Instruction: Generate impression based on medical findings.

Input: 58 year old male with mesothelioma s/p chemo. CHEST:LUNGS AND PLEURA: Basilar atelectasis and mild consolidation, unchanged. Post-surgical changes in the right lung base. Multiple right pleural nodules appear unchanged.A pleural nodule at the 5 o'clock position at the level of the right pulmonary artery (Series 4 Image 40) measures 6 mm (previously 6 mm on prior study).Nodular right pleural thickening at the 4 o'clock position at the level of the aortic arch (Series 4 Image 29) measures 11 mm. This measured approximately 11 mm on the prior examination.A third right pleural nodule at the 5 o'clock position, at the level of the AP window (Series 4 Image 31) measures 7 mm. This measured approximately 7 mm on the prior examination.MEDIASTINUM AND HILA: An enlarged subcarinal lymph node measures 14 mm (Series 4, Image 40), previously measuring 14mm. Additional small mediastinal lymph nodes are unchanged.Post surgical changes to the right mediastinum.No cardiomegaly or significant pericardial effusion. CHEST WALL: Right chest port with tip in the RA. Stable right-sided rib deformities, likely postsurgical in nature.Degenerative changes of the thoracic spine. ABDOMEN:LIVER, BILIARY TRACT: New perihepatic ascites. No focal liver lesions. No intra or extra-hepatic biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Near complete infiltration of the omentum with tumor. No bowel loop dilatation or evidence of obstruction. 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: Near complete infiltration of the omentum with tumor. No bowel loop dilatation or evidence of obstruction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Stable pleural disease.2. New omental infiltration with tumor and perihepatic ascites, likely compatible with progression of mesothelioma.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: eval for pna History: leukocytosis, psych facility request Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 71 year old female with history of anal cancer status post chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No measurable disease.


Instruction: Generate impression based on medical findings.

Input: Age: 94 yearsGender: FemaleReason for Study: Reason: pneumonia History: hypoxia Stable cardiomediastinal silhouette.Mild chronic appearing basilar opacities.No focal areas of consolidation.No pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change. No specific evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: chest pain History: as above Low lung volumes with mild right basilar atelectasis. No specific evidence of infection or edema.Heart size within normal limits.No pleural effusion. No pneumothorax.

Output: Right basilar atelectasis with no specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: s/p aortic dissection repair History: s/p aortic dissection repair Line position stable. No pneumothorax.No change in left lower lobe consolidation and effusion.

Output: No change in left basilar effusion and consolidation. Support devices are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Cough, Neutropenia; evaluate for PNA History: as above Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality. Specifically, no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: Eval for Effusion atelectasis and Pneumothorax History: S/P Mediastinal Tube removal Mediastinal tubes have been removed.No evidence of a significant pneumothorax.Small bilateral pleural effusions and basilar atelectasis.Stable cardiomediastinal silhouette with

Output: Interval removal of mediastinal tubes. No significant pneumothorax. Persistent small pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female patient with newly diagnosed breast cancer, sarcoidosis and benign pancreatic mass status post Whipple CHEST:LUNGS AND PLEURA: Biapical scarring, not significantly changed from previous CT dated 8/2009..scattered micronodules unchanged.MEDIASTINUM AND HILA: Reference pretracheal lymph node measures 10 by 7-mm image number 22, series number 3. Reference right hilar lymph node measures 14 by 11 mm on image number 41, series number 3. No new enlarged mediastinal or hilar lymph nodes are evident.CHEST WALL: 4.9 x 4.7 cm collection within the right breast secondary to recent surgery. Small right axillary lymph nodes. Index node measures 8mm in diameter image number 29, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Changes secondary to Whipple surgery. Pneumobilia is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Changes secondary to Whipple surgery. Pancreatic duct in the residual pancreas is slightly dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach is distended.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: Distended stomach. The etiology is unknown.Fluid collection within the right breast. Small right axillary lymph nodes.Biapical scarring, mediastinal and hilar lymph nodes are stable.Postsurgical changes involving the pancreas.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Post thoracentesis evaluation. Evaluate for pneumothorax. Left jugular catheter tip at the SVC/artery junction.Moderate pleural effusions with associated atelectasis; volume of pleural fluid on the left has decreased. Multifocal airspace opacities appear slightly increased in size and density in the mid and upper lungs.No visible pneumothorax.

Output: No visible pneumothorax. Moderate pleural effusions. Worsening multifocal airspace opacities


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Cough evaluate for pneumonia. Recent diagnosis of pulmonary coccidioidomycosis. AVR similar in position. Lung volumes remain low. Left lower lobe consolidation. Scarring or atelectasis at the bases elsewhere.Mottled appearance of the skeletal structures.Multilevel loss of vertebral body height in the visualized spine with a mid thoracic spine compression fracture

Output: 1. Left lower lobe consolidation presumably reflects known diagnosis of coccidioidomycosis. 2. Diffuse lytic skeletal lesions could recent reflect disseminated coccidioidomycosis to the bone or multiple myeloma. Consider bone technique skeletal survey. Hematology/oncology moonlighter #01(4786) notified via Web exchange text page at 9:19 a.m. on 5/18/16


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: 85 yo F with advanced lung cancer; transferred for NSTEMI History: see above Right pleural effusion smaller than before with no pneumothorax if the thoracentesis was performed.Right perihilar opacities consistent with tumor and radiation.New left perihilar edema like opacities.

Output: Improvement in right pleural effusion. New perihilar edema like opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out infiltrate vs edema History: shortness of breath, cough wheezing, Hx of asthma Normal heart size with a tortuous aorta, unchanged.Mild bronchial thickening.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Hepatic hydrothorax with SOB TIPS. Normal heart size. No pleural fluid. No focal pulmonary opacities.

Output: No acute pulmonary abnormality. Specifically, no visible pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: unexplained hoarseness in a former smoker History: weight loss, and hoarseness in former smoker Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Evaluate pulmonary edema. SOB. ETT tip 3 cm above the level of the carina. I jugular catheter tip in the cranial aspect of the right atrium.Multichamber cardiomegaly. Pleural fluid and edema slightly worse.

Output: Worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: infiltrates History: tachycardia No change in small retrocardiac opacity which likely represents atelectasis. Low lung volumes.Mid and upper lung zones clear.No change in cardiomediastinal silhouette.

Output: No interval change in left basilar opacity likely representing atelectasis.


Instruction: Generate impression based on medical findings.

Input: Chronic left ventricle failure Swan-Ganz has been advanced, tip projects into the right middle lobe artery takeoff.Cardiopulmonary appearance is otherwise similar with moderate nonspecific cardia megaly and no distinct definitive acute superimposed focal process

Output: Swan-Ganz mildly repositioned


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Mitral valve replacement with shortness of breath. Left jugular catheter unchanged in position. Pericardial and mediastinal drains have been removed. The left hemithorax remains opacified.Right lung with layering pleural fluid, dependent atelectasis and possibly mild superimposed edema, about the same. Sternotomy hardware similar in alignment. Chronic left rib fracture deformity.

Output: No significant change in pleural fluid, dependent atelectasis and possible edema in the right lung. Opacification of the left hemithorax presumably due to a large pleural fluid collection


Instruction: Generate impression based on medical findings.

Input: Clinical male with left-sided chest pain at the site of cardiac defibrillator. Stable mild cardiomegaly.Defibrillator located at the left chest wall with intact single lead located presternally. No surrounding discrete soft tissue abnormality is seen.Blunting of the bilateral costophrenic angles may represent small bilateral pleural effusions or scarring. Pleural thickening is again seen, unchanged.

Output: Defibrillator located at the left chest wall with intact single lead located presternally. No surrounding discrete soft tissue abnormality is seen.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ETT daily check History: intubated ET tube tip approximately 2 cm above the carina.Bilateral opacity compatible with atelectasis and nonspecific consolidation.Mediastinal widening consistent with excess fat and lymphadenopathy as shown on recent CT scan.Large pulmonary artery consistent with pulmonary hypertension.

Output: Little interval change in bilateral pulmonary opacities and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for pleural effusion History: sob New opacity in the mid aspect of the right lung with stable left basilar opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: New opacity in the mid aspect of the right lung, consistent with aspiration or pneumonia. Stable left basilar atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna History: cough, chest pain Unremarkable cardiac and mediastinal silhouette. Mild streaky opacity in the right lower lobe of uncertain chronicity but compatible with infection and/or aspiration in the appropriate clinical setting.

Output: Mild right lower lobe opacity compatible with infection and aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: sob - adhf vs infection History: doe, orthopnea, pnd Bilateral lower zone perihilar airspace opacity compatible with edema or aspiration.Diffuse interstitial opacities with small pleural effusions and subcutaneous edema, consistent with fluid overload.PICC line tip in the right subclavian vein.

Output: Findings suggestive of pulmonary edema, possibly with a component of aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Evaluate for IABP marker. IABP catheter marker tip is approximately 2 cm below the aortic arch. ICD leads are unchanged.No new airspace opacity. No pleural effusion or pneumothorax.Unchanged cardiomegaly.

Output: IABP catheter marker is approximately 2 cm below the aortic arch. No interval change.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: CHF, eval lung fields for effusion History: CHF. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Interstitial changes are seen in the bilateral perihilar regions. There is no evidence of focal pneumothorax. There is blunting of the left cardiophrenic angle, which may be due to small left pleural effusion. The tubes and lines are stable in position.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Interval change in L lung opacities History: s/p multiple bronchoscopies w/ clot/mucus plug removal Median sternotomy with multiple chest tubes but no pneumothorax.Improvement in left lower lobe consolidation with stable basilar opacities and pleural effusions.ET tube high, at least 7 cm above the carina.A Dobbhoff tube terminates in the stomach. Unchanged ECMO cannulae and LVAD. Left subclavian Swan-Ganz catheter tip in right pulmonary artery.

Output: Improvement in left upper lobe opacity. Unchanged support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: daily CXR - intubated History: as above Nonspecific basilar subsegmental atelectasis.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip at right atrial level. An NG tube extends below the lower margin of the image.

Output: ET tube tip approximately 3 cm above the carina. Basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: 1-year-old male with a history of a right middle lobe nodule, for reevaluation LUNGS AND PLEURA: A small 3-mm micronodule is redemonstrated in the right middle lobe (image 63, series 5). The notable change in comparison to the two prior examinations. An isolated small cyst is also noted in the right lower lobe. No other pulmonary, pleural abnormalities can be identified.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy. Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Redemonstration of degenerative changes in the thoracic spine and the left glenohumeral joint.UPPER ABDOMEN: Cholelithiasis

Output: Stable benign 3-mm micronodular right middle lobe. No further follow-up is needed.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: chest pain, sob History: 45968 No significant cardiopulmonary abnormality.Extensive sternal internal fixation hardware following sternotomy.

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


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: chest pain, wheezing History: as above Right costophrenic angle scarring. There is flattening of the diaphragms which may be compatible with COPD. No focal pulmonary abnormality. The cardiomediastinal silhouette is within normal limits.

Output: Flattening of the diaphragms compatible with COPD.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: 70 male presents for preoperative evaluation. Orthopedic hardware of the lumbar spine is partially visualized.The cardiac contour is normal. Evidence of prior granulomatous disease. Bibasilar discoid atelectasis. Retrocardiac opacity consistent with a hiatal hernia. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: Sepsis History: Sepsis No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with history of testicular cancer CHEST:LUNGS AND PLEURA: Granuloma in at the lung bases are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference lesion in the posterior segment of the right lobe is much smaller measuring 8 x 5 mm image number 94, series number 4. Other subcentimeter hypodense lesions are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Right paracaval soft tissue mass is also significantly smaller measuring 2.3 x 2.2 cm image number 111, series number 4.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 decrease in the size of the paracaval and hepatic metastatic lesions


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: r/o pneumonia History: cough, fever The cardiomediastinal silhouette is normal. Lungs are clear of airspace and interstitial opacities. No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: MaleReason for Study: Reason: et tube placement History: as above ET tube with its tip 5 cm above the carina.NG tube with its side-port in the stomach.Right central venous catheter with tip in the SVC.Esophageal temperature probe identified.Decreased lung volumes with stable cardiac enlargement.Perihilar and basilar opacities are compatible with edema.Left retrocardiac consolidation/atelectasis again noted.

Output: ET tube with its tip 5 cm above the carina. NG tube with side-port in the stomach. Stable cardiopulmonary appearance with left retrocardiac consolidation/atelectasis, pulmonary edema, and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Changes secondary to bronchial atresia in the left lower lobe is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Reference right axillary lymph node measures 1.4 by 1.2 cm on image number 35, series number 3, stable. Previously closed measuring 1.6 x 1.1 cm.A second right axillary lymph node more superiorly located measures 2.3 by 1.3 cm on image number 24, series number 3, minimally increased in size.ABDOMEN:LIVER, BILIARY TRACT: Coarse calcification the liver is unchanged. Fat infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter lesion in the lower pole of the right kidney is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bone metastases are grossly unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Endometrial stripe is slightly dilated. Further evaluation with pelvic ultrasound is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bone metastases are grossly stable.OTHER: No significant abnormality noted.

Output: Bone metastases are grossly stable.Minimal increase in the size of one of the right axillary enlarged lymph nodes.Pelvic ultrasound is recommended for further evaluation of the dilated endometrial stripe


Instruction: Generate impression based on medical findings.

Input: Reason: assess for esophageal abnormality, ie diverticulum, web, stricture, mass History: right sided globus sensation with swallowing; no regurgitation or choking Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus showed no mucosal abnormality. There was moderate to severe dysmotility with tertiary waves. There was hiatal hernia measuring 28 x 26 mm. Minimal provoked gastroesophageal reflux was seen. Barium pill passed freely. TOTAL FLUOROSCOPY TIME: 3 minutes 18 secondsEntrance dose: 93 mGy

Output: 1. Moderate to severe dysmotility with tertiary waves. 2. Small lateral hernia. 3. Minimal provoked gastroesophageal reflux.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.IABP, Swan, concern for aspiration pneumonia. IABP marker projects over the descending thoracic aorta 4.5 cm below the top of the aortic arch.The left jugular Swan-Ganz catheter tip in the projection of the right main pulmonary artery.Focal airspace opacity at the right lung base. Hazy opacity elsewhere consistent with atelectasis and aspirated secretions with perhaps minimal improvement. No new opacities.

Output: Partial clearing of pulmonary opacities suggestive of aspirate. Persistent focal opacity in the right lower lobe may reflect pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: baseline cxr History: 3L NC O2 Interval placement of a left IJ central catheter that terminates at the junction of the left brachiocephalic/SVC junction. External defibrillator pads are present.Relatively large lung volumes compatible with CD with chronic lower zone interstitial opacities. No focal pneumonia, evidence of pneumothorax or edema. Heart size is enlarged.

Output: Cardiomegaly without associated edema. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Difficulty speaking, check for progression of known tongue cancer with metastatic disease Nodular pulmonary metastatic lesions seen greater both bases and on the right appear grossly unchanged when compared to the prior chest CT, however subtle differences may be missed due to differences in technique. No superimposed new airspace abnormalities. No effusionsCardiac and mediastinal contours are within limits. A well-positioned right jugular dual port

Output: Bilateral nodular opacities compatible with known metastatic disease


Instruction: Generate impression based on medical findings.

Input: 41 years old Female. Reason: ETT change, assess position History: ETT change, assess position. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.The tubes and lines are stable in position. The tip of the ET tube is immediately proximal to the right main bronchus.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: 20 year-old male with history of osteosarcoma status post limb salvage chemotherapy; off therapy evaluation CHEST:LUNGS AND PLEURA: Micronodules appear similar to prior study (for example, series 4, images 54 and 56). No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. Metallic prosthesis in left humerus is again seen.UPPER ABDOMEN: No significant abnormality noted in the visualized portions of the abdomen.

Output: No evidence of metastatic disease in the lungs


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Endocarditis. Swan-Ganz catheter placement. Cardiomegaly with bibasilar atelectasis is stable. No consolidation or significant pleural effusion. Right jugular Swan-Ganz catheter is simple back slightly within the interlobar pulmonary artery. No pneumothorax.

Output: Swan-Ganz catheter pulled back slightly within the right intralobar pulmonary artery. Bibasilar atelectasis stable.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: MaleReason for Study: Reason: evolving pneumonia History: SOB Right Port-A-Cath with its tip in the SVC.NG tube with its tip in the stomach.Decreased lung volumes with increasing right lung airspace and interstitial opacities.Right pleural effusion and underlying consolidation/atelectasis similar to the prior exam.

Output: Increasing right lobe opacities and persistent right pleural effusion with underlying consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Post right intercostal nerve blocks No pneumothorax. Median sternotomy hardware is unchanged. Cardiomediastinal silhouette is unchanged. No specific evidence of infection or edema.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: intubated History: intubated The cardiomediastinal silhouette is unchanged.Persistent left lower lobe consolidation and small left pleural effusion with right basilar subsegmental atelectasis. Trace right pneumothorax.ET tube tip is approximately 3 cm above the carina. Swan-Ganz catheter has been removed. Central venous catheter tip is in the right atrium. Enteric tube tip projects over the gastric fundus. Mediastinal and pleural drains are present. Postsurgical changes of medial sternotomy.

Output: ET tube tip is approximately 3 cm above the carina. Persistent left lower lobe consolidation and small left pleural effusion with right basilar subsegmental atelectasis. Trace right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.SOB. Is there pulmonary edema? Left subclavian ICD unchanged. Cardiomegaly, about the same. Vascular unsharpness and redistribution suggestive of mild hypervolemia/edema. Blunting of the posterior costophrenic angles may indicate trace pleural fluid.Thoracic aorta again noted to be tortuous. Enlargement of the central pulmonary vasculature suggestive of pulmonary hypertension. Surgical clips the low neck.

Output: Mild hypervolemia/CHF. Signs of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with known metastatic melanoma, known sinonasal melanoma. Starting chemotherapy. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No new suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Small calcified lymph nodes, unchanged. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Small hypoattenuating lesion in the left hepatic lobe (series 3, image 79) remains too small to characterize but is unchanged in size accounting for differences in technique.No intra-or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of inflammation.Thickening at the gallbladder apex as seen previously and again compatible with adenomyomatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally, unchanged. Several other smaller hypoattenuating foci remain too small to characterize but are unchanged in size.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine. Left inguinal surgical clips as seen previously.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PNA History: night sweats Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Liver transplant Bilateral basilar minimal scarring without evidence of superimposed acute abnormalityCatheters overlying the right and left neck and chest wall representing known previously described shunts unchanged

Output: Minimal pulmonary scarring without evidence of acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: 81y/o lady w/sp thoracentesis History: 81y/o lady w/sp thoracentesis Decreased size of right pleural effusion. Left pleural effusion and bibasilar opacities, unchanged. Unchanged cardiomegaly. No pneumothorax.

Output: Decreased size of right pneumothorax status post thoracentesis without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulm eval History: stroke wu Unremarkable cardiac and mediastinal silhouette. Small calcified granuloma in the left lower lung.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: fever; cough History: cough Mild cardiomegaly.Small lung volumes, otherwise unremarkable.Esophageal probe and a shunt are unchanged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Vent. ETT positioned changes. ETT tip 5 cm above the level of the carina. Enteric tube looped in the stomach with tip near the fundus.Dependent atelectasis and small pleural effusions about the same.

Output: ETT tip 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, eval pulm source History: as above Right basilar opacity compatible with pleural effusion and underlying atelectasis, better demonstrated on the subsequent CT scan.Marked splenomegaly.

Output: Right pleural effusion with atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: s/p redo bilateral lung transplant (5/29/2015), cough, fever History: as noted above Increasing diffuse interstitial opacities with septal lines consistent with edema.New focal right middle lobe consolidation which may represent concomitant infection.Small bilateral pleural effusions. No pneumothorax.Sternotomy hardware and multiple surgical clips overlying the anterior chest wall are again noted.

Output: Diffuse interstitial opacities with septal lines consistent with edema, and right middle lobe consolidation which may represent concomitant infection.CT is recommended for further evaluation of these findings.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: pneumonia History: fevers at home 101, productive cough; recent URI, concern for secondary bacterial infection; having CP as well Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Central line placement. History of lung cancer status post RT. Interval extubation and removal of the nasogastric tube. A right upper extremity PICC extends cranially into the neck, likely in the jugular vein. Right upper lobe volume loss with groundglass opacity and a peripheral density, poorly visualized by this technique, please refer to recently performed CT scan report.Low lung volumes with patchy opacities suggestive of bronchiolitis in the lung bases, most likely due to aspiration.

Output: Right central line extends cranially into the jugular vein. Probable aspiration bronchiolitis.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval placement of LIJ double-lumen HD catheter, r/o pneumothorax Left IJ line extends into the left upper hemithorax rather than the mediastinum and has been subsequently repositioned. Other lines and tubes, unchanged. No substantial change in bibasilar pleural-parenchymal opacities. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Left IJ line extends into the left upper hemithorax rather than the mediastinum and has been subsequently repositioned. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: s/p pacemaker History: s/p pacemaker New left subclavian dual chamber pacemaker, leads projected over the right atrium or right atrial appendage, and the ventricular lead directed cephalad towards the right ventricular outflow tract.No significant pneumothorax.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.

Output: New left subclavian pacemaker, no pneumothorax, but the RV lead is directed towards the right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: 66 year old woman with metastatic colon cancer and mental status changes. Please evaluate for brain METs, worsening pleural effusion worsening hepatic or GI process. CHEST:LUNGS AND PLEURA: There is progression of metastatic disease in the lungs with multiple pleural-based masses particularly along the right chest wall. For baseline purposes lesions seen on series 5 image 33/82 measures 2.4 x 1.5 cm. Previously on the 2/13/2008, image 34/100 measured 5 mm in maximal dimension.There are moderate-sized bilateral pleural effusions which are significantly increased compared to the prior exam.MEDIASTINUM AND HILA: No measurable axillary hilar or mediastinal nodes. There are some right cardiophrenic nodes.CHEST WALL: Increasing soft tissue tumor tracks along the right chest wall pleural catheter. Tumor is growing in the intercostal space and back muscles and subcutaneous tissues tracking along the catheter. See image 68 through 74/206. Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic masses have increased in size and compressed the portal and hepatic vasculature but without evidence of frank thrombosis or biliary dilatation. The baseline purposes one of the smaller lesions are amenable to measurement in the lateral segment of the left lobe is measured on image 75/206 is 2.4 x 2 cm. On the previous exam image 83/208 measured 1.4 x 1.3 cm.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: Extensive carcinomatosis throughout the mesentery and omentum and massive generalized ascites has all increased compared to the prior exam. This distorts but does not obstruct the bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Severe uterine mass is unchanged. Difficult to separate out from the large pelvic mass and ascites.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Massive generalized ascites and a large mass filling the pelvis with solid and cystic in nature likely related to carcinomatosis. Extensive loculations of the ascites.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Progressive disease with increase in carcinomatosis, ascites, pulmonary lesions, pleural effusions, chest wall tumor tracking along catheter and hepatic lesions.


Instruction: Generate impression based on medical findings.

Input: Productive cough rule out infectious process. Masslike consolidation in the right lower lobe associated with a small to moderate volume of chronic loculated pleural fluid. This has been present on multiple studies dating back to about 2010. Hazy opacities unchanged over multiple prior studies and appear improved from February 2016 though have not completely resolved; underlying nonbenign pathology cannot be excluded.

Output: 1. Diffuse hazy opacities present on multiple prior studies and have improved, though not completely resolved compared to February 2016. Recommend thoracic CT when feasible for further evaluation of these subsolid opacities to exclude possibility of multifocal adenocarcinoma.2. Right lower lobe rounded atelectasis with a chronic associated loculated pleural fluid collection.


Instruction: Generate impression based on medical findings.

Input: 23-year-old female who is 40 days post transplant with tachypnea, shortness of breath and left chest pain.VIEWS: Chest PA/lateral (two views) 2/27/2015 12:43 Right internal jugular venous catheter tip in the right brachiocephalic vein. Interval removal of right upper extremity PICC.Cardiac silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax.

Output: Right internal jugular venous catheter tip in the right brachiocephalic vein. No focal pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: s/p TECAB History: s/p TECAB Small bilateral pleural effusions with left lower lobe atelectasis, slightly improved from prior examination. No pneumothorax. Heart size is within normal limits.

Output: No pneumothorax. Slightly improved left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.History of +PPD Cardiomediastinal silhouette is normal. There is no focal pulmonary opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: ETT placement. ETT tip 2.5 cm above the level of the carina. Left jugular catheter terminates at the level of the right atrium. Enteric tube looped in the stomach.Extensive interstitial and airspace opacities bilaterally compatible with ARDS and infection about the same. Left lower lobe atelectasis and consolidation similar to prior, with a layering left pleural fluid collection. No pneumothorax.

Output: Low endotracheal tube with tip 2.5 cm above the level of the carina. No acute change in extensive pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with chest pain, tachycardia, positive d-dimer. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study diagnostic to the level of the lobar pulmonary arteries.LUNGS AND PLEURA: Right lower lobe consolidation abutting the minor fissure and the pleura peripherally (series 7, image 64). There is mild associated pleural thickening/effusion.MEDIASTINUM AND HILA: Right hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Gynecomastia. UPPER ABDOMEN: No significant abnormality noted.

Output: Right lower lobe consolidation, compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: ETT position History: n/a The ET tube has been retracted and is localized approximately 3.4 cm above the carina, in adequate position.Stable additional support apparatus.The size of the left apical pneumothorax is unchanged. Unchanged position of left apical chest tube.

Output: Adequate repositioning of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: evaluate hypoxia History: see above Heart size upper normal.Retrocardiac scarring or subsegmental atelectasis.No specific evidence of infection or edema.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: IABP placement History: IABP placement Bilateral humeral prostheses partially visualized. Intra-aortic balloon pump tip is barely visible, projecting approximately 2 cm inferior to the superior distal transverse arch.Persistent elevation of the left hemidiaphragm with streaky opacities compatible with left lower lobe subsegmental atelectasis. No significant pleural effusion or interval pneumothorax. There is lucency at the left apex favoring subcutaneous emphysema or gas within the soft tissues. Correlation to clinical examination is recommended.

Output: Intra-aortic balloon pump tip faintly visualized. Lucency at the left apex of uncertain etiology, possibly related to intra-aortic balloon pump placement.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: congestion History: congestin Unchanged enteric tube. Diffuse pulmonary opacities again noted. Unchanged heart size. No pneumothorax.

Output: Unchanged diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: pneumonia ET tube tip approximately 2 cm above the carina.Catheter tip in the SVC.Small lung volumes with mild basilar opacities compatible with atelectasis and aspirated secretions.No specific evidence of pneumonia.

Output: Mild basilar atelectasis and no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 58 year-old female history of asthma and acute shortness of breath LUNGS AND PLEURA: There is mild bronchial and bronchiolar wall thickening with scattered areas of inspissated mucus and bronchial plugging in the lower lobes. No significant air trapping identified on the expiration views. No evidence of interstitial lung disease.No suspicious pulmonary nodules. No evidence of a pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Fatty infiltration of the liver.

Output: Mild bronchial and bronchiolar wall thickening with scattered areas of inspissated mucus and bronchial plugging compatible with the history of asthma. No evidence of acute infection or other pulmonary pathology..


Instruction: Generate impression based on medical findings.

Input: New oxygen requirement rule out pneumonia assess for pulmonary edema. History of neutropenic fever and AML. Moderate pleural effusions with basilar atelectasis, slightly increased. On the left, opacification of the basal lung parenchyma may reflect superimposed infection.

Output: Moderate pleural fluid and atelectasis. Left basal opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old. Reason: cardiac silhouette History: chest discomfort Cardiomediastinal silhouette is unremarkable.Low lung volumes with elevation of right hemidiaphragm.No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: r/o pulm pathology History: acute liver failure Small lung volumes.No specific evidence of infection or edema.Tracheostomy tube tip approximately 3 cm above the carina.

Output: Tracheostomy tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: new crackles History: crackles Bilateral lower zone nonspecific airspace opacities, new on the right suggestive of infection and possible aspiration. Left jugular catheter tip in the area of the left innominate vein. Pacemaker device unchanged.

Output: Bilateral airspace opacity, increased at the right base, suggestive of infection and aspiration.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: No consolidation or pleural effusion. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Few calcified mediastinal lymph nodes. No significant mediastinal or hilar lymphadenopathy. No significant abnormality noted in the extra cardiovascular portions of the mediastinum. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality in the extra cardiovascular portions of the exam.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: chest pain History: SOB. Interval removal of right IJ catheter and placement of left subclavian pacemaker.Small to moderate bilateral pleural effusions with basilar edema.Basilar subsegmental atelectasis.Moderate cardiomegaly again noted.

Output: Small to moderate bilateral pleural effusions with basilar edema.


Instruction: Generate impression based on medical findings.

Input: 39 year old male status post right thoracotomy and decortication. Cardiomediastinal silhouette is obscured.Elevation of the right hemidiaphragm. Decreased right pleural effusion. Unchanged diffuse right interstitial and airspace opacities. Ill-defined patchy opacities at the right lung base appear slightly increased. Linear opacities in the left mid lung zone compatible with subsegmental atelectasis. No pneumothorax.Interval placement of 2 right-sided chest tubes.

Output: Decreased right pleural effusion. Ill-defined patchy opacities at the right lung base appear slightly increased and may represent atelectasis or consolidation.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with pancreatic cancer CHEST:LUNGS AND PLEURA: Micronodular image number 30, series number 9 in the right upper lobe is unchanged.MEDIASTINUM AND HILA: Small precarinal mediastinal lymph node is unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatitis minimally prominent. There is no well-defined pancreatic mass, however, slightly heterogeneous enhancement in the region of the pancreatic head and uncinate process. This is unchanged from previous study. No evidence of biliary dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease. Pancreatic mass is not well seen on CT. If further characterization of this mass is clinically indicated MRI may be more helpful.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.History of pneumothorax with thoracic vent recently removed. Previously seen thoracic vent has been removed without recurrent visible pneumothorax. Tubular lucency projected over left upper lung zone likely reflects prior subcutaneous catheter tract.Persistent moderate left effusion with underlying atelectasis, not significantly changed.No new focal pulmonary opacities.

Output: Removal of thoracic vent without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Left sided pleuritic pain, s/p left lung biopsy on 8/5. Evaluate for pneumothorax. History: as above No pneumothorax following recent biopsy.Enlarging left pleural effusion and increased left basilar atelectasis.Unchanged pulmonary metastases.Left jugular catheter, tip in SVC.

Output: Enlarging left pleural effusion, but no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: evaluate lung fields History: s/p TECAB Right IJ sheath remains in place. Bilateral chest tubes again noted. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increased basilar opacities, likely atelectasis. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male 48 years old Reason: Eval for infection, edema History: hypoxia, hypothermia Right chest wall pacemaker lead positions are unchanged. The sternotomy hardware is intact. Left ventricular assist device in place.Streaky left basilar opacities suggests atelectasis/scarring. No pleural effusion or pneumothorax is evident.There is persistent enlargement of the cardiac silhouette.The imaged skeleton and upper abdomen are unremarkable.

Output: Cardiomegaly and retrocardiac atelectasis similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: pneumonia, aspiration History: wheezes; choking. Small left pleural effusion, otherwise unremarkable.No reliable evidence of pneumonia.Heart size normal.Right jugular catheter, tip in SVC.

Output: Small left pleural effusion, but no obvious underlying pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: sob History: sob Small lung volumes with unchanged moderate to severe interstitial opacities and pleural fluid or pleural thickening.Right subclavian catheter tip at RA level.Left subclavian ICD, leads unchanged in position.

Output: Moderate to severe interstitial opacities suggestive of edema although there may be a component of underlying fibrosis.


Instruction: Generate impression based on medical findings.

Input: Right ventricular outflow track reconstruction. Is there pneumothorax?VIEW: Chest AP (one view) 10/21/16, 1129 Right chest tube has been removed. No pneumothorax is seen.Left chest tube remains in place. Mediastinal surgical clips and PDA stent are again seen. Two right atrial lines are present. Epicardial pacer leads are noted.Right upper lobe has reexpanded. Minimal hazy opacity is seen in left upper lobe. Cardiothymic silhouette is mildly to moderately enlarged.

Output: Removal of right chest tube and no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Check chest tube Bilateral chest tubes are unchanged without evidence of new superimposed focal airspace abnormalities. See subsequent report

Output: Bilateral chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with mesothelioma and chemotherapy with Byrne measurements CHEST:LUNGS AND PLEURA: Nodular thickening of the right pleura is again identified compatible with patient's diagnosis of mesothelioma. A small left pleural effusion is identified. Reference measurements as below.  Mass-effect is again noted on the SVC, right atrium, and right mainstem bronchus, all appear to be stable.  Aortic arch level: 3 o'clock, measuring 44.5 mm. previously measuring 44.5 mm: 21 mm at 7 o'clock previously measured 22.9 mm.: 21.8 mm at 11 o'clock previously measured 22.5 mmCoronary sinus: 20.5 mm at 4 o'clock previously measured 23.6 mm: 23.2 mm at 7 o'clock previously measured 27.9 mm: 27.1 mm at 9 o'clock previously measured 17.2 mmCostophrenic sulcus level: 33.5 mm at 7 o'clock previously measured 32.5 mm: 51.2 mm at 9 o'clock previously measured 54.3 mmEmphysematous changes are noted in the upper lobes. Again identified are scattered pulmonary nodules in left lung unchanged.MEDIASTINUM AND HILA: Again identified is mass effect upon the mediastinal structures as described above. Port-A-Cath is in place with its tip in the superior vena cavaCHEST WALL: There has been mild increase in size of the right chest wall mass and subcutaneous nodulesABDOMEN:LIVER, BILIARY TRACT: Mild extrahepatic biliary dilatation unchanged since the previous examSPLEEN: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule unchanged since the previous examinationKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No significant interval change in the multiple reference measurements .2. there is a very minimal increase in the right chest wall mass and subcutaneous nodules.3 . There is a small increasing left pleural effusion  4. The mild extrahepatic biliary dilatation stable in comparison to the previous examination.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Stable apical scarring. Stable bilateral below.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Stable left renal complex cystic lesion.RETROPERITONEUM, LYMPH NODES: Index lymph node measures 1.2 by 2.9 cm on image number 126, series number 3BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroid.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: Stable exam. No new adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: 8/12/15 Mediastinal mass biopsy, Drainage of pleural effusion History: none Interval removal of left-sided chest tube. Increased size of moderate left pleural effusion. Probable patchy left basilar atelectasis. Mediastinal mass again noted. Right lung remains clear. Unchanged heart size. No acute bony abnormality.

Output: Interval removal of left-sided chest tube. Increased size of moderate left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: follow up right mid and lower lobe lung opacities. History: shortness of breath Right perihilar interstitial and airspace opacity, consistent with infection and/or aspiration, not significantly changed allowing for technique.No new findings.

Output: Persistent right perihilar opacity consistent with infection and possibly aspiration.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Chronic scarlike changes greater both bases and right apex are all unchanged with associated volume loss and mediastinal shift. Surgical staples and sutures are again observed in the hilar region also unchanged. No specific findings or changes to suggest recurrence.Cardiac and mediastinal contours remain grossly within limits given distortion described. Borderline cardiomegaly unchanged

Output: Postsurgical changes with chronic appearing scarring.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: ? PTX History: fall and CP Sternotomy wires and postoperative changes of prior CABG redemonstrated.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval tube History: intubated Iatrogenic devices are unchanged. Unchanged cardiomegaly. Mild bibasilar opacities again noted. Question of small pleural effusions. No pneumothorax.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: Reason: syncope, infectious workup History: syncope Normal heart size with a moderately tortuous aorta.Large lung volumes consistent with COPD and coarse bilateral basilar interstitial opacity with evidence of bronchiectasis, suggestive of recurrent aspiration.Left basilar opacity is new or increased compared to the previous radiograph but the appearance also suggests chronicity.Biapical scarring, unchanged.

Output: COPD and basilar interstitial abnormality suggestive of bronchiectasis and scarring, likely related to recurrent aspiration.


Instruction: Generate impression based on medical findings.

Input: LUNGS AND PLEURA: Heterogeneous right upper lobe mass (image 11/139) not significantly changed, measuring 38 x 26 mm, previously 38 x 27 mm. Surrounding radiation fibrosis is stable. Stable nonspecific micronodules.MEDIASTINUM: Reference pretracheal lymph node (image 23/139) measures 7 x 10 mm, previously 7 x 9 mm. Reference precarinal node appears the same or smaller than on prior exam, although not adequately measurable now. No cardiomegaly. Small amount of pericardial fluid remains stable.CHEST WALL: No skeletal metastases.UPPER ABDOMEN

Output: .Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: left ij line placement History: concerned it got pulled out Two left jugular catheters are identified both tips in the left brachiocephalic vein approximately 1 cm apart. These appear without substantial interval change. The right pleural effusion stable. Moderate to severe multichamber cardiomegaly with significant enlargement of the central pulmonary arteries again noted. No pneumothorax.

Output: Two left jugular catheters both with tips in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: 51 years old Female. Reason: pna? History: focal wheeze RUL, DM, hyperglycemia. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: r/o fx History: [pain Heart size normal.No focal lung opacities.No pleural effusion. No pneumothorax. No obvious rib fracture.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Bloody emesis and hematemesis No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of rectal cancer. Evaluate for aspiration. Enteric tube tip below the field of view. Tubes and lines otherwise unchanged. Mild cardiomegaly. Questionable increased right basilar opacities may represent aspiration and atelectasis. Diffuse patchy airspace opacities are stable. Mild pulmonary edema.

Output: Questionable increased right basilar opacities may represent aspiration. Diffuse opacities consistent with atelectasis, edema and infection about the same.


Instruction: Generate impression based on medical findings.

Input: Reason: post op cardiac surgery History: post op cardiac surgery Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with bilateral pulmonary opacity compatible with edema, atelectasis and small effusions.No pneumothorax or other acute change.

Output: Pulmonary edema and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with shortness of breath. PULMONARY ARTERIES: Diagnostic examination demonstrate no acute or organizing pulmonary embolism in large or medium-size pulmonary arteries.LUNGS AND PLEURA: Diffuse mild mosaic attenuation. No pneumonia or pleural effusions. No honeycombing, air trapping, or interlobular septal thickening.MEDIASTINUM AND HILA: Enlarged main pulmonary artery, compatible with pulmonary artery hypertension. Enlarged right atrium and right ventricle. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Very limited examination of the upper abdomen is unremarkable. No reflux of contrast into the hepatic veins or SVC.

Output: 1. Diagnostic examination demonstrating no acute or chronic pulmonary emboli in central, segmental or subsegmental branches.2. Mosaic attenuation without airtrapping is compatible with small chronic thromboembolic disease.3. Pulmonary artery hypertension.


Instruction: Generate impression based on medical findings.

Input: Male; 53 years old. Reason: PRE Lung or Heart-Lung Transplant Evaluation History: PRE Lung or Heart-Lung Transplant Normal cardiac and mediastinal silhouettes.Large lung volumes suggestive of COPD. No abnormal pulmonary opacities. No pleural effusions.

Output: COPD but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for pna History: aspiration risk, No pleural effusion or pneumothorax. Right-sided posterior bridging callus between multiple midthoracic ribs, unchanged. No new focal pulmonary opacities. The cardiomediastinal silhouette is stable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: 75yoM OSH transfer with hemoptysis, worsening bibasilar opacities History: as above Upper lobe predominant emphysema.Increased interstitial opacities in the lower lung zones most likely chronic in origin.However, superimposed edema cannot be excluded.Cardiac size is normal.No focal areas consolidation.No pleural effusions.

Output: Basilar predominant interstitial opacities most likely chronic in origin. Superimposed edema cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.IABP. IABP marker about 2.5 cm below the top of the arch.Coarse pulmonary opacities with bronchial wall thickening slightly increased and appear atypical for edema. Skeletal summation artifact from known rib fractures bilaterally.Emphysema.

Output: Slight worsening of pulmonary opacities which could reflect aspiration bronchiolitis superimposed upon mild atypical edema and atelectasis. Correlate for signs of infection.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic melanoma. Restaging prior to chemotherapy treatment. CHEST:LUNGS AND PLEURA: Stable right upper lobe nodule measuring 1.4 cm in diameter on image number 27/104. No new nodules.MEDIASTINUM AND HILA: Previous described nonenlarged multiple mediastinal nodes are smaller and have decreased in size. Previously mentioned borderline enlarged subcarinal lymph node now measures 9 x 7 mm on image number 46/230.CHEST WALL: Previously described multiple axillary lymph nodes are smaller in size.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Subtle hypoattenuating lesion in the spleen is unchanged. The spleen is enlarged measuring 14.1 cm craniocaudally.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Small bowel masses difficult to evaluate but is likely unchanged measuring 4 x 4.1 cm on axial image number 132/230.Vague stranding of the fat in the mesentery in the midabdomen and borderline enlarged lymph nodes are unchanged.BONES, SOFT TISSUES: Symmetric lytic lesions within the sacrum and pelvis are unchanged and likely due to osteopenia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval decrease in the size of the mediastinal lymph nodes. Lung nodule, small bowel mass, hazy increase in the density of the mesentery fat, retroperitoneal and mesenteric lymph nodes are stable to minimally increased..


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval lung fields History: seizure Minimal left basilar subsegmental atelectasis. No significant acute cardiopulmonary abnormality.

Output: Minimal left basilar subsegmental atelectasis. No significant acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Check pulmonary status. Acute respiratory failure. Low position of left jugular catheter with which terminates in the region of the low right atrium/suprahepatic IVC in this patient with right diaphragmatic elevation.Enteric tube makes a large loop within the stomach before exiting off the caudal margin of the film. A right upper quadrant percutaneous pigtail catheter is noted. Upper abdominal surgical drain and staples project over the midline.Small pleural effusions with associated atelectasis and consolidation about the same. Pulmonary edema is slightly worse. Centralization of bowel consistent with ascites.

Output: Worsening interstitial opacities consistent with edema. Small pleural effusions with basal compressive atelectasis and consolidation about the same.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: altered History: above Mild cardiomegaly.No specific evidence of infection or edema.Moderate scoliosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: assess change from prior cxr, change in pneumothorax History: decreased L sided lung sounds Left pleural drain unchanged in position with a persistent apical pneumothorax, not as well identified.Left lower lobe consolidation stable.Severe soft tissue emphysema unchanged.Endobronchial valves remain in place.

Output: No change in left pneumothorax and pleural drain.


Instruction: Generate impression based on medical findings.

Input: History of colorectal cancer. Evaluate for surveillance. CHEST:LUNGS AND PLEURA: Subcentimeter calcified granulomas are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense hepatic lesion is unchanged. No intra-or extrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measuring 2 x 2.1-cm likely representing an adenoma is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Postsurgical changes in the sigmoid colon, unchanged. Fat containing ventral hernia is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic or recurrent disease. No significant change from previous CT.Left adrenal nodule likely representing an adenoma is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: check chest tube placement History: tachypnea Slight improvement in right pneumothorax, right chest tube unchanged in position.Diffuse interstitial opacities with small right pleural effusion are unchanged.

Output: Improvement in right apical pneumothorax. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: r/o acute process History: s/p fall No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pulmonary effusion History: SOB Moderately large bilateral pleural effusions with underlying atelectasis, not significantly changed allowing for position and projection.Port catheter with its tip in the SVC.No new findings.

Output: Large pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: FemaleReason for Study: Reason: baseline cxr for pre op clearance for surgery History: The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophagectomy History: s/p esophagectomy Bilateral chest tubes and NG tube unchanged.Small lung volumes with nonspecific air space opacity, small effusions and atelectasis.Mediastinal widening consistent with recent esophagectomy.No pneumothorax or other acute change.

Output: Postoperative findings consistent with aspiration, atelectasis and small effusions without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: F/u wt pneumothorax, chest tube History: As above Left pleural drain with improvement in size of a left pneumothorax, with a small bulla in the apex.Lungs otherwise unremarkable.

Output: Improvement in size of left pneumothorax, but still present.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: sob Extensive volume loss in the right hemithorax with pleural thickening and underlying radiation reaction, not significantly changed.Airspace opacity in the left mid and lower lung, unchanged or slightly increased from previous, compatible with pneumonia.

Output: Nonspecific airspace opacity in the left lung compatible with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 37 yearsGender: FemaleReason for Study: Reason: pre surgical History: SOB There is moderate cardiac enlargement with prominence of central pulmonary vasculature.Mild increase in perihilar reticulonodular ground glass opacities.No focal areas of consolidation.No pleural effusions.

Output: Moderate cardiac enlargement with considerable prominence of the central pulmonary vasculature.Diffuse increased interstitial and groundglass opacities which may represent acute and/or chronic interstitial disease including bronchiolitis. Less likely edema. Recommend CT of the chest further evaluation.


Instruction: Generate impression based on medical findings.

Input: Three year old female with URI/decreased bowel sounds. Cystic mass in the right lower lung concerning for diaphragmatic hernia. CHEST:LUNGS AND PLEURA: A right-sided diaphragmatic hernia is seen with loops of contrast-filled large and small bowel herniating into the right hemithorax. They occupy the mid and lower right hemithorax with relative sparing of the right upper hemithorax. Additionally, the bowel mesentery, branches of the SMA, and a fluid-filled structure likely representing the gallbladder are also seen herniating into the right hemithorax.Right upper lobe apical atelectasis is also visualized. There is also atelectasis seen at the left lower lobe.MEDIASTINUM AND HILA: The mediastinum and trachea are slightly shifted to the left.CHEST WALL: No significant abnormality noted. OTHER: The caliber of the left internal jugular vein is smaller in comparison to the right side.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder appears to have herniated into the lower right hemithorax. Normal enhancement of the liver.SPLEEN: The spleen appears unremarkable.PANCREAS: The pancreas appear unremarkable.ADRENAL GLANDS: The visualized adrenals appear unremarkable.KIDNEYS, URETERS: The visualized kidneys appear unremarkable and there is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy.BOWEL, MESENTERY: The stomach is distended and filled with contrast. Part of the bowel is herniated into the right hemithorax as described above.  BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Large right-sided diaphragmatic hernia as described above.The contents within this hernia contain both small and large bowel loops, branches of SMA and likely gallbladder.2.Right upper lobe apical and left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: 28-year-old female with non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary dilatation with plastic stent in the common bile duct, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged hypoattenuating lesion within the left kidney likely a para pelvic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged compression fracture of the L4 vertebral body more than 90 % height loss.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: No significant change from prior study. Significant compression fracture of L4 vertebral body is unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 92 year-old female with esophageal cancer. Dysphagia. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions. Calcified right hilar lymph nodes and calcified granuloma in the right lung base.MEDIASTINUM AND HILA: Masslike thickening of the distal esophagus is identified, extending to the GE junction. Small periesophageal and subcarinal lymph nodes are identified. A paraesophageal lymph node measures 11 x 11 mm (series 3; image 56).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Two tiny hypodensities in the liver are too small to definitively characterize but likely cysts. Incidental note is made of a low insertion of the cystic duct.SPLEEN: Splenic granulomataPANCREAS: The pancreas is atrophic. 7-mm hypodensity in the uncinate process is too small to definitively characterize, but may represent a dilated side branch or possibly mucinous neoplasmADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 17 x 13 mm lesion in the upper pole of the right kidney (series 3; image 87) represents a complex cyst versus neoplasm.Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic lymph nodes are identified. A reference a gastrohepatic lymph node measures 16 x 8 mm (series 3; image 80).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic versus absentBLADDER: 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: Masslike thickening of the distal esophagus with regional adenopathy, consistent with known carcinoma.Complex cystic versus solid lesion in the right kidney, measuring 1.7 x 1.3 cm. CT or MRI with renal mass protocol can be obtained.Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 19 years old.Reason: Are there any focal findings to suggest pneumonia? History: SOB, wheezes The cardiomediastinal silhouette is normal.There is no focal pulmonary opacity, pleural effusion or pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval for pna, pulmonary edema History: sob, crackles Question of new focal nodular opacity at the right lung base. Increased left basilar opacity. Lower lung volumes. No large pleural effusion or pneumothorax. Heart size likely unchanged given lower lung volumes.

Output: New lower lung opacities which certainly could represent aspiration or pneumonia versus atelectasis/artifact. Close interval imaging is suggested to reassess these abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Status post tracheostomy. Inability to swallow. Tracheostomy tube in place, similar to prior. Small amount of lower neck subcutaneous emphysema, similar to prior.Right venous catheter with tip in the SVC.Enteric tube tip projects over the upper neck at the level of the mandible.Unremarkable cardiac mediastinal silhouette.Bibasilar subsegmental atelectasis/scarring. No specific evidence of infection or edema.Unchanged 14 mm right lower lung nodule.

Output: 1. No acute cardiopulmonary abnormality.2. Enteric tube tip projects over the upper neck.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: sp ex lap, LOA, bowel resection, ho COPD, CHF History: shortness of breath Scarring or atelectasis along the right hemidiaphragm. Blunting of the left costophrenic angle. Left basal scarring and atelectasis, present previously but exaggerated by underinflation.Interval extubation. Left jugular catheter and NGT unchanged in position.Faint opacity in the right upper lobe may be the result of aspirated secretions, nonspecific.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female 81 years old Reason: r/o obstruction/stool burden assessment History: abd distension Upright chest radiograph demonstrates right mid zone atelectasis/scarring with flattening of the bilateral hemidiaphragms. Lungs grossly clear. No subdiaphragmatic free air.Nonobstructive bowel gas pattern with above-average stool burden. No intramural air or free intraperitoneal air. Vascular calcifications noted.

Output: Nonobstructive bowel gas pattern. Above-average stool burden.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval for volume overload History: chest pain No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male status post induction chemotherapy for head and neck cancer. Evaluate response. Compared to previous, measurements required per study. CHEST:LUNGS AND PLEURA: Right upper lobe hamartoma with fat and punctate calcification, unchanged (measuring 20 x 20 mm). No suspicious nodules, masses, or pleural effusion.Mild paraseptal emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary calcifications.Left jugular central venous catheter with tip in the SVC. Small amount of thrombus is seen at the catheter tip (series 3, image 47).CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Benign-appearing hypoattenuating foci in the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts bilaterally. Nonobstructing renal calculi bilaterally, the largest measures approximately 5 mm in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of metastatic disease.2. Right upper lobe hamartoma.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: s/p chest tube removal History: s/p chest tube removal Cardiomegaly status post sternotomy and valve replacement.Minimal pleural effusions and residual basilar edema noted.Right jugular Swan-Ganz catheter and chest tubes removed, with a minimal right apical pneumothorax.

Output: Small right apical pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: s/p thoracentesis History: shortness of breath Decrease in size of right pleural effusion. No pneumothorax. Small left pleural effusion again noted. Bibasilar nodular opacities, not substantially different. Port catheter terminates just below the cavoatrial junction. No acute bony abnormality.

Output: Decreased size of right pleural effusion status post thoracentesis without pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Syncope Left ventricular assist device, valve prosthesis, and median sternotomy wires are unchanged.Mild cardiomegaly.No pleural effusion or pneumothorax.No focal airspace opacities.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for CHF vs PNA History: ESRD, SOB Cardiomegaly unchanged. Mediastinal lipomatosis as seen on prior CT. Right basilar patchy air space opacity. No large pleural effusions or pneumothorax.

Output: Right basilar patchy airspace opacity, suggestive of aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with WBC 25,000 CHEST:LUNGS AND PLEURA: Peripheral consolidation in the right upper lobe is identified, consistent with pneumonia. Ground glass opacity in the left upper lobe and right middle lobe is noted. Mild-moderate right pleural effusion, partially loculated with trace left effusionMEDIASTINUM AND HILA: A few borderline enlarged lymph nodes are identified in the mediastinumCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post partial resection of the right hepatic lobe.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland has been removed.KIDNEYS, URETERS: Status post right nephrectomy.In the postsurgical bed, scattered pockets of gas are identified along with a large amount of fluid. This fluid extends along an intraperitoneal and retroperitoneal (adjacent to the right psoas muscle) coarse. High density components, compatible with hemorrhage, are intermixed with lower density fluid. No definitively loculated components are identifiedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several pockets of pneumoperitoneum are identifiedBONES, 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: Small fluid collection along the right femoral vessels, from prior line placementOTHER: No significant abnormality noted

Output: Phlegmonous changes and hemorrhage located in the postsurgical bed with significant intraperitoneal and retroperitoneal extension. Findings worrisome for infection/developing abscess.Consolidation in the right upper lobe, compatible with pneumonia.Mild-moderate right pleural effusion. Scattered bilateral ground glass opacities in the lungs, infection versus inflammation.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: R IJ placed in the OR Right internal jugular sheath has its tip superimposing the right internal jugular vein. Bullet fragment projects over the mid abdomen.Low lung volumes detailed limit cardiopulmonary assessment. Bronchial wall thickening noted. Diffuse increased haziness of the lungs favored to be due to vascular crowding. Favor film to be taken during expiration. Left-sided basilar atelectasis and bibasilar scarring. No large pleural effusion or pneumothorax.

Output: 1.Right internal jugular sheath overlies the right internal jugular vein. No radiographic evidence of immediate post procedural complications.2.New acute abnormalities in this expiratory portable chest radiograph.Findings discussed with Dr. Trever Symalla at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male s/p CABG, evaluate lung fields Median sternotomy hardware and mitral valve replacement noted.Interval removal of ET tube.Swan Ganz catheter, mediastinal and chest tubes stable in position.Right apical pneumothorax.Stable widening of mediastinum.Stable retrocardiac and left midlung opacities with increasing bibasilar streaky opacities.Pleural effusions.

Output: Right apical pneumothorax now identified. Interval extubation. Increasing bibasilar atelectasis compatible with atelectasis/edema.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Fever in ventilated patient. Tubes and lines unchanged in position with the right jugular dual lumen catheter remaining low in the right atrium.Lung volumes are low, unchanged. Diffuse interstitial and air space opacities are not appreciably changed compared recent films though they do appear somewhat confluent at the right lung base and a superimposed pneumonia would be difficult to exclude in this area.

Output: No acute change in pulmonary opacities; confluent consolidation within the right lung base nonspecific making it difficult to exclude superimposed infection in this area.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Aspiration pneumonitis versus pneumonia. New wheezing, worsening SpO2, SOB, aspiration precautions. Interval development of bilateral moderate pleural fluid collections and perihilar edema-like opacities. Cardiomegaly with retrocardiac atelectasis. No visible signs of aspiration or infection, but they may be obscured by edema and atelectasis.

Output: Worsening hypervolemia/CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: PICC line placement History: PICC line placement No significant cardiopulmonary abnormality.Right PICC, tip in the SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: chest pain History: chest pain No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 81 yearsGender: FemaleReason for Study: Reason: leukocytosis of unknown origin History: see above Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Intubated. ETT tip 3.5 cm above the level of the carina. Right jugular catheter tip at the SVC level.Low lung volumes with basal atelectasis, increased on the left. The mid to distal left lower lobe airway is not visualized and could be filled with debris.

Output: Overall lung volumes have slightly improved though they remain low. Atelectasis on the left has increased, suspicious for aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: c/f pulm edema History: sob Mild interstitial pulmonary edema. No large pleural effusion or pneumothorax. Moderate cardiomegaly. Patient status post sternotomy and CABG.

Output: Mild interstitial pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: MaleReason for Study: Reason: ACS History: CP 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: 62-year-old male status post esophagectomy c/b leak, status post IR drain, now healed, presents with emesis, abdominal distention, please evaluate for obstruction/leak CHEST:LUNGS AND PLEURA: Increasing loculated left pleural effusion with underlying atelectasis. Minimal right pleural effusion. MEDIASTINUM AND HILA: Patient is status post esophagectomy with gastric pull through. Previously described abnormal fluid collection, medial to the thoracic stomach with the pigtail catheter within it has resolved. In comparison to prior study. No obvious air-fluid level identified. (Image 35 coronal plane, axial image 48, series 4. No measurable collection is identified. Catheter is present within this collection and exits posteriorly through the chest wall. Another catheter is identified within the gastric pull up, unchanged in comparison to prior study. Oral contrast delineated the gastric pull up. No evidence of mediastinal lymphadenopathy.CHEST WALL: Port-A-Cath noted at the junction of right atrium and SVC.ABDOMEN:LIVER, BILIARY TRACT: Scattered small subcentimeter hypodensities (series 4, image 85, image 74) too small to characterize. Larger low-attenuation lesion (image 96, series 4), most likely a benign cyst in inferior right lobe is unchanged. No intrahepatic or extrahepatic duct dilatation and gallbladder appears normal. Hepatic vessels appear patent. Interval increase in fluid in the perihepatic and subhepatic spaceSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Area of focal scarring identified in the right kidney, unchanged in comparison to prior study could represent prior old infarct of infectionRETROPERITONEUM, LYMPH NODES: Few prominent lymph nodes identified, and change in comparison to prior study, not pathologically enlargedBOWEL, MESENTERY: Gastric pull-through with anastomosis in chest. Jejunostomy tube through mid left anterior abdomen is identified. Within the mid intra-abdomen. A tear of fat stranding mesenteric haziness noted adjacent to the jejunostomy insertion (image 132 on series 4), minimally increased in comparison to prior study, this last finding appears to be adjacent to the transverse colon and with minimal wall thickening of the transverse colon, this could represent focal colitis or diverticulitis. Ischemia is less likely, rest of the large bowel appears unremarkable. Interval increase in ascites in the abdomen. No obvious evidence of leak. Focal distention of jejunum proximal to the J-tube best seen on image 116, series 4), the oral contrast is seen in the pelvic bowel loops. This could be suggestive of minimal obstruction at the level of the jejunostomyBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged nodular prostate without other abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See bowel description above Sigmoid colon diverticula without complication. Interval increase in ascitesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Status post esophagectomy with gastric pull through. Interval decrease in fluid collection medial to the gastric pull-through, drain noted in appropriate location.2. Interval increase in left loculated pleural effusion.3. Interval increase in ascites.4. Interval increase in fat stranding in the mesentery adjacent to the transverse colon in the mid plantar abdomen, and suggestive of focal colitis (inflammatory or infectious), or diverticulitis.5. Jejunal loop just proximal to the tip of the J-tube is dilated suggestive of mild obstruction. No evidence of free intraperitoneal air.Findings conveyed to the service by Radiology resident on call.


Instruction: Generate impression based on medical findings.

Input: CHF history Mild nonspecific cardiomegaly with patchy largely perihilar and right basilar opacities have a moderate toe large layered right pleural effusion. Suspected atelectasis, however asymmetric CHF given patient history must be considered. See separate reports.

Output: Suspected moderate CHF


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: eval for focal infiltrate, effusion History: CP, hx of effusions Interval removal of left permacatheter.New widened upper mediastinum, recommend cross-sectional imaging for further evaluation.Postsurgical changes the right lung.Increased moderate right pleural effusion tracking into the minor fissure. Increased nonspecific patchy opacities and subsegmental atelectasis.

Output: New widened upper mediastinum, recommend cross-sectional imaging for further evaluation.Postsurgical changes the right lung.Increased moderate right pleural effusion tracking into the minor fissure. Increased nonspecific patchy opacities and subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: s/p AVR and CABG History: -- Endotracheal tube, right IJ Swan-Ganz catheter and mediastinal chest tubes remain unchanged. Status post median sternotomy and valve surgery.Stably enlarged cardiac silhouette.Low lung volumes with mild improvement in edema and persistent bibasilar atelectasis. Small left pleural effusion suspected. No pneumothorax.

Output: Postoperative changes with mild improvement in edema and persistent bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: rule out aspiration History: as above Moderate to severe cardiomegaly.Mild basilar interstitial opacities in either edema or fibrosis.No specific evidence of infection.Left subclavian transvenous pacemaker unchanged.Contrast material is present in the colon.

Output: Severe cardiomegaly with basilar edema or fibrosis but no sign of infection. No significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval for effusion, PNA History: SOB Small lung volumes with mild basilar subsegmental atelectasis, otherwise unremarkable.No reliable evidence of edema or pneumonia.

Output: Small lung volumes with nonspecific basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Pain and swelling at Hickman insertion site. The left jugular catheter has been retracted and may be extravascular. Neck soft tissue swelling is noted.No pneumothorax.Severe enlargement of the central pulmonary vasculature. Heart size unchanged. Mild basal atelectasis and vascular unsharpness which could reflect very mild edema. Trace pleural fluid.

Output: Retraction of the left jugular catheter which may be extravascular. This, in combination with neck soft tissue swelling, is highly suspicious for extravasation of catheter infusion and/or hematoma.In addition to the stat consult performed by the radiology resident on call at 12:19 a.m. on 6/3/2016, a courtesy text page was sent to Dr.Gomberg at 8:19 a.m. on 6/3/2016 regarding position of the catheter.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: FemaleReason for Study: Reason: fever work-up History: fever work-up VP shunt tubing noted overlying left hemithorax. Intrathecal shunt unchangedLarge pleural effusions on the left with underlying consolidation/atelectasis may be on basis of acute infection.The right lung is clear.

Output: Large left-sided pleural effusion and underlying consolidation/atelectasis is compatible with acute infection.