Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: eval for pacemaker placement History: chest pain/sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right subclavian dual chamber ICD, leads in appropriate position.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and cough. Vomiting without nausea Patchy densities in both bases with small to moderate effusions observed bilaterally. Borderline cardiomegaly.Single right jugular port extends into the SVC near the RA junction

Output: Nonspecific patchy and streaky densities in both bases with small effusions, likely minimal CHF with atelectasis.


Instruction: Generate impression based on medical findings.

Input: Cough Minimal basilar atelectasis and/or scarring without discrete superimposed new airspace or interstitial abnormalities. No effusions. Lungs well-expandedCardiac and mediastinal contours are unremarkable other than mild atherosclerotic disease, unchanged

Output: Minimal atelectasis and/or basilar scarring


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Right upper quadrant pain rule out pneumonia. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. No free intraperitoneal air is appreciated.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old, with shortness of breath and chest pain. PULMONARY ARTERIES: Technically adequate exam. No evidence of pulmonary embolus.LUNGS AND PLEURA: Predominantly bibasilar subsegmental atelectasis or scarring. Scattered pulmonary cystic structures. Mild bronchial wall thickening may reflect chronic aspiration or bronchitis.Left upper lobe calcified micronodule likely represents prior granulomatous disease. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Mild cardiomegaly. No pericardial fluid. No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No pulmonary embolus. Other nonspecific findings as above.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: Gift of Hope Tracheostomy tube remains in place. Right IJ line again noted, not substantially changed. Diffuse pulmonary opacities again noted. Pleural effusions, as before. Difficult to assess heart size.

Output: Diffuse pulmonary opacities again noted. Pleural effusions, as before.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: chest tightness and cough History: productive cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Surgical clips overlie the low neck region.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 21 years, Female. Reason: concern for sbo vs other cause of upper abdominal pain in pt with hx of sbo x 3 History: midline upper abdominal pain with tympany on exam Large colonic stool burden without evidence of bowel obstruction. No free intraperitoneal air. Scattered intraabdominal surgical clips.No acute cardiopulmonary abnormality.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Reason: pulmonary edema, pneumonia History: hypoxia Cardiomegaly status post median sternotomy.Mild basilar interstitial edema with small pleural effusions noted.No specific evidence of infection.Right jugular catheter, tip in SVC.Prior right thoracotomy.

Output: Cardiomegaly with mild edema and small pleural effusions, but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Femoral line placement. 16-week-old former 27 week gestational age patient with history of chylothorax.VIEWS: Chest and abdomen AP (two views) 03/14/15, 1431 Endotracheal tube tip is in right mainstem bronchus. Feeding tube tip is in gastric body. Left chest tube is in place. Left lower extremity central line tip is in right atrium.Soft tissue edema persists. Coarse bilateral lung opacities are seen. Small right pleural effusion is noted. Mediastinum appears slightly shifted to the right.Gas is present in the stomach. Very little distal gas is identified.

Output: Right mainstem bronchus intubation. Small left pleural effusion. Changes from chronic lung disease. Paucity of bowel gas.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval for acute pathology History: acute chest pain, dyspnea Study limited by leftward patient rotation. No focal lung consolidation or overt left-sided heart failure. No large pleural effusion or pneumothorax. Heart size is likely normal. Patient status post cholecystectomy.

Output: No acute cardiopulmonary process on radiography, given limitation, as above.


Instruction: Generate impression based on medical findings.

Input: Female; 61 years old. Reason: Cardiomegaly, pleural effusions? History: SOB, dyspnea on exertion Normal heart size. Stable calcified right paratracheal lymph node, likely due to prior granulomatous process.Mild streaky left basilar opacities, most likely due to subsegmental atelectasis and/or scarring. No specific evidence of infection or edema.Median sternotomy changes.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluation of small pleural effusion noted on limited echo History: SOB Basilar fibrosis with honeycombing unchanged. Minimal pleural effusions versus pleural scarring.Mild cardiomegaly.

Output: Basilar fibrosis, without significant sized pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: intubated, s/p pneumothorax History: pneumothorax s/p chest tube Trace less than 5-mm right apical pneumothorax.Bilateral air space opacities, improving in some areas. Persistent retrocardiac consolidation. Improving right chest wall subcutaneous emphysema. Other tubes and lines unchanged in position.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: 69-year-old female for evaluation of post procedural pneumothorax. Stable moderate right apical pneumothorax with the apex of the lung about 2.5 cm from the chest wall. No significant interval change of the moderate right pleural effusion. No focal consolidation. Port-A-Cath tip remains in the SVC. There is a small air-fluid collection at the GE junction, presumably a small hiatal hernia.

Output: No significant interval change of the right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: s/p chest tube removal; ?PTX History: SOB Chest tubes been removed and there is no pneumothorax although pleural effusions persist, small, with adjacent atelectasis.Left lower lung zone consolidation has significantly improved.Heart size upper normal status post median sternotomy.Left subclavian pacemaker, leads unchanged in position.

Output: Chest tube removal with no pneumothorax, and improvement in basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with malignant spindle cell tumor. CHEST:LUNGS AND PLEURA: Previously mentioned nodule in the lingula is larger now measuring 15 x 13 mm image number 56, series number 4. He show nodule in the left upper lobe is also larger now measuring 8mm in diameter on image number 27, series number 4. Multiple other nodules are also increased in size within the internal.MEDIASTINUM AND HILA: 3 cm thyroid nodule on the right side is unchanged. Subcentimeter mediastinal and hilar lymph nodes, some of which are calcified are unchanged. Reference subcarinal lymph node measures 13 x 9 mm, unchanged on image number 44, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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: Interval increase in the size of the lung metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: evaluate for aspiration pneumonia History: fever to 100.8 in patient with inflammatory myositis Mild basilar atelectasis, which may be the result of aspirated secretions or mucous plugging.A Dobbhoff tube terminates in the stomach.

Output: A Dobbhoff tube terminates in the stomach. Basilar atelectasis which may be the result of aspirated secretions or mucous plugging. No large pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: swan in place History: swan in place Left IJ Swan-Ganz with its tip in the pulmonary artery.Right IJ central venous catheter with its tip in the SVC.Redemonstration of a left pneumonectomy.The right lung is clear.

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


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited by field of view and range of coverage.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted in the extracardiovascular portions of the examination.


Instruction: Generate impression based on medical findings.

Input: Reason: Cardiogenic shock History: - Complete opacification of the left hemithorax compatible with pleural effusion and atelectasis.Swan-Ganz catheter tip in a relatively peripheral branch of the left pulmonary artery.Right jugular catheter, tracheostomy tube and ECMO cannula, unchanged.NG tube doubled back in the stomach.

Output: Complete opacification of the left hemithorax consistent with effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: Is there LLL opacity? History: PNA Continued interval improvement in previously described left basilar atelectasis, now only faintly appreciable. No new pulmonary opacities are evident. No pleural effusions.

Output: Near complete resolution of left basilar atelectasis, with residual scarring, presumably postinfectious. This can be followed by PA and lateral chest radiographs in 3 months if clinically warranted or if patient has a history of smoking.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Right pneumothorax, status post chest tube placement Venous catheter unchanged. Interval placement of right basilar chest tube. NG tube in the stomach. Endotracheal tube tip 4 cm above the carina. Right apical pneumothorax is unchanged. Stable cardiac silhouette. Diffuse pulmonary opacities are unchanged. No large effusions.

Output: Interval placement of right basilar chest tube with persistent right pneumothorax and diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: chest pain History: chest pain Lungs and pleural spaces are clear. Heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ET tube placement History: ET tube placement Unchanged interstitial opacities and radiation fibrosis.Heart size normal.ET tube tip at least 7 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Unchanged interstitial opacities and radiation fibrosis. High ET tube, subsequently corrected.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p intubation History: dyspnea Small lung volumes with basilar edema and pleural effusions.Unchanged cardiomegaly.ET tube tip approximately 5 cm above the carina.Bilateral jugular catheters terminate in the SVC.A Dobbhoff tube extends below the lower margin of the image.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 38 yearsGender: MaleReason for Study: Reason: eval lung fields History: eval lung fields Support devices unchanged with ET tube tip 9 cm above the carina.Stable cardiomediastinal silhouette.Pleural effusions and basilar atelectasis/edema similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip in a high position 9 cm above the carina. Stable cardiopulmonary appearance with pleural effusions and basilar atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: is there pul edema History: leg edema bilateral 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: Female, 34 years old.Epigastric pain. Dysphagia. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. There is no airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: routine CXR for CT ICU post-op patient History: routine CXR for CT ICU post-op patient Small lung volumes with basilar opacities consistent with atelectasis and effusions.Right jugular catheter, pacemaker leads and mediastinal and pleural drains unchanged.Increased opacity at the left apex may be due to loculated pleural fluid or an extrapleural hematoma.

Output: 1. Basilar atelectasis and pleural effusions with no significant change.2. Possible left apical hematoma versus loculated effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Persistent cough. The cardiomediastinal silhouette is normal. There is no focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: Evaluate for metastatic disease. History: History of Ewings Sarcoma The cardiomediastinal silhouette is normal.There is minimal scarring at the right apex, otherwise no focal pulmonary opacities, or pleural effusions.

Output: No abnormal radiographic findings to explain patient's symptoms.Of note, conventional radiographs are limited for the assessment of noncalcified pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Esophagectomy Postsurgical changes appear similar with the NG tube again projecting towards the distal neoesophagus.Continued mild improvement with shifting patchy mixed interstitial and airspace opacities, specifically improvement in the right upper lung since prior study. Small effusions

Output: Shifting opacities representing suspected changes in post obstructive atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: Weakness, IS, Eval pna History: above Prominent right nipple shadow, the lungs otherwise unremarkable. This could be confirmed by a repeat study with nipple markers.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Status post left lung transplant. Chronic interstitial opacities with volume loss in the right lung similar to the prior exam.Increasing right mid lung focal opacity is noted on recent CT and may represent infection although neoplasia can't be excluded.Increasing interstitial and airspace opacities in the left lung again suggestive of infection or aspiration.Left CP angle not well enough visualized to evaluate pleural effusion.No evidence of a pneumothorax.

Output: 1.Chronic interstitial disease in the native right lung with focal right infrahilar opacity slightly more prominent than prior exam and probably increased from exam dated 11/6/2014 raises the question of possible underlying neoplasm.2.Interstitial and patchy airspace opacities in the left lung increased from the prior exam may represent aspiration .3.No evidence of a pneumothorax post procedure.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: eval lung fields History: s/p LVAD Iatrogenic devices are unchanged. Improvement in bibasilar opacities. Small pleural effusions, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: eval lung fields History: cp No focal opacity, pleural effusion or pneumothorax. Normal cardiomediastinal silhouette.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Right chest and rib pain no trauma. Upper normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.Exuberant costochondral cartilage calcification bilaterally, atypical for age.Subtle bronchial wall thickening and linear opacities in the lower lobes suspicious for bronchiolitis.

Output: 1. Faint basal opacities suspicious for bronchiolitis. This may indicate aspirated secretions in the absence of clinical signs of viral pneumonia.2. Exuberant costochondral cartilage calcification, atypical for the patient's age. This may be seen with metabolic abnormalities and has been described in hyperthyroidism and porphyria.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: eval lung fields History: s/p CABG Right IJ sheath and bilateral chest tubes unchanged. No appreciable pneumothorax.Small bilateral pleural effusions, probably increased.Unchanged retrocardiac consolidation/atelectasis.Unremarkable cardiomediastinal silhouette.

Output: Unchanged retrocardiac consolidation/atelectasis and small bilateral effusions.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Minimal right basilar scarring without additional cardiopulmonary abnormality. Persistent minimally decreased lung volumes. Cardiac and mediastinal contours are within limits

Output: Minimal atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above No significant cardiopulmonary abnormality.No evidence of metastases. Moderate thoracolumbar scoliosis.

Output: No evidence of metastases, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of urothelial cancer status post cystectomy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined hyperdense heterogeneous area in the left lobe of the liver superiorly measuring 14 x 10 mm number 88, series number 3 is better seen on today's study and may represent an extension of the vessel or possibly focal lesion which is more likely benign. No other focal lesions in the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderate left sided hydronephrosis with dilated ureter new from previous CT. The right kidney is unremarkable.RETROPERITONEUM, 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: Not visualized. Neobladder is unremarkable.LYMPH NODES: Bilateral small inguinal lymph nodes are unchanged or smaller.BOWEL, MESENTERY: Previously described postoperative changes around the vessels have completely resolved.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New left-sided hydronephrosis and hydroureter. Left ureter is dilated throughout its course.Previous described postoperative changes in the pelvis nearly completely resolved.Heterogeneous hyperdense area in the left lobe of the liver near the dome is better seen on the current study. The etiology is more likely to be benign. MRI of the liver may be obtained if further characterization is clinically indicated. l


Instruction: Generate impression based on medical findings.

Input: Female 59 days old Reason: ex 29 wk female, on oscillator with recurrent bilateral atelectasis, eval for resolution following repositioning History: recurrent bilateral atelectasisVIEW: Chest AP (one view) 9/7/2015 at 0634 hours. ET tube, right-sided chest tube, central line, NG tube and gastrostomy are again noted and unchanged.Cardiac silhouette size is top normal but stable. Multifocal opacities of the right upper, left upper, right middle lobe and left lower lobe are noted.

Output: Worsening in multifocal opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: iabp placement, effusion History: iabp placement, effusion Catheter tip in the SVC.Balloon catheter marker at the level of the aortic arch, unchanged.Pleurx catheter projected over the right lung base.Skinfolds over the left apex but no pneumothorax.Cardiomegaly with mild basilar interstitial edema and small pleural effusions.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with chronic lymphoid leukemia in remission CHEST:LUNGS AND PLEURA: No significant abnormality.MEDIASTINUM AND HILA: Reference left paratracheal lymph node measures 17 x 12 Billiter image number 21, series number 3, not significantly changed. Other mediastinal lymph nodes are also unchanged.CHEST WALL: Bilateral axillary adenopathy. Referenced right axillary node measures 10 x 7 mm image number 20, series number 3. Stable from previous study.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific punctate hypodense lesions are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Presumed simple renal cysts are unchanged. RETROPERITONEUM, LYMPH NODES: Referenced portacaval lymph node measures 21 x 18 mm in image number 99, series number two, unchanged. Other retroperitoneal lymph nodes are also unchanged.BOWEL, MESENTERY: Stable his enteric adenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Referenced right obturator lymph node measures 3.1 x 1.6 cm, minimally enlarged. Other pelvic enlarged lymph nodes are stable.BOWEL, MESENTERY: Previous described wall thickening of the cecum has improved.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from the previous study other than minimal enlargement of the referenced right obturator lymph node.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: re-eval L pleural effusion, eval for worsening PNA and pulmonary edema vs atelectasis History: fever, L pleural effusion, chest pain Cardiomegaly with left lower lobe consolidation.Small lung volumes with an edema pattern consistent with CHF or aspiration.

Output: Cardiomegaly with pulmonary opacities suggestive of edema and/or infection in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male; 66 years old. Reason: 66yoM, high risk for COPD and CAD, new DOE History: as above Large lung volumes suggestive of COPD. No abnormal pulmonary opacities or pleural effusions. Normal heart size.

Output: COPD but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Mild pulmonary edema. No focal consolidation or significant pleural effusion.MEDIASTINUM AND HILA: Few prominent mediastinal and hilar lymph nodes, for example a right hilar lymph node measures 11 mm in short axis (series 4, image 209). No other significant abnormality noted in the extra cardiovascular portions of the mediastinum. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Mild pulmonary edema. Prominent mediastinal lymph nodes, may related to edema.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: intubated, assess progression of bilateral opacities History: as above Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Small pleural effusions, as before. Unchanged heart size. No pneumothorax.

Output: Unchanged diffuse pulmonary opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: ett placement History: see above No significant pulmonary or pleural abnormality.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 6 cm above the carina. No significant pulmonary or pleural abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Pretracheal adenopathy is unchanged measuring 19 by 9-mm image number 39, series number 4. This adenopathy could not demonstrate significant uptake on the previous PET CT exam.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal stone and mild right-sided caliectasis are unchanged. Left double J stent is placed within the internal.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter retroperitoneal lymph nodesBOWEL, 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: Right obturator adenopathy measuring 2.2 x 1.7 cm image no 196, series number 4. Left obturator adenopathy measuring 2.4 x 3 cm in image number 183, series number 4. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Large pelvic mass measuring 13.4 x 7.7 cm image number 184, series number 4 invading the bladder, prostate and the seminal vesicles.

Output: Large pelvic mass and pelvic adenopathy which have not significantly changed from previous CT. interval place of the left double J stent. The right mild hydronephrosis and dilated right ureter secondary to invasion by the pelvic mass is unchanged.Borderline enlarged mediastinal lymph node, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: 56 y/o on chemo for ALL, apneic episodes; eval for effusions, infection History: apneic episodes, orthopnea Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: 82 y/o with new fevers, eval for infection History: fevers The cardiomediastinal silhouette is within normal limits.Nonspecific ill-defined opacity in the right upper lobe overlying the first costochondral junction. Bibasilar streaky opacities are consistent with atelectasis or scarring. There is blunting of bilateral costophrenic angles, which may reflect scarring or small effusions.Surgical clips overlie the right upper quadrant. Degenerative changes affect the right shoulder.

Output: No specific evidence of infection. Nonspecific ill-defined opacity in the right upper lobe overlying the first costochondral junction may be further evaluated with repeat upright PA and lateral chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Abdominal distention, assess for bowel obstruction Large stool burden. Nonobstructive bowel gas pattern.Please see same day chest radiography for additional findings.

Output: Large stool burden, especially apparent in rectal vault. No evidence of bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: include site of LVAD insertion History: pain at site of LVAD insertion Patient status post sternotomy. LVAD projects over the inferior heart at the expected location.Left-sided cardiac conduction device is present.Cardiomegaly.No specific evidence of infection or edema.No pneumothorax.

Output: Status post LVAD. Cardiomegaly with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: resp insuf History: same No change in appearance of bilateral pulmonary opacities. No pneumothorax.Stable position of mediastinal drains. No significant pneumothorax.

Output: No change in appearance of the extensive bilateral pulmonary opacities, right greater than left. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Pre-transplant workup. r/o cardiomegaly, r/o effusions. History: pre-surgical evaluation Mild cardiomegaly.No significant pulmonary or pleural abnormality.Left subclavian catheter, tip in SVC.Right axillary vascular stent.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Dyspnea Moderate to marked unchanged CHF with cardiomegaly, effusions diffuse edema-like changes and small lung volumesETT, NG and right jugular catheter unchanged

Output: Moderate CHF similar to prior


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: s/p PICC line placement for TPN, confirm midline placement History: short bowel requiring TPN Cardiomegaly, with retrocardiac atelectasis and pleural effusions, similar to a recent CT.Left sided catheter, tip at SVC/RA junction level.

Output: PICC placement.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumonia, infiltrates, pulm edema History: SOB, chest pain, acs r/o Mild cardiomegaly with evidence of previous median sternotomy and a coronary artery stent in place.Mild basilar interstitial opacity, probably at least partly chronic though there may be a component of edema.No sign of pneumonia.

Output: Cardiomegaly and mild chronic interstitial opacity with no reliable evidence of pneumonia or acute edema.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: assess for acute process - shortness of breath History: assess for acute process - shortness of breath Cardiac silhouette is partially obscured the left but normal in size. There is fullness of the left mid cardiomediastinal contour/PA shadow. Left lower lobe and lingular nodular airspace disease. Question small left pleural effusion. No pneumothorax

Output: 1.Left lower lobe and lingular nodular airspace disease compatible with pneumonia in the proper clinical setting. Follow-up imaging to resolution recommended.2.Mild fullness of the left hilum probably related to reactive adenopathy. Attention on follow-up imaging.


Instruction: Generate impression based on medical findings.

Input: Reason: pt with met lung ca s/p 3 cycles of chemo History: now needs re-evaluation prior to more chemo compare to previous scans and comment CHEST:LUNGS AND PLEURA: Left suprahilar mass, partially obscured by adjacent radiation reaction, measuring 22 mm in short axis, not significantly changed. The long axis measurement is not evaluable due to obscuration of the margins. Interval involution of radiation reaction with progression of volume loss and fibrosis.Interval decrease in septal thickening at the left base.Multiple additional small nodules compatible with metastases, most of which have not appreciably changed though some are slightly smaller.Reference right middle lobe nodule, 10 x 10 mm (70/7) not significantly changed from 10 x 11 mm previously.MEDIASTINUM AND HILA: Bilateral supraclavicular lymphadenopathy without significant change, with compression of the left jugular vein.Moderate lymphadenopathy in the area of the AP window and lower paratracheal areas.Subcarinal and right hilar lymphadenopathy, decreased from previous.Right hilar lymph node (43/146) now 10 x 11 mm, decreased from 12 x 13 mm previously.Moderate pericardial thickening or small effusion, slightly decreased from previous.Severe and extensive coronary artery calcification.CHEST WALL: Multiple spinal metastases as previously described. Compared to the previous scan there is increased sclerosis and slight increase in the size of the lytic component at T9 and T11.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter device in place.BOWEL, MESENTERY: Limited evaluation due to lack of GI contrast material with no gross abnormalities.BONES, SOFT TISSUES: Metastasis in the anterior L1 vertebral body, slightly increased from previous.OTHER: No significant abnormality noted.

Output: Generally stable disease with a slight increase in some skeletal metastases.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with rising white count, concern for abscess, especially perinephric abscess. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Swan-Ganz catheter seen in the right pulmonary artery. The left-sided central venous catheter terminates in the superior intercostal vein.Small pericardial effusion is seen, whose density may be minimally increased.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: Essures are noted bilaterally.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: No abscess or perinephric inflammatory changes.The left-sided central line terminates in the superior intercostal vein.Small pericardial effusion, decreased in size when compared to 9/09.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: pna? History: wheezing, sob Chronic appearing basilar interstitial opacities.Heart size normal.Healed left rib fractures.

Output: Chronic interstitial disease, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: 59 y/o woman with cardiomyopathy s/p single chamber ICD History: cardiac arrest, syncope, evaluate for pneumothorax Cardiomegaly unchanged. Pulmonary prosthetic valve unchanged. Interval placement of left-sided ICD device. No evidence of pneumothorax. Bibasilar linear opacities compatible with atelectasis. No large pleural effusion.

Output: Interval placement of left-sided ICD device. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female with history of chest on therapy CHEST:Biapical scarring, more prominent on the left is unchanged. Left upper lobe, Focal pleural thickening is unchanged.No evidence of mediastinal adenopathy.ABDOMEN:LIVER, BILIARY TRACT: Small, hypodense lesions in the liver, are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Slightly prominent pancreatic duct, unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral parapelvic cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small, mesentery, soft tissue density is unchanged, measuring 13 by 9-mm image number 126, series number 9. The second reference lesion with calcifications has changed. Its shape and location, but grossly unchanged and measures 30 x 18 mm Schommer 143, series number 9.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is unchanged and measures 2.2 x 2.9 cm in image number 177, series number 9. Adjacent soft tissue density lesion with calcifications may represent a parenchymal part of the ovary and measures 15 x 60 minutes. On image number 100 73, series number 9.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: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with elevated lactate. Evaluate for mesenteric ischemia. The examination is limited due to inadequate venous phase imaging. Images labeled "venous reconstructions" were obtained during late arterial enhancement. Within this limitation, the following observations were made:CHEST:LUNGS AND PLEURA: Severe paraseptal emphysema is evident. Moderate bilateral pleural effusions with overlying compressive atelectasis are unchanged to slightly increased compared to the prior exam. Patchy air space and groundglass opacities are seen bilaterally which have increased, with differential considerations including edema, hemorrhage, or infection.MEDIASTINUM AND HILA: Endotracheal tube tip is above the carina. Numerous enhancing mediastinal and hilar lymph nodes are again seen, none of which are enlarged by CT criteria, grossly unchanged. Heart size is enlarged, with no pericardial effusion.CHEST WALL: Diffuse soft tissue edema is seen compatible with anasarca. No enlarged axillary lymph nodes or chest wall lesions are evident. Right internal jugular central venous catheter distal tip is in the SVC. Left internal jugular central venous catheter distal tip is also in the SVC.ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates markedly decreased attenuation on precontrast images, compatible with severe diffuse fatty infiltration. No focal intrahepatic lesions or biliary ductal dilatation is evident. The gallbladder is partially collapsed, with significant wall enhancement, and layering gallstones.SPLEEN: The spleen demonstrates a typical enhancement pattern, worrisome for splenic infarction. Direct comparison with hepatic parenchyma is difficult given significant hepatic steatosis. The splenic artery and vein appear patent, though decreased caliber. No focal intrasplenic lesions are evident.PANCREAS: The pancreas is markedly atrophic with calcifications, with heterogeneous enhancement of the body. The previously described heterogeneous mass arising from the pancreatic tail is no longer evident, compatible with additionally obtained history of prior ruptured pseudocyst.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney is markedly atrophic, suggesting prior infarction. The right kidney demonstrates markedly heterogeneous or striated corticomedullary enhancement, which may in part be due to the phase of contrast enhancement, though worrisome for infarction. The right renal artery and vein appear patent. The previously identified saccular outpouching which projects posteriorly from the right renal artery near the hilum containing calcification is unchanged, which may represent a small aneurysm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel demonstrates normal wall thickness and caliber, with no nonenhancing loops evident. No intramural air or free intraperitoneal air is identified. A jejunal loop in the left upper quadrant demonstrates increased density of the wall, suggesting hyperemia, which is nonspecific. The previously described wall thickening involving the ascending colon has resolved.Atherosclerotic calcification of the abdominal aorta and branch vessels is noted. As described above, the splenic artery demonstrates decreased caliber, though appears grossly patent. Likewise, the inferior mesenteric artery is diminutive in size, though patent. Apart from the right renal artery aneurysm, no additional aneurysmal dilatation is evident. Linear hypodensity noted within the lumen of the superior mesenteric vein is likely related to flow artifact, rather than thrombosis.BONES, SOFT TISSUES: Degenerative changes are noted in the spine and pelvis, with no destructive lesions evident. Diffuse soft tissue edema compatible with anasarca is seen.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Urinary bladder is collapsed around a Foley catheter, with an air noted within the bladder lumen, likely due to recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Numerous sigmoid diverticula, without evidence of diverticulitis.OTHER: No significant abnormality noted

Output: 1. Findings suspicious for right renal and splenic infarction, as described above.2. No specific CT evidence for bowel ischemia, with no evidence of perforation.3. Moderate bilateral pleural effusions and patchy air space opacities, with differential considerations including edema, hemorrhage, or infection.Findings were discussed with Annie Nelson from the MICU service at the time of interpretation (9:30 AM, 4/24/2008), who reported that the patient died this morning.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.AMS, initial seizure of unknown etiology. Rule out pneumonia. No pulmonary or pleural abnormalities.Cardiomediastinal silhouette is within normal limits

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: assess for pneumo s/p thoracentesis History: sob No pneumothorax following thoracentesis.The right pleural effusion is significantly smaller than on the recent chest CT.Minimal right basilar subsegmental atelectasis.Left subclavian catheter, tip in right atrium directed towards the mitral region.

Output: Improvement in right pleural effusion with no pneumothorax following thoracentesis.


Instruction: Generate impression based on medical findings.

Input: 78 year old female status post right mastectomy for right breast cancer. Patient presents with right chest wall pain. LUNGS AND PLEURA: Mild centrilobular emphysema. Calcified peripheral nodule which likely represents prior granulomatous infection. MEDIASTINUM AND HILA: Mild cardiomegaly. The pulmonary artery measures 3.5 cm in diameter which is suggestive of pulmonary arterial hypertension, however, stable from prior exam. Tortuous aorta.CHEST WALL: Dual chamber pacemaker is seen in the anterior right chest wall (not well evaluated on this exam). Please correlate if pacemaker could be a source of patient's pain. UPPER ABDOMEN: Simple cysts are seen in the upper pole of the left kidney.

Output: No evidence of metastatic disease in the chest or findings to explain the patient's chest wall pain (and see above). Please see nuclear study done on the same day for further correlation.


Instruction: Generate impression based on medical findings.

Input: Age: 34 yearsGender: MaleReason for Study: Reason: assess et tube placement History: assess ET tube placement ET tube unchanged with its tip 5 cm above the carina.Enteric tube is in place with its tip beyond the margin of the image.Stable cardiac enlargement.No new pulmonary opacities identified.No pleural effusions.

Output: ET tube in satisfactory position. Stable cardiopulmonary appearance with marked cardiac enlargement.


Instruction: Generate impression based on medical findings.

Input: Female 74 years old Reason: please evaluate pleural effusions History: SOB, O2 requirement Left PICC unchanged position.Stable heart size.Mild interstitial edema and increased perihilar opacities consistent with pulmonary edema.Interval increase and layering of pleural effusions with underlying bibasilar atelectasis.

Output: Mild pulmonary edema with pleural effusions and bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Status post thoracentesis assessment History: post thoracentesis Improvement in right greater than left pleural effusions. Improvement in bibasilar probable atelectasis. No overt pulmonary edema. Unchanged heart size. No pneumothorax.

Output: Status post thoracentesis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusions History: SOB, pleuritic pain Small lung volumes with streaky basilar opacities suggestive of subsegmental atelectasis, increased from previous.Possible small effusions in the posterior costophrenic angles versus scarring. Skeletal findings consistent with sickle cell disease.

Output: Increased basilar atelectasis and possible small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: new consolidation, line History: leukocytosis, tachycardia, ET tube ET tube tip approximately 6 cm above the carina.Catheter tip in the SVC. NG tube coiled in the gastric fundus.Small lung volumes with basilar atelectasis and nonspecific consolidation, unchanged.

Output: Basilar atelectasis and nonspecific consolidation, unchanged from previous.


Instruction: Generate impression based on medical findings.

Input: History of recurrent stage IIIc ovarian cancer. CHEST:LUNGS AND PLEURA: 4-mm nodule in the left upper lobe on image number 22, series number 3 is unchanged. Nonspecific density in the right middle lobe on image number 59, series number 3 is also unchanged. No new nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst is unchanged. Perihepatic implant measures 16 by 8mm on image number 109, series number 3, unchanged.SPLEEN: Lobulated splenic mass measures 2.5 x 1.7 cm image number 92, series number 3, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided moderate hydronephrosis a double-J stent is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left rectus muscle mass appears to increased in size measuring 20 x 22 mm which on the 6 to, series number 3.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous complex pelvic mass measures 5.2 x 7.4 cm image number 171, series number 3, increased in size.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: Multiple pelvic peritoneal implants and invasion of the sigmoid colonic wall is unchanged. Small amount of ascites is unchanged.

Output: Minimal increase in the size of the left rectus muscle mass and complex pelvic mass. Other findings as described above and are mostly stable.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: FemaleReason for Study: Reason: 80F with worsening hypoxia. History: hypoxia Port-A-Cath has tip in the SVC.Stable cardiac mediastinal silhouette.Increasing multifocal airspace opacities most pronounced in the right upper lobe.Underlying increased interstitial opacities again noted.Probable small pleural effusions.

Output: Significant interval increase in multifocal airspace opacities suggestive of infection, aspiration, or atypical edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: r/o pneumonia History: sob, cough, history of lung cancer. Right internal jugular central venous catheter tip terminates in the SVC.Large lung volumes consistent with COPD. Scarlike nodular opacity with associated surgical clips in the right upper lobe is unchanged from the prior examination. Patchy basilar scarring and faint chronic peribronchial opacities, likely reflecting chronic. No new focal opacities. The cardiac and mediastinal contours are within normal limits for size.

Output: Faint chronic opacities likely reflect chronic endobronchial debris. No acute cardiopulmonary abnormality. Known right apical nodule suspicious for an indolent malignancy is not visible by this technique.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: s/p 6/5 Drainage of effusion and lobar bleb resections and talc pleurodesis. History: none Left-sided endobronchial valves unchanged.Significant interval reduction in the subcutaneous emphysema noted along the left lateral chest wall and left neck.No evidence of a pneumothorax.Stable cardiomediastinal silhouette.Increased lung volumes compatible with known emphysema.Small pleural effusions.

Output: Interval reduction of subcutaneous emphysema along the left lateral chest wall and left neck. No pneumothorax identified. Small pleural effusions noted.


Instruction: Generate impression based on medical findings.

Input: Reason: tachycardia, shortness of breath History: chest pain Moderately large bilateral pleural effusions with underlying atelectasis, not significantly changed.No new findings.

Output: Moderately large pleural effusions and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: ? infiltrate History: hemoptysis The cardiomediastinal silhouette is unremarkable. There are increased lung volumes compatible with COPD.Minimal left basilar scarring/discoid atelectasis.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Infection History: AMS Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: follow-up to 6/19 significant reaccumulation of pleural fluid s/p thoracentesis. 85F stage IV lung ca History: as above Persistent right-sided volume loss with large right pleural effusion and opacities over the aerated right upper lobe of atelectasis and edema. The left lung remains fully inflated and clear. No interval pneumothorax.

Output: Persistent large right pleural effusion with right sided opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Evaluate IABP position History: IABP Cardiomegaly without acute edema.IABP catheter proximal marker projects over the aortic arch.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: No change in support devices.


Instruction: Generate impression based on medical findings.

Input: History cough and shortness of breath. Fibrosis on outside CT. Evaluate lungs. CHEST:LUNGS AND PLEURA: No evidence of interstitial lung disease. No air trapping identified. A few nonspecific pulmonary cysts are present.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ? PNA History: cough The cardiomediastinal silhouette is within normal limits. There are no pleural effusions or pneumothorax. The vascular and airway structures appear within normal limits. There is minimal bibasilar subsegmental atelectasis/scarring. There is no specific radiographic evidence of edema or infection.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: edema History: stemi No significant cardiopulmonary abnormality.GE junction surgical clips.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Rule out pneumothorax / hemothorax / fluid collection History: SOB Post-PROCEDURE Pleuroscopy / Thorascopy Interval insertion of left chest tube, with its tip at the cardiophrenic angle.Stable cardiomediastinal silhouette. Persistent left hydropneumothorax with a significant decrease in the pleural fluid component and increased volume of pleural air. Left upper lobe subsegmental atelectasis, slightly increased. Small right pleural effusion. No new focal pulmonary opacities.

Output: Persistent left hydropneumothorax following chest tube insertion, with decreased volume of pleural fluid and increased pleural air.


Instruction: Generate impression based on medical findings.

Input: Female 56 years old Reason: Soft tissue osteosarcoma left supra-clavicular region, evaluate for local recurrence/metastasis Left chest wall pacemaker, leads unchanged in position. Small left pleural effusion, increased from prior exam. No suspicious pulmonary nodules. Calcified mediastinal lymph nodes are again noted. Cardiomediastinal silhouette is normal.

Output: No radiographic evidence of pulmonary metastases. Small left pleural effusion, increased from prior exam.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, 75 years old.Reason: hypervent History: ? congestion Stable support lines. Interval removal of nasogastric tube. Lungs remain clear. Low lung volumes.

Output: No acute abnormality


Instruction: Generate impression based on medical findings.

Input: 65-year-old female. History of kidney disease as an adult. Assess for persistent disease. CHEST:LUNGS AND PLEURA: Bibasilar atelectasis. Pleural thickening posterior wall of the right apex, less marked than on the prior exam. No focal lesions.MEDIASTINUM AND HILA: The small mediastinal nodes, unchanged. Stent left coronary artery. Atherosclerotic changes.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to lack of intravenous contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney normal size. No hydronephrosis. No obvious renal cysts although there is a sub-centimeters small exophytic focus of the lateral aspect of the mid kidney and series 6 image 89 too small to characterize.Left kidney is mildly malrotated and has cortical scarring along the level pole. There may be a small exophytic hypoattenuating lesion measuring about 6.8 mm too small to characterize; see coronal image 45/89.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, ADNEXAE: Somewhat prominent in contour to uterus. See MRI pelvis 12/15/09.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes. No lytic or blastic disease. Midline surgical scar.OTHER: No significant abnormality noted.

Output: Scarring left lower pole. Two small hypoattenuating foci too small to characterize. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Reason: 81F w/ large effusion History: - Cardiomegaly with aortic aneurysm and pacemaker leads unchanged.Lower zone nonspecific opacity compatible with pleural effusions and underlying atelectasis.No new findings.

Output: Cardiomegaly with aortic aneurysm and large pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: cough, hypoxia Moderate cardiomegaly and superior mediastinal widening, unchanged.Mild nonspecific basilar opacity, suggestive of edema with blunting of the costophrenic angles compatible with small pleural effusions.No specific evidence of pneumonia.

Output: Findings suggestive of fluid overload/CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old with heart failure. No significant interval change of the minimal basilar edema with septal lines. Small bilateral pleural effusions. Stable cardiac size. No focal consolidation. No pneumothorax.Left jugular Swan-Ganz catheter tip in right main pulmonary artery.Left PICC tip in the SVC.

Output: Stable pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 75 years old Male. Reason: Infection. History: Infection. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: r/p pulm edema History: hypoxia Slight improvement in diffuse pulmonary opacities. Improvement in small right pleural effusion. Unchanged heart size. No pneumothorax.

Output: Slight improvement in diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: First right rib resection Postsurgical changes including excision of the right first rib with scattered surgical staples unchanged. Underlying cardiopulmonary appearance is also similar with mild improvement in overall aeration and no new superimposed focal abnormality

Output: Right rib resection


Instruction: Generate impression based on medical findings.

Input: Female 90 years old Reason: r/o infiltrate History: AMS and hypotense Left subclavian pacemaker device lead position unchanged. Low lung volumes, but no focal consolidation, pleural effusion or pneumothorax is evident. Mild cardiomegaly and aortic tortuosity similar to prior.

Output: Mild cardiomegaly, but without reliable evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Reason: cough with yellow sputum - r/o infiltrate History: cough Large right chest wall mass with associated pleural effusion, increased compared to previous.Left lower lobe nodule, also increased.No specific evidence of pneumonia.

Output: Interval progression of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: r/o infection History: sickle cell pain, hx HIV, elevated WBC Moderate cardiomegaly.No specific evidence of infection or edema.No sign of infarction.

Output: Cardiomegaly, otherwise unremarkable. No significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: MaleReason for Study: Reason: sob History: sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.Mild bronchial wall thickening.There are no pleural effusions.

Output: Bronchial wall thickening without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with known small cell lung cancer diagnosed in 2/07, declined treatment. Now with 4 days of hemoptysis. LUNGS AND PLEURA: Interval development of a loculated left pleural effusion with complete collapse of the left upper lobe. The referenced right upper lobe mass is larger measuring 3.5 x 3.2 cm on axial image 37/100 (compared to 2.7 x 2.4 cm on 1/14/07, axial image 39/98). Multiple additional nodules have increased slightly in size. No definite new nodules or masses. Right apical scarring is stable as is mild emphysema.MEDIASTINUM AND HILA: Marked progression of mediastinal and hilar lymphadenopathy. The referenced pretracheal lymph node now measures 4.0 x 3.8 cm on axial image 36/100 (compared to 2.7 x 2.9 cm on 1/14/07, axial image 39/98). Cardiac size is normal with no pericardial effusion.CHEST WALL: Minimal compression of a midthoracic vertebral body is new (coronal image 35/91) and may reflect degenerative changes, but a metastatic process cannot be excluded.UPPER ABDOMEN: No significant abnormality noted.

Output: Progression of disease in the chest with interval development of left upper lobe collapse and a loculated left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p LVAD; ?PTX History: SOB Left chest tube has been removed. Other support hardware unchanged in position. Stable bilateral pleural effusions and basilar opacities suggestive of edema. Stable cardiomegaly. Trace left apex pneumothorax.

Output: Trace left apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Chest pain, chronic, The cardiomediastinal silhouette is unremarkable.No evidence of infection, edema, or effusions.Bilateral stabilization rods and pedicular screws involving the T3-L1 levels.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: PNA History: sob/back pain Left pleural effusion with overlying consolidation, possible infection.Normal interstitial opacity right lung base.At least mild cardiomegaly is present.

Output: Lower lobe consolidation left pleural effusion, infection in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.SOB status post MVR. New peripheral catheter from the left terminates in the left mid subclavian vein projection.Left subclavian ICD unchanged.Sternotomy hardware appears in alignment.Small lung volumes with basal atelectasis and at least a small volume of pleural fluid bilaterally, not appreciably changed.

Output: New left sided peripheral venous catheter terminates in the left subclavian vein projection, mid clavicular line.Lung volumes remain low with basal atelectasis and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Coarse lung sounds Enteric tube tip enters the stomach and extends beyond the field-of-view.Interval removal of the right central venous catheter.Mild cardiomegaly, similar to prior. Unremarkable cardiac mediastinal silhouette otherwise.Decreased bibasilar opacities suggestive of aspiration and decreased small left pleural effusion.

Output: Decreased bibasilar opacities and small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval lung fields History: s/p MVR Interval extubation and removal of one of the right IJ sheaths. A solitary right IJ sheath terminates at the level of the azygos vein, kinked in its proximal portion. A right chest tube appears advanced, angled at the right apex and terminating left of midline at the expected location of the atria. A complete annuloplasty ring occupies the mitral position.Subcutaneous emphysema is more prominent at the right infralateral chest wall. Retrocardiac subsegmental atelectasis. Possible trace right pleural effusion. No pneumothorax. The heart size is normal.

Output: Right chest tube now terminates slightly left of midline, possibly at the posterior mediastinum. No complication following extubation and right IJ sheath removal.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with weight loss and right middle lobe nodule and anemia. CHEST:LUNGS AND PLEURA: Previously described right lower lobe nodular opacity is unchanged in size and appearance.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in the left lobe of the liver, too small to actively characterize.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, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Peripherally calcified soft tissue density lesion at the symphysis pubis extending inferiorly. The etiology is unknown. This may represent heterotopic ossification. Adjacent pubic bones are unremarkable.OTHER: No significant abnormality noted.

Output: Right middle lobe nodular opacity is unchanged. Partially calcified soft tissue density lesion at the symphysis pubis extending inferiorly. Correlation with history of trauma, plain film and if clinically indicated MRI is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: concern for CAP History: productive cough, fevers Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Weakness. Abnormal glucose. Cardiomediastinal silhouette unchanged in appearance. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: evaluate ETT History: see above Unchanged lower lung zone edema, left lower lobe consolidation and cardiomegaly.IABP catheter tip at the level of the top of the aortic arch, unchanged.Left jugular Swan-Ganz catheter tip in proximal right interlobar pulmonary artery.Right jugular catheter, tip in SVC. Left subclavian ICD, leads unchanged in position. ET tube tip approximately 3 cm above the carina.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: lines s/p lung transplant History: lines, s/p lung transplant Left IJ venous catheter and bilateral basilar chest tubes unchanged.Enlarging left apical pneumothorax.Decreased lung volumes with stable cardiomediastinal silhouette.Pulmonary unchanged.

Output: Enlarging left-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: recent lung tx, eval lung fields History: as above Tubes and lines are unchanged with right central venous catheter tip in the right atrium.Diffuse pulmonary opacities and pleural effusions are similar in appearance to the prior exam.

Output: Support devices unchanged. Stable appearance of diffuse and extensive pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: OG tube advanced, eval location History: see above Median sternotomy, heart size normal.Unchanged interstitial opacities possibly edema or aspiration.ET tube tip approximately 4 cm above the carina.The NG tube is coiled in the hypopharynx before extending partly into the stomach.Right jugular catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina. NG tube coiled in hypopharynx. Changed interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: acute chest? History: Chest pain, SOB Small lung volumes.No significant cardiopulmonary abnormality.No evidence of infection or infarction.Skeletal abnormalities of sickle cell disease are seen throughout the spine.

Output: No active disease. Chronic skeletal abnormalities of sickle cell disease are present.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: s/p pericardectomy History: s/p pericardectomy Interval removal right-sided chest tube. Very small right apical pneumothorax. Unchanged heart size. Cardiac lead, unchanged.

Output: Interval removal right-sided chest tube. Very small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Check chest tube Right chest tube projects across the right lung base towards midline. Superimposed large effusion with suspected loculation and associated with underlying atelectasis marked compression of the right lung. Left lung otherwise clearMild cardiomegaly with mediastinal contours otherwise within limits. Midline sternotomy

Output: Right chest tube projects across lung base with associated large suspected loculated effusion


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: Cough, SOB History: Cough x 1 week Cardiomegaly.Small lung volumes with bronchial wall thickening. No specific evidence of infection or edema.

Output: Cardiomegaly and bronchial wall thickening. No reliable evidence of edema or pneumonia, however.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: s/p CABG, assess lung fields History: high output from chest tubes Small bilateral apical pneumothoraces despite bilateral chest tubes.Unchanged left chest wall soft tissue emphysema. Small pleural effusions.

Output: Persistent apical pneumothoraces, unchanged.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Unchanged cardiopulmonary appearance with underinflation and perihilar bronchial thickening in suspected atelectasis. Cardiac and mediastinal contours remain within limits for technique and semiupright positioning

Output: Decreased lung volumes and suspected nonspecific bronchial wall thickening with superimposed atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: eval for infiltrate History: chest pain The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: r/o pna, cardiomegaly, other cardiopulmonary abnormality History: CP Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: assess for worsening infiltrates History: assess for worsening filtrates ET tube and venous catheters unchanged.Large lung volumes with mild residual perihilar opacity compatible with resolving edema.Bullet fragments projected over the upper thorax.

Output: Resolving pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Reason: r/o lung nodules consistent with sarcoid or TB History: anterior uveitis Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.Degenerative changes affect the thoracic spine.

Output: No significant cardiopulmonary abnormality. No evidence of active tuberculosis or sarcoid.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old. Right jugular catheter tip in the area of the brachiocephalic vein.Markedly underinflated lungs with basilar opacities compatible with subsegmental atelectasis and possibly interstitial edema.No pneumothorax.

Output: New right jugular catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 65-year-old man with history of follicular non-Hodgkin's lymphoma initial diagnosis 2003 with recurrent disease 2/08 status post 4 cycles chemo. Evaluate. CHEST:LUNGS AND PLEURA: There is some moderate amount of scarring in both apices with somewhat nodular pleural thickening seen bilaterally right greater than left unchanged from the prior exam. Small micronodules in the right middle lobe series 4 image 70, unchanged. No new nodules. No effusions.MEDIASTINUM AND HILA: No pathologic size lymph nodes. There are some small middle mediastinal lymph nodes unchanged in the pretracheal area and AP window.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: 23 small punctate hypodensity is nonspecific and unchanged the right lobe.SPLEEN: Normal size with no focal lesions.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small renal cysts bilaterally. Otherwise normal.RETROPERITONEUM, LYMPH NODES: Small preaortic aortocaval and left periaortic nodes redemonstrated, unchanged. Index aortocaval node series 2 image 124 measures 11 x 6 mm.BOWEL, MESENTERY: Scattered colonic diverticula otherwise normal. No ascites. No pathologic size lymph nodes.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: Corkscrew staples anterior abdominal wall consistent with laparoscopic surgery. Varices seen along the left inguinal canal extending into the scrotal sac.

Output: Stable retroperitoneal nodes and small mediastinal nodes. Stable fibrotic changes and nodular pleural thickening in the apices of the lungs right greater than left.  Few small probable hepatic and renal cysts. Varicoceles left scrotum.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: s/p CABG c/b respiratory failure, pneumonia History: as above The patient is rotated to the right. The Dobbhoff tube tip is visualized within the mid stomach. The remaining support devices are unchanged in position.Increasing opacities in the upper zones over the last two days. Large layering pleural effusions with progressive basilar edema. Skinfold projects over the right apex; no pneumothorax is visualized.

Output: Increasing edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: presence of pulmonary edema History: as above Unremarkable cardiac and mediastinal silhouette. Bilateral jugular catheters unchanged.Interval improvement in perihilar opacities suggestive of edema or aspiration.Residual streaky basilar opacities consistent with subsegmental atelectasis.

Output: Interval improvement in perihilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.New home O2 requirement, status post Nissen fundoplication Low lung volumes. Mediastinal clips are noted.Small pleural effusions and basilar atelectasis appear improved since the prior exam. Improvement in known posterior mediastinal fluid collection. No pneumothorax.Mild cardiomegaly.

Output: Improvement in posterior mediastinal fluid collection as well as small pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old Reason: assess for obstruction or toxic megacolon History: c diff, constipation, abd pain, distention No focal consolidation. Pleural spaces are clear. The heart size is enlarged.Catheter or wire type device projects over the expected location of the SVC and extends to the left chest.Bowel gas pattern is nonobstructive. There is gas and fecal matter within a nondistended colon. Small bowel is not distended and is relatively gasless. Postsurgical changes with clips in the right upper abdomen.Sclerosis of the left femoral head suggestive of avascular necrosis.

Output: Nonobstructive bowel gas pattern.Catheter type device projects over the chest.Avascular necrosis of the left femoral head.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: MaleReason for Study: Reason: lung infiltrate; enlarged cardiac silhouette History: chest pain; cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: eval for SOB History: as above There are decreased lung volumes with borderline cardiac enlargement.Basilar subsegmental atelectasis without focal areas of consolidation.No large pleural effusions.Extensive degenerative changes of the thoracolumbar spine with mild scoliosis.Cervical stabilization hardware identified.

Output: Decreased lung volumes with mild basilar subsegmental atelectasis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: kidney transplant-baseline evaluation Linear scarring right lung, with small lung volumes, otherwise unremarkable.Healed granulomatous disease is evident.Heart size normal.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Intubated assess for infiltrates. Endotracheal tube tip about 7 cm above the level of the carina.Normal heart size. Thoracic aorta appears tortuous, similar to prior. No focal airspace opacities or pneumothorax.

Output: No signs of aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 49 yearsGender: MaleReason for Study: Reason: r/o active TB (+ quant gold) History: none The cardiomediastinal silhouette is unremarkable.Mild left basilar scarring/discoid atelectasis unchanged.No new pulmonary opacities identified.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: Reason: dyspnea History: dyspnea Marked cardiomegaly with a tortuous aorta.No sign of CHF or active pulmonary disease.

Output: Cardiomegaly with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 52 year-old female with pancreas cancer CHEST:LUNGS AND PLEURA: A 5-mm nodule along the left major fissure is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference lesion in the right lobe of the liver measures 19 x 60 mm image number 85, series number 3. No new lesions. There is stent is in place.SPLEEN: No significant abnormality noted.PANCREAS: Patient's known mass in the pancreatic body measures 4.1 x 2.5 cm on image number 96, series number 3. Again noted attenuation of the portal vein confluence, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node measures 16 x 12 minutes on image number 92, series number 3.BOWEL, MESENTERY: Small fat containing ventral hernia is unchanged.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: Grossly stable disease.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with metastatic colon cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Enlarged thyroid gland, extending into the mediastinum with multiple bilateral thyroid nodules are stable. Calcified right hilar and small mediastinal lymph nodes are stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference metastatic lesion at the junction of segments 4 and segment two is now less well-defined and measures 15 x 13 mm image number 75, series number 3. Second index metastatic lesion in the right lobe measures 5.3 by 2.9 cm on image number 83, series number 3. Overall, metastatic lesions are stable.. nodularity of the peritoneum around the liver suggests peritoneal spread of disease, stable.Cholelithiasis without biliary dilatation or cholecystitis is stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged porta hepatis and gastric hepatic lymph nodes are again noted. Index lymph node in the upper the duodenal ligament measures 15 by 13-mm in image number 90, series number 3, grossly stable. Other retroperitoneal lymph nodes are also stable.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: Small amount of free fluid in the pelvis.

Output: Hepatic metastases and peritoneal nodularity around the liver in the right upper quadrant are stable. Upper abdominal adenopathy is also stable.


Instruction: Generate impression based on medical findings.

Input: Male 76 years old Reason: CHF ? History: CHF. Cardiomediastinal silhouette is upper limits of normal.No focal opacity, pneumothorax, or significant pleural effusions. No evidence of edema.

Output: No acute cardiopulmonary abnormality. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o pneumonia History: fever No significant cardiopulmonary abnormality.Left PICC, tip in the SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval fluid overload History: CP, SOB, LE swelling Cardiomediastinal silhouette is unchanged.Low lung findings with elevation of the right hemidiaphragm and right basilarNo specific evidence of infection or edema. No pneumothorax. No pleural effusion.

Output: Elevation right hemidiaphragm with basilar atelectasis but no specific specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 29-year-old male with headache. SHUNT DEVICE: A ventriculoperitoneal shunt catheter exits the calvarium via a burr hole in the right posterior parietal bone, with the shunt catheter tubing seen coursing down the neck soft tissues, anterior chest wall, entering the abdominal cavity in the right upper quadrant, terminating in the left hemipelvis. There is no evidence of kinking or discontinuity. Again seen is an orphaned shunt catheter within the anterior right chest wall.SKULL: No significant abnormality noted.CERVICAL SPINE: No significant abnormality noted.CHEST: There is an atrial septal device in unchanged position. No focal consolidation, pleural effusion or pneumothorax is evident.ABDOMEN: The bowel gas pattern is nonspecific.

Output: Shunt catheter tubing without evidence of kinking or fracture as detailed above.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male status post distal pancreatectomy. Presenting with increased white count. Evaluate for undrained fluid collection. CHEST:LUNGS AND PLEURA: Pleural catheter is present on the left side with its tip projecting towards the apex. Left-sided pleural effusion is decreased in size within the interval. However, there are multiple loculated left pleural lesions which are not drained by the catheter. A medial loculation measures 5.8 x 4 cm. A more lateral and anterior loculation measures 5.3 x 2 cm.. There is also a third loculation containing air measuring 4.6 x 3.9 cm.. A second percutaneous catheter is placed into a cavity with air fluid level measuring 2.8-cm in diameter. This cavity is likely beneath the left diaphragm. This drain is also not in communication with the other mentioned loculations. Consolidation in the left lower lobe suggestive of pneumonia. Right lung is unremarkable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the liver is unchanged. Layering sludge in the gallbladder is unchanged.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. 5.1 x 1.8 cm collection in the pancreatectomy bed is better seen today on contrast enhanced study. A second peripancreatic collection is anterior to the head and measures 5 x 3 cm, image number 108, series number 3. Main portal vein and splenic vein are patent. Stranding and inflammatory changes around the residual pancreas.ADRENAL 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: Small amount of fluid in the pelvis.

Output: Interval decrease in the left pleural effusion with multiple undrained loculations as described above. Small cavity with air-fluid level likely in the left subdiaphragmatic space with percutaneous drainage catheter in it.Peripancreatic fluid collections are better seen on the current study and have increased in size compared to previous study.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with metastatic GIST on Gleevec. Please evaluate disease status. CHEST:LUNGS AND PLEURA: Stable nodularity in the right lower lobe is noted on image 78/104, which is indeterminate in appearance. No focal consolidation or pleural effusion is evident.MEDIASTINUM AND HILA: Subcentimeter prevascular and right hilar lymph nodes are again noted. The right paratracheal node is stable and measures 1.3 cm x 0.8 cm (image 30/217, series 3), compared to 0.7 x 1.3 cm on the previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted are large hepatic veins with serpiginous vessels at the periphery of the dome with stable apparent fistulization of the portal and hepatic venous systems. Stable coils in the liver parenchyma. No focal hepatic mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The mass anterior to the left kidney is stable and measures 4.0 x 6.0 cm on image 106/217, series 3, unchanged in size and appearance when compared to the prior study. The retrocecal mass is slightly smaller in size but similar in appearance measuring 3.0 cm x 4.7 cm (image 144/217, series 3), compared to 3.2 x 5.0 cm on the previous exam.BOWEL, MESENTERY: Extensive tumor involving the peritoneum and mesentery throughout the abdomen appears stable.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant pelvic adenopathy.BOWEL, MESENTERY: Extensive peritoneal and mesenteric tumor is again seen throughout the pelvis and appears stable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: pulmonary edema, pneumonia History: hx of heart transplant on immunosuppresion Left IJ venous catheter and right-sided pacemaker unchanged.Stable cardiomediastinal silhouette.Left basilar opacity compatible with atelectasis and small effusion/thickening.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with left basilar atelectasis and small effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: assess swan position, pulmonary edema History: s/p swan placement Left subclavian central venous catheter remains unchanged. Status post median sternotomy, mitral and aortic valve replacements.Stably enlarged cardiac silhouette.Slight worsening in right basilar partially loculated effusion and atelectasis. Left retrocardiac bandlike atelectasis. Mild diffuse interstitial edema pattern. No pneumothorax.

Output: Slight worsening in right basilar partially loculated pleural effusion and atelectasis. No other significant interval changes.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Female 60 years old Reason: perf History: lymphoma, worsening abd pain Lungs are clear. Heart size is unremarkable. Bilateral percutaneous nephrostomy catheter. Nonobstructive bowel gas pattern. No free air.

Output: No free air.


Instruction: Generate impression based on medical findings.

Input: SOB, can only walk a block now. Left-sided back pain. Evaluate for pneumonia or other causes of SOB. Normal heart size. No pleural fluid or pneumothorax. No focal airspace opacities. Nonspecific bronchial wall thickening. Cervical spine fixation hardware noted. Mild degenerative changes of the thoracic spine. No convincing evidence of pulmonary edema. No visible lymphadenopathy.

Output: Mild bronchial wall thickening, nonspecific. Partially visualized right lower lobe groundglass density nodule seen on abdominal CT is due for follow-up imaging, beyond the resolution for visualization by this technique. Recommend follow-up CT when feasible to exclude nonbenign process.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: s/p TECAB History: NA The cardiomediastinal silhouette is unremarkable.The lungs are clear.Interval clearing of the previously noted pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB/wheezing History: as above Heart size about upper normal with a tortuous aorta, unchanged.Mild blunting of the left costophrenic angle, unchanged, compatible with scarring.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for effusions, s/s infection; new O2 requirement with rhinovirus History: evaluate for effusions, s/s infection; new O2 requirement with rhinovirus Normal heart size with a tortuous and ectatic aorta, unchanged. Mild nonspecific basilar opacity suggestive of atelectasis and possibly small pleural effusions, greater on the right.These findings could be better evaluated with erect PA and lateral radiographs.

Output: Mild basilar opacity suggestive of increased atelectasis and possibly small effusions, of uncertain etiology.These findings could be better evaluated with erect PA and lateral radiographs.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Concern for PNA, volume overload History: SOB, chest pain, cough with sputum production Right sided pleural thickening again noted. Bullet again noted in the right lateral chest wall. No new focal lung consolidation. Mild cardiomegaly. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: subclavian IABP placement History: subclavian IABP placement Unchanged right basilar opacity and pleural effusions.The left lower lobe is more consolidated than on the prior study.Right jugular Swan-Ganz catheter tip directed towards the right interlobar pulmonary artery.

Output: Basilar opacities, the left base more consolidated than on the prior study with persistent pleural effusions. No IABP catheter is identified.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: eval sob History: post arrest SOB Streaky basilar opacities right greater than left compatible with atelectasis, as seen on the CT abdomen examination from the same day. Possible small left pleural effusion. No pneumothorax is evident. The cardiomediastinal contours are within normal limits for size. Persistent mild gaseous distention of the stomach. No rib fractures are evident.

Output: Basilar atelectasis and possible small left pleural effusion, but no rib fractures or pneumothorax evident.


Instruction: Generate impression based on medical findings.

Input: Female, 101 years old.Reason: pneumonia History: fever Enteric tube tip in gastric body. Moderate cardiomegaly is unchanged. Left basilar opacity is improved compared to the prior exam with mild residual basilar consolidation. Right lung is clear. Calcified hilar lymph nodes. Calcification of the aortic arch.

Output: Left basilar opacity is improved compared to the prior exam with only mild residual basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: SOB question pneumonia. Scattered areas of scarring. No specific signs of pulmonary edema or pneumonia. No pleural fluid or pneumothorax. Normal heart size.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: 79 yo M s/p thora History: s/p thora Complete opacification of the right hemithorax, a new finding since prior. Interval mild rightward tracheal deviation. No evidence of right pneumothorax. Slight decrease in the left perihilar reticulonodular opacities suspicious for aspiration or bronchiolitis. Small left pleural effusion. No pneumothorax.

Output: Progressive, now complete opacification of the right hemithorax with signs of right-sided volume loss. Improving opacities on the left.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with history of papillary thyroid cancer, follicular variant, status post thyroidectomy in March 2013. Please follow up for thyroid cancer. There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Again seen is a faint focus of radioisotope accumulation in the thyroid bed, compatible with functioning thyroid tissue. This residual functioning thyroid tissue is similar when compared to the previous examination. No new focus of radioisotope accumulation is seen. Probe uptake of the neck is 0.091%.

Output: Stable examination with residual functional thyroid tissue in the thyroid bed. No new areas of accumulation of the tracer.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Productive cough. Lungs are clear. Heart is normal in size. No pneumothorax. Previous right PICC is been removed.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: ETT placement, OGT placement History: Intubated, tube feeds ET tube tip approximately 5.8 cm above the carina.Enteric feeding tube tip extends beyond inferior margin of the image with sidehole projecting over the gastric body, as before.Mild cardiomegaly.Slight improvement in left pleural effusion.Left lower lobe streaky subsegmental atelectasis.

Output: ET tube tip approximately 5.8 cm above the carina.