Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Chest pain and shortness of breath. Normal cardiomediastinal silhouette. No focal consolidation, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with metastatic melanoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable anterior mediastinal soft tissue and small intestinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subcentimeter soft tissue nodule anterior to the ascending colon is unchanged measuring 7 mm in diameter image number 147, series number 3.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: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: pnuemonia? History: COPD , pulmonary hypertension on oxygen with increased shortness of breath Large lung volumes consistent with emphysema. Streaky basilar interstitial opacities, unchanged consistent with scarring and subsegmental atelectasis.Moderately enlarged central pulmonary arteries suggestive of pulmonary hypertension. No specific evidence of pneumonia or other acute change.

Output: COPD with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: sob History: sob No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: hypotension, concern for sepsis Tracheostomy tube and right jugular catheter unchanged.Moderately large bilateral pleural effusions with underlying atelectasis.Skinfold over the left lung but no pneumothorax.Focal pleural thickening in the left upper hemithorax that may represent loculated fluid, though I cannot exclude a mass based on the available images. Further follow-up is recommended.

Output: Pleural effusions and basilar atelectasis with loculated fluid or pleural mass in the left hemithorax.


Instruction: Generate impression based on medical findings.

Input: Evaluate for bowel gas concerning for SBO, nausea and vomiting on narcotics Relative paucity of small bowel gas. No specific evidence of bowel obstruction. 10 mm peripherally radiodense rounded structure in left upper quadrant nonspecific but may represent a calcified splenic aneurysm versus a diverticulum.

Output: No specific evidence for bowel obstruction. Please see above for additional findings.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: MaleReason for Study: Reason: r/o cardiopulm History: chest pain 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: Female, 28 years old.Reason: Persistent cough with green sputum. The cardiomediastinal silhouette is normal. No focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: sob ? PNA History: SOB No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: central line placement History: central line placement Moderate to marked enlargement of cardiac silhouette consistent with known pericardial effusion. Right internal jugular central venous catheter tip is at the superior cavoatrial junction. Superior IAPB markers noted at the T6 - T7 level.  ICD leads ae unchanged.  Bibasilar opacities are seen on prior CT are also unchanged.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: ARDS, severe hypoxia, intubated History: as above ET -tube, NG tube, and left PICC line unchanged. Stable cardiac enlargement with extensive opacities in both lungs similar in appearance to the prior exam.No new pulmonary opacities identified

Output: Support devices unchanged. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Sepsis Nasogastric tube sidehole is within the distal esophagus, as before. Other lines and tubes are also unchanged. Mild bibasilar opacities again noted likely atelectasis. Unchanged heart size. No pneumothorax. No definite pleural effusion.

Output: The substantial change compared to previous study. Nasogastric tube side hole is within the distal esophagus and could be advanced into the stomach.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: CTICU History: HTX, PTX New Dobbhoff tube, with tip projecting in the stomach.Low lung volumes.Small left apical pneumothorax mildly improved.Nonspecific basilar opacities, suggestive of effusions and atelectasis, not appreciably changed.Cardiac silhouette is obscured.

Output: Small left apical pneumothorax mildly improved.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: assess PTX and chest tubes History: as above Chest tube extending to the right apex with no visible pneumothorax.Small lung volumes with basilar subsegmental atelectasis.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old."EET" epileptic grand mal seizure ETT tip at the level of the clavicular heads, 4.5 cm above the level of the carina. Right subclavian catheter unchanged in position. NGT tip off the caudal margin of the film.Moderate to large layering pleural fluid collections with associated compressive atelectasis at the lung bases, slightly improved. Edema and atelectasis elsewhere with signs of aspiration within the posterior lung fields, also similar, correlate for signs of infection. Unchanged appearance of the cardiomediastinal silhouette.

Output: Improving pleural fluid volume. Dependent atelectasis and aspirate, correlate for signs of infection


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: FemaleReason for Study: Reason: chf History: shortness of breath, chest pain Stable cardiomediastinal silhouette.Mild basilar scarring/discoid atelectasis.No focal airspace consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Right IJ line placement. Motion artifact degrades image quality. Right jugular catheter tip at the SVC level. No pneumothorax.

Output: Exam limited by motion. No visible pneumothorax. Right jugular catheter tip at the SVC level.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old. IABP position. IABP marker in the proximal descending thoracic aorta.Right IJ Swan-Ganz catheter tip is obscured by the overlying defibrillator pad, but likely is in the region of the right main pulmonary artery. Right IJ catheter and ICD, unchanged. Stable cardiomegaly.Hazy lower lung zone opacities likely represent edema, unchanged. Retrocardiac atelectasis, unchanged.

Output: IABP marker in the proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: LVAD Cardiac device, Swan-Ganz and Dobbhoff all appear unchanged.Underlying moderate CHF with large effusions and mild cardio megaly all appear similar. No discrete new focal airspace process within this limitation

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer with unknown primary CHEST:LUNGS AND PLEURA: New patchy ground-glass opacity within the right lower lobe. Small granuloma in the left lower lobe. Few nonspecific micronodules unchanged. No suspicious pulmonary opacities. MEDIASTINUM AND HILA: No lymphadenopathy. Residual thymic tissue unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypodensity within the caudate lobe and adjacent to the gallbladder. Lesion adjacent to the gallbladder like represents a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal hypodensity likely cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Focus of ground glass opacity within the right lower lobe likely secondary to mild aspiration. 2. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: Shortness of breath Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Unchanged cardiomegaly. Spinal curvature, unchanged.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: IABP placement History: none Balloon catheter marker at the level of the aortic arch.Right jugular catheter and ICD leads unchanged.Cardiomegaly with no acute pulmonary abnormality.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Central PICC placement. Right upper extremity PICC tip at the superior cavoatrial junction.Dobbhoff tube tip projects over the gastric body.Mild cardiomegaly.Subtle groundglass opacity may be artifact of underinflation and motion and can be reevaluated by erect PA and lateral chest radiographs if required.

Output: Right PICC tip at the SVC/artery junction.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: check pulmonary status History: check pulmonary status NG tube with its tip in the stomach. There are decreased lung volumes and stable cardiomediastinal silhouette.Nonspecific basilar opacities compatible atelectasis.No large pleural effusions or focal areas consolidation.Severe rotoscoliosis of the thoracic lumbar spine.

Output: Nonspecific basilar opacities compatible with atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.COPD, PD-1 pneumonitis, worsening hypoxia evaluate for interval change. Mesothelioma. Interval increased conspicuity of pleural nodules and masses since the prior chest radiograph though they are not appreciably changed compared to the last CT. New moderate left pleural fluid collection. Left lower lobe paramediastinal opacity is probably unchanged from the 4/13/2016 CT.Hazy opacities in the right lung have recurred.

Output: Recurrent edema-like opacities in the lower lung zones which may reflect edema or pneumonitis. The interstitial appearance is very similar to the examination of 3/9/2016.


Instruction: Generate impression based on medical findings.

Input: 63 year-old female with history of PEA arrest. Support devices unchanged.Stable cardiomegaly. Left basilar opacities likely representing atelectasis/aspiration.

Output: Left basilar opacities likely representing atelectasis/aspiration without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated, hypoxia, VAP, edema? History: see above ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.An NG tube terminates in the stomach.Bilateral diffuse airspace and interstitial opacity, suggestive of edema, improved compared to previous.

Output: Resolving pulmonary opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for infection, effusion History: elevated WBC, aspiration Bilateral lower zone air space and interstitial opacity, greater on the left, compatible with aspiration and/or infection.Enteric tube traversing the esophagus.No new findings. I

Output: Basilar airspace opacity, greater on the left, compatible with aspiration and infection.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: PNA or effusion History: cough Right chest port with tip in SVC. No specific evidence of infection or edema.Stable fibrotic changes seen at right lung apex.Heart size within normal limits.

Output: Stable chronic changes with no specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: 87 yo s/p intubation History: respiratory failure Subtle improvement in left lower lobe consolidation. Stable cardiomegaly.Atelectasis still is present in the left perihilar region.ET tube tip approximately 5 cm above the carina.Left subclavian pacemaker, leads unchanged in position.

Output: Improving left lower lobe consolidation with no new findings.


Instruction: Generate impression based on medical findings.

Input: 90 years old Male. Reason: ETT in place History: see above. The tip of the enteric tube projects over the distal gastric body. The tip of the ET tube is about 3 cm above carina. The tip of the right IJ catheter project over the atriocaval junction. Extensive bilateral airspace opacity, suggestive of aspiration, infection and edema unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedUPPER ABDOMEN: No significant abnormality.

Output: No active cardiopulmonary disease. No infiltrates, nodules or effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval cause of hypoxemia, hardware position History: eval bilateral opacities Stable left basilar opacity.No change in support devices.

Output: No change in left basilar opacity. Stable appearance of support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: eval for volume overload, cardiomegaly, pna History: cough, sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Congestion and cough. Rhonchi left greater than right on physical exam. BMT for CLL, rule out pneumonia. Right chest port tip at the SVC level. Normal heart size.Large left hilar mass similar in appearance to recent PET CT.Subtle nodularity peripheral to the mass may indicate impacted airways due to clearance of secretions. The left upper lobe airways in particular were noted to be slightly attenuated by the mass.No pleural fluid.Persistent atelectasis in the lingula, present on the prior PET/CT.

Output: Diffuse nodular opacities in the left lung may reflect aspirated, more likely, retained secretions due to central mass incompletely obstructing the airways. Recommend serial radiographic follow-up to ensure that this does not evolve into a post obstructive pneumonia.


Instruction: Generate impression based on medical findings.

Input: 4-day-old female, prior 35 week and 2 day gestational age patient, right pneumothoraxVIEW: Chest AP (one view) 5/23/2016, 5:21 The ETT tip is between carina and thoracic inlet. The feeding tube side-port is in the stomach. Right chest tube in similar position. UVC tip in a branch of the left portal vein. UAC tip at T8-9.Right pneumothorax has resolved and right upper lobe aeration has improved. The background of granular pulmonary opacities persists. The cardiothymic silhouette is obscured, with interval complete opacification of the left hemithorax and leftward mediastinal shift. No pleural effusion.Nonspecific mildly dilated loop of bowel in the right upper quadrant.Mild body wall edema.

Output: 1. New complete opacification of the left hemithorax, consistent with complete left lung atelectasis most likely from mucous plugging.2. Improved aeration of the right upper lobe. No significant residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: r/o acute process History: cough The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: CP s/p fall History: R rib pain Nondisplaced fracture of the right ninth rib laterally, confirmed on subsequent rib views.Port catheter with tip in the SVC.Moderate cardiomegaly, unchanged.

Output: Fracture of the right ninth rib, compatible with recent trauma.


Instruction: Generate impression based on medical findings.

Input: Metastatic renal cell carcinoma CHEST:LUNGS AND PLEURA: Peripheral right upper lobe lesion is not significantly enlarged and measures 3.7 x 2.5 cm in image number 27, series number 5. Second opacity in the right lower lobe with hazy borders has resolved. Other right upper lobe nodules are also slightly smaller.MEDIASTINUM AND HILA: Reason mentioned mediastinal lymph nodes are unchanged. Previously measured precarinal lymph node measures 15 x 10 mm image number 37, series number 5.CHEST WALL: No significant abnormality noted.ABDOMEN:The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is normal. Right adrenal gland is been removed.KIDNEYS, URETERS: Right nephrectomy site does not show any evidence of recurrence. Hyperdense lesion in the upper pole of the left kidney slightly enlarged measuring 15 x 14 mm on image number 93, series number 5. Lack of IV contrast limits optimal evaluation of this lesion. A neoplasm cannot be excluded.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: Interval increase in the size of the right upper lobe mass. Other nodules are slightly smaller.Interval increase in the size of the left upper pole renal lesion. A solid neoplasm cannot be excluded. Further evaluation with ultrasound is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: ETT placement? History: see above ET tube is been placed with its tip 2 cm above the carina.NG tube with its tip in the stomach.Stable cardiomediastinal silhouette.Left retrocardiac opacity compatible consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: ET tube with its tip 2 cm above the carina. Left retrocardiac opacity similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval ET tube History: intubated Endotracheal tube is approximately 2 cm above the carina.Right upper lobe and perihilar masslike opacity is not significantly changed. No large pleural effusion or pneumothorax. Heart size is stable.

Output: 1. ET tube tip 2 cm above the carina. 2. Right perihilar mass can be further evaluated with CT if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: f/u pleural effusions History: effusion Pleural effusions right larger the left, with mild basilar subsegmental atelectasis, unchanged.Moderate cardiomegaly.Status post mitral valve repair.Left subclavian pacemaker, leads unchanged in position.

Output: Unchanged cardiomegaly and pleural effusions right larger than left.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with history of questioned left IJ catheter placement. Interval placement of Dobbhoff tube with tip projecting over the EG junction. Right IJ central venous catheter tip in the right atrium. Endotracheal tube tip 2 cm above the carina. Left IJ central venous catheter has been retracted 2 to 3 cm, still projecting over the left paramediastinal region.No significant change in diffuse bilateral pulmonary opacities. There are small to moderate size bilateral pleural effusions.Unchanged cardiomediastinal silhouette.

Output: 1. Interval placement of Dobbhoff tube with tip projecting over the EG junction. Recommend repositioning.2. Interval retraction of left IJ central venous catheter, still projecting over the left upper chest. This could still be intraarterial in position. Clinical correlation is recommended.3. Otherwise, stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: hx endocarditis and bacteremia History: ams No significant cardiopulmonary abnormality.Left PICC tip in axillary region.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 31 years old Reason: Patient w/ cardiomegaly, pulmonary edema, pericardial effusion History: cardiomegaly, pulmonary edema, pericardial effusion Cardiomegaly and/or pericardial effusion, similar to prior exam. Bibasilar opacities likely representing pleural effusions, and edema, similar to prior exam. No pneumothorax.

Output: Cardiomegaly and/or pericardial effusion, and edema, similar to prior exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Line confirmation and evaluation for pneumothorax. Right jugular catheter tip projects over the right brachiocephalic vein approximately 1 cm above the level of the azygos arch. Multifocal airspace opacities about the same. Bullous emphysema at the right apex, but no visible pneumothorax.

Output: Right jugular catheter tip in a central vein, no visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: s/p blebectomy and chest tube placement- assess for PTX History: none Left apical chest tube remains in place. Increased patchy left basilar opacity. Small pleural effusions. Unchanged heart size. No acute bony abnormality.

Output: Increased left basilar atelectasis or consolidation. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Respiratory distress and history of asthma. The cardiomediastinal silhouette is within normal limits. Large lung volumes compatible with hyperinflation. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with metastatic small cell carcinoma. CHEST:LUNGS AND PLEURA: Atelectatic changes at lung bases. Multiple punctate nodules in both lungs are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is markedly enlarged. Liver parenchyma is replaced by innumerable metastatic lesions. Thin number of the lesions is unchanged but there is size is smaller.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: Small lung nodules unchanged.The number of the extensive hepatic metastases unchanged, however, they are smaller compared to previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Shortness of breath. Cardiomegaly, unchanged.Bibasilar opacities suggestive of edema and small pleural effusions are similar to prior.Interval removal of the right jugular catheter.

Output: CHF with mild edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: R hemopneumothorax, eval for improvement History: fever, shortness of breath with activity No significant change in the size of the right pneumothorax with associated subsegmental atelectasis. However, the pleural fluid or blood component is increasing. The left lung remains fully inflated. Heart size is normal.

Output: Increasing pleural fluid within the right hemo/hydropneumothorax. In the setting of fever, development of empyema may be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.CHF with infection, WBC, tachycardia. Cardiomegaly with extensive pericardial calcification unchanged. Prominence of the left superior mediastinal contour incompletely assessed by portable technique.Central bronchial wall thickening, present previously, slightly worse. Mild septal thickening suggesting edema.

Output: Bronchial wall and septal thickening most likely the result of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Evaluate cardiac and lung fields post op. Right upper lobe is collapsed, probably due to mucous plug. Endotracheal tube tip is about 4 cm above the expected level of the carina. Multifocal atelectasis on the left. Basilar atelectasis and perhaps minimal pleural fluid on the right. Right jugular Swan-Ganz catheter tip at the level of the main pulmonary artery. Mediastinal drains and a left chest tube are in place. No significant pneumothorax.

Output: Right upper lobe collapse likely due to mucous plug. Clinical service notified.


Instruction: Generate impression based on medical findings.

Input: Colon cancer, status post chemotherapy and resection of hepatic metastases. Evaluate for recurrence. 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: Diffuse fatty infiltration of the liver is unchanged. Previously described lesion at the paraphrenia the segment two is unchanged measuring 11 x 10 mm. No other focal hepatic lesions.SPLEEN: Stable splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Changes secondary to colonic resection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: tachypnea History: tachypnea Cardiomediastinal silhouette is upper limits normal, unchanged. There is mild retrocardiac subsegmental atelectasis. No new pulmonary or pleural abnormalities. Surgical clips in the right upper quadrant reflect prior cholecystectomy.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: rule out pneumonia or other type of abnormalities History: chest pain Cardiomediastinal silhouette is normal in size.Subsegmental atelectasis in the lung bases.No focal airspace opacity, pleural effusion or pneumothorax.

Output: Subsegmental atelectasis in the lung bases. No signs of pneumonia.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: 36-year-old female with history of Hodgkin's disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right paratracheal adenopathy measures 15 x 10 mm image number 25, series number 4.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous enhancement of the liver is unchanged. Mild hepatomegaly is unchanged.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: Stable right paratracheal adenopathy and heterogeneous enhancement of the liver


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT History: scc of the tongue; s/p left tongue resection and lateral neck dissection ET tube tip approximately 6 cm above the carina. Small lung volumes with basilar atelectasis.Approximately normal heart size with a mitral valve prosthesis.No pneumothorax.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 65 years old Male. Reason: provox dislodged and possible aspiration History: provox dislodged and possible aspiration. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The vascular stents in the left upper chest and left lower neck are noted. The cardiac pacemaker/defibrillating electrodes are noted. There is no evidence of pneumothorax. There is no evidence of radiopaque foreign body noted in the lungs and mediastinum.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: fever History: fever Right Port-A-Cath unchanged.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.History: Status post PICC line placement, evaluate location Interval placement of right PICC line with tip in the right atrium.Support devices are otherwise unchanged in prior radiograph.Stable cardiomediastinal silhouette.Small lung volumes with nonspecific bilateral opacity, not significantly changed.

Output: Interval placement of right PICC line with tip in the right atrium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: AMS History: As above No pleural effusion or pneumothorax. No focal pulmonary opacity. The cardiomediastinal silhouette is unchanged. Left chest port terminates in the SVC. Surgical hardware from a left neck dissection unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Right chest tube placement. Interval removal of right percutaneous pigtail catheter and placement of a right-sided chest tube. The previously seen right pneumothorax has nearly resolved, with only a few millimeters of pleural separation visible at the lung apex. Subcutaneous emphysema right chest wall. Low lung volumes with diffuse interstitial lung disease compatible with fibrosis.

Output: Interval reexpansion of the right lung post chest tube placement.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Acute on chronic systolic heart failure. LVAD. Hardware and devices similar in position. Small pleural effusions, improving on the right. No significant pneumothorax. Improving atelectasis at the lung bases. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.

Output: Improved volume of pleural fluid on the right, with better aeration of the adjacent lung.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Weakness and weight loss rule out infection or malignancy. Normal heart size. Mild tortuosity of the thoracic aorta. No focal airspace opacity, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality by plain film technique.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: MaleReason for Study: Reason: desat History: desat Right-sided chest tube unchanged.Minimal subcutaneous emphysema noted along the right lateral chest wall slightly decreased from the prior exam.No significant pneumothorax identified.Stable cardiomediastinal silhouette.Small pleural effusions and perihilar opacities compatible with edema.

Output: Small pleural effusions and perihilar/basilar edema increased from the prior exam.


Instruction: Generate impression based on medical findings.

Input: 68 years old Male. Reason: evalaute OG tube placement History: suctioned material color of tube feeds. The OG tube tip projecting over the proximal gastric body. ET tube is stable in position. Stable bilateral streaky and patchy opacities in both lungs.

Output: Streaky and patchy opacities, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p open chest; evaluate lung fields History: SOB Interval extubation.Surgical drains in a sternotomy wound and at the left lung base, unchanged.Volume loss and atelectasis at the left base.No new findings.

Output: Interval extubation and no significant change.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: MaleReason for Study: Reason: r/o ptx History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: History of NF1 and MPNST LUNGS AND PLEURA: Since the last examination the left apical mass appears more heterogeneous and some surgical clips are noted however there is no significant change in the size. Decreasing in the size of the left upper loculated pneumothorax. Subsegmental atelectasis of the upper segment of the left lower lobe and left lung base.MEDIASTINUM AND HILA: No interval change in right paravertebral mass. A surgical clip is noted on the right paraaortic space.CHEST WALL: Central line noted. Stable scoliotic changes of the thoracic spine. Reidentification of spinal canal invasion by tumor at the forearm and of T 5/6UPPER ABDOMEN: No change in upper abdominal retroperitoneal mass abutting the aorta and its branches.

Output: Status post chest surgery with no significant change in size of the mass as described.Interval decreasing in the size of the left apical loculated pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for mass History: remote hx of lung ca, states coughs up blood occasionally Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No residual tumor identifiable, or other significant abnormality.

Output: No significant abnormality. If hemoptysis persists a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: patient with swan, moved this morning by himself, want to eval placement History: moved swan Patchy atelectasis right mid to lower lung zone, the lungs otherwise unremarkable.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.Left subclavian ICD, leads unchanged in position.

Output: Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: History of pulmonary Blastomycosis History: reproducible back and chest pain, status post VATS, left mediastinal mass, history of asthma The heart size is normal. Pectus carinatum. No pleural effusion or pneumothorax. Apical scarring with interval resolution of the pneumothorax.

Output: Resolved left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Where is the Swan? History: Swan placed Swan-Ganz catheter tip in right pulmonary artery. Other findings stable in short interval.

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


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: EVALUATE CARDIOPULMONARY FIELDS History: fever Worsening basilar opacities suggestive of atelectasis, which may be from mucous plugging or aspirated secretions.Small lung volumes.Left subclavian pacemaker, leads unchanged in position.Gastrostomy tube.

Output: Worsening basilar opacities which may be from aspirated secretions or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: check swan placement History: see above Mild cardiomegaly status post sternotomy and left ventricular appendage clipping.No significant pulmonary or pleural abnormality.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter, tip in right main pulmonary artery.

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


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: eval for infiltrate History: sob. Spiculated opacities in the left upper and lower lung zones are not significantly changed.No new focal pulmonary opacity, pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of rectal cancer CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Stable calcified mediastinal lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Presacral soft tissue density likely represent postsurgical changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

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


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: post-op intubated History: ICU patient Increased pleural effusions and basilar opacities.ET tube is 3.5 cm from the carina. Chest tube and drains noted. Left IJ line unchanged. Cardiomediastinal silhouette is unremarkable.

Output: Interval placement of ET tube.Increased pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.TB exposure. Chronic right hemithorax volume loss unchanged, with basilar scarring bilaterally.Heart size normal.No active TB.

Output: No evidence of active TB or other significant disease.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Status post left VATS robotic thymectomy. Final pathology revealed lymphoid hyperplasia of the thymus. Unremarkable cardiac and mediastinal silhouette.Interval resolution of right pleural effusion. Moderate left pleural effusion with overlying atelectasis, unchanged.

Output: Right pleural effusion has resolved. Left moderate pleural effusion, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Coughing and vomiting. Small lung volumes with left greater than right basilar opacity appearing similar to the prior.Calcified left apical granuloma. Stable cardiomediastinal silhouette.

Output: Left greater than right basilar opacity appearing similar to the prior, which may reflect aspiration.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with metastatic renal cell carcinoma on Sunitinib. Evaluate response to therapy. CHEST:LUNGS AND PLEURA: Reference right middle lobe lesion is less well-defined and measures 8 x 10 mm at axial image 52 of series 4. Other small metastatic lesions are also unchanged in size. No evidence of new nodules. Emphysema is unchanged.MEDIASTINUM AND HILA: Stable right hilar lymph node.CHEST WALL: Diffuse bony metastases in the spine and sternum. ABDOMEN:LIVER, BILIARY TRACT: Reference cystic metastatic disease in the right lobe is stable measuring 18 x 13 mm on image number 87, series number 3. Other numerous metastatic lesions are unchanged or slightly smaller. No new hepatic lesions.SPLEEN: Ill-defined hypodense splenic lesion is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Thickened left adrenal gland. KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence in the nephrectomy site.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous bone metastases throughout the vertebral bodies and other bones.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous enlarged uterus is unchanged. Left ovarian cyst is enlarged since the prior exam and now measures 4.2 x 5.7 cm at axial image 140 of series 3. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic lesions in the pelvic bones and pathologic fracture in the left humerus bone unchanged.OTHER: No significant abnormality noted.

Output: Enlarged left ovarian/adnexal cyst now measures 5.7 cm in diameter. Lung metastases are unchanged. Stable liver metastases. Extensive bone metastases are unchanged.


Instruction: Generate impression based on medical findings.

Input: 87 years old Male. Reason: Swan positioning History: As above. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse bilateral interstitial edema. There is also bilateral patchy air-space edema. Small amount of bilateral pleural effusions are noted. The tip of Swan-Ganz catheter projects over the atriocaval junction. The cardiac pacemaker/defibrillator electrodes are stable in position.

Output: The above findings are consistent with CHF. The tip of the Swan-Ganz catheter projects over the atriocaval junction.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: hx multiple myeloma new upper respiratory infection-pre-transplant History: bilateral wheezing on exam Old healed rib fracture on the leftRight subclavian port extends into the SVC.No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: eval PICC line placement History: pulled back line 4 cm Cardiomegaly, status post sternotomy for CABG.No specific evidence of infection or edema.Left PICC in axillary region, incompletely imaged but probably no longer doubled back.

Output: Left PICC repositioned. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: eval for cause of hypoxemia History: h/o COPD, here with heroin overdose, now recovered but has persistent hypoxemia Stable cardiomediastinal silhouette.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: H/O lymphoma s/p thoracentesis in need of CXR post thoracentesis. History: Post Thoracentesis Large left pleural effusion occupying nearly 1/2 of the left hemithorax volume compressing the left lung base.No pneumothorax following thoracentesis.Right lung unremarkable.Left subclavian ICD, leads unchanged in position.

Output: Large left pleural effusion. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: ETT verification ETT minimally retracted, currently terminating 3 cm above the carina. Left PICC line again extends into the SVC just the on the confluence.Underlying cardiopulmonary appearance otherwise stable without new superimposed focal abnormalities

Output: ETT minimally repositioned


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval acs History: cp Mild cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with large cell neuroendocrine tumor of the pancreas CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Pretracheal lymph node is grossly stable measuring 12 by 15-mm in image number 39, series number 9.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Index lesion adjacent to middle hepatic vein measures 22 by 24-mm image number 97, series number 9, not significantly changed from previous study. Numerous new small hypodense lesions have in the interval developed in the liver consistent with metastatic disease.SPLEEN: Status post splenectomy. Previous described enhancing lesion in the splenectomy bed is smaller measuring 16 x 14 mm and demonstrates less enhancement.PANCREAS: Postsurgical changes. Main pancreatic duct is dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic mass is smaller in size and demonstrates less enhancement. It measures 2.2 by 2-cm image number 131, series number 9.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: Left adnexal/nodal mass measures 5 by 3.4 cm on image number 154, series number 9, smaller compared to previous study. The lesion also enhances less compared to previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid is unchanged.

Output: Interval development of numerous metastatic hepatic lesions.Index lesions in the chest abdomen and pelvis are either stable or slightly decreased.


Instruction: Generate impression based on medical findings.

Input: Male, 96 years old.Reason: assess PM lead placement History: higher impedance Mild left basilar subsegmental atelectasis, the lungs otherwise unremarkable.Left subclavian dual-chamber pacemaker leads are unchanged, with the right atrial lead directed inferiorly and vertical in the right atrium, a position generally associated with dislodgment from the right atrial appendage. This right atrial lead has been disconnected from the generator since the prior study.

Output: Left subclavian dual-chamber pacemaker, likely not anchored in the right atrium, the lead removed from the generator since the prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o pneumo History: s/p left sided VATS Cardiomediastinal silhouette is normal in size. Tortuous aorta.Low lung volumes. Bibasilar patchy opacities. No pneumothorax or large pleural effusion.Left chest tube in place. Minimal left chest wall subcutaneous emphysema.

Output: Bibasilar patchy opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Infiltrates History: fever No significant cardiopulmonary abnormality.Right jugular catheter, tip at cavoatrial junction level.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: eval for infiltrate History: sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Chest pain. Elevation of the right hemidiaphragm is chronic. Right apical scarring. Mild atelectasis at the left base, but no specific evidence infection or pulmonary edema. Right clavicle is surgically absent.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: lung infiltrate History: SOB; cough Unremarkable cardiac and mediastinal silhouette.Mild basilar scarring, unchanged.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cough Mild cardiomegaly, nonspecific. Lungs are grossly clear, however redistribution of vasculature may reverse an early mild edema. No effusions.

Output: Questionable early edema without frank evidence of CHF


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: MaleReason for Study: Reason: SOB, COPD, Hypoxia History: as above Mild cardiac enlargement with pulmonary vascular redistribution.Interstitial opacities suggestive of edema similar to the prior exam.No focal areas of consolidation.No large pleural effusions.Again noted are kyphoplasties in the lumbar spine and internal fixation of a left humeral head fracture.Median sternotomy is intact with evidence of prior CABG as well as mitral valve repair.

Output: Mild CHF.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male status post renal transplant in 2006 male with likely acute kidney failure with decreased urine output. SOB and hypoxia, and hemoptysis x 3 days. Rule out nephrolithiasis hydronephrosis pulmonary edema pneumonia. Replaces previous request CHEST:LUNGS AND PLEURA: Severe diffuse patchy fluffy airspace disease in a pattern consistent with pulmonary edema. Underlying pneumonia cannot be excluded. There is some focal dense consolidation or atelectasis in the right base. No effusions however. Also consider drug reaction and pulmonary hemorrhage. There does not appear to be vascular redistribution.MEDIASTINUM AND HILA: Multifocal small nodes in the precarinal, AP window and prevascular spaces.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs or bowel due to the lack of IV or oral contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: Contracted gallbladder with gallstones. No obvious biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small consistent with chronic medical renal disease bladder with ex tensive but symmetric bilateral perinephric fat stranding. No obvious hydronephrosis or hydroureter. No pathologic calcifications.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes.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 noted. Minuscule amount of free fluid in dependent portion of pelvis.BONES, SOFT TISSUES: Radiopaque foreign body in the region of the right gluteus muscle possibly bullet fragmentOTHER: Renal allograft right iliac fossa with no hydronephrosis. No perinephric fat stranding. No perinephric fluid collections.

Output: Diffuse fluffy pulmonary airspace disease differential includes edema, hemorrhage, drug reaction, infection.Bilateral small kidneys with perinephric fat stranding marked, but symmetric. Cholelithiasis. Minimal free fluid in the pelvis. Radiopaque foreign body or right gluteus area.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: r/o abnormality History: hiccups x 4 days Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Chest pain further evaluation of effusion. Unchanged mild elevation of the left hemidiaphragm. Peripheral 3 cm mass in the left upper lobe, recommend correlation with CT. Small volume of pleural fluid on the left. Basal atelectasis. Unable to exclude left hilar lymphadenopathy.

Output: Small left pleural effusion with a left upper lobe mass and possible ipsilateral hilar lymphadenopathy. CT chest recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Gangrene and necrosis of lung status post removal of chest drain, status post pneumothorax. Interval removal of left apical pigtail catheter.New right jugular single-lumen chest port terminates at the SVC level.Normal heart size.Leftward mediastinal shift unchanged.Collapse of the left upper lobe with a large mass at the left hilum. Left apical cavity with adjacent pleural thickening or fluid is smaller no pneumothorax. Small left effusion unchanged. The right lung is clear.

Output: Small cavity at the left apex, but no pneumothorax. Left upper lobe collapse with a central left hilar mass.


Instruction: Generate impression based on medical findings.

Input: Increasing oxygen requirement rule out pneumonia or consolidation. Lung volumes are very low, similar to prior. Moderate to large left pleural fluid collection with associated atelectasis and consolidation unchanged; underlying pathology such as infection cannot be excluded. Small to moderate volume of pleural fluid on the right.

Output: Persistent pleural fluid and left lower lobe opacity; underlying infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 65-year-old man with history of RA-ILD status post left lung transplant (2008) presents with fevers/chills. Stable cardiomediastinal silhouette. Decreased lung volumes and right-sided diffuse interstitial pulmonary fibrosis in the patient's native lung are again seen. Focal enlarging nodular density within the peripheral right upper lobe may represent progressive fibrosis or superimposed infection, however underlying neoplasm cannot be excluded. The left lung is clear. No pleural effusions.

Output: Diffuse fibrosis in the patient's native right lung again seen, with increasing focal nodular density in the peripheral right upper lobe. This may represent progressive fibrosis or infection, but CT is recommended to exclude developing neoplasm.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: eval L pleural effusion, look for PNA History: fever, recent hx of empyema s/p chest tube An enteric tube extends below the field-of-view.The cardiac mediastinal silhouette is apparently magnified and probably enlarged. Mild decrease in size of the left-sided pleural effusion. Left basilar streaky opacities likely atelectasis and/or scarring. No focal pulmonary opacity suggestive of pneumonia. No right-sided pleural effusion. No pneumothorax.Partial fusion of T1 and T2 with spina bifida occulta.

Output: Mild decrease in the size of the left-sided pleural effusion. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.History of shortness of breath Low lung volumes and small-moderate bilateral pleural effusions and overlying atelectasis. No pneumothorax.Cardiac silhouette partially obscured but grossly unchanged. Cholecystostomy tube and external support devices project over the right upper abdomen.

Output: Small-moderate bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Interval worsening of RLL opacity; new opacities c/f blossoming pneumonia History: worsening hypoxia Increased aeration of the right lower lobe. No new focal pleural parenchymal opacity. Small right-sided pleural effusion again noted. No pneumothorax. Unchanged cardiomegaly.

Output: Increased right lower lobe aeration.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: hypoxia and dyspnea History: hypoxia and dyspnea Small lung volumes with pleural effusions and basilar atelectasis.Heart size appears normal.

Output: Small lung volumes with pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: assess for pna History: delirium in demented patient Mild left basilar subsegmental atelectasis.Heart size upper normal.No specific evidence of infection or edema.

Output: Left basilar subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: monitor IABP History: s/p IABP Aortic balloon catheter marker at the level of the top of the aortic arch, unchanged.ICD lead extending to the apex of the right ventricle, also unchanged. No significant pulmonary abnormalities.

Output: Aortic balloon catheter in the distal aortic arch and descending aorta, without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Hx of pancreatic cancer with celiac plexus block with left chest pain with fever History: left chest pain Right chest port tip overlies the distal SVC. Persistent elevation of the right hemidiaphragm. Mild cardiomegaly with a tortuous aorta. Interval increase in size of the right pleural effusion. Loss of the thoracic intervertebral disc spaces appears chronic, but please correlate with pain in this area as skeletally abnormality such as discitis cannot be accurately excluded by chest technique film. Small nodular opacity in the left lung base appear stable.

Output: Interval increase in right pleural effusion. No other findings to account for patient's left chest pain.


Instruction: Generate impression based on medical findings.

Input: Reason: daily ccu cxr, assess interval change History: advanced heart failure Severe cardiomegaly with ICD leads in the LVAD unchanged.Swan-Ganz catheter tip in the right descending pulmonary artery.No specific evidence of pulmonary edema or infection.Mild basilar atelectasis.

Output: Severe cardiomegaly and mild atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery Line position stable. Progression of basilar opacities.Cardiomegaly.No change in orientation of the Swan-Ganz catheter.

Output: Progression of basilar opacities. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Shortness of breath rule out pneumothorax. Right hilar mass with atelectasis of the right middle lobe.No significant pneumothorax. Probable emphysema. Mild cardiomegaly. Possible small pleural effusions.

Output: Right middle lobe mass consistent with known neoplasm. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: 80 yo F with NICM, ?Swan ganz position History: ?swan ganz position Swan-Ganz catheter looped in the right atrium and terminating in the right pulmonary artery, unchanged.No focal airspace opacity, pleural effusion, or pneumothorax.Moderate cardiomegaly.

Output: Swan-Ganz catheter unchanged, looped in the right atrium and terminating in the right pulmonary artery.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: Age: 48 yearsGender: FemaleReason for Study: Reason: r/o infiltrate History: fever, sepsis Right IJ venous catheter with its tip in the artery.Decreased lung lines with stable cardiomediastinal silhouette.Mild basilar atelectasis/edema.Small pleural effusions.

Output: Small bilateral pleural effusions without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: eval pulmonary edema History: worsening SOB Interval extubation and removal of enteric tube. IABP marker again projects over the proximal descending aorta at the level of T5. Status post posterior posterior cervical fusion.Stable enlarged cardiac silhouette.Perihilar vascular congestion and minimal interstitial edema again seen. Interval increase left upper lung airspace opacity with persistent left lung base effusion and atelectasis/consolidation. No pneumothorax.

Output: Interval increase in left upper lung airspace disease with persistent left lung base effusion and atelectasis/consolidation may relate to worsening asymmetric edema, but correlate with concern for pneumonia/aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change History: ARDS, intubation ET tube, catheters and feeding tube unchanged.Small lung volumes with diffuse nonspecific opacity compatible with ARDS.No new findings.

Output: ARDS with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 94 years old.Reason: SOB h/o CHF History: above Mild basilar interstitial opacities are suggestive of edema, but no sign of infection.Mild cardiomegaly.Scoliosis.

Output: Mild basilar interstitial opacities suggestive of edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.CHF, pulmonary edema? SOB. Unchanged cardiomegaly and enlargement of the central pulmonary vasculature. Left subclavian and chest wall ICDs unchanged in position.Very mild edema-like opacity, left greater than right.

Output: Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o pneumothorax History: r/o pneumothorax 2. Right apically directed chest tubes are unchanged in position.Stable size of the right hydropneumothorax. Multifocal opacities in the partially atelectatic right lung are stable. Subcutaneous emphysema right infralateral chest wall unchanged. Left lung remains fully inflated and clear. Evidence of prior coronary arterial stent placement.

Output: Stable size of right hydropneumothorax in the setting of 2 chest tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: intubated on ECMO eval interval change. History: NA. Superior ECMO cannula tip overlying the cavoatrial junction with the inferior ECMO cannula tip overlying the SVC with approximately 3.8 cm overlap between the cannulae which is increase in overlap compared to prior exams. Additionally, this is a significant change in position compared to earlier studies such as 10/16/2016, with the superior cannula overlying the SVC and the inferior cannula overlying the suprahepatic IVC. Clinical correlation is recommended for possible dysfunction caused by cannulae overlap.Otherwise unchanged position of support devices.No significant change to patchy bilateral multifocal patchy airspace opacities and consolidations compatible with ongoing ARDS, taking into account differences in respiration and technique.Persistent moderate pleural effusions.

Output: Overlapping ECMO cannulae with superior cannula overlying the cavoatrial junction in the inferior cannula overlying the SVC. Stable multifocal opacities and consolidations compatible with ongoing ARDS.Text page sent to the clinical service at time of signing of report.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Shortness of breath rule out pneumothorax. SCC skin. Left jugular catheter tip at the superior cavoatrial junction. Upper normal heart size. Interval improvement in right apical opacities, likely radiation fibrosis.No conclusive change in right lung peripheral airspace and groundglass opacities since the last CT.Lung volumes are large suggestive of COPD.Blunting of the right costophrenic angles unchanged from recent CT.No pneumothorax.

Output: No pneumothorax. Although difficult to compare technique, there is no conclusive change in right lung opacities since the prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: rule out chest mestastasis History: hx of renal cell carcinoma The cardiomediastinal silhouette is within normal limits. There are no pulmonary or pleural abnormalities. Cervical spinal fixation hardware is incompletely evaluated.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 69 years old Female. Reason: Evaluate placement of intra-pulomanary artery catheter for tPA . The left ventricle is a prominent. A small hyperdensity is seen in the right perihilar region, which is of uncertain clinical significance. There is no evidence of acute infiltrate, pleural effusion or pneumothorax.

Output: Prominence of the left ventricle, which can be further evaluated with EEG and echocardiography if clinically indicated. Small hyperdensity in the right perihilar region which is of uncertain clinical significance.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p OHT History: heart transplant Status post median sternotomy for heart transplant, the heart size unchanged.No specific evidence of infection or edema.Right subclavian and brachiocephalic vein stent.IVC filter partially imaged.

Output: Unchanged heart size following transplant, without evidence of edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Intubation History: None ET tube tip 5 cm above carina. Other support hardware also stable.Slightly improved basilar aeration. No new opacity. Left-sided rib fractures were better seen on prior.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Cough Persistent moderate tortuous aorta without additional cardiopulmonary abnormality. Interval placement of a right jugular single port, tip projects at the RA junction

Output: Right jugular port placed


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: quinton line placement History: diffuse weakness No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Nausea and vomiting No acute cardiopulmonary abnormality. Unchanged right jugular dual port

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 70-year-old male with a history of a right middle lobe micronodule, for reevaluation LUNGS AND PLEURA: A small 3-mm micronodule is noted in the right middle lobe (image 67 series 4). This was present on the prior examinations and demonstrates no interval change. Several small intrapulmonary lymph nodes are noted . An isolated small cyst is identified in the right lower lobe. No other pulmonary or pleural abnormalities can be identified.. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy identified. There is no evidence of pericardial effusion or cardiac enlargement.CHEST WALL: Degenerative changes in the cervical and visualized thoracic spine. Mild anterior listhesis of C7 on T1. Degenerative changes of the left glenohumeral jointUPPER ABDOMEN: Cholelithiasis

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


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for chf History: heart transplant with rejection Normal heart size with intact sternal fixation devices.Mild elevation of the left hemidiaphragm, unchanged.No sign of CHF or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Positive PPD Right chest port with tip at the cavoatrial junction. No specific evidence of infection or edema. No pleural effusion or pneumothorax. Pulmonary nodule in the right lower lung. No specific evidence for TB.

Output: 1.Pulmonary nodule in the right lower lung. CT is recommended for further evaluation.2.No evidence of TB.


Instruction: Generate impression based on medical findings.

Input: 24-year-old female history of Hodgkin's disease status post chemo. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No pathologic size nodes are seen.Previously measured tiny high right axillary node (image 19; series 3) is stable and measures 1.1 x 0.6 cm.The previously measured small right hilar node (image 43) measures 1.0 x 0.8 cm. This is probably stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tiny mesenteric nodes not pathologically size criteria and unchanged. Small shotty retroperitoneal nodes also unchanged.BOWEL, MESENTERY: No significant abnormality noted.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: Small lymph nodes not pathologically size criteria and unchanged. The index node in the right common iliac artery distribution (image 156) measures 1.0 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in very small lymph nodes which are re-measured. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: s/p TECAB History: s/p TECAB Left chest tube removed with no pneumothorax.Small pleural effusions and left basilar atelectasis, unchanged.Right jugular introducer removed.

Output: No pneumothorax following left chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Age: 92 yearsGender: FemaleReason for Study: Reason: eval pulm edema History: dyspnea Left IJ venous catheter has been removed.Mild interval increasing cardiac size with increasing interstitial opacities and pleural effusions compatible with CHF.No focal areas of consolidation.

Output: CHF with pulmonary edema, pleural effusions, and increasing cardiac size.


Instruction: Generate impression based on medical findings.

Input: Fevers. Evaluate for infiltrate or effusion. LUNGS AND PLEURA: There are small bilateral pleural effusions, right greater than left. Underlying consolidation in both right and lower lobes are again seen.MEDIASTINUM AND HILA: Right-sided PICC line with distal tip in the distal right subclavian vein. Left-sided central line with distal tip in the right atrium. Coronary artery stent. Valvular calcifications. CHEST WALL: Diffuse edema again noted.UPPER ABDOMEN: Hypodensity in the spleen again noted. This was better evaluated on the prior contrast exam. Hepatomegaly again seen.

Output: Bilateral lower lobe consolidation and bilateral small pleural effusions are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: assess for new pleural effusions and opacities History: hypoxic respiratory failure Right internal jugular central venous catheter tip terminates in the SVC. Low lung volumes. There are increased hazy basilar interstitial opacities, particularly on the left, which may be somewhat accentuated by low lung volumes. Additionally, there is a new retrocardiac opacity, which may represent atelectasis or consolidation. No pleural effusion is evident. The cardiac and mediastinal contours are within normal limits for size.

Output: Worsening pulmonary opacities suggestive of atelectasis and possibly superimposed edema. Retrocardiac opacity, unable to exclude pneumonia in that area.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o pneumonia History: chronic cough; shortness of breath Heart size upper normal, with severe pulmonary arterial enlargement.No specific evidence of infection or edema.No significant pleural effusions.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary artery enlargement. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old, with peripartum cardiomyopathy status-post heart transplant, now with right opacity on chest x-ray. LUNGS AND PLEURA: Right apical air space opacity has not significantly changed. Airspace opacity at the left lung base has improved. Diffuse groundglass centrilobular nodules, most prominent in the right lower lobe, have increased in prominence. No pleural fluid.MEDIASTINUM AND HILA: Central venous catheter tip in the SVC. Mediastinal postsurgical change compatible with heart transplant. The cardiac size is mildly enlarged. No significant pericardial effusion. No pathologically enlarged hilar or mediastinal lymph nodes are evident.CHEST WALL: Status post median sternotomy.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval worsening of groundglass centrilobular nodules which is nonspecific but can be seen with viral or atypical etiologies as well as fungal and mycobacterial infection.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Tracheostomy History: Tracheostomy Tracheostomy remains in place. Improvement in left basilar opacity. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Intubated, BiVAD. Motion artifact degrades image quality. Visualized hardware and devices appear similar in position. Interval increase in left pleural fluid collection, with significant compressive atelectasis of the left lung and only partial remaining aeration of the left upper lobe. Interval clearing of opacities on the right, likely related to aspiration.

Output: Large left pleural fluid collection with significant compressive atelectasis of the majority of the left lung.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: above Large lung volumes with diffuse coarse nodular interstitial opacities, better characterized on a subsequent CT scan, compatible with aspiration and possibly metastatic disease.Partly loculated left pleural effusion, not significantly changed.Port catheter with its tip in the SVC.

Output: Extensive pulmonary and pleural abnormalities, better characterized on a subsequent CT scan performed on the same day.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Status post pacemaker implant. Interval placement of left subclavian pacemaker with leads in the distribution of the the right atrial appendage and right ventricle.No significant pneumothorax.Basilar opacities suggestive of atelectasis and aspiration.

Output: Pacemaker placement without significant pneumothorax. Basilar opacities suggestive of aspiration and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Eval for interval change in pleural effusion, location of R pigtail catheter, tracheostomy, PEG tube History: s/p trach/PEG/pigtail catheter Cardiomediastinal silhouette is normal in size.Diffuse interstitial opacities, left lower lobe atelectasis and moderate left pleural effusion do not appear significantly changed from prior. No pneumothorax.Tracheostomy tube is in place. Right IJ central catheter tip is in the proximal SVC. Left upper extreme PICC tip is at the distal SVC. A right pigtail drain projects over the right hilum. Staples skin staples and surgical clips project over the left upper chest wall.

Output: 1. Continued improvement of pulmonary edema. 2. Persistent left lower lobe atelectasis. 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: Age: 38 yearsGender: FemaleReason for Study: Reason: 38F in CCU with Swan, ?placement History: 38F in CCU with Swan, ?placement LEFT sided ICD right IJ venous catheter unchanged.New left IJ Swan-Ganz with its tip in the pulmonary artery.Decreased lung volumes with marked cardiac enlargement and pulmonary vascular redistribution.Perihilar/basilar opacities compatible with edema.No evidence of pneumothorax.

Output: Placement of a left IJ Swan-Ganz without complication. CHF slightly worse than the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female 48 years old Reason: PNA? History: cough Cardiac silhouette is top normal in size. Bibasilar linear opacities, likely representing atelectasis. No specific evidence of infection or edema.

Output: Bibasilar atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Checking placement; Right IJ line pulled back 2 cm History: Checking placement; Right IJ line pulled back 2 cm Right jugular catheter tip in lower SVC. Other findings stable in short interval.

Output: Right jugular catheter tip in lower SVC.


Instruction: Generate impression based on medical findings.

Input: 62 years old Male. Reason: eval swan placement History: see above. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. Small left pleural effusion unchanged.The tip of the Swan-Ganz catheter projects over the inferior right pulmonary artery. The cardiac pacemaker/defibrillator electrodes are stable in position. There is no evidence of pneumothorax.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with mesothelioma on observation. Compared to previous. CHEST:LUNGS AND PLEURA: Stable mild pleural thickening as well as parenchymal scarring on the left, particularly at the base. Clear right lung.Reference lesions at the following levels:1. Aortic arch (series 3, image 28): At the 10 o'clock position, the pleura measures 2 mm (stable).2. Pulmonary artery (series 3, image 38): At the 10 o'clock position, the pleura measures 2 mm (stable).3. At the level of the aortic root there continues to be no measurable disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Reference left hilar node continues to measure 8 x 7 mm (series 3, image 38). Heart size normal without pericardial effusion. Moderate calcifications of the right and left coronary and LAD arteries.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Cholecystectomy clipsSPLEEN: No significant abnormality noted.PANCREAS: Fatty atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable exam with reference measurements as above.


Instruction: Generate impression based on medical findings.

Input: 64-year-old female with history of lymphoma. CHEST:LUNGS AND PLEURA: Stable lingular scarring. No suspicious nodules.MEDIASTINUM AND HILA: Hypodensities within the thyroid gland are stable. No lymphadenopathy. Coronary artery calcifications.CHEST WALL: Right-sided chest port in place with catheter tip at the SVC/right atrial junction. Are intact.ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is prominent, but slightly less so than on the prior study. There is no intrahepatic biliary ductal dilatation. No focal masses. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: Punctate pancreatic cysts are unchangedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities, some of which are too small to characterize but likely represent cysts, are stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus is unchanged.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 disease recurrence.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: FemaleReason for Study: Reason: assess for pneumonia History: fever Tracheostomy tube and left-sided pacemaker unchanged.Stable cardiac mediastinal silhouette.Left retrocardiac consolidation/atelectasis increased from the prior exam and may be related to aspiration and/or infection.

Output: Increasing left retrocardiac opacity suggestive of aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: pre-op History: pre-op Right atrial enlargement, increased compared to 2008. This configuration can also be seen with partial congential absence of the pericardium, though this is rare on the right. Septal lines indicate pulmonary edema. Surgical clips about the right hilum. No focal abnormalities to suggest infection.

Output: Mild pulmonary edema. Right atrial enlargement, increased compared to 2008. This configuration can also be seen with partial congential absence of the pericardium, though this is rare on the right.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Wheezing, r/o pneumonia History: see above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement for hemothorax History: same New right chest tube with interval drainage of a large pleural effusion with small residual.Moderate left effusion.Other devices unchanged.

Output: Interval drainage of right pleural effusion/hemothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval for acute process History: 10 d h/o cough Linear atelectasis or scarring left lung periphery, otherwise unremarkable.Heart size normal.No specific evidence of infection or edema.Surgical clips overlie the chest.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Breast cancer Cardiomediastinal silhouette is within normal limits.No focal air space abnormality. No pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: 25 yo M with NICM, ?newly placed PICC position History: new PICC Motion artifact makes detailed cardiopulmonary evaluation difficult. Right-sided PICC terminates within the right subclavian vein. Presternal cardiac lead, unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Motion artifact makes detailed cardiopulmonary evaluation difficult. Right-sided PICC terminates within the right subclavian vein. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval for change in mediastinum, PTX History: chest pain Resolution of prior left pleural effusion and adjacent atelectasis.No significant pneumothorax, or other significant pulmonary/pleural abnormality.Mild cardiomegaly status post median sternotomy.

Output: Resolution of prior left pleural effusion and adjacent atelectasis, with no new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: pre op eval History: pre op eval Cardiomegaly.No specific evidence of infection or failure.Marked degenerative abnormalities of both shoulders possibly rheumatoid arthritis.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: chest tube placement History: s/p diaphragmatic hernia repair Left-sided chest tube in place with its tip at the apex.No significant pneumothorax.The cardiomediastinal silhouette is unremarkable.No focal airspace opacities.Free peritoneal air is identified compatible with recent surgery.

Output: Left chest tube in place without evidence of a pneumothorax. Free peritoneal air compatible with recent surgery.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.ET tube placement ETT tip 3.5 above the level of the carina.A cannula projects over the right mediastinum, terminating at the SVC level.Lung volumes remain low with basal atelectasis or scarring.

Output: ETT tip 3.5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Chest pain evaluate for CHF Cardiomegaly unchanged. Unchanged appearance of the cardiomediastinal silhouette. Mild atelectasis at the lung bases, right greater than left, new from previous. No specific signs of pulmonary edema. There may be trace pleural fluid on the right.

Output: Trace pleural fluid on the right. Subsegmental atelectasis at the lung bases, but no conclusive signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Eval for pulmonary edema History: Hypoxia Cardiomegaly and unchanged interstitial opacities possibly edema.Left subclavian pacemaker, leads unchanged in position.

Output: Unchanged interstitial opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: CP History: above Cardiac silhouette appears borderline enlarged likely magnified. Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: Borderline cardiomegaly with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female 24 years old Reason: eval for infiltrate History: chest pain. Cardiomediastinal silhouette is within normal limits and is unchanged.No focal opacity, pneumothorax, or pleural effusion is identified.

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


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Crackles in left lung, evaluate for acute pulmonary abnormalities History: SOB Small pleural effusions and possible basilar edema.Heart size upper normal. No specific evidence of infection.

Output: Small pleural effusions and possible basilar edema. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 91 years old.Status post AVR. Prosthesis in the aortic position.Sternal hardware similar in alignment.Heavily calcified mitral annulus.Unchanged cardiomegaly.Moderate to large right pleural fluid collection is larger. Small left pleural fluid collection unchanged.Increasing basal atelectasis on the right.Central pulmonary vasculature appears enlarged.Right apical pneumothorax is resolved.

Output: Increased pleural fluid and atelectasis on the right.


Instruction: Generate impression based on medical findings.

Input: Gastric cancer 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: Sub-centimeter, subtle indeterminate hypodensities in the liver are unchanged from previous CT. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hydronephrosis with delayed nephrogram and dilated right ureter. Underlying etiology is not certain but could be the retroperitoneal soft tissue encasing the distal ureter.RETROPERITONEUM, LYMPH NODES: Soft tissue infiltration of the paraceliac peripancreatic, porta hepatis, and around the IMA have increased.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: The uterus is unremarkable. Both ovaries are enlarged with soft tissue densities which may represent metastatic disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: Interval increase in the retroperitoneal metastatic disease extending along the aorta. Enlarged ovaries with soft tissue nodules likely representing metastatic disease. Ascites is also suspicious for peritoneal carcinomatosis.New left-sided hydroureter and hydronephrosis likely caused by retroperitoneal metastatic disease.These findings were discussed with the clinical team at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: LVAD, cause of SOB History: SOB for 1 week hx of LVAD Left-sided ICD, LVAD, right central venous catheter unchanged from the prior exam.Stable cardiac enlargement.Decreased lung volumes with nonspecific basilar opacities compatible with atelectasis and/or edema.No new pulmonary opacities identified.No large pleural effusions.

Output: Cardiomegaly with basilar atelectasis/edema unchanged from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p Myxoma History: s/p Myxoma removal Unchanged cardiac leads. No new focal pleural parenchymal opacity. Scar like opacity again noted in the lateral aspect of the right hemithorax. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Tachypnea and leukocytosis. Right paratracheal thickening and nodularity at the AP window compatible with lymphadenopathy. Stable cardiomediastinal silhouette.Nodular opacities are again noted in both lungs, similar to prior.Slightly increased basilar predominant interstitial opacities with small pleural effusions compatible with edema.Retrocardiac opacity of a known distal esophageal mass with hiatal hernia is again noted and better visualized on the recent prior CT.

Output: Nodular opacities suggestive of infection with slightly increased edema.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male with hyperglycemia. Evaluate for pulmonary infectious source. Minimal subsegmental atelectasis at the bases, no evidence of pneumonia. Normal cardiomediastinal silhouette.

Output: Minimal subsegmental atelectasis at the bases, no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: History of rhabdomyosarcoma, off therapy assessment LUNGS AND PLEURA: No significant abnormality noted. There is a diffuse is slight hazy groundglass appearance throughout both lungs especially in the lower lobes, though improved since the last study.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of pulmonary or mediastinal metastases.


Instruction: Generate impression based on medical findings.

Input: 23-year-old woman with history of benign intracranial hypertension. Evaluate shunt. SHUNT DEVICE: A right frontal approach VP shunt has its tip near the midline. The shunt catheter courses within the soft tissues along the right skull, right neck, and right anterior chest wall, and then enters the abdomen, coiling within the right hemiabdomen with tip in the right lower quadrant. Portions of the shunt overlying the skull are radiolucent which limits their evaluation, but we see no evidence of discontinuity or kinking. The notch on the pressure valve is directed along the course of the shunt, appearing similar to prior. SKULL: Note is made of impacted molars, but no acute abnormalities are evident.CERVICAL SPINE: Note is made of calcification of the stylohyoid ligaments. CHEST: Mild degenerative disc disease affects the lower thoracic spine.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Ventriculoperitoneal shunt as described above without radiographic evidence of complication.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: chest tubes History: chest tubes Chest tubes extending to the right apex with no significant pneumothorax.Nonspecific opacity in the right lung consistent with edema and postoperative contusion.Moderate bilateral pleural effusions and basilar atelectasis.Severe upper zone emphysema left lung.

Output: No change in bilateral pulmonary opacities in line position.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: heart failure, swan placement - not functioning swan History: heart failure Left-sided ICD unchanged.Right IJ Swan-Ganz in place with its tip in the right pulmonary artery.No evidence of a pneumothorax.Right pleural effusion similar to the prior exam.No new pulmonary opacities identified.

Output: Interval placement of a Swan-Ganz catheter with its tip in the right pulmonary artery. Stable cardiac enlargement with right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: hypoxemia eval for volume overload History: hypoxemia Severe cardiomegaly status post sternotomy.Persistent left lower lobe consolidation and left pleural effusion suggestive of pneumonia, more so than edema.

Output: Severe cardiomegaly with left lower lobe pneumonia and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for pneumothorax History: SOB Normal heart size with pacemaker leads in place, unchanged from previous.Blunting of both costophrenic angles, unchanged, consistent with scarring and possibly small effusions.Mild chronic interstitial opacities and bronchial thickening.No sign of pneumothorax or other acute change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.History: CHF, ESRD, lupus. Query: Interval change in pleural effusion. Persistent cardiomegaly and bilateral pleural effusions with no significant change.Persistent interstitial opacities and vascular redistribution.

Output: No significant interval change in moderate CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: cardiac silhouette; lung infiltrate History: chest pain; DOE Moderate cardiomegaly.No specific evidence of infection or edema.Cholecystectomy clips.

Output: Cardiomegaly, but no acute abnormality.