc bulge with left paracentral/foraminal disc protrusion, with left lateral recess narrowing. There is impingement of the descending left L5 nerve root with overall mild central spinal canal stenosis and moderate left foraminal narrowing.At L5-S1, there is a mild disc bulge with mild bilateral facet arthropathy and ligamentum flavum thickening. There is moderate severe bilateral foraminal narrowing.

Output: 1.Moderate predominantly anterior compression deformity involving L1 along its superior endplate, with small area of residual STIR hyperintensity suggestive of mild bone marrow edema. This does not appear to be acute, although please correlate clinically.2.Predominantly lower lumbar spondylotic changes, with findings most conspicuous at L4-L5 where there is a left paracentral/foraminal disc protrusion impinging on the descending left L5 nerve root. Associated moderate left foraminal narrowing at this level.3.Additional moderate-severe bilateral foraminal narrowing at L5-S1.


Instruction: Generate impression based on medical findings.

Input: 53-year-old male with history of metastatic sigmoid cancer and recent liver recurrence, status post radiation therapy CHEST:LUNGS AND PLEURA: Interval increase in the size of the right upper lobe nodule. This nodule now measures 10 x 7 mm on image number 34, series number 6. Previously it was measuring 5 x 6 mm on image number 27, series number 10. Other calcified granulomas and subcentimeter nodules are stable. New atelectasis and scarring in the right lower lobe which may be secondary to radiation.MEDIASTINUM AND HILA: Enlarged left lobe of the thyroid is unchanged. The tip of the left port catheter is at the level of superior SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Patient's metastatic lesion in the right lobe of the liver measures 5.6 x 2.7 cm on image number 82, series number 4, grossly stable compared to previous study. CT is very limited in detection of focal lesions in this patient due to fatty infiltration of the liver. Follow-up with MRI is recommended.SPLEEN: 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: Index mesenteric lymph node is stable measuring 1.7 x 0.8 cm on image number 120, series number 4.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.OTHER: 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 interval increase in the size of the right upper lobe lung nodule.Postradiation changes in the right lower lobe.Liver lesion has not significantly changed.The tip of the left port catheter is at the level of superior SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Evaluate ETT and lung fields status post AVR, MVR, TV repair. ETT tip 5.5cm above the level of the carina. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level. Mediastinal drains in place. Valve prosthesis faintly seen. Sternotomy hardware appears in alignment.Postoperative pneumomediastinum and subcutaneous emphysema.Small to moderate pleural effusions with basal atelectasis bilaterally. Mild pulmonary edema.

Output: ETT tip 5.5 cm above the level of the carina. Mild pulmonary edema with pleural fluid and atelectasis at the lung bases.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: s/p small bowel resection for perf SBO. Intubated- confirm ETT and line position History: ETT, CVC Enteric tube has been pulled back slightly with side port just below the gastroesophageal junction. Other lines and tubes, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities. No new focal pleural parenchymal opacity. Unchanged heart size. Small pleural effusions. No pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess IABP and swan positioning, as well as effusion History: as above Right IJ Swan-Ganz catheter remains in stable position, within the central right pulmonary artery. Intra-aortic balloon pump tip is approximately 1 cm superior to the left mainstem bronchus. The right PICC and biventricular ICD electrodes are in stable position.The left costophrenic angles excluded from the field-of-view. Stable consolidation and atelectasis involving the left lower lobe partially visualized. Left pleural effusion is unchanged.

Output: Stable position of support devices. Although the left costophrenic angle is excluded, left lower lobe opacities appear unchanged.


Instruction: Generate impression based on medical findings.

Input: Male; 59 years. Reason: h/o met thyroid ca, compare to previous, measurements pls CHEST:LUNGS AND PLEURA: Redemonstrated are innumerable pulmonary metastases, appearing similar to prior.Index lesion in the left upper lobe (series 6, image 64) measures 2.1 x 1.8 cm (previously 2 x 1.9 cm). Index lesion in the right upper lobe (series 6 image 64) measures 1.2 x 1 cm (previously 1.2 x 1.2 cm).MEDIASTINUM AND HILA: Multiple subcentimeter mediastinal lymph nodes, similar to prior.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule, unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fat-containing left inguinal hernia. Diverticulosis, no CT evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable pulmonary metastases. No evidence of intra-abdominal metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: s/p AV replacement, MV replacement, MAZE, CT in place History: asx Two chest tubes are unchanged. Venous catheter unchanged with obtained after skin site.No significant pneumothorax. Stable cardiomegaly with basilar edema and effusions. Skin fold on the left.

Output: No evidence of significant pneumothorax


Instruction: Generate impression based on medical findings.

Input: 41 years, Male. Reason: Is there evidence of obstruction or ileus? History: abdominal distension and g-tube Bilateral nephroureteral stents and renal calculi are again noted. Gastrostomy tube overlies the stomach. Additional calculi are noted within the bladder. Chronic degenerative changes of bilateral hips are noted. Overall there is a gasless bowel gas pattern, which is nonspecific.

Output: Gasless bowel gas pattern, which is nonspecific.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Known chronic empyema now with red drainage from Pleurx. The marker on the right lower thorax pigtail catheter projects over the external cortex of the adjacent rib, outside of the pleural space. Persistence of subcutaneous emphysema along the right anterior and lateral chest wall may be the result of an air leak. Chronic loculated right pleural air and fluid collection about the same. Several small air/ fluid levels are seen in the right lower thorax which are unchanged. Esophageal stent, right chest port and embolization coils projecting over the thorax are unchanged.

Output: Right-sided pigtail catheter marker projects outside of the pleural space, probably resulting in an air leak. Loculated chronic complex right pleural air and fluid collection without appreciable change; blood products within the pleural space cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: post op, eval lung fields History: s/p pericardial stripping Chest tubes are present with no pneumothorax.Basilar atelectasis postop.ET tube tip approximately 3 cm above the carina.Right jugular introducer unchanged.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Hypoxia and SOB rule out infection. Unchanged appearance of the cardiomediastinal silhouette with tortuosity of the thoracic aorta as well as atherosclerotic calcifications. Improving pulmonary opacities. Mild blunting of the cardiophrenic angles consistent with small pleural effusions.Coarse reticular opacities particularly in the left lung, most notably at the base, about the same. Opacities elsewhere in the left lung slightly worse.

Output: Small pleural effusions with coarse basilar opacities on the left, possibly the result of aspiration or infection. Reticular opacities elsewhere were previously characterized as evolving radiation pneumonitis by a recent CT scan.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: acutely altered r/o PNA History: acutely altered Emphysema and possible fibrosis unchanged.No specific evidence of infection or failure.Small right upper lobe nodule unchanged.

Output: Known right upper lobe adenocarcinoma, with stable emphysema and mild fibrosis. No specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: Reason: post cardiac surgery, line placement, ett History: ett ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the proximal right main pulmonary artery.Right jugular catheter tip in the right atrium.Cardiomegaly with basilar atelectasis, greater on the left.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: 70M hx RCC s/p partial nephrectomy. Evaluate for metastasis. History: None The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.CVC insertion. AML in relapse. Right jugular catheter tip at the SVC. Asymmetric lung volumes, right greater than left, with a small left pleural fluid collection. Mild retrocardiac atelectasis or scarring on the left and minimal chronic appearing basal opacities, nonspecific. No pneumothorax.

Output: Appropriate position of right jugular central line with the tip at the superior vena cava. Nonspecific small left pleural fluid collection with volume loss in the left lung for which short-term follow-up chest radiograph is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: GI bleed History: As above Low lung volumes. 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: Age: 67 yearsGender: MaleReason for Study: Reason: s/p esophagectomy History: NA ET tube has been removed.Two right-sided chest tubes with their tips directed at the apex.Right Port-A-Cath with its tip in the SVC.NG tube with its side port in the distal esophagus.Stable cardiac size with widening of the mediastinum most likely representing postsurgical changes.Left upper lobe atelectasis improved.Left pleural effusion and left retrocardiac consolidation/atelectasis.No pneumothorax.

Output: Interval extubation. Mild interval improvement in left upper lobe atelectasis.Persistent left pleural effusion and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.PICC placement. Left PICC tip can be followed to the left brachiocephalic vein near the midline.LVAD and a presternal ICD noted.No pneumothorax. Basal atelectasis. Cardiomegaly.

Output: Left PICC terminates in the left brachiocephalic vein near the midline.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: Intubated, pleural effusions History: Intubated, pleural effusions Unchanged pulmonary opacities suggestive of edema and pleural effusions as well as left lower lobe consolidation.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 5 cm above the carina. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with recurrent ovarian cancer CHEST:LUNGS AND PLEURA: New subcentimeter nodule abutting the fissure on the right side measuring 5-mm image number 59, series number 4.MEDIASTINUM AND HILA: Paratracheal adenopathy measuring 14 x 7 mm on image number 28, series number 3 is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval resection of the hepatic mass. Small amount of fluid accumulated in the hepatectomy bed.SPLEEN: Surgically absent.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: Evidence of gastric surgery, omentectomy, and splenectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.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: New subcentimeter right lung nodule.Interval resection of the patient's known hepatic metastases with small amount of postsurgical fluid in the hepatectomy bed.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: patient with pneumonitis, now with worsening SOB, want to evaluate status of lung History: SOB, Trouble breathing Left-sided ICD unchanged.Stable cardiomediastinal silhouette.Interstitial and patchy nodular opacities similar to the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate pneumothorax History: shortness of breath Large left pneumothorax not significantly changed with the lateral margin of the upper lobe about 2 cm from the chest wall.Small left effusion.Underlying chronic interstitial disease as previously characterized by CT scan.Focal atelectasis at the right base and elevation of the right hemidiaphragm.

Output: Large left pneumothorax without significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: interval change, swan placement History: cardiogenic shock Swan-Ganz catheter advanced slightly in the right pulmonary artery.Other devices unchanged.Cardiomegaly with patchy bilateral airspace opacities, generally unchanged.

Output: Swan-Ganz catheter tip in the right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Improved overall aeration with clearance of previously described basilar atelectasis. Minimal scarring most prominent in the right upper lobe unchanged. Stable appearing multi lead left subclavian ICD.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of base of tongue cancer status post chemotherapy. T3N2 CHEST:LUNGS AND PLEURA: Previously noted left lower lobe micro-nodule unchanged (series 5, image 74). Additional stable subpleural micronodule in left lung base (series 5, image 98). No new suspicious nodules. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable micronodules with no evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Swan position History: Swan Cardiomegaly.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.Right jugular Swan-Ganz catheter removed leaving the introducer.

Output: Swan-Ganz catheter removed. No other change.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval lung fields History: chest tube s/p ptx Left chest tube unchanged without pneumothorax.Small pleural effusions remain, with mild basilar atelectasis, unchanged.Left subclavian ICD, leads unchanged in position.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Hickman placement The multilead right subclavian ICD appears unchanged. No additional cardiopulmonary abnormality superimposed upon borderline to mild cardiomegaly.No central line or catheter is observed

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Missing 6.5 mm curved needle Two left-sided chest tubes. ET tube approximately 4 cm above the carina. Right internal jugular venous catheter.Cervical spinal fusion hardware noted. Mediastinal and left thoracic surgical clips, unchanged. Right upper abdominal surgical clips, unchanged. No unexpected radiopaque foreign body is evident.

Output: No unexpected radiopaque foreign body is evident. After page attempt, these findings were text paged to Dr. Balkhy, the attending surgeon, on 8/5/15 at 1710.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p right VATS bullectomy History: shortness of breath Two right chest tubes with no pneumothorax following apical surgery.Right upper lobe consolidation is probably related to recent bullectomy.Marked emphysema unchanged with mild postoperative basilar edema and atelectasis.

Output: Status post right bullectomy with two chest tubes and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: IABP Placement History: IABP Placement Iatrogenic devices are unchanged.Unchanged marked cardiomegaly. No new focal lung consolidation.

Output: No substantial change compared to last study.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: spontaneous pneumothorax History: spontaneous pneumothorax s/p thoracic vent placement Left hemithorax stent in place. Left pneumothorax, now barely perceptible.

Output: Left hemithorax stent in place. Left pneumothorax, now barely perceptible.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surg History: - Cardiomegaly with a mitral valve ring and bilateral pleural effusions with basilar atelectasis, unchanged.Tracheostomy tube and feeding tube in place.No new findings.

Output: Pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: evaluate cardiac silhouette History: s/p OHT Status post median sternotomy, heart size normal.Unchanged superior mediastinal widening from mediastinal fat deposition.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Sickle cell here with vaso-occlusive crisis, had temperature of 104 2 days ago. Reports chest pain. Mild cardiomegaly for age.No focal airspace opacities. Scarring at the left base.No signs of edema.Osseous stigmata of sickle cell disease.

Output: No signs of acute chest.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.OHT surveillance. Normal heart size. No pleural fluid on the left. Blunting of the right costophrenic sulcus may indicate a minimal amount of pleural fluid but is unchanged. The lungs are clear.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: swan placement History: swan placement Small lung volumes with basilar opacities, a right pleural effusion and cardiomegaly, unchanged.IVC Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian right jugular catheters to terminate at the right atrial level.

Output: No change in tubes and devices, pulmonary opacities or right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with squamous cell cancer of the tongue. LUNGS AND PLEURA: Radiation fibrosis in the apices unchanged. Dependent patchy airspace opacities compatible with aspiration. Mild bronchiectasis and bronchial wall thickening. No pleural effusion.MEDIASTINUM AND HILA: Tracheostomy in place. Small pretracheal lymph nodes are unchanged. Cardiac size normal with no pericardial effusion.CHEST WALL: Right-sided Port-A-Cath in place with its distal tip in the SVC. Surgical clips within the right neck.UPPER ABDOMEN: No significant abnormality noted.

Output: Patchy airspace disease compatible with aspiration. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: hx of back pain x 2 days, cough and cold symptoms. Eval for widened mediastinum or pneumonia History: cough, cold symptoms, back pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Follow-up of micro-nodule in left lung base. LUNGS AND PLEURA: Solid triangular shaped 5-mm nodule adjacent to the major fissure in the left lower lobe (58/101), unchanged since the previous scan of 10/16/2010. The location and morphology are typical of an intrapulmonary lymph node and no further follow-up is recommended.Very mild subpleural reticulonodular interstitial opacity in both lower lobes, probably chronic and also unchanged.MEDIASTINUM AND HILA: Markedly enlarged thyroid gland with inhomogeneous texture, compatible with a goiter, predominantly involving the left lobe, with deviation of the trachea to the right.Extensive coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Limited evaluation due to absence of contrast material. No gross abnormalities noted.

Output: Unchanged left lower lobe nodule compatible with an intrapulmonary lymph node.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fxr History: r/o fxr Mild cardiomegaly with at least one coronary artery stent in place.Mild blunting of the costophrenic angles compatible with scarring or small effusions.No visible fractures though a chest radiograph is not sensitive for rib fracture detection.

Output: Cardiomegaly with possible small effusions. No visible fractures.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: evaluate for infiltrate History: course lung sounds Moderate cardiomegaly. Small lung volumes.No obvious edema or pneumonia.

Output: No acute abnormality. Cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Lung cancer Persistent moderate to large right pleural effusion with underlying compression. The entire left lung and partially visualized right lobes appear grossly clear with compression on the rightMidline sternotomy and CABG clips

Output: Large right pleural effusion without significant interval change. Suspected underlying mass incompletely visualized


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Evaluate pleural effusion History: SOB Left subclavian dual-chamber ICD with leads overlying the expected location of the right atrial appendage and right ventricle. Median sternotomy wires and surgical clips overlying the left mediastinal margin suggesting CABG surgery. Partially visualized drain overlying the upper abdomen.Cardiac silhouette is at the upper limits of normal in size.Low lung volumes with question trace pleural effusions versus pleural thickening. Mild streaky left retrocardiac atelectasis. No pneumothorax.

Output: Low lung volumes with question trace pleural effusions versus pleural thickening. Otherwise, no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: chest tube History: empyema Right chest tube with no pneumothorax. Decreased inflation since the prior study. Slight increase in pulmonary opacities suggestive of edema and atelectasis.Status post TIPS.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: hx PUD, here with abdominal pain, evaluate for free air History: hx PUD, here with abdominal pain, evaluate for free air No significant cardiopulmonary abnormalities.No sign of free air in the abdomen.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: request by radiology for VQ scan History: request by radiology for VQ scan There is new right basilar opacity; the cardiomediastinal silhouette is again enlarged. Patchy bibasilar airspace opacities are nonspecific but are favored to represent pulmonary edema. A less likely consideration is pneumonia or aspiration. Faint septal thickening noted. Left-sided pleural effusion again noted. Right-sided pleural effusion likely worse. No pneumothorax.

Output: 1.Patchy multifocal airspace opacities are nonspecific; favor to represent pulmonary edema a less likely consideration is multifocal pneumonia or aspiration.2.Cardiomegaly, septal thickening, and bilateral pleural effusions are in keeping a diagnosis of congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.SBO. Abdominal pain and hematemesis. Normal heart size. No focal airspace opacities. Mild basal atelectasis. Possible small left pleural fluid collection.

Output: No signs of pneumonia. Mild basal atelectasis. Possible small left pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: ACS wu History: CP with pleuritic component Stable global cardiomegaly. ICD/pacemaker in place, with leads terminating in the right atrium and apex of the right ventricle.Normal lung volumes. Right lower lobe discoid atelectasis.Small right pleural effusion with right lateral and basilar pleural thickening. No pneumothorax.

Output: Right basilar pleural thickening with new small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.LVAD exchange POD 2 evaluate lung fields. Visualized hardware and devices similar in position.Lung volumes remain low.Mild atelectasis and vascular unsharpness suggesting mild edema.Minimal residual intraperitoneal air.Cardiothoracic ratio unchanged.

Output: No acute change in cardiopulmonary appearance. Low normal lung volumes with basal and dependent atelectasis and perhaps minimal edema.


Instruction: Generate impression based on medical findings.

Input: Reason: assess IABP position History: as above Balloon catheter marker in the descending aorta projected about 2 cm below the top of the aortic arch.Bilateral lower lobe subsegmental atelectasis, unchanged.

Output: Balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with large B cell non-Hodgkin's lymphoma. Exam was performed for research protocol. CHEST:LUNGS AND PLEURA: Bilateral apical scarring and calcified granulomas are again seen and unchanged. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: Reference subcarinal lymph node measures 0.5cm x 1.6cm (Image 40, Series 3), previously measuring 0.6cm x 1.6cm. Extensive atherosclerotic changes of the aortic arch and thoracic is again noted. CHEST WALL/OTHER: The thyroid is heterogenously enlarged with a small calcification in the lobe, unchanged from prior examination . ABDOMEN:LIVER, BILIARY TRACT: Within the limitations of a contrast enhanced exam,prominence of the intrahepatic vasculature is suggestive of diffuse fatty infiltration. SPLEEN: Absent spleen with only a visualized accessory spleen is again noted and unchangedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst is stable in size. Nonobstructing calculus in the right renal collecting system is again noted as well and not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat containing ventral hernia is noted.BONES, SOFT TISSUES: Sclerotic lesions in the bony pelvis are unchanged.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the bony pelvis are unchanged.OTHER: No other significant abnormality noted.

Output: Stable examination without new lymphadenopathy. Sclerotic bone lesions in the pelvis are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: CT daily CXR History: CT daily CXR Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly, mediastinal widening and pleural effusions, greater on the left with underlying atelectasis. No pneumothorax or other acute change.

Output: Stable cardiopulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.ARDS, evaluate for interval change ET tube tip is 3 cm above the carina. Enteric tube tip courses below the field-of-view. Right internal jugular central venous catheter tip is at the superior cavoatrial junction, unchanged.Cardiomediastinal silhouette with a tortuous aorta is unchanged.Diffuse bilateral interstitial and airspace opacities are not significantly changed since the prior exam. Small left pleural effusion is unchanged.No pneumothorax.

Output: Diffuse bilateral interstitial and airspace opacities with small left pleural effusion are not significantly changed since the prior exam.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with abdominal pain and history of colon cancer CHEST:LUNGS AND PLEURA: Index left upper lobe metastatic nodule has increased in size and now measures 8 x 8 mm on image number 48, series number 4. Other subcentimeter nodules are also increased in size. There are also new metastatic lesions in both lungs.MEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Bilateral renal scarring. Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Index retroperitoneal lymph node measures 7 x 8 mm on image number 118, series number 3, smaller compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size and number of lung lesions suspicious for metastatic disease.Minimally to the crease in the size of the reference retroperitoneal lymph node.Diffuse wall thickening of the bladder representing cystitis.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: ro pneumonia History: cough Cardiac size is within normal limits. Bibasilar and right hilar reticular opacities, favor chronic atelectasis/scarring. No significant pleural effusions. No evidence of pneumothorax.

Output: Bibasilar and right hilar reticular opacities, favor chronic atelectasis/scarring. However, without prior images, subtle changes cannot be evaluated. Recommend follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Cough The cardiomediastinal silhouette is unremarkable.No focal airspace opacity, significant pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality or significant interval change.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: Male, 69 years old.Reason: question of ETT position change History: ICU patient Lucency in the right hemidiaphragm unchanged, possibly a combination of fluid in the minor fissure and right pleural effusion rather than a pneumoperitoneum as none was confirmed on the recent decubitus view. Basilar opacities unchanged.ET tube tip approximately 4 cm above the carina.Dobbhoff tube terminates in the proximal duodenum.Right jugular catheters terminate at the SVC/artery junction level.IVC filter noted.

Output: Stable pulmonary opacities. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: eval for infiltrate History: wheezing Mild atelectasis left lung base periphery, otherwise unremarkable.Heart size normal.No reliable evidence of pneumonia.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with new diagnosis of acute cancer. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Biapical scarring.MEDIASTINUM AND HILA: Precarinal mediastinal borderline enlarged lymph node measuring 17 x 12 mm on image number 43, series number 5.CHEST WALL: Borderline enlarged, nonspecific axillary lymph nodes.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: Punctate left upper pole stone without evidence of hydronephrosis. 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: Enlarged, Leiomyomatous uterus with multiple fibroids, some of which demonstrating calcifications.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: Enlarged leiomyomatous uterus. Patient's known endometrial carcinoma could not be well seen in this enlarged uterus.Nonspecific borderline enlarged mediastinal lymph nodes and axillary lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Counts were correct. Worsening bilateral pulmonary opacities consistent with edema or ARDS. Subcutaneous emphysema in the right lateral chest wall. Skin staples overlie the chest. There are 5 chest tubes present. Endotracheal tube tip is approximately 4 cm above the carina. Swan-Ganz catheter is in the main pulmonary artery. Multiple surgical clips overlie the mediastinum. Cardiomediastinal silhouette cannot be evaluated on this radiograph. Counts were correct. No unexpected radiopaque foreign object.

Output: Worsening bilateral pulmonary opacities. No unexpected radiopaque foreign object. Discussed findings with resident in the OR. Findings were text paged to attending Dr. Wigfield.


Instruction: Generate impression based on medical findings.

Input: Reason: eval PTX History: PTX Persistent bilateral pneumothoraces, unchanged on the left and slightly decreased on the right, with underlying pulmonary interstitial opacity suggestive of edema and atelectasis.Bilateral chest tubes in place. Port catheter tip in the upper right atrium.

Output: Slightly decreased right pneumothorax and unchanged left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: ? Chest pain History: CM c CP; ? Volume The lungs and pleural spaces are clear. Heart size is within limits of normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Rule out pneumonia pneumonia, COPD exacerbation with history of shortness of breath. There is bilaterally decreased lung volumes and bilateral pleural effusions with underlying bibasilar atelectasis . The cardiac silhouette appears enlarged as on prior however difficult to evaluate due bibasilar pleural effusions.No pneumothorax.

Output: Bilaterally decreased lung volumes with bilateral pleural effusions and underlying atelectasis with or without consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: fever Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with mild basilar atelectasis and a small left pleural effusion, unchanged.No specific evidence of pneumonia.

Output: Basilar atelectasis and pleural effusion but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Check Pulmonary Status COPD History: Check Pulmonary Status COPD Stable cardiomediastinal silhouette.Low lung volumes. Basilar opacities compatible with atelectasis and effusions, similar in appearance to the prior exam. No new focal air space abnormality.

Output: Atelectasis and small pleural effusions, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Head and neck CA. Evaluate for aspiration or pneumonia. Fever and intermittent cough. Poorly defined right upper lobe suprahilar mass new from prior exam. Basal bronchial wall thickening and hazy opacities consistent with aspirated secretions and atelectasis. No pneumothorax. Normal heart size. Right jugular chest port tip at the SVC.

Output: Right upper lobe suprahilar mass new from 5/18/2016 and is favored to represent pneumonia. Mild basal opacities compatible with prior aspiration. Follow-up PA and lateral chest radiographs recommended in 6 weeks to assess for resolution and exclude alternate pathology.


Instruction: Generate impression based on medical findings.

Input: chest tube placement. Loculated right pleural effusion with right basilar pigtail catheter and right lateral chest tube, in which the associated side port appears external to the pleural interface and with small amount of chest wall emphysema as well as minimal iatrogenic hydropneumothorax. No significant decrease in right pleural effusion.Unchanged diffuse pulmonary nodules bilaterally. Distortion of the right lung with interstitial opacities, unchanged.

Output: The right chest drain may be advanced.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: Reason: r/o PNA History: cough, congestion, on prednison Unremarkable cardiac and mediastinal silhouette. Healed right rib fractures and pleural scarring at the right base.Large lung volumes consistent with COPD.No sign of pneumonia.

Output: COPD with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ? Chest pain History: ? Chest pain and cough -> ? PNA No significant cardiopulmonary abnormality.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: evaluate pneumothoraces, and cystic lung dx, thymic mass History: SOB Chest tubes are unchanged in position. The right pneumothorax is stable to marginally improved. The left pneumothorax is improved.Diffuse chronic cystic lung disease.

Output: Chest tubes are unchanged in position. The right pneumothorax is stable to marginally improved. The left pneumothorax is improved.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate ETT positioning History: see above Cardiomegaly with lower lung zone edema and left basilar atelectasis, unchanged.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter tip at cavoatrial junction.

Output: ET tube tip approximately 3 cm above the carina. Unchanged pulmonary opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Moderate to severe cardiomegaly, unchanged.No specific evidence of infection or failure.Left subclavian ICD, leads unchanged in position.No significant pneumothorax.

Output: Severe cardiomegaly. Uncomplicated recent ICD placement.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: S/P cardiac surgery History: S/P cardiac surgery Endotracheal tube tip 5 cm above the carina. Right IJ venous catheter tip in the SVC. Enteric tube tip in the stomach.Artificial heart. Perihilar opacities, right greater than left, and pleural effusions unchanged. No pneumothorax.

Output: Perihilar opacities, right greater than left, and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: fluid overload History: tachypneia, increased work of breathing Stable cardiomegaly with no change in basilar opacities.

Output: Stable cardiomegaly with small effusions and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with your pancreatic cancer. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Benign left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy. No evidence of recurrence. Post operative changes in the pelvis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Ill-defined fluid/soft tissue density adjacent to the right common iliac vein measuring 3 x 2.1 cm. This may represent postoperative changes or a lymphocele, however, follow-up imaging is recommended to exclude a neoplasm.

Output: Postoperative changes in the pelvis. Follow-up imaging is recommended to evaluate the right inguinal ill-defined soft tissue/fluid density.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: eval for pna, cough/chest congestion History: eval for pna, cough/chest congestion Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female 6 years old Reason: s/p left chest tube for empyema History: empyemaVIEW: Chest AP (one view) 5/6/2015 at 0613 hours. Right-sided chest tube is again noted. Subcutaneous emphysema is unchanged. Residual contrast material in bowel loops is again noted. Cardiac silhouette size is normal. Right-sided hydropneumothorax and right lung base opacity are unchanged.

Output: Persistent right-sided hydropneumothorax and right lung base opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: F/U ILD History: none The cardiomediastinal silhouette is unremarkable.There are decreased lung volumes with subpleural reticular opacities compatible with interstitial fibrosis.No focal areas of consolidation.No pleural effusions.Again noted are bilateral shoulder arthroplasties.

Output: No acute cardiopulmonary abnormality identified. Redemonstration of decreased lung volumes and subpleural reticulation compatible with interstitial fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old. No change in moderate cardiomegaly.Endotracheal tube tip approximately 3 cm above the carina.Right internal jugular catheter tip in the area of the right brachiocephalic vein. Additional new right internal jugular 6 venous catheter with tip in SVC.Small lung volumes with streaky opacities likely secondary to subsegmental atelectasis.No pneumothorax. Severe evidence of infection or edema

Output: No pneumothorax following line placement. Stable pulmonary findings with no specific evidence of infection or edema. Support devices stable as well.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Pulmonary edema History: Hypoxia and pink frothy sputum post extubation requiring re-intubation c/f negative pressure pulmonary edema Patchy interstitial and airspace opacities consistent with acute noncardiogenic edema or aspiration.Heart size normal.ET tube tip approximately 3 cm above the carina.

Output: Patchy interstitial airspace opacities consistent with noncardiogenic edema, hemorrhage or aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: Primary pulmonary hypertension. Large bilateral pleural effusions with underlying atelectasis and possibly edema.Nonspecific underlying pulmonary opacity compatible with edema and atelectasis.Tracheostomy tube unchanged.

Output: Pleural effusions with edema and atelectasis, and no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: weakness, hypotensive c/f infection History: weakness, hypotensive, c/f infection The cardiomediastinal silhouette is unremarkable.Minimal basilar scarring/discoid atelectasis.No focal areas of consolidation.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: r/o infiltrate History: h/o HIV w/ productive cough, SOB, and left-sided CP Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.Surgical clips are projected over the GE junction region.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval temporary pacemaker wire placement History: bradycardia, syncope Pacemaker lead extending at least to the right atrium, though its tip is not visible due to motion artifact.Mild atelectasis or scarring at the left base.No pneumothorax.

Output: Pacemaker lead extending to the area of the right atrium but not clearly visible.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: AM CXR for chest tube and left pneumo History: AM CXR Right chest tube unchanged in position.The cardiomediastinal silhouette is stable.There is a small right pneumothorax. The left pneumothorax has decreased in size, now small. Left basilar consolidation appears to have increased. Small bilateral pleural effusions.

Output: Small bilateral pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob Bilateral pleural effusions, greater on the left, with underlying consolidation and atelectasis, not significantly changed.Bilateral chest tubes and pleural drain, also unchanged. Catheter in the area of the right jugular vein and a second catheter from the right arm extending to the area of the SVC..NG tube tip projected over the lower mediastinum.

Output: Pleural effusion, atelectasis and consolidation with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Eval for Pulmonary edema vs signs of COPD ex History: Wheezing Unchanged pulmonary opacities suggestive of aspiration or edema with focal atelectasis.Heart size unchanged, normal.Cervical spine stabilization hardware.

Output: Unchanged pulmonary opacities suggestive of edema or aspiration with areas of focal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: s/p wedge resection. Assess pneumothorax and/or pleural effusions History: s/p wedge resection Left-sided chest tubes overlies the aortic knob medially.Cardiac silhouette is magnified likely within normal limits in size.Mild right basilar atelectasis and tiny left apical pneumothorax. No large pleural effusions.

Output: Tiny left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: Swan Ganz Placement History: Swan Ganz Placement Right IJ Swan-Ganz with its tip in the main pulmonary artery.Left-sided ICD unchanged.Stable cardiac enlargement.No new pulmonary opacities identified.

Output: Right IJ Swan-Ganz with its tip in the pulmonary artery. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male. Evaluate for pneumonia. Cardiomediastinal silhouette is within normal limits.No focal pulmonary consolidation or pleural effusion.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Cough and upper chest wall pain. Mild intermittent asthma. Rule out infection. Soft tissue artifact from the patient's axillae/upper extremities obscure visualization of the upper lobes and chest wall on the lateral radiograph, limiting evaluation. There is no visible abnormality in these areas on the frontal radiograph. Upper normal heart size, unchanged.No focal airspace opacity or pleural fluid.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: No visible acute pulmonary abnormality. Lateral radiograph is somewhat limited by soft tissue artifact.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.History of anasarca Cardiac silhouette stable in size.No pulmonary airspace opacities or pleural effusions. No pneumothorax. Healed right rib fracture.

Output: No acute cardiopulmonary abnormalities or significant interval change. No specific evidence of 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: Female, 79 years old.Reason: s/p arrest History: s/p arrest Severe leftward patient rotation makes detailed evaluation very difficult. No focal lung consolidation. Endotracheal tube terminates 3 cm from the carina. No large pleural effusion or pneumothorax.

Output: Severe leftward patient rotation makes detailed evaluation very difficult. No focal lung consolidation. Endotracheal tube terminates 3 cm from the carina.Consider repeat study.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: eval acute process History: resp distress Large lung volumes consistent with COPD.Upper lobe fibrosis and cyst formation may be a combination of sarcoidosis and emphysema.Heart size normal.

Output: Upper lobe fibrosis suggestion of sarcoidosis as well as emphysema. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.History of ICD placement Interval placement of a subcutaneous presternal ICD lead which projects to the left of midline. The ICD generator is partially imaged in the left chest wall soft tissues with adjacent subcutaneous air consistent with the recent procedure.Cardiomegaly unchanged.Left basilar subsegmental atelectasis/scarring. No pneumothorax.

Output: Interval placement of a subcutaneous ICD without acute 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: Male, 69 years old.Right pneumoperitoneum. History of nontraumatic pneumoperitoneum. Left side down decubitus view of the chest. Layering pleural fluid bilaterally, but no visible pneumothorax. Interstitial and airspace edema. ETT at the thoracic inlet level. Feeding tube projects over the stomach but the tip is off the caudal margin of the film.

Output: Pleural fluid and pulmonary edema, but no visible pneumothorax. If there is concern for pneumoperitoneum, a left side down lateral decubitus view of the abdomen may be of use if required.


Instruction: Generate impression based on medical findings.

Input: 42 years old Male. Reason: assess for PNA, effusions History: h/o CHF (RV failure), ?hypoplastic left lung. ET tube tip is proximally 4 cm above the carina. Enteric feeding tube sidehole is in the proximal stomach. Severe cardiomegaly and markedly dilatation of the central pulmonary arteries compatible with pulmonary artery hypertension is again seen. Nonspecific basilar and questionable retrocardiac opacities may represent layering pleural effusion/atelectasis.

Output: Severe cardiomegaly and marked dilatation of the central pulmonary arteries, compatible with pulmonary hypertension and heart failure. Nonspecific and retrocardiac opacity may represent layering effusion/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: MaleReason for Study: Reason: overload History: SOB Right central venous catheter with its tip in the SVC.Stable cardiomediastinal silhouette. Right lung dense peripheral opacity suggestive of chest wall or extrapleural hematoma.The left lung is clear.

Output: No peripheral right lung opacity may represent a pleural/extrapulmonary hematoma and/or loculated pleural effusion. Recommend CT of the chest for further evaluation.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with history of emphysema/COPD with right upper lobe lung nodule seen on CT from 3/9/2009 and PET from 3/26/2009 CHEST:LUNGS AND PLEURA: Previously-noted, irregular nodular opacity in right upper lobe is now a more organized cluster of smoothly-marginated nodules. The nodules are slightly smaller on current study. No abnormality is seen at this location on review of CT chest from Northwestern Memorial Hospital. Findings likely represent an evolving inflammatory process.Previously seen, 6-mm right upper lobe nodule (series 6, image 29) is stable on comparison to prior study. Atelectatic changes in the right middle lobe and left upper lobe also stable. Severe centrilobular emphysema unchanged.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: Endplate depression again seen superiorly at T10.UPPER ABDOMEN: No significant abnormality noted.

Output: Evolving right upper lobe nodular opacity is more consistent with an inflammatory process than with neoplasm, given slight decrease in size and change in configuration; however, in light of the recent positive PET findings, continued follow up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Patient with new onset productive cough, dyspnea, history of lymphoma with lung disease, eval for Pneumonia History: see above Left subclavian port catheter remains unchanged.Cardiac silhouette is again normal in size.Stable to slight increase in right-sided pleural and fissural nodular thickening.In addition, there is increase haziness of the right lung with prominent interstitial markings which appear grossly unchanged.

Output: Limited evaluation of the right hemithorax given underlying disease with no definitive evidence of new pneumonic consolidation.


Instruction: Generate impression based on medical findings.

Input: Heart failure Unchanged Swan-Ganz extending into the right pulmonary flow tract from an inferior approachMarked nonspecific cardiomegaly with otherwise clear lungs. ICD unchanged

Output: Swan-Ganz unchanged in position


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Reason: Shortness of breath History: SOB The cardiomediastinal silhouette is normal.Mild peribronchial thickening. No focal airspace opacity, pleural effusion or pneumothorax.

Output: Mild peribronchial thickening can be seen with asthma or chronic bronchitis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p 2/20 Ivor-Lewis esophagectomy with distal esophageal and proximal resection of the stomach, Laparoscopic laparotomy and thoracotomy approach,Mediastinal lymphadenectomy, feeding jejunostomy History: follow up Moderately large left pleural effusion, unchanged or possibly increased compared to previous.Minimal right apical pneumothorax, decreased from previous and mild residual right basilar atelectasis, also improved.Retrocardiac opacity compatible with recent esophagectomy.

Output: Moderately large left pleural effusion and minimal right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: bilateral effusion History: bilateral effusions Iatrogenic devices are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in diffuse pulmonary opacities. Small pleural effusions. No pneumothorax. Unchanged cardiomegaly.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in diffuse pulmonary opacities, presumably edema.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate History: sob Mild cardiomegaly with vascular redistribution.Mild basilar opacities consistent with edema and atelectasis, not significantly changed.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old, with metastatic head and neck cancer to the lung status post chemotherapy. CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules and masses have increased in size. A reference right upper lobe lesion measures 3.8 x 4.1 cm on axial image 39, series 5, compared to 2.4 x 3.4 cm on the prior exam. Scattered right-sided interstitial and groundglass opacities are grossly stable and may represent post therapy change or lymphangitic tumor spread.MEDIASTINUM AND HILA: Postoperative change status post anterior neck dissection. Within the limits of this noncontrast examination, no pathologically enlarged hilar or mediastinal lymph nodes are seen.The cardiac size is mildly enlarged. No pericardial effusion. Aortic and coronary artery atherosclerotic calcifications are seen.CHEST WALL: Spinal degenerative disease.ABDOMEN: Within the limitations of a noncontrast examination, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild spinal degenerative disease.OTHER: No significant abnormality noted

Output: Progression of disease in the chest.


Instruction: Generate impression based on medical findings.

Input: Evaluate ETT, lung fields. A. Fib ablation. Endotracheal tube tip at the level of the carina and has been removed on a subsequent radiograph.Right jugular introducer terminates at the level of the right brachiocephalic vein. Left chest tube tip at the apex. Right basal chest tube tip projects medially near the cardiophrenic angle. A left atrial appendage clip is present.No visible pneumothorax. Basal atelectasis and pleural fluid bilaterally as expected. Subcutaneous emphysema left chest wall. Signs of mild hypervolemia.

Output: Low endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of malignant melanoma CHEST:LUNGS AND PLEURA: 3-mm right middle lobe nodule image number 57, series number 5, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Postsurgical changes in the right axilla.ABDOMEN:LIVER, 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: 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 notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Left lower lobe consolidation NG remains well advanced, tip projects into the distal stomach and/or possibly the pylorus. Interval removal of the left subclavian catheter. No associated complicationSmall lung volumes persist with mild retrocardiac opacities and suspected atelectasis. No new superimposed focal changes.

Output: Left subclavian catheter removed


Instruction: Generate impression based on medical findings.

Input: Reason: pulmonary edema History: Hypoxia Diffuse airspace and interstitial opacity compatible with edema with moderate pleural effusions, not significantly changed.No new findings.

Output: Pulmonary edema and pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: 83-year-old female with syncope. Evaluate for cardiopulmonary disease. Cardiomediastinal silhouette is within normal limits.Mild, nonspecific basilar scarring/atelectasis, unchanged.Vascular calcifications are noted.

Output: No acute cardiopulmonary abnormality without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for signs of pneumonia History: SIRS Cardiopulmonary monitoring and support devices, unchanged. Basilar opacity, greater on the left, consistent with atelectasis and consolidation, unchanged.Probable small bilateral pleural effusions.No new findings.

Output: Persistent left lower lobe atelectasis likely related to aspirated secretions and mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: s/p intubation, possible tracheal trauma from NG tube placement History: above Worsening basilar opacities with an enlarging right pleural effusion, consistent with basilar edema and superimposed right lower lobe pneumonia or aspiration.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.SVC stent unchanged.

Output: Worsening right basilar opacity and enlarging right pleural effusion consistent with infection or aspiration, with underlying edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: chest pain History: chest pain No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: aspiration pneumonia History: hypotension Cardiomegaly with bilateral airspace and interstitial opacities suggestive of edema and possibly aspiration with small pleural effusions, not significantly changed.Catheter projected over the lower mediastinum, unchanged.No new findings.

Output: Extensive pulmonary opacity compatible with edema and aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: eval for treatment response History: legionella pna affecting LLL No change in left lower lobe pneumonia.Heart size normal.No effusion. No pneumothorax.

Output: No change in appearance of left lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with history of breast cancer. CHEST:LUNGS AND PLEURA: Scattered bilateral micronodules, some of which are calcified, nonspecific.MEDIASTINUM AND HILA: Minimal pericardial effusion.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: 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: 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: Nonspecific scattered bilateral micronodules, some of which are calcified.


Instruction: Generate impression based on medical findings.

Input: Reason: icu History: Mitral insufficiency. Cardiomegaly with pulmonary edema, atelectasis and effusions, unchanged.Tracheostomy tube and pacemaker lead also unchanged.PICC tip in the area of the left subclavian vein.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Status post CABG POD 1. Interval removal of right jugular introducer. Other hardware and devices similar in position. Trace left apical pneumothorax. Small to moderate pleural effusions, basal edema and atelectasis appear to be improving.

Output: Improving hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Prostate cancer presents with fever, chills, cough. Chest x-ray with ill-defined mass CHEST:LUNGS AND PLEURA: 3.3 x 2.9 cm ill-defined mass in the right upper lobe consistent with bronchogenic carcinoma.Diffuse emphysematous changes. Eight by 7-mm ill-defined nodule in the right middle lobe suspicious for metastatic disease.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 9-mm hypodense lesion in the lateral aspect of the left lobe, etiology is unknown. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal stones with calyectasis of the lower pole collecting system. Bilateral extrarenal pelvis. Bilateral parapelvic and cortical cysts.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 2.8-cm in largest AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral inguinal hernias containing small amount of fluid on the right, a small amount of fluid and non- obstructing bowel segments on the left.PELVIS:PROSTATE, SEMINAL VESICLES: Multiple radiation pellets in the enlarged heterogeneous prostate causes them with patient's known history of prostate cancer.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: Right upper lobe mass crosses the bronchogenic carcinoma. Right middle lobe spiculated lesion.Right nephrolithiasis and lower pole caliectasis.Emphysema.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male history of head and neck cancer. CHEST:LUNGS AND PLEURA: Few scattered micronodules, some of which are calcified, unchanged. No new lesions or evidence of pulmonary metastases.MEDIASTINUM AND HILA: Index superior right paratracheal lymph node (series 3 image 9) measuring 14 x 9 mm of apparent previously 15 x 10 mm). Left paratracheal lymph node at the same level with interval decrease in size.No significant mediastinal or hilar adenopathy.Extensive coronary artery calcifications with minimal pericardial fluid.CHEST WALL: Tracheostomy tube in place. Right Port-A-Cath tip in the SVC/RA junction.Few subcentimeter sclerotic lesions in the ribs, likely represent benign bone islands, unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate, nonobstructing bilateral nephrolithiasis, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube inflated within the gastric lumen. Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease. Few upper paratracheal borderline enlarged lymph nodes, decreased in size.


Instruction: Generate impression based on medical findings.

Input: 21 years old Male. Reason: Patient with sickle cell disease and hypoxia, please evaluate for infiltrate, ?acute chest History: Hypoxia. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Basilar streaky opacities, suspicious for scar or atelectasis. The cardiac silhouette is borderline enlarged.

Output: Borderline cardiomegaly and streaky opacities in both lower lungs, which may represent scar or atelectasis. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: chronic cough, hx of metastatic thyroid ca, r/o PNA or mets History: chronic cough Unremarkable cardiac and mediastinal silhouette.Surgical clips in the thyroid bed.No significant pulmonary or pleural disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: tube placement History: as above The ET tube has been advanced and now overlies the mid trachea, in adequate position. Stable adequate position of additional support apparatus.Persistent low lung volumes and left basilar subsegmental atelectasis. Possible trace left pleural effusion. No pneumothorax.

Output: Adequate repositioning of ET tube.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Bilateral perihilar opacities with associated bronchial changes compatible with bronchiectasis and bronchitis. No definite distinct superimposed focal air space process, no specific evidence of edema. Cardiac and mediastinal contours are otherwise within limitsNo effusions. Extensive numerous scattered bilateral healed rib fractures and deformity

Output: Bilateral perihilar bronchial changes compatible with bronchiectasis and bronchitis.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: cough and drooling Small to moderate right pneumothorax visible on both at the lung base and apex. This has enlarged on a subsequent radiograph.Moderate left pleural effusion with underlying atelectasis.Moderate cardiomegaly, unchanged.

Output: Moderate right pneumothorax and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion again degrades sensitivity.Similar cardiopulmonary appearance and equipment. LVAD, ICD, tracheostomy tube, and Dobbhoff are all similar. A new NG tube has been placedDecreased lung volumes with bilateral moderate to large pleural effusions greater on the right with underlying compression atelectasis in probable edema similar to prior

Output: NG tube placed


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: assess causes for syncope History: left ventricular assist device (end stage heart failure) Left-sided ICD and LVAD unchanged.Stable cardiac enlargement and decreased lung volumes.Left basilar atelectasis and pleural thickening/effusion similar to prior exam.No focal areas of consolidation.Median sternotomy is intact with evidence of a prior CABG.

Output: No significant interval change without evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: ho cardiac arrest, intubated History: - Unchanged pleural effusions but increasing left lower lobe consolidation.Increasing basilar edema.Right jugular catheter, tip in SVC.ET tube tip approximately 1 cm above the carina.Right chest wall drain.

Output: Worsening pulmonary opacities. Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Eval for Pneumothorax History: S/P Chest tube removal Improvement in upper lobe edema like opacities, but new basilar atelectasis.Chest tubes been removed with no pneumothorax.Right jugular Swan-Ganz catheter removed.

Output: New basilar subsegmental atelectasis but no pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Swan History: Swan Cardiomegaly.No specific evidence of infection or edema.Unchanged tubes and devices, the Swan-Ganz catheter tip in the right interlobar pulmonary artery.

Output: No change in tubes and devices, or cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for PTX, acute cardiopulmonary process History: R sided pleuritic chest pain x1 day Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: Preop MAZE History: Preop MAZE Moderate cardiac enlargement unchanged from the prior exam.Lungs are clear.No pleural effusions.

Output: Persistent cardiac enlargement without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval pulmonary edema History: eval pulmonary edema Stable position right IJ central catheter.Septal lines are no longer visible. Nodular opacity projects over the anterior left fifth rib which was not visible on prior radiograph. Recommend dedicated PA energy subtracted radiograph for further evaluation. Heart size is upper limits of normal, stable.

Output: Resolution of pulmonary edema. Energy subtracted PA radiograph recommended to further characterize a nodular opacity not previously visible.


Instruction: Generate impression based on medical findings.

Input: Age: 35 yearsGender: FemaleReason for Study: Reason: SLE pt with severe rib pain on R posterior ribs History: tender chest wall R posterior ribs The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: evaluate for infection, volume overload History: chest pain, dyspnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Chest pain Given differences in technique, no definite discrete cardiopulmonary abnormality.

Output: No distinct acute abnormality given differences in technique


Instruction: Generate impression based on medical findings.

Input: 69-year-old female with history of ovarian cancer status post Avastin therapy CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Mildly enlarged main pulmonary artery, unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific, subcentimeter hypodense lesions in the liver are stable. Cholelithiasis without cholecystitis or biliary dilatation, stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodense lesions in both kidneys, likely representing cysts, unchangedRETROPERITONEUM, LYMPH NODES: Atherosclerotic disease involving the aorta and its main branches, stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.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: Asymmetric Presacral soft tissue density on the left side of the rectum is unchanged from previous study. Its etiology and significance is unknown. This soft tissues unchanged from preoperative CT dated 3/25/2011.

Output: No significant change from previous study. No definite evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: eval for pathology History: wheezing, h/o melanoma Pulmonary metastases ranging in size from less than 1 cm to nearly 10 cm.No evidence of superimposed edema or pneumonia.Heart size normal.Right jugular catheter, tip in SVC.

Output: Pulmonary metastases. No acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Pneumonia vs other lung pathology History: Prolonged productive cough, SOB, chest tightness, congestion Small lung volumes.Elevated right hemidiaphragm.No focal opacity, pleural effusion, or pneumothorax.Patchy bibasilar opacities, likely atelectasis.

Output: No evidence of pneumonia; bibasilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.SOB recent DVT, evaluate for PE Mild cardiac enlargement with enlarged pulmonary arteries but no evidence of edema or pleural effusions. No specific evidence of infection.Left IJ catheter tip in the SVC.

Output: Mild cardiac enlargement and enlarged pulmonary arteries consistent with severe pulmonary arterial hypertension confirmed on recent CT.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p TECAB History: s/p TECAB Unremarkable cardiac and mediastinal silhouette. Mild residual blunting of the left posterior costophrenic angle, consistent with small effusion or scarring.Interval resolution of basilar atelectasis.

Output: Very small residual left effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: chest pain, recent pericardial drain placed History: chest pain, recent pericardial drain placed Pericardial drain is identified. Decreased lung volumes stable cardiac enlargement/pericardial effusion. Nonspecific basilar opacities compatible with atelectasis.No focal areas of consolidation.No pleural effusions.

Output: Stable cardiac enlargement/pericardial effusion with pericardial drain in place. Mild nonspecific basilar opacities compatible with atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: 70yo F w/ congestion, cough, eval for PNA History: as above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild disc degeneration.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Left hemithorax pleural thickening and volume loss compatible with clinical history of mesothelioma. Reference measurements as follows:1. The level of the aortic arch (image 36): Unchanged at 9-mm at the 4 o'clock position. Unchanged at 10-mm at the 11 o'clock position.2. At the level of the left main pulmonary artery (image 48): Unchanged at 7-mm at the 3 o'clock and unchanged at 7-mm at the 7 o'clock position.3. At the level of the pulmonary venous confluence (image 71): Unchanged at 7-mm at 4 o'clock, and unchanged at 6-mm at 7 o'clock.Nodular tumor involving the visceral pleura is noted on the left, unchanged. Also stable small left pleural effusion.MEDIASTINUM: Tumor extends into the epicardial and mediastinal fat.CHEST WALL: Large, heterogeneous left thyroid lobe which has ill-defined borders on some of the images, suspicious for underlying neoplasm. This extends cranially off the superior field-of-view. For reference, this measures 5.1 x 4.2 cm (image 14/175), unchanged.UPPER ABDOMEN

Output: 1. Stable disease with unchanged reference measurements as above. 2. Stable right thyroid mass.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Productive cough. No acute cardiopulmonary abnormalities.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lung fields History: s/p cardiac surgery Interval removal of aortic balloon catheter. Other cardiopulmonary devices, unchanged.Small lung volumes with diffuse opacity compatible with edema, atelectasis and pleural effusions.

Output: Postoperative edema, atelectasis and effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: Areas of uptake? History: thyroid cancer s/p surgery and I131 There is a questionable small focus of increased activity in the right mediastinum, seen only on the anterior view. A small artifactual focus of activity in the left pelvis resolves with removal of the patient's clothing. There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. No increased activity consistent with functioning thyroid tissue is seen.Probe uptake of the neck is 0.12%.

Output: Questionable small focus of increased activity in the right mediastinum seen only on the anterior view, for which continued follow up is recommended. Otherwise no convincing evidence of functioning thyroid tissue.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: listed for OHT with bivad, CTs in place History: asx Interval decrease in right pleural effusion with some residual fluid extending into the fissure. Left pleural effusion also decreased. Support hardware unchanged. No evidence of significant pneumothorax.

Output: Interval decrease in right pleural effusion with some residual fluid extending into the fissure. Left pleural effusion also decreased.