Instruction: Generate impression based on medical findings.

Input: Follow-up ovarian cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable right hilar lymph node measuring 12 by 8mm on image number 35/197.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic implants around the liver are again noted. Some of them have completely resolved and others are significantly smaller. The first reference lesion is not visualized. The second reference lesion measures 8 x 6 mm on image number 96/197.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: Slight interval decrease in the size of the right paracolic index lesion. The lesion now measures 8 by 8mm image number 127/197.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small right para-toe peritoneal deposit is also smaller now measuring 5 mm in diameter on image number 170/197.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right hilar lymph node. Peritoneal implants have decreased in size and some of them have resolved within the interval.


Instruction: Generate impression based on medical findings.

Input: Liver transplant Persistent mild to moderate CHF changes with decreased lung volumes and mild cardiomegaly.Tracheostomy tube and left jugular catheters unchanged

Output: Unchanged pleural effusions and mild suspected edema with atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: pleural effusion and BiVAD History: pleural effusion Support devices are unchanged in position. Bilateral layering pleural effusions, greater on the right, with associated atelectasis. No pneumothorax.

Output: No significant change in the right greater than left pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: assess for pulmonary edema, hx of RV failure History: worsening DOE, fatigue Moderate cardiomegaly with enlarging pleural effusions and persistent basilar edema like opacities.Status post clamshell sternotomy.

Output: Unchanged basilar edema like opacities with enlarging pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Fevers and chronic cough, ALL. Mild central bronchial wall thickening. No focal airspace opacities. Subtle opacity along the medial aspect of the right hemidiaphragm most suggestive of atelectasis.Left PICC unchanged in position, terminating at the SVC/RA junction.

Output: Bronchial wall thickening. Subtle opacity along the medial aspect of the right hemidiaphragm may represent atelectasis however should be monitored by serial plain films to exclude development of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: r/o aspiration pna, esophageal tear History: nausea/hematemesis No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Pleural effusions status post intubation. ET tube tip approximately 4 cm above the carina.Enteric tube tip enters the stomach and extends beyond the field of view.Right chest port with tip in the SVC.Left axillary surgical clips noted.Sclerotic osseous metastases are again noted.Unremarkable cardiomediastinal silhouette.Large layering left pleural effusion and left basilar consolidation are similar to prior.A developing opacity in the right upper lobe may reflect infection or small amount of aspiration, or external artifact.

Output: Stable large layering left pleural effusion. Right upper lobe opacity may reflect infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male 89 years old Reason: SOB History: above. Cardiomediastinal silhouette is unremarkable.No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old with chest pain. Left chest port catheter tip at the cavoatrial junction. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with cirrhosis and restrictive lung disease. Severe dyspnea on exertion. LUNGS AND PLEURA: Previously noted large pleural effusions have nearly completely resolved. Only minimal pleural fluid is evident on the left.Multiple scattered bilateral pulmonary micronodules are nonspecific. A large calcified right lower lobe granuloma is noted.Mosaic attenuation on the expiration views suggests air trapping, possibly related to small airways disease.MEDIASTINUM AND HILA: The cardiac size is mildly enlarged. No pericardial fluid. No pathologically enlarged mediastinal or hilar lymph nodes.CHEST WALL: Degenerative changes affect the thoracic spine.UPPER ABDOMEN: Cholelithiasis in a contracted gallbladder. Calcified, atrophic pancreas compatible with chronic pancreatitis. Shotty gastrohepatic lymph nodes are evident.

Output: Nonspecific pulmonary micronodules and small airways disease.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of increasing oxygen requirement. Diffuse bilateral interstitial opacities are unchanged. Cardiomegaly with enlargement of the central pulmonary vasculature. Less in the aortopulmonary window region may be secondary to adjacent subsegmental atelectasis in the left upper lobe however hematoma cannot be excluded at the postoperative site if there has been intervention in this area..

Output: Interval widening of the mediastinum which may be due to partial left upper lobe atelectasis or a hematoma depending upon the clinical history. Short-term follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: rule out infecton History: confusion, infectious screening Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o pneumonia History: crackles on lung exam, productive cough Small lung volumes, with apparent increased opacity over the left lower lung zone related to an overlying breast implant.Questionable edema, but no evidence of infection.Heart size normal.

Output: No reliable evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: MaleReason for Study: Reason: rule out chest metastasis History: history or renal cell ca, sp nephrectomy The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 76 your old female with right upper lobe lung nodules and left adrenal mass LUNGS AND PLEURA: Demonstration of marked interval enlargement of a previous reference nodule (image 26, series 5), now measuring 10 mm x 14 mm, previously, measuring millimeters by 4 mm. Additional reference nodule (image 20, series 5), now measures 10 mm x 6 mm, previously, measuring 7 mm x 6 mm..Two right upper lobe nodule (image 45, series 5).Diffuse bronchiolar and bronchial wall thickening with mild diffuse tree in bud opacities is compatible with bronchiolitis.No evidence of pleural effusion.MEDIASTINUM AND HILA: No obvious hilar or mediastinal adenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Degenerative changes throughout the thoracic spine.UPPER ABDOMEN: Previously noted left adrenal nodule is not imaged on this exam.

Output: 1.Enlarging right upper lobe reference nodules and development of a new right upper lobe nodule. These may be inflammatory in origin , however neoplasia certainly cannot be excluded. PET scan is recommended in view of this may represent metastatic disease.2.Diffuse changes of bronchiolitis


Instruction: Generate impression based on medical findings.

Input: Reason: eval pna History: cough Heart size but upper normal with mild distention of the azygos vein. Mild blunting of both posterior costophrenic angles compatible with small effusions, and very mild basilar interstitial opacity suggestive of edema. Small calcified granuloma in the right upper lobe, unchanged.No specific evidence of pneumonia.

Output: Small bilateral pleural effusions and mild basilar interstitial edema suggestive of CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: altered mental status, increased secretions, eval for infiltrate History: see above Marked cardiomegaly.Small lung volumes with no specific evidence of pulmonary edema or infection.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Hypoglycemia check for pneumonia Mildly diminished lung volumes with mild vascular redistribution yet without additional cardiopulmonary acute abnormality. Minimal atelectasis

Output: Nonspecific mildly decreased lung findings in redistribution, possibly due to patient size


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: productive cough History: cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: Clear lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Bilateral pulmonary opacities at OSH, H1N1 influenza on HFNC History: as above Interstitial predominant pulmonary opacities with possible right pleural effusion.Heart size normal, apparent mediastinal widening the result of mediastinal lipomatosis seen on prior CT.

Output: Pulmonary opacities consistent with atypical infection including viral pneumonia.


Instruction: Generate impression based on medical findings.

Input: 55 years, Female. Reason: pneumoperitoneum - interval change History: abdominal pain Large amount of pneumoperitoneum is again noted. Mild dilatation of bowel loops, consistent with mild ileus pattern. Cystgastrostomy tubes and stent. Bilateral nephroureteral stents. Surgical clips and wire overlie the abdomen and pelvis. Enteric tube tip overlies the gastric body. Elevation of both hemidiaphragms. Cardiac silhouette size is top normal. Basilar atelectasis.

Output: Large amount of pneumoperitoneum, differences in appearance of pneumoperitoneum likely due to technique.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Interval change in pulmonary opacities History: s/p diuresis No change in linear interstitial abnormality consistent with edema. Patient is rotated and has extensive bullous changes in the apices causing a lucency in the left upper chest which is unlikely to represent a pneumothorax though should be continued to be monitored. Support hardware is unchanged.

Output: No change in linear interstitial abnormality consistent with edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval for pna History: fatigue Scarlike opacity left lower lobe, with left hemithorax chronic volume loss.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.History of breast cancer and malignant pleural effusion. Evaluate after chest tube removal. Interval removal of right IJ catheters, right chest tube, and mediastinal drain. Bioprosthetic aortic valve and trans-cutaneous pacer wires are unchanged.Cardiomegaly is unchanged. Mediastinal widening is less prominent on prior exam.There is a persistent moderate left and new small right pleural effusions with associated subsegmental atelectasis. No pneumothorax.

Output: Unchanged moderate left and new small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: 45 yo F with PNA, parapneumonic effusion s/p thora History: as above Worsening airspace opacities consistent with infection or aspiration.Persistent pleural effusions.No significant pneumothorax.Support devices unchanged.

Output: Worsening opacities consistent with infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: chest pain History: pna? The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormalities noted.


Instruction: Generate impression based on medical findings.

Input: Reason: infection vs RAD History: SOB Unremarkable cardiac and mediastinal silhouette.Marked motion artifact obscures diagnostic detail. Hazy opacity at the right base may be artifactual or due to an acute process such as pneumonia.PA and lateral radiographs would be helpful to clarify this.

Output: Suboptimal examination with motion artifact and possible right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with chest pain. Evaluate for infiltrate or pulmonary edema. Cardiomediastinal silhouette is unchanged. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: wheezing. The cardiomediastinal silhouette is within normal limits. There is no focal pulmonary opacity to indicate infection, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: et tube History: et tube The ET tube is no longer visualized.Extensive bilateral chronic pulmonary abnormalities as previously described without significant change.

Output: The ET tube is no longer visualized.


Instruction: Generate impression based on medical findings.

Input: Check for pneumonia. Muscle weakness and altered mental status Questionable right lower lung opacity, specifically a possible air-fluid level most likely represents subdiaphragmatic bowel segment. However follow-up evaluation and possibly a lateral would be helpful for confirmation, if patient can perform.Borderline cardiomegaly with mild tortuosity of aorta with more moderate atherosclerotic changes, similar to prior studies. Mild scoliosis

Output: Basilar interstitial scarring is essentially unchanged, however there is a questionable additional superimposed right basilar nonspecific opacity. Infection such as pneumonia and/or aspiration must be considered given patient history. Close serial imaging will be helpful, please see description and detail above


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.History: CHF, CKD, CAD. Signs and symptoms: Cough, fatigue. Clinical question: Pulmonary edema or infection. Left subclavian ICD with 2 electrodes, unchanged.Right central venous catheter with tip in the SVC.Unremarkable cardiomediastinal silhouette.Bibasilar atelectasis/scarring consistent with subpleural opacities seen on abdominal CT from 2012.No pleural effusions. No pneumothorax.

Output: No evidence of edema or pneumonia. Chronic basal opacities may reflect scarring or early fibrosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.SOB question pneumonia Low lung volumes. Right lower lobe airspace opacity suspicious for pneumonia.

Output: Right lower lobe airspace opacity suspicious for pneumonia. In an adult patient, follow-up PA and lateral chest radiographs are recommended in 6 weeks to assess for resolution and exclude alternate, nonbenign etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: eval for PNA History: SOB, CP Cardiomegaly with basilar opacities and pleural effusions, dense on the right where there may be infection or atelectasis adjacent to a very large hiatal hernia; the proceeding CT show this likely to be atelectasis in both bases.

Output: Pleural effusions, basilar atelectasis and a large hiatal hernia.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with questionable esophageal pleural fistula.Esophageal perforation. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions are seen, stable.Mild interstitial edema is noted within the bases.MEDIASTINUM AND HILA: A small amount of oral contrast is noted to be extravasating into the mediastinum with layering in the right pleural space. The possible point of extravasation (series 4, image 65) is just inferior to the tip of the NG tube on the right, where the esophageal wall is thinned. A right-sided chest tube terminates in the paraesophageal region, stable. The right posterior chest tube may communicate with the extravasated contrast in the mediastinum. It is uncertain whether the tract extends along the chest tube into the pleural space.Linear left pleural hypodensities are unchanged and not likely related to extravasation. A few small pockets of pneumomediastinum are seen.The nasogastric tube is coiled in the distal esophagus, stable. Right-sided central lines are evident. A tracheostomy is noted.Coronary calcifications are seen.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: Nonobstructive right nephrolithiasis is noted. A right renal cyst is again seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G and J-tubes are noted. Evidence of prior bowel resections are noted. No evidence of obstruction. Contrast is present in the gastric fundus from a patent GE junction. BONES, SOFT TISSUES: No significant abnormality noted OTHER: Mild ascites is seen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Stones are noted within the bladder. The bladder is not well distended but appears thickened.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple areas of fatty density are scattered throughout the colon, from enteric feeds.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic disease is seen.

Output: Contrast extravasation from the esophagus, which extends to the right pleural space. Small perforation in the distal esophagus on the right just distal to the kink in the OG tube. No evidence of bowel obstruction.Multiple chronic findings as above.


Instruction: Generate impression based on medical findings.

Input: 39-year-old man with history of type B aortic dissection and thoracic aortic aneurysm status post left thoracotomy and thoracic aneurysm repair on 4/4/2016. Transesophageal echocardiography probe and multiple drains are seen overlying the chest. No unexpected radiopaque foreign body is evident on these lateral views.

Output: No unexpected radiopaque foreign body. Findings were discussed by the radiology resident on call with physician assistant John Gnezda by telephone on 4/4/2016 at 6:50pm. Attending surgeon, Dr. Ota, was notified by text page.


Instruction: Generate impression based on medical findings.

Input: Coronary bypass. Dialysis catheter Right subclavian split-dialysis catheter is unchanged, tip projects into the mid SVC.Midline sternotomy with broken wires both proximally and distally also similar

Output: New right subclavian dialysis catheter, tip well-positioned


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p line insertion for PN administration History: picc line insertion Right peripheral central venous catheter terminates in the superior vena cava. There has been interval removal of the enteric tube. There has been interval removal of left PICC.Cardiomediastinal silhouette is unremarkable. Low lung volumes with interstitial opacities appear similar to prior exam. Small bilateral effusions are unchanged.

Output: Right PICC terminates in the superior vena cava. Low lung volumes, interstitial opacities, and bilateral small effusions, similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 55-year-old female with bladder cancer status post cystectomy in April 2010. CHEST:LUNGS AND PLEURA: Multiple micronodules bilaterally, some of which are calcified, appear similar to prior study from 9/10/2010. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: Multiple unenlarged mediastinal and hilar lymph nodes. Heart size normal without pericardial effusion.CHEST WALL: Right chest Port-A-Cath with tip in SVC.Previously seen lesion in left breast (series 3, image 37) measures 2.8 x 1.8 cm; previous measuring 4.5 x 1.9 cm.ABDOMEN: LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney with dilated renal pelvis, unchanged. Mildly dilated left renal pelvis with interval removal of left nephroureterostomy tube.RETROPERITONEUM, LYMPH NODES: Scattered, periaortic lymph nodes are grossly unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Status post cystectomy with conduit in right lower quadrant.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of metastatic disease with interval removal of left nephroureterostomy tube.2. Interval decrease in size of previously noted left breast mass.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female with history of metastatic melanoma. Status post 85 days of IFN treatment. Compare prior scan. CHEST:LUNGS AND PLEURA: Stable, moderate right pleural effusion. Stable punctate micronodules in left upper lobe (series 5, image 44).MEDIASTINUM AND HILA: Large confluent pleural based mass is identified in the right, measuring 18.7 x 11.3 cm (series 4, image 78); previously measuring 18.8 x 0.6 cm. There is stable mediastinal shift to the left.Reference right pleural-based nodule along the anterior chest wall measures 2.8 x 1 cm (series 4, image 45); stable.CHEST WALL: Tunneled catheter terminates in the right pleural cavity. Previously noted mildly enlarged right axillary lymph nodes appear similar to prior study.ABDOMEN: LIVER, BILIARY TRACT: Multiple metastatic lesions are again seen throughout the liver:Reference segment 4a left hepatic lobe lesion measures 2.6 x 3.1 cm (series 4, image 104); previously measuring 2.8 x 3.2 cm.Reference segment 8 right hepatic lobe lesion measures 3.7 x 4.2 cm (series 4, image 110); previously measuring 3.8 x 4.4 cm.Heterogeneous enhancement of the liver is likely related to phase of contrast.Small amount of perihepatic ascites is also again seen.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: Retroperitoneal lymphadenopathy is reidentified. Reference left periaortic lymph node measures 1.3 x 1.2 cm (series 4, image 124); previously measuring 1.4 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No new sites of metastatic disease with reference measurements as detailed above.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: assess ET tube position History: new ET tube ET tube is been advanced with its tip now in the proximal right mainstem bronchus.NG tube with its tip beyond the margin of the image.Right subclavian/innominate stent redemonstrated.Decreased lung volumes is stable cardiac enlargement.Left retrocardiac opacity is compatible with atelectasis/consolidation.

Output: ET tube in low position with its tip within the proximal right mainstem bronchus. Pager #5085 paged at 9:45 AM.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: r/o mets History: none The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: hx of bladder cancer evaluate for metastatic disease History: see above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Degenerative changes of thoracic spine.

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


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p bronch, right extended/pleurectomy and decortication History: follow-up Right subpulmonic effusion with overlying atelectasis, slightly improved.Left lung unremarkable.

Output: Right pleural effusion with overlying atelectasis, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Shortness of breath evaluate for pathology. Large lung volumes suggestive of COPD/emphysema. Coarse interstitial markings in the region of the right middle lobe and lingula, present previously.Unchanged appearance of the cardiomediastinal what. No pneumothorax. No visible pleural fluid.Subcentimeter right upper lobe nodular opacity near the tip of the anterior right fourth rib has probably been present previously dating back to 2013 and may be a granuloma, though is incompletely assessed by plain film.

Output: No acute pulmonary abnormality. Signs of COPD/emphysema. Mild chronic appearing interstitial abnormality in the right middle lobe and lingula could be the result of recurrent aspiration or possibly chronic indolent infection in these areas from etiology such as atypical mycobacteria.


Instruction: Generate impression based on medical findings.

Input: Lung transplant Persistent scattered mild mixed interstitial and airspace and largely perihilar and basilar pulmonary opacities with small effusions and borderline cardiomegaly, again suggest CHF. Chest tubes, Dobbhoff are also unchanged. No new superimposed focal pulmonary abnormality. Left chest tube overlies chest wall unchanged

Output: Suspected persistent moderate CHF and unchanged right basilar chest tube


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: primary lung adenocarcinoma, right History: primary lung adenocarcinoma, right Postoperative changes noted within the right hemithorax. Scarring or atelectasis again noted at the left lung base. No new focal lung consolidation. No large pleural effusion or pneumothorax. Unchanged heart size. Bullet again noted within the right hemithorax. Patient again status post sternotomy and CABG.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with history of hepatitis C. Evaluate for hepatoma and evaluate left inferior pole renal cyst. CHEST:LUNGS AND PLEURA: Biapical scarring. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: Indeterminate hypoattenuating lesion in segment 7 of the liver that is too small to characterize (series 4, axial image 109/236). No evidence of cirrhosis or ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Small pancreatic cyst (series 4, axial image 116/236).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple renal cysts bilaterally, the largest of which measures 6.1 cm x 6.9 cm.There are two indeterminate cysts (one in each kidney: series 4, axial image 135/36 and axial image 139/236) with increased attenuation. Unable to tell if this is intrinsic attenuation versus enhancement as patient needs a noncontrast study for comparison. The patient will be rescheduled for a noncontrast study and an addendum will be attached to this report further characterizing these lesions.RETROPERITONEUM, LYMPH NODES: Mildly dilated portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.As detailed above, there are two indeterminate renal cysts which need further characterization upon comparison to a noncontrast study. Patient will be rescheduled for noncontrast abdominal CT and an addendum will be added to this report.2.Large simple inferior pole left renal cyst as described above.3.Indeterminate hypoattenuating lesion that is too small to characterize in the right hepatic lobe.4.Mildly dilated portacaval lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: f/u infiltrates, consolidation, evaluate for pneumomediastinum History: intubated, oxygen requirement, Assessment is very limited by overlying pad.Persistent signs of pneumomediastinum.Bilateral lower lobe consolidative opacities are unchanged, partially obscured.Possible bilateral pleural effusions. Very limited assessment for pneumothorax.Stable position of ET tube overlying the mid trachea. Enteric tube coursing below the diaphragm.The right IJ venous catheter overlies the SVC.

Output: Very limited assessment of the cardiomediastinum and the lungs.Persistent signs of pneumomediastinum.Adequate position of support apparatus.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with metastatic sarcoma CHEST:LUNGS AND PLEURA: Status post right pneumonectomy. Subcentimeter nodule in the right lower lobe is stable measuring 3-mm image number 46, series number 5.Small right-sided pleural effusion unchanged.MEDIASTINUM AND HILA: Shift of mediastinal structures to the right side. Subcentimeter mediastinal lymph nodes are stable. Left paratracheal reference node measures 15 x 13 mm image number 24, series number 3.CHEST WALL: Status post right thoracoplasty. Postsurgical findings are stable. Scripps stable spurted foci involving the ribs thoracic spine and sternum.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hypodense lesion in the left lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged. Some of the lesions are again too small to acutely characterize. Hyperdense lesion in the upper pole of the right kidney measuring 12-mm is stable from previous study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Unchanged left posterior lateral flank hernia containing nonobstructed colon and small bowel loops.BONES, SOFT TISSUES: Numerous metastases are unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Unchanged sclerotic foci in the bones of the pelvis. Deformity and pathology fracture of the left ilium is unchangedOTHER: No significant abnormality noted

Output: Reidentified numerous bone metastases and reference measurements. No significant change compared to previous examination.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: UnremarkableMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral nonobstructing punctate renal stones are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: 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 exam without evidence of measurable disease.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: interval change and cause if hypoxia History: hypoxia, bronchial stent placed yesterday and pneumonia Increasing right upper lobe airspace opacity.Diffuse edema pattern elsewhere.Status post extubation.NG tube removed.Right jugular catheter, tip in SVC.Unchanged right lower lobe bronchial stent.

Output: Increased right upper lobe opacity following extubation.


Instruction: Generate impression based on medical findings.

Input: IABP check Mildly improving and decreasing edema with persistent moderate to large pleural effusions greater on the left. IVP marker remains 5 cm below the aortic arch and a Swan-Ganz project into the right pulmonary outflow tract. Mild cardiomegaly

Output: Decreasing edema


Instruction: Generate impression based on medical findings.

Input: 66 year-old female with colon cancer. Status post resection on 7/18/08. Postop staging. CHEST:LUNGS AND PLEURA: Bilateral numerous lung nodules. The reference nodule measures 8 by 8mm image number 39/87, series number 102 2 7.Lesion is suspicious for metastatic disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left axillary adenopathy measuring 11 x 11 mm on image number 25, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Fat infiltration of the liver. Multiple ill-defined hypodense lesions in the liver. These are too small to accurate characterize but are suspicious for metastatic disease. A reference lesion measures 9 x 9 mm on image number 80, series number 3.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: Retroperitoneal adenopathy. Reference left para-aortic adenopathy measures 19 x 14 mm image number 105, series number 3.BOWEL, MESENTERY: Mesentery ill-defined soft tissue density adjacent to the clips measuring 19 x 15 mm image number 124, series number 3. Status post right hemicolectomy. The small collection near the anastomosis measuring 3 x 1.2 cm. Associated fast rending and small amount of free fluid in the right lower quadrant are also present. These are suspicious for possible anastomotic leak.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Uterus is not well visualized. 2.5 x 1.8 cm ill-defined soft tissue density between the bladder and vagina. The etiology of this lesion is not certain they are present metastatic disease. Further evaluation with pelvic ultrasound may be helpful.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small lung and liver lesions suspicious for metastatic disease. Retroperitoneal and mesenteric metastatic adenopathy. Pelvic mass between the vagina and bladder suspicious for metastatic disease.Infarct or changes and small peripherally enhancing collection adjacent to anastomosis suspicious for an anastomotic leak.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with shortness of breath, rule out pneumothorax. Surgical clips in the right perihilar region. Left perihilar mass extending to left upper lobe consistent with malignancy. No pleural effusion or pneumothorax.

Output: Left perihilar mass consistent with malignancy. Dedicated CT chest study is recommended for further characterization.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: surveillance of effusion History: doe Surgical clips in the upper abdomen.Stable cardiomediastinal silhouette.Right lower lobe mass similar in appearance to the prior exam.Right-sided pleural effusion, not significantly changed from the prior exam accounting for differences in patient positioning.

Output: Stable right-sided pleural effusion. Right lower lobe mass again seen.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.History of cough for one month. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Et tube placement,, ards History: Et tube placement Moderate cardiomegaly with unchanged pulmonary opacities suggestive of edema or ARDS.NG tube tip above the diaphragm. Right jugular catheter, tip in SVC.ET tube tip approximately 3 cm above the carina.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Infxn w/u History: above Moderate cardiomegaly.Small lung volumes.No specific evidence of infection or edema.

Output: Cardiomegaly and small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Shortness of breath check for reaccumulation of pleural fluid. Unchanged mild elevation of the right hemidiaphragm. Small right subpulmonic fluid collection. Small volume of pleural fluid on the left has increased. Diffuse septal thickening consistent with edema. Patchy atelectasis and consolidation in the left lower lobe. Compressive atelectasis right lung base.Unchanged cardiomegaly and mediastinal lymph node enlargement.

Output: Severe CHF with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Cough Cardiomegaly without superimposed acute additional abnormality. Renal osteodystrophy changes similar to prior

Output: No acute new disease, cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: r/o infection, edema, effusion History: shortness of breath No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Tachypnea, increased work of breathing. Concern for worsening edema and pneumonia. History: As above Moderate cardiomegaly with ICD leads and right jugular catheter unchanged.Bilateral mainly perihilar airspace opacity, nonspecific but compatible with edema or aspiration pneumonia, not slightly increased since the previous day.

Output: Increasing perihilar airspace opacities compatible with acute edema or aspiration pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: pleural effusion History: pleural effusion, malignant Right pleural catheter unchanged.Moderate right-sided pleural effusion similar in size to the prior exam.Air has been interval resolution of the right-sided pneumothorax.Innumerable pulmonary nodules in both lungs compatible with metastatic disease.

Output: Right pleural effusion and innumerable pulmonary metastases without significant interval change. Resolution of right-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: Tachypnea, Dyspnea, Hypoxia History: Above Endotracheal tube terminates 10 cm from the carina. Lines and tubes are otherwise unchanged. Unchanged diffuse pulmonary opacities. Unchanged moderate right-sided pneumothorax. Unchanged cardiomegaly. Near complete resolution of pneumoperitoneum.

Output: Unchanged diffuse pulmonary opacities. Unchanged moderate right-sided pneumothorax.Near complete resolution of pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Chest pain Study is adequate for detection of pulmonary embolism. There are no filling defects within the pulmonary arteries or their branches to suggest a pulmonary embolism.There are no enlarged hilar, mediastinal or axillary lymph nodes.Again noted is extensive centrilobular emphysema with stable scarring in the right upper lobe. There is no pneumothorax or displaced rib fractures.Anterior left chest wall gas is likely post iatrogenic in etiology. Left pacemaker device and wires wires are noted.There is a low density lesion enlarging the left adrenal gland, measuring 14 x 19 mm and having a CT value (Hounsfield units) of -6, compatible with a lipid rich adrenal adenoma, stable since multiple prior studies.A subcentimeter cystic structure in the midpole of the right kidney has lower attenuation compatible with a renal cyst. Subcentimeter mixed attenuation lesion in the midpole of the left kidney on image 318 of series 8 is to small to characterize by CT but may also represent a renal cyst.Diffuse atherosclerotic disease is present.

Output: 1.No evidence of pulmonary embolism.2.Stable emphysema and scarring in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fluid overload History: sob Heart size about upper normal with mild nonspecific interstitial opacity and basilar atelectasis.There may be small pleural effusions in the posterior costophrenic angles.

Output: Probable mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p bronchoscopy History: evaluate for pnuemothorax No pneumothorax following bronchoscopy.Port catheter with its tip in the SVC.Volume loss and opacity in the right perihilar region and right upper lobe suggestive of scarring which may be secondary to radiation reactionNodular opacity in the right apex may represent residual tumor and could be better evaluated by CT scan.

Output: No pneumothorax. Right apical opacity compatible with scarring and possibly residual tumor.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Line(from 2006) removal. Eval for PTX History: Line removal The pulmonary arteries are markedly enlarged. No focal pulmonary opacity to suggest pneumonia. No large pleural effusion. No pneumothorax. Interval removal of central venous catheter. Surgical clips project over the right upper quadrant of the abdomen consistent with a prior cholecystectomy.

Output: 1.Interval removal of central venous catheter. No pneumothorax.2.Findings of severe pulmonary arterial hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Right arm swelling, concern for compressive malignancy in patient with smoking history. No evidence of intrathoracic malignancy. No evidence of acute cardiopulmonary abnormality.Stable placement of left chest wall pacemaker.

Output: No evidence of neoplasm or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: The spine is in normal alignment. There is mild reversal of the normal cervical lordosis centered at C4-C5 The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level.At C5-C6, there is a trace disc bulge with tiny right paracentral annular fissure.At T4-T5 through T6-T7, there are tiny central disc protrusions without stenosis.At T11-T12, there are shallow bilateral paracentral disc protrusions which indent the ventral thecal sac without stenosis.Within the lumbar spine, there are scattered mild disc bulges most conspicuous at L1-L2. No axial images are available through the lumbar spine. At L4-5, there also appears to be a small right paracentral annular fissure is a minimal disc bulge at this level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the spine. There is a somewhat enlarged empty sella. Incidental note made of prominent nerve root sleeve cysts along the lower cervical spine on the left side.

Output: No evidence of concerning osseous lesions. Very minimal scattered spondylotic changes as detailed above, without significant stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Reason: persistent sob. elevated o2 requirement. History: as above Pacemaker device with leads in the area of the right atrial appendage and right ventricular apex, unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.No significant change.

Output: Basilar atelectasis and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with metastatic bladder cancer. Back pain. Skin nodules? 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: Multiple new ill-defined, hypodense lesions in the liver. An index lesion is near the dome of the liver measuring 18 x 18 mm on image number 78, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Specific, small hypodense lesions in both kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node has increased in size and now measures 19 x 18 mm in image number 115, series number 3. Other lymph nodes are also slightly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post bladder resection. Ill-defined enhancing mass adjacent to the right pelvic bowl measures 3.5 by 1.7-cm image number 182, series number 3. Previously it was measuring 2.3 x 1.6 cm image number 185, series number 4. Similar enhancing focus is also likely present on the left side.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thickening of the skin in the right lower quadrant with small subcentimeter soft tissue density foci, some of them are new from previous study. An index lesion measures 6 x 5 mm image number 151, series number 3.OTHER: Small amount of ascites.

Output: Interval progression of disease with interval development of new liver metastases, increase in the size of the retroperitoneal lymph nodes and pelvic mass.Subcentimeter skin nodules in the lower pelvis may also represent metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 95 years old.Reason: NG tube placement History: advanced NG tube Unchanged dense perihilar opacities with small pleural effusions. Heart size normal.Right jugular catheter, tip in SVC.NG tube tip in proximal duodenum.

Output: Unchanged pulmonary opacities and support devices, except the NG tube advanced into the proximal duodenum.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: CTICU patient History: CTICU patient There is interval removal of the ET tube as well as the enteric feeding tube. Right jugular central venous catheter tip in the area of the right brachiocephalic vein. Cardiomegaly with mediastinal widening is compatible with postoperative hematoma and appears similar compared to prior examination. Bibasilar opacities are compatible with pleural effusions and overlying atelectasis. Left lower lobe atelectasis is mildly improved compared to prior exam. Patchy airspace opacity in the right upper lobe is nonspecific and may represent aspiration.

Output: Interval extubation with improved left lower lobe atelectasis and persistent bilateral pleural effusions.Patchy airspace opacity in the right upper lobe is nonspecific and may represent aspiration.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: Shortness of breath Mild interval improvement in overall technique, however mild motion again degrades sensitivity. Lung volumes remain decreased with mild basilar changes again suggesting atelectasis, however aspiration cannot be excluded. Mild cardiomegaly and atherosclerotic changes of the aorta

Output: Mild persistent basilar changes suggesting probable atelectasis and/or possibly aspiration, less likely pneumonia


Instruction: Generate impression based on medical findings.

Input: 59-year-old female metastatic breast cancer on clinical trial status post 8 cycles. Measurements compare with previous. CHEST:LUNGS AND PLEURA: Multifocal bilateral metastases. Index lesion in the right middle lobe lesion series 5 image 1/76 13.8 x 13.7 mm. Previously measured 12 x 10.9 mm.Index lesion in the left lobe, series 5 image 46 measures 15.9 x 15.2 mm. Previously measured 12.8 x 10.7 mm.MEDIASTINUM AND HILA: Mediastinal adenopathy. Previous conglomerate of two lymph nodes seen in the left middle mediastinum estimate on current study, series 3 image 1719.2 x 16.8 mm previously 19.9 x 19.5 mm. However I believe these are unchanged. Numerous other nodes seen throughout the middle mediastinum are grossly unchanged.Small perihilar index node, series 2 image 38 9.5 x 7.3 mm, previously 9.3 x 8.4 mm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Punctate multifocal irregular hypoattenuating lesions in the liver consistent with metastases. Previous index lesion abutting the inferior vena cava in the dome of the anterior segment of the right lobe measures 58.9 x 42.5 mm series 3 image 64. It previously measured 50.7 x 39 mm.SPLEEN: Index lesion in the spleen of uncertain significance could be an incidental cyst is unchanged as seen on series 2 image 69 to measure 38 x 33 mm. It previously measured 39.4 x 32.7 mm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous injection sites.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple subcutaneous injection sites. The sclerotic focus in L3 vertebral body is unchanged. Lytic focus in L2 vertebral body is unchanged.Lytic focus in the left iliac wing consistent with a metastasis is unchanged. No new lesions are seen.OTHER: No significant abnormality noted.

Output: No new sites of disease. Increase in size of several lesions as detailed above.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate lung fields History: hx of pleural effusion Cardiomegaly, pleural effusions and basilar atelectasis, slightly improved in the left lower lobe.Tracheostomy tube in place.

Output: Partial clearing of left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: assess balloon pump History: cardiogenic shock Superior marker of the IABP is unchanged in position. ICD with lead unchanged. Right upper extremity PICC is in the right axillary vein.Moderate cardiomegaly.No pleural effusion or pneumothorax.No specific evidence of pulmonary edema.

Output: IABP superior marker is unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: eval lung fields History: AMS Stable cardiomediastinal silhouette with atherosclerotic changes of the aorta.Basilar chronic appearing interstitial opacities compatible with fibrosis.No focal airspace consolidation.No pleural effusions.

Output: Chronic appearing basilar interstitial opacities compatible with fibrosis. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? cough, fever, mildly course sounds in R L field History: cough Focal opacity in the posterior costophrenic angles suggestive of small effusions and possibly associated consolidation or atelectasis.Unremarkable cardiac and mediastinal silhouette.

Output: Focal posterior opacity compatible with consolidation and effusion which may be secondary to pneumonia in the appropriate clinical setting.The findings were discussed with Dr. Ahn in the ED at the time of reporting.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for impacted food bolus History: dysphagia Large lung volumes but no evidence of acute cardiopulmonary abnormality. Specifically there is no evidence of foreign body.

Output: No evidence of radiopaque foreign body.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: cp History: cp s/p ngt Patchy bibasilar opacities with small pleural effusions. Normal heart size. No pneumothorax.

Output: Probable patchy bibasilar atelectasis with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: r/o infiltrate History: chest pain The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.Status post right upper lobectomy.

Output: No acute cardiopulmonary process is identified. 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, 51 years old.Reason: home inotrope therapy with r arm swelling, evaluate for line placement History: home inotrope therapy with r arm swelling, evaluate for line placement Right-sided PICC terminates within the superior aspect of the right hemithorax. The exact location of this line is unknown. Defibrillator lead terminates in expected location the RV. Low lung volumes. Patchy basilar opacities. No focal lung consolidation or pulmonary edema. Mild-to-moderate cardiomegaly again noted. No large pleural effusion or pneumothorax.

Output: Right-sided PICC terminates within the superior aspect of the right hemithorax. The exact location of this line is unknown.Patchy basilar opacities. No focal lung consolidation or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: s/p picc History: s/p picc Right-sided PICC terminates within the right axilla. Focal nodular opacity again noted at the left apex. Question of developing focal opacity in the mid aspect of the left lung which can be reevaluated and imaging follow-up. Unchanged heart size. Large patient body habitus. No definite pneumothorax on the left lateral costophrenic angle is excluded from view.

Output: Right PICC terminates in the right axilla.Focal nodular opacity again noted at the left apex. Question of developing focal opacity in the mid aspect of the left lung which can be reevaluated and imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Bronchoscopy with valve, evaluate right pneumothorax. Endobronchial valves project over the right upper lobe. Pigtail catheter unchanged in position. Right lateral chest tube sidehole remains overlying the chest wall and appears extrapleural.Small right pneumothorax with maximal pleural separation from the chest wall of about 1 cm, not significantly changed.Severe upper lobe bronchiectasis and architectural distortion with mediastinal/hilar lymphadenopathy in a pattern suggestive of sarcoidosis, unchanged.

Output: No significant change in right pneumothorax. The right lateral chest tube sidehole straddles the bony thorax, outside the pleural space, consider repositioning.


Instruction: Generate impression based on medical findings.

Input: 60 years old Male. Reason: IABP, swan placement, PNA History: ADHF requiring ionotropic support, afterload reduction s/p IABP placement awaiting transplant.. Cardiomegaly and diffuse bilateral interstitial opacities, unchanged as compared with prior study. The tip of the intra-aortic balloon pump catheter projects over the aortic arch. The tip of the Swan-Ganz catheter projects over the descending branch of the right pulmonary artery. The cardiac pacemaker/defibrillator electrodes are stable in position.

Output: Cardiomegaly and bilateral interstitial changes, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: SOB History: SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Evaluate for possible aspiration/pleural effusions Endotracheal tube tip at thoracic inlet. Enteric tube tip at the antropyloric region, though the proximal portion is looped in the hypopharynx. Additional enteric tube tip in the proximal gastric body. Low lung volumes with bilateral basilar opacities which are not significantly changed and likely a combination of pleural effusions and atelectasis/consolidation.

Output: Persistent bilateral basilar opacities likely combination of pleural effusions and atelectasis/consolidation. Enteric tube tip at the antropyloric region, though the proximal portion is looped in the hypopharynx.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o acute process History: chest pain Unremarkable cardiac and mediastinal silhouettes. No specific evidence of infection or failure.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: febrile, r/o infection History: febrile, r/o infection Small pleural effusions and patchy bibasilar opacities again noted. Moderate cardiomegaly, unchanged. No pneumothorax. Lines and tubes are unchanged..

Output: Small pleural effusions and patchy bibasilar opacities, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Eval lung fields History: Eval lung fields Low lung volumes and basilar atelectasis. The mediastinum and retrocardiac area contain a known intrathoracic stomach. There is no obvious signs of pneumonia or pneumomediastinum. Surgical clips project in the right upper quadrant. Likely small bilateral effusions persist.

Output: Low lung volumes and basilar atelectasis. Mild interval improvement of bilateral effusions. Large intrathoracic stomach limits evaluation of the mediastinum.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: 67 year old male with history of laryngeal cancer; rule out recurrence. LUNGS AND PLEURA: Punctate calcification within the right upper lobe likely represents prior healed granulomatous disease.MEDIASTINUM AND HILA: Trace pericardial effusion. Calcified mediastinal and right hilar lymph nodes; likely represent prior healed granulomatous disease.CHEST WALL: Unchanged low neck lymph nodes; the reference lymph node measures 0.9 x 1.1 cm (image 12 of 101).UPPER ABDOMEN: Severe pancreatic atrophy with multiple punctate calcifications throughout the remainder of the body and massive pancreatic duct dilatation. In addition, there is a large calcification within the pancreatic head that measures 1.5 x 1.2 cm (image 101 of 101); however, this calcification is incompletely evaluated on this examination.

Output: 1. Stable cervical lymph nodes.2. Large calcification within the pancreatic head noted; however, pancreatic atrophy with punctate calcifications and ductal dilatation are unchanged.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: infection History: wheezing and sob cold like symptoms Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: r/o acute process History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Shortness of breath. Left pleural effusion and left lower lobe opacity is unchanged from prior examination. Interval removal of NG tube. Other support devices unchanged.

Output: Unchanged left lower lobe consolidation with left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: FemaleReason for Study: Reason: r/o infectious process History: fever of unknown origin There is mild cardiac enlargement.Left retrocardiac consolidation/atelectasis may be source of infection.Minimal right basilar atelectasis.

Output: Retrocardiac consolidation/atelectasis may be a source of infection.


Instruction: Generate impression based on medical findings.

Input: Female 43 years old Reason: s/p CryoMAZE Right perihilar discoid atelectasis/scarring unchanged. No new focal consolidation, pleural effusion or pneumothorax is evident. There is unchanged mild cardiomegaly.

Output: Mild cardiomegaly and right hilar atelectasis/scarring, but no evidence of pneumothorax.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, 60 years old.Reason: rule out infection History: rule out infection Interval placement of right internal jugular catheter, tip in the SVC.Normal cardiac and mediastinal silhouette.No pleural effusion, or pneumothorax.Ill-defined opacity at the level posterior 8/9 right ribs may relate to vessels or artifact.Healed left clavicular fracture.

Output: Interval placement of right central venous catheter. Ill-defined opacity at the right lung base which may relate to vessels or artifact; dedicated PA and lateral chest radiograph recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: cardiac or pulmonary etiology of chest pain? History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 40-year-old woman with history of lupus and antiphospholipid antibody syndrome, now with chest pain, evaluate for aortic dissection. CHEST:LUNGS AND PLEURA: No focal pulmonary signal abnormality.MEDIASTINUM AND HILA: The aortic root and arch appear normal without evidence of dissection flap or aneurysmal dilatation. The aortic root measures 29 mm in diameter. There appears to be common origin of the brachiocephalic and left common carotid artery.No mediastinal mass or lymphadenopathy. The heart and pericardium appear normal.CHEST WALL: No significant abnormality noted.OTHER: T2 hyperintense multilobulated splenic lesion (601/19) measures 24 mm, previously 9 mm.

Output: 1.No aortic dissection or evidence of acute aortic pathology.2.Increase in size of T2 hyperintense multilobulated splenic lesion, nonspecific by imaging findings.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Evaluate size pleural effusion. The cardiomediastinal silhouette is unremarkable.Severe emphysema and large right apical bulla, stable. Right middle lobe atelectasis and consolidation are unchanged. Persistent moderate right pleural effusion.

Output: Unchanged right middle lobe atelectasis and consolidation with no significant change in size of the moderate right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Left ventricular assist device Unchanged single-lead ICD, Swan-Ganz catheter, mitral valve prosthesis, surgical clips, left chest tube, mediastinal drains, graft O-rings, and sternotomy hardware.Interval extubation.The left ventricular assist device is partially imaged.Right chest tube with tip now closer to the lung base.Cardiomegaly, slightly accentuated from surrounding atelectasis.Small pleural effusions and mild pulmonary edema and bibasilar subsegmental atelectasis are not significantly changed.No significant pneumothorax.

Output: Unchanged small pleural effusions and mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: febrile, assess for infection History: febrile, assess for infection Increasing bibasilar airspace opacities highly suggestive of infection or aspiration.

Output: Increasing bibasilar airspace opacities highly suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: ? volume History: ? volume -> missed dialysis Right central venous catheter with its tip in the SVC/RA junction.Decreased lung volumes with moderate cardiac enlargement.Elevation right hemidiaphragm with small pleural effusion and right basilar atelectasis.Scattered areas of scarring/discoid atelectasis in the left lung.

Output: Small right pleural effusion and right basilar atelectasis. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: 86 years, Male. Reason: evaluate DHT position post-op History: post-op Dobbhoff tube tip overlying the gastric antrum. Cardiomegaly and retrocardiac opacity, please refer to chest radiograph on the same day. Incompletely visualized bowel gas pattern.

Output: Dobbhoff tube tip overlying the gastric antrum.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: s/p lvad, assess for effusions or pna History: leukocytosis Unchanged LVAD and ICD.Status post median sternotomy presumably for CABG and mitral repair.Cardiomegaly with nonspecific basilar opacities unchanged, with very small pleural effusions.

Output: Small pleural effusions and nonspecific basilar opacities, unchanged. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Hypoxemia History: Hypoxemia, desat to 80s Pleural effusions with lower lung zone edema and retrocardiac consolidation, unchanged.Median sternotomy with a normal sized heart with dense mitral annular calcification.

Output: CHF, with pulmonary edema and pleural effusions. No significant change.


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with acute hypoxic respiratory failure. Evaluate for cardiopulmonary disease. Tracheostomy tube tip is approximately 7 cm above the carina. Left internal jugular venous central catheter tip projects over the superior vena cava. An enteric tube extends below the field-of-view. Surgical clips project over the mid abdomen.Extensive pleural and pulmonary parenchymal abnormalities as previously described. Moderate bilateral pleural effusions.

Output: Unchanged appearance of the chest.


Instruction: Generate impression based on medical findings.

Input: Cough Persistent borderline cardiomegaly with underlying mild interstitial changes suggesting edema, partially resolved. No definite effusions. No superimposed acute airspace abnormality

Output: Persistent borderline cardiomegaly with partially resolved changes suggesting minimal interstitial edema


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: picc line placement History: picc line placement Right PICC tip at RA/SVC junction. Left PICC has been removed. Port is unchanged. Small bilateral pleural effusions.

Output: Right PICC tip at RA/SVC junction.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: assess size of hepatic hydropneumothorax sp chest tube placement History: as above PICC and right chest tube unchanged.No significant change in small right pleural effusion. No significant pneumothorax is visualized.

Output: No significant change in small right pleural effusion. No significant pneumothorax is visualized.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: sob this morning History: acute sob this morning w/ chest pain New right suprahilar opacity suggestive of a mass. There may be an associated pulmonary nodule in the right apex. Follow-up with CT is recommended.

Output: New right suprahilar opacity suggestive of a mass. There may be an associated pulmonary nodule in the right apex. Follow-up with CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Altered mental status. Hypertension Motion degrades sensitivity. Within this limitation, the multifocal bilateral and somewhat confluent nodular opacities are again observed and essentially unchanged. Moderate effusions and moderate nonspecific cardiomegaly are also identified and similarTracheostomy tube and midline sternotomy

Output: Nodular opacities and patchy basilar changes with effusions are unchanged representing suspected metastatic disease. No definite new superimposed distinct acute airspace process, however please note limitations described


Instruction: Generate impression based on medical findings.

Input: Lung transplant Postsurgical changes without additional acute abnormality. Lungs remain clear

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia? History: sore throat cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Port catheter with its tip in the SVC.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: eval ptx History: pneumothorax Left chest tube, unchanged. No pneumothorax. Small left pleural effusion and basilar atelectasis, unchanged.Unremarkable cardiac and mediastinal silhouettes.Scattered bilateral healed rib fractures.Punctate metallic focus projecting over the left lower chest is unchanged and may be external to the patient.

Output: Left chest tube. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: S/p CardioHelp, pVAD, CTs, ETT in place History: asx Support hardware unchanged in position with no evidence of significant pneumothorax. Pulmonary edema and pleural effusions unchanged. Stable cardiomegaly.

Output: Pulmonary edema and pleural effusions unchanged. Stable cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: productive cough Bilateral lower zone airspace opacity, greater on the right, involving at least the right lower, right middle and left lower lobes, highly compatible with pneumonia.Unremarkable cardiac and mediastinal silhouette.

Output: Bilateral pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: evaluate ett position and central line position from outside hospital History: intubated patient Focal opacity in the right infrahilar region likely is atelectasis related to intubation.Heart size upper normal.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Left PICC and right jugular catheter, tips at cavoatrial junction level.

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


Instruction: Generate impression based on medical findings.

Input: Reason: ptx History: sob Moderately large right hydropneumothorax with underlying atelectasis, unchanged or slightly increased. Left upper lobe nodules, recently characterized by CT scan.No new findings.

Output: Persistent right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Sarcoidosis, check for lymphadenopathy Minimal fullness in the hilar regions without distinct definite plain film findings to support lymphadenopathy. Correlation with prior images might be helpful.Lungs are otherwise clear. Cardiac and mediastinal contours significant for minimal atherosclerotic changesMild scoliosis

Output: Questionable hilar fullness preventing exclusion of lymphadenopathy, however no overt changes to confirm. Follow-up serial imaging and/or possibly comparison with prior images are even CT may be indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: assess for pna - sob History: assess for pna - sob Extensive upper lobe predominant volume loss with fibrosis including a reticulonodular abnormality and apical cavity formation.Prominent central pulmonary arteries suggestive of PA hypertension.No reliable evidence of lymphadenopathy.

Output: Upper lobe predominant fibrosis with cyst formation suggestive of sarcoidosis. The distribution is not typical for UIP. No evidence of superimposed edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 84-year-old male with metastatic carcinoid tumor CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Extensive bilobar hepatic metastases are again seen. Reference lesion in segment 6 measures 8 x 7.5 cm image number 133, series number 12, not significantly changed. Other hepatic metastases are also grossly unchanged. Sludge in the gallbladder without evidence of biliary dilatation, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cyst. Stable nonobstructive nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged portacaval and porta hepatis lymph nodes. Stable infrarenal abdominal aortic aneurysm demonstrating a focal saccular bulging on image number 139, series number 12. Largest AP dimension is 2.3-cm.BOWEL, MESENTERY: Reference mesenteric mass is stable measuring 3.4 by 2.2-cm on image number 105, series number 12.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Stable suprapubic catheter. Bladder stones are unchanged.LYMPH 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: Female, 68 years old.Reason: evaluate for malignancy History: none The sternotomy hardware is intact.There is no focal consolidation, pleural effusion or pneumothorax. Cardiac and mediastinal contours are within normal limits for size. Calcified mediastinal lymph nodes again noted.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: ett location History: intubated, ARDS ET tube with its tip 2 cm above the carina.Right central venous catheter with its tip in the SVC.Dobbhoff tube with its tip in the stomach.The cardiomediastinal silhouette is unremarkable.Diffuse interstitial and patchy airspace opacities in both lungs compatible with edema/ARDS.Left basilar atelectasis and possible small effusion.

Output: ET tube tip 2 cm above the carina. Extensive pulmonary opacities compatible with edema/ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: Screening has history of positive PPD - V74.1 - (needed for work). History: Screening has history of positive PPD - V74.1 - (needed for work). No significant cardiopulmonary abnormality.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: MaleReason for Study: Reason: infection History: SOB New right-sided pleural effusion and basilar consolidation/atelectasis.Stable cardiac mediastinal silhouette.The left lung is clear.

Output: New right pleural effusion and basilar consolidation/atelectasis suspicious of acute infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Reason: diease process PNA? History: sob ,cough Focal nodular opacity in the lingula adjacent to the left cardiac border, better seen on the lateral view, and a second nodular subpleural opacity posteriorly on the lateral view, likely in the left lower lobe, both of which are new since a previous CT scan of 10/6/2014.No other significant interval change.

Output: Two new nodular opacities in the left lung which appear relatively discrete on lateral view, and the differential diagnosis includes both infection and metastatic disease. If these findings do not resolve promptly a CT scan is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male; 58 years old. Reason: Swan ganz catheter placement History: HF Stable Swan-Ganz catheter and left subclavian ICD.Stable mild cardiomegaly.Stable mild increased perihilar opacities suggestive of edema.

Output: Stable Swan-Ganz catheter and findings suggestive of mild CHF.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: SOB History: SOB/Pleural Effusion on OSH CT Mild cardiomegaly.Small pleural effusions are noted without significant edema, and no evidence of infection.Residual contrast material is seen in the kidneys and bowel.

Output: Mild cardiomegaly with small pleural effusions, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Status post para esophageal hernia repair. Left-sided chest tube is noted. Retrocardiac opacities likely represent postoperative change. Patchy bibasilar opacities are noted. Currently small pleural effusions. Heart size likely normal given low lung volumes and AP projection. No acute bony abnormality.

Output: Likely expected postoperative appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: ETT eval History: intubated in MICU ET tube tip 4 cm above carina. Enteric tubes extend beyond the field-of-view of study. Pigtail drain on right.No change in extensive basilar opacities with pleural effusions.

Output: ET tube tip 4 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: s/p thoracentesis, assess for post procedure ptx History: see above Interval decrease in left pleural effusion with no evidence of pneumothorax.

Output: Interval decrease in left pleural effusion with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of shortness of breath. Evaluate for pneumonia. Cardiomediastinal silhouette is unchanged. Large lung volumes compatible COPD. No specific evidence of infection.

Output: COPD with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 95 yearsGender: FemaleReason for Study: Reason: r/o acute process History: Crackling bilaterally Stable mild cardiomegaly with tortuosity of the aorta.Mild chronic appearing interstitial opacities at the lung bases.No focal areas of consolidation.No pleural effusions.Left-sided pacemaker unchanged.

Output: Stable mild cardiac enlargement. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Respiratory distress. Large bilateral pleural effusions with associated atelectasis and consolidation, left greater than right. Severe pulmonary edema, increased. Cardiothoracic ratio appears slightly enlarged compared to the prior studies.

Output: Worsening CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: s/p chest tube placement c/b small apical PTX, evaluate for expansion History: as above Left chest tube with no large pneumothorax.Severe pulmonary arterial hypertension and nonspecific pulmonary opacities with pleural effusions, unchanged.Right and left subclavian catheters terminate in the SVC.

Output: Unchanged pulmonary opacities. No significant pneumothorax, left chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Preoperative evaluation for right total hip arthroplasty. There is advanced sclerosis and subchondral lucency with marked flattening/collapse of the right femoral head, consistent with advanced avascular necrosis. Degenerative changes are also noted. There is slight lateral displacement of the femoral head in relation to the acetabulum.

Output: Advanced avascular necrosis with subchondral collapse of the femoral head with degenerative changes of the right hip as described.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: Chronic dyspnea and cough Minimal interstitial and airspace changes remain in both lung bases with mild nonspecific cardiomegaly, however no discrete superimposed focal airspace process within this limited evaluation. Please note left lower lobe is incompletely evaluated due to cardiomegaly and positioning. Serial imaging would be helpful to confirm the absence of possible aspiration and/or pneumonia.Pigtail catheter projected over left upper quadrant

Output: Questionable retrocardiac mixed interstitial and airspace opacity with mild air bronchograms difficult to confirm due to cardiomegaly and patient positioning. Serial imaging would be helpful


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: s/p Ct removal Right IJ sheath remains in place. Mediastinal drains again noted. Slightly lower lung volumes. Basilar opacities with probable small pleural effusions, as before. Unchanged cardiomegaly. No significant left-sided pneumothorax. Questionable small right apical pneumothorax which is not evident on follow-up imaging.

Output: Lower lung volumes. Persistent basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Hypoxia Mild improved minimal aeration, specifically left lower lobe, however changes are minimal given the extensive mixed interstitial and air space opacities again greater in both bases. Mild cardiomegaly. Suspected moderate effusions greater on the left.No new hardware.

Output: Shifting mild edema with questionably partial resolution of the nonspecific basilar opacities again suggestive of multifocal infection versus edema; less likely aspiration


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: follow up PTX History: hypoxia Persistent small right pneumothorax. Lateral margin of the upper lobe is a few millimeters from the chest wall. Improved right pleural effusion. Persistent right lower lobe airspace opacity and bibasilar atelectasis.

Output: Persistent small right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: infiltrate? mediastinum eval, missed HD History: SOB Left subclavian stent now noted.Mild cardiac enlargement with prominence of the central pulmonary vasculature.Scattered areas of atelectasis without evidence of focal consolidation.No pleural effusions.

Output: Cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 74 yearsGender: MaleReason for Study: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath The cardiomediastinal silhouette is unremarkable.Decrease in size with peripheral interstitial abnormality compatible with fibrosis.Right lower zone consolidation similar to that seen on recent CT.No evidence of a pneumothorax post biopsy.

Output: Pulmonary fibrosis with right lower zone consolidation similar to recent CT. No evidence of a pneumothorax post procedure.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: heart/lung pathology History: lower extremity edema Interval appearance of patchy consolidation within the right middle and likely lower lobes compatible with pneumonia. Possible associated trace right pleural effusion. The left lung is clear. The heart size does appear normal.

Output: Interval opacity at the right heart border suspicious for pneumonia within the right middle and possibly lower lobes.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p esophagectomy now w/ anastomotic leak, s/p removal of right and left chest tubes - please eval for pneumo History: chest tube removal Persistent small right apical pneumothorax and moderately large bilateral pleural effusions.Mediastinal widening consistent with esophagectomy and gastric interposition.Interval removal of a right chest tube and NG tube.

Output: Persistent small right pneumothorax, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 56 years old Female. Reason: r/o pneumonia History: fever, prod cough. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female presents with cough. Evaluate for pneumonia. The cardiomediastinal silhouette is normal. Mild prominence of the right paratracheal stripe favored to be tortuous vasculature which correlates to prior CT scans of the cervical neck on 11/10/16. Streaky opacity of the left lower lobe favored favored to be scarring or atelectasis. No new focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: hx of testicular cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: 9-mm right hilar lymph node on image number 44, series number 3 not enlarged by CT criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific punctate hypodensities in the right lobe of the liver and in the left lobe of the liver are unchanged. Wedge shaped hypodensity near the falciform ligament likely represents a perfusion defect rather than a true lesion.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: New adenopathy adjacent to the caudate lobe of the liver, measuring 3.1 x 2 cm, image number 91, series number 3. Other smaller lymph nodes are also present in that area.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: New retroperitoneal adenopathy adjacent to the liver.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: fever, ams Small lung volumes with no gross cardiopulmonary abnormalities.

Output: No sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Post-ERCP pancreatitis, SIRS, evaluate for pneumonia History: SOB Tortuosity of the descending thoracic aorta. Heart size is normal. Streaky lower zone opacities may represent retained secretions. No focal pneumonia or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? acute pathology History: sickle cell chest pain Mild cardiomegaly and basilar scarring compatible with sickle cell disease.Skeletal abnormalities consistent with sickle cell disease.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Cardiac valve replacements Mildly enlarging small effusions greater on the right with interval removal of the jugular catheters. Lungs otherwise clear No additional immediate acute postprocedural complication. Borderline cardiomegaly.

Output: Jugular catheters removed


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p MVR, CABG ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Balloon catheter marker in the proximal descending aorta projected 4 cm from the top of the aortic arch.Cardiomegaly with bilateral opacity compatible with edema, atelectasis and small effusions.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Midline placement. Midline catheter from the left is only partially visualized, the tip projects over the left subclavian vein at the level of the clavicular head.No pneumothorax.Low lung volumes with minimal atelectasis but no focal airspace opacity.

Output: Left midline catheter tip projects over the left subclavian vein near the left clavicular head level.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Pt with PSP, having frequent throat clearing, mucous production, rule out aspiration pneumonia or other abnormality The heart size is normal. Mildly tortuous thoracic aorta. Multifocal patchy airspace opacities in the right middle and lower lobes, consistent with pneumonia. No large pleural effusion or pneumothorax. Unchanged osseous abnormalities, including multiple healed rib fractures.

Output: Right middle and lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.New coronary artery disease. No focal airspace opacity, pleural effusion, or pneumothorax.Mild cardiomegaly.

Output: Cardiomegaly without evidence of acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Moderate COPD without superimposed new abnormality, specifically no evidence to suggest infection.

Output: COPD without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: RV lead malfunction History: ICD shock Left-sided ICD unchanged.The cardiomediastinal silhouette is unremarkable.Increased lung volumes compatible with COPD.No focal airspace opacities.No pleural effusions.

Output: Left-sided ICD unchanged. No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: chest pain, COPD, HepC History: chest pain Unremarkable cardiac and mediastinal silhouette. Large lung volumes consistent with COPD.No sign of pneumonia or other acute disease.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 81 years, Male. Reason: eval for constipatoin History: constipation/abdominal pain The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax. Aortic calcification is noted.Nonobstructive bowel gas pattern with average stool burden. Two circular opacities are seen projecting over the colon, likely representing ingested pills. Penile implants are also noted.There is patchy sclerosis and flattening of the right femoral head which may be degenerative in etiology, although avascular necrosis cannot be excluded.

Output: 1. Nonobstructive bowel gas pattern.2. Patchy sclerosis and flattening of the right femoral head which may be degenerative in etiology, although avascular necrosis cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with leiomyosarcoma of sinuses CHEST:LUNGS AND PLEURA: Small soft tissue density in the prevascular space which may represent residual thymus or small lymph node is stable measuring 8 x 7 mm image number 26, series number 4. 4-mm nodule in the left upper lobe on image number 35, series number 4 which is more prominent on today's study. Subcentimeter nodule in the right middle lobe is also unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large left renal cyst is unchanged. Left lower pole stone without hydronephrosis is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pna History: sob Focal scarlike opacity with volume loss in the left midlung at the site of previous pneumonia.No new findings to suggest active infection.Unremarkable cardiac and mediastinal silhouette.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Shortness of breath. Asthma exacerbation. Stable symmetric bronchial wall thickening consistent with history of asthma. Lungs otherwise clear without consolidation, effusion, or edema. No pneumothorax. Heart size within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval acute process History: fatigue, tachycardia Small lung volumes with mild basilar atelectasis.No specific evidence of pneumonia or CHF.

Output: Mild basilar atelectasis.