Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.History of pneumothorax. Follow-up. Interval placement of left apical Pleurx catheter. Small residual left pneumothorax, slightly decreased in size from prior. Apical and left suprahilar anterior medial components are again noted. Attention on follow-up.The position of the left basilar chest tube is unchanged.Additional findings stable from recent same day chest radiograph

Output: Interval placement of left apical Pleurx catheter. Small left apical pneumothorax, slightly decreased in size. No findings to suggest postprocedural complication.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Left upper lobe mass suggestive of malignancy. No evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o PNA History: productive cough, chill, on immunosuppression The lungs and pleural spaces are clear. Heart size is within limits of normal, unchanged. No pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Shortness of breath, cough, evaluate for pneumonia Increased lung volumes compatible with COPD. Probable nipple shadow projects over the right base.No specific evidence of infection or edema. No pleural effusions. The cardiac silhouette is unremarkable. Tracheostomy and percutaneous gastrostomy tube is noted.

Output: COPD without acute abnormality. Probable nipple shadow projects over the right base and could be confirmed on follow up radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 101 years old.Reason: AMS, h/o cv disease History: above Chronic appearing opacities and calcification but no evidence of edema or pneumonia.Mild to moderate cardiomegaly and a tortuous calcified aorta, unchanged.Right supraclavicular calcifications are unchanged possibly from healed infection.

Output: No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for worsening pleural effusion History: hypotension, CHF Slight improvement in right pleural effusion, with unchanged interstitial opacities suggestive of edema.Mild cardiomegaly.Right pleural drain unchanged.Left subclavian ICD, leads unchanged in position.

Output: Slight improvement in right pleural effusion, with unchanged pulmonary interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: 67-year-old female with history of recurrent stage IIIB ovarian cancer. Patient status post TAH/BSO (6/2005) CHEST:LUNGS AND PLEURA: Stable scattered micronodules. No suspicious nodules, masses, or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Calcified subcarinal node is stable. Heart size normal without pericardial effusion. Prominent ascending aorta measures 3.7 cm in AP dimension and is unchanged.CHEST WALL: Right chest wall Port-A-Cath. Oval, homogenous left breast mass is stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable subcentimeter hypodensity in the tail of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable cortical deformity in left upper pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Surgically absent uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites is new and of unknown etiology.

Output: New, small pelvic ascites of unknown etiology but no discrete evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Right upper lobectomy Continued improvement with improved aeration of the remaining right lung with an associated small to moderate effusion. Scattered atelectasis without new superimposed acute airspace abnormalities. No cardiac or mediastinal new findingsLower cervical spine fixation

Output: Postsurgical right upper lobectomy changes and improved expansion and re-aeration of the remaining right lung


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: r/o infiltrate History: cough Mild to moderate cardiomegaly.Unchanged basilar interstitial opacities likely chronic.No specific evidence of infection or edema.Left axillary to subclavian stent.

Output: Card he megaly, with chronic interstitial opacities but no evidence of acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: cough for 3 months, r/o pneumonia History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: cardiopulmonary abnormality? History: chest pain No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: nv History: nv Unremarkable cardiac and mediastinal silhouette. Elevated right hemidiaphragm, unchanged from previous, with mild overlying atelectasis.Filter device in the IVC.No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: ett History: ett Increased interstitial markings may be artifactual or edema.No substantial pleural effusions.Unremarkable mediastinal contours and cardiac silhouette.ET tube tip approximately 5 cm above the carina.A Dobbhoff tube terminates in the stomach.

Output: Mild interstitial opacities, edema versus artifact. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: swan, hypoxic respiratory failure, volume overload Interval improvement in pulmonary opacities. Stable bilateral pleural effusions.Unchanged left pigtail pleural drain, with no pneumothorax.Swan-Ganz catheter tip in right pulmonary artery, unchanged.

Output: Stable bilateral pleural effusions and improving pulmonary opacities consistent with edema. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old. Multiple skin staples. Moderate to large stool burden in right colon. Gaseous distention of colon seen beyond this level involving splenic flexure. Small air seen in mildly dilated small bowel, measuring up to 3.1 cm. Findings suggestive of ileus due to patient's recently postoperative state, but continued follow-up recommended to exclude a distal colonic obstruction.

Output: Moderate to large stool burden in right colon. Mild gaseous distention of colon seen beyond this level involving splenic flexure. Small air seen in small bowel. Findings most consistent with ileus due to patient's recently postoperative state, no evidence of bowel obstruction seen currently but continued follow-up recommended to exclude a distal colonic obstruction.


Instruction: Generate impression based on medical findings.

Input: Reason: pacer placement History: pacer placement Temporary pacemaker lead projected over the area of the right ventricle.ET tube tip approximately 3 cm above the carina.Pleural effusions, larger on the right with extensive loculation and underlying atelectasis.

Output: Pacemaker tip projected in the area of the right ventricle, directed towards the outflow tract.


Instruction: Generate impression based on medical findings.

Input: Previous groundglass opacities on an outside exam, complains of chronic cough, LUNGS AND PLEURA: There is interval clearing of the groundglass opacities present on the prior outside exams.Postsurgical changes are noted in the right midlung with evidence of mild pleural and parenchymal scarring.Stable right middle lobe nodular opacity (image 67, series 4).No evidence of interstitial fibrosis.There is significant peripheral air trapping noted in both lungs.No evidence of pleural effusion.MEDIASTINUM AND HILA: Substernal extension of the thyroid gland.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Interval clearing of the multiple groundglass opacities identified on the prior outside exams.2.Bilateral extensive areas of airtrapping compatible small airways disease.3.No evidence of interstitial fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: acute resp failure History: s/p trach Lines and tubes are unchanged. Diffuse pulmonary opacities, unchanged. Coronary increase in pleural effusions. Increased basilar opacities. Unchanged heart size. No pneumothorax.

Output: Stable diffuse pulmonary opacities most consistent with pulmonary edema. Increased basilar pleural-parenchymal opacities suggestive of increase in effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.SOB, pneumonia. The endotracheal tube cuff appears overinflated measuring 32 mm in transverse dimension (the approximate transverse dimension of the trachea at this level on a prior neck CT was 25 mm). ETT tip approximately 4 cm above the carina.Cardiomegaly.Extensive interstitial and airspace opacities in the dependent and lower lung fields compatible with aspiration, not significantly changed. Probable small to moderate pleural effusions.

Output: Extensive aspiration bronchiolitis, correlate for signs of pneumonia. The endotracheal tube cuff appears to be overinflated.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old. New catheter from the left arm extending to the SVC.Right jugular catheter unchanged.No significant cardiopulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Evaluate for pleural effusion History: dyspnea Severe cardiomegaly and/or pericardial effusion are present.No specific evidence of infection or edema.

Output: Severe cardiomegaly and/or pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: 95-year-old female with history of malnutrition, evaluate for infection Dense nodule projecting over the right atrium.Left basilar atelectasis and/or scarring.Tortuous thoracic aorta with age related calcification of aortic knob.Osseous degenerative changes.

Output: Dense nodule projecting over the right atrium, which appears well circumscribed and calcified. This can be confirmed with a PA/lateral chest radiograph.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: Intubated patient History: intubated patient, eval ET tube Patchy left base opacity suggestive of aspiration or localized edema.Mild to moderate cardiomegaly noted.ET tube tip 7 cm above the carina. An NG tube terminates in the stomach.

Output: Increasing left basilar opacity which may represent aspirated secretions or mucous plugging, or localized edema.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: eval edema History: CHF, SOB Stable marked cardiac enlargement with pulmonary vascular redistribution.Blunting of the the costophrenic angles compatible with small effusions and/or pleural thickening.Bullet fragment in the region of the aortic arch.No new focal areas of consolidation.

Output: No interval change with stable appearance of cardiomegaly and mild CHF.


Instruction: Generate impression based on medical findings.

Input: Newborn 25 week gestational age patient with respiratory distress. Endotracheal tube placement.VIEWS: Chest and abdomen AP (two views) 06/14/16, 1202 Endotracheal tube tip is at carina. Umbilical venous line has its tip high in right atrium. Umbilical arterial line tip is at T7/8. Right chest tube remains in place.Cardiothymic silhouette is normal in size. Hazy lung opacities are present bilaterally and decreased in the interval. No pneumothorax is present. Lung volumes are upper limits of normal.Mildly dilated bowel loops are seen in an organized pattern.

Output: Decrease in lung opacities. No pneumothorax. Mildly dilated bowel.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.S.O.B. question edema Cardiopulmonary support devices unchanged. Cardiomegaly. No focal pulmonary opacities or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: pna? Edema? History: chest pain Small lung volumes.Median sternotomy, heart size upper normal, with a tortuous aorta.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for infection, volume status. Patient with palpitations, known CHF History: palpitations, hypoxia Cardiomegaly with interstitial opacity compatible with edema and focal subsegmental atelectasis or scarring in the left midlung.No new findings.

Output: CHF with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 43 year-old female with malignant neoplasm of the ovary, on chemotherapy status post 3 cycles of weekly Taxol and carboplatin D1, please evaluate disease CHEST:LUNGS AND PLEURA: Stable micronodules identified bilaterally. No new nodules. No pleural effusion.MEDIASTINUM AND HILA: Referenced right paratracheal lymph node measures 10 x 0 .7 cm, previously measured 0.9 to 0.6 cm (image 30, 3). The Port-A-Cath at the junction of right atrium and SVC.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hypodense lesion in the right lobe of liver is best seen on the coronal plane (image 17 , 80220), measuring 1.1 by 1.2 cm, previously measured 1.6 x 1.1 cm.. The lesion is not well seen in the axial plane probably due to difference in timing of the contrast injection and location of the lesion.Referenced hypodense caudate lobe soft tissue lesion measures 3.2 x 1.6 cm (image 133), previously measured 4.1 x 3.2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypodensities in both kidneys are too small to be characterized.RETROPERITONEUM, LYMPH NODES: Multiple surgical clips are identified along bilateral para-aortic region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right lobe liver lesion is seen in the coronal plane.Interval reduction in size of caudate lobe hypodense lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: trach'd History: trach'd Line position stable. Improved aeration but little change in the degree of basilar opacities and effusions. No obvious pneumothorax.

Output: No significant change in pulmonary opacities and effusions. No change in line position.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: Mass/Infection History: ALL Left-sided PICC terminates at the cavoatrial junction. Clear lungs.

Output: Left-sided PICC terminates at the cavoatrial junction. Clear lungs.


Instruction: Generate impression based on medical findings.

Input: 5-year-old female with malignant rhabdoid tumor with neutropenia and fevers for 6 days. CHEST:LUNGS AND PLEURA: Interval development of multiple bilateral nodular opacities most prominent in the left lower lobe where the appearance is suggestive of patchy air space disease although a conglomerate of nodules cannot be excluded. Scattered additional nodular opacities are noted including a right lower lobe nodule which measures 4.9 mm (high-resolution axial image 116/184) and a left lingular nodule which measures 6 x 4 mm (high-resolution axial image 74/184). Inferior lingular atelectasis is also new. Please note that the study is suboptimal secondary to respiratory motion artifact.MEDIASTINUM AND HILA: The cardiac size is normal with no pericardial effusion. No pathologically enlarged mediastinal or hilar lymph nodes.CHEST WALL: No pathologically enlarged axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: An H-type portal vein is identified as a normal variant. The liver parenchyma is otherwise unremarkable. The gallbladder and bile ducts are unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is slightly prominent. The pancreatic parenchyma is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval development of multiple nodular opacities in both lungs. We recommend repeating the study in one month to assess for changes or resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Convulsion, ETT placement. Endotracheal tube has been retracted with tip now 3-cm above the level of the carina. Nasogastric tube looped in the stomach.Unchanged masslike opacity projecting over the left lower lobe/left heart border. Compressive atelectasis of the adjacent lung is noted.Thoracolumbar scoliosis.

Output: ETT 3-cm above carina. Masslike left lower lobe opacity; a rounded pneumonia is possible but unusual in the adult population. Other diagnostic considerations include neoplasm or cardiac aneurysm with adjacent atelectasis. In the absence of clinical signs of pneumonia, an enhanced thoracic CT would be advised. Follow-up to complete radiographic resolution is recommended. This was discussed with the ED resident who will pass recommendation along to the admitting neurology service.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: hx of CF, increased hemoptysis History: hemoptysis, pleuritic chest pain The right port is no longer accessed. There is evidence of prior embolization in the upper lobes. Gastrostomy balloon is partially visualized in the left upper abdomen.Predominantly upper zone bronchiectasis and fibrosis compatible with cystic fibrosis. No new consolidation or pleural effusion. Heart size remains normal. Architectural distortion of the hila unchanged.

Output: Extensive upper zone bronchiectasis and fibrosis compatible with cystic fibrosis. No evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old. Left jugular catheter tip in the area of the SVC with no pneumothorax or other complications.Mild blunting of the left costophrenic angle medially which may be due to a small effusion.No acute pulmonary abnormalities.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Needs Dobbhoff. Confirm placement. Low lung volumes. Multifocal atelectasis. Perihilar groundglass opacity on the left may reflect asymmetric edema, aspiration or infection. Dobbhoff tube tip just beyond the GE junction and may be advanced. Globular cardiomegaly, suspicious for pericardial effusion.Abnormal skeletal mineralization unchanged from the most recent previous study but new compared to remote exams. Vascular calcifications. Paucity of bowel gas in the upper abdomen, correlate for ascites or peritoneal dialysis.

Output: Dobbhoff tip just beyond the GE junction and may be advanced. Probable pulmonary edema/hypervolemia. Question of intraperitoneal fluid.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: s/p DC-PM implant --> r/o pneumothorax and evaluate lead positions History: as above Left-sided pacemaker is now noted with lead wires in the right atrial appendage and right ventricle.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: Interval placement of a left-sided pacemaker without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: hemothorax, hypoxia History: above Cardiomegaly, with worsening lower lung zone opacities consistent with edema, as well as basilar consolidation and pleural effusions.Left chest tube, minimal left apical pneumothorax.Right jugular catheter, tip in SVC.

Output: Gradually worsening edema like opacities as well as left lower lobe consolidation and pleural effusions left larger than right.


Instruction: Generate impression based on medical findings.

Input: Left upper lobe nodule. CHEST:LUNGS AND PLEURA: A left upper lobe mass is unchanged and measures approximately 14 x 14 mm on axial image 25/102. A left upper lobe nodule is also stable in size (axial image 23/102). MEDIASTINUM AND HILA: Left hilar mass shows interval development of enhancement (axial image 50/106) as do AP window lymph nodes which, in addition, appear to have increased in size. These findings could be secondary to infectious or inflammatory processes or tumor. However, the presence of a suspicious left upper lobe mass with progressive, enhancing adenopathy is suspicious for an indolent tumor with metastatic disease. PET or a tissue diagnosis is recommended.Cardiac size is normal with no pericardial effusion.CHEST WALL: Well corticated lucency within an upper thoracic vertebral body likely represents a Schmorl's node.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: Multiple nodules off the left adrenal gland are nonspecific and unchanged.KIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Severe aortic atherosclerotic disease with penetrating atherosclerotic ulcers.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted

Output: 1.Left upper lobe mass with progressive, enhancing lymphadenopathy suspicious for an indolent tumor with metastatic disease as above. PET or tissue diagnosis recommended.2.Stable nonspecific left adrenal nodules.3.Severe aortic atherosclerotic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Cough. Cardiomegaly again noted. Scattered basilar opacities suggestive of atelectasis not significantly changed. Calcified right lower paratracheal lymph node. No pneumothorax.

Output: Stable cardiomegaly without acute-appearing cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: evaluate for infection, fevers with productive cough, h/o mesothelioma History: as above Left Port-A-Cath with its tip in the SVC.Diffuse right pleural thickening compatible with diagnosis of mesothelioma.No focal areas of consolidation.Bilateral bronchial wall thickening with nodular interstitial opacities more pronounced in the right lung are suggestive of aspiration bronchiolitis

Output: 1. Extensive right pleural thickening compatible with known diagnosis of mesothelioma.2.Bilateral bronchial wall thickening and nodular interstitial opacities, more pronounced on the right, compatible with aspiration/ bronchiolitis.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Expressive aphasia. Ventriculoperitoneal shunt can be seen crossing of the anterior chest and entering the peritoneum, the visualized portion appears intact.Mild cardiomegaly.Right apical scarring.Vascular redistribution without overt edema.No focal opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: r/o pulmonary edema, infection History: SOB Left-sided ICD and LVAD unchanged.Stable cardiomediastinal silhouette. Lungs are clear.Blunting of the left costophrenic angle unchanged from prior exam.

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


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: 57 y/o F s/o en bloc resection of abdominal mass including diaphragm, chest tube placement, left s/p adjustment History: as above No significant change in moderate pneumoperitoneum. Stable left basilar opacity and position of chest tube.Stable appearance of single lumen chest port. Minimal left apical pneumothorax.

Output: Stable cardiopulmonary appearance. Stable moderate pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Cough and fever No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Mediastinal lymphoma, status post Hickman repositioning. Check position. Right IJ catheter has partially retracted with approximately 3 cm of redundant loop extending up into the proximal IJ. The tip has been retracted into the upper SVC.No acute focal pulmonary abnormalities. No pleural effusions or pneumothorax.Cardiac silhouette is within normal limits.

Output: No cardiopulmonary abnormalities. Right IJ catheter partially retracted with redundancy, see details provided


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Evaluate swan placement History: swan The distal aspect of the Swan-Ganz catheter now terminates in the main pulmonary artery. The portion of the catheter within the heart is difficult to visualize perhaps due to cardiac motion. No new focal lung consolidation. Moderate cardiomegaly again noted. No pneumothorax.

Output: Distal aspect of the Swan-Ganz catheter terminates in the main pulmonary artery. However, the portion of the catheter within the heart is difficult to visualize distinctly. Consider repeat chest radiograph coned-down to the mediastinum to better assess the catheter in this area.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: Metastatic ACC, has malignant pleural effusion, now with worsening DOE. History: as above Heart size is normal.Diffuse opacities consistent with effusions, atelectasis/consolidation, and metastatic disease without significant interval change.IVC filter in place. Right port with tip at the SVC/right junction.

Output: Bilateral effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 80 year old female with back pain and cough. No focal air space opacities. Bilateral nonspecific basilar opacities, more prominent on the left. No pleural effusion or pneumothorax. Mild cardiomegaly with pulmonary vascular redistribution.

Output: Cardiomegaly without specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.History of recent pericardial drainage, evaluate for pleural effusion. Bilateral shoulder arthroplasties noted.The cardiomediastinal silhouette is unchanged.No focal pulmonary opacity or pleural effusion. No pneumothorax. Mild biapical scarring noted. Calcified granulomas. Probable right venous catheter tip in the axillary vein.

Output: No pneumothorax or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 23 yearsGender: FemaleReason for Study: Reason: cough and upper respiratory illness History: cough Stable cardiomediastinal silhouette.Mild left basilar scarring.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Cardiomegaly Mild cardiomegaly without additional superimposed pulmonary abnormality

Output: Mild cardiomegaly


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Reason: r/o pna History: sob Enteric and endotracheal tubes have been removed. Shunt tubing partially visualized. Venous catheter tip in right atrium. Lungs hypoinflated. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia


Instruction: Generate impression based on medical findings.

Input: 64-year-old male with prostate cancer. Evaluate progress. CHEST:LUNGS AND PLEURA: Stable micronodules. No new nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A hypodense lesions in the right kidney are occult on this exam, possibly secondary to decreased volume of contrast used. Low density cyst noted in the right kidney 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: Prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: Scattered small lymph nodes are noted in the pelvis. Difficult to appreciate secondary to patient's large body habitus. For reference purposes, right internal obturator lymph node measures 1.8 x 0.9 cm (image 175; series 4). This is unchanged compared to prior.BOWEL, 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, 67 years old.Reason: Evaluate pulmonary edema, s/p lung transplant 2012 History: dyspnea, hypoxemia Stable cardiomegaly. Chronic right lower hemithorax pleuroparenchymal opacities are again noted. There has been interval improvement in interstitial opacities suggestive of edema. Persistent right pleural effusion. Loop recorder is noted.

Output: Interval improvement in interstitial edema with unchanged cardiomegaly and chronic right lower hemithorax pleuroparenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Female 50 years old Reason: Vp and Lp shunt , please assess connectivity /setting and status. History: headache, pain to chest near LP shunt, Please make sure the valves are visable for setting check..... SHUNT DEVICE: VP shunt tip is seen exiting extracranially via a right frontal parietal burr hole, courses through the soft tissues of the right neck and right anterior chest wall, enters the right hemiabdomen with its tip in the mid abdomen. There is no evidence of disruption or kinking of the radiopaque portions of the VP catheter.SKULL: Aforementioned VP shunt catheter, otherwise no significant abnormality.CERVICAL SPINE: Aforementioned VP shunt catheter, otherwise no significant abnormality.CHEST: Aforementioned VP shunt catheter, otherwise no significant abnormality.ABDOMEN: Aforementioned VP shunt catheter. The bowel gas pattern is unremarkable.

Output: Expected course of VP shunt catheter without discontinuity or kinking in the radiopaque portions.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: infection? History: leucocytosis Lungs hypoinflated though there is no focal opacity to suggest pneumonia.

Output: Lungs hypoinflated though there is no focal opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.ETT and Swan-Ganz catheter position. Swan-Ganz catheter from an IVC approach terminates at the right descending pulmonary artery, appearing slightly retracted from its former position.ETT tip 3 cm above the level of the carina. Enteric tube tip off the caudal margin of the film. A single right atrial lead is noted. ECMO cannula projects over the right atrium.Small lung volumes with diffuse groundglass opacities appearing slightly worse. Consolidation of the left lower lobe and consolidation/atelectasis within the left upper lobe is slightly worse.Superior mediastinal widening unchanged on the left, but with new SVC distention suggesting hypervolemia.

Output: ETT 3 cm above carina. SGC projects over the proximal right descending PA. Worsening atelectasis and consolidation in the left lung, correlate for signs of pneumonia. SVC distention with worsening groundglass opacities suggestive of hypervolemia/edema.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: Eval pneumonia vs effusion vs edema History: ADHF, shock, leukocytosis Left-sided ICD and right central venous catheter and change.Stable cardiac enlargement.Mild basilar scarring/discoid atelectasis.No new pulmonary opacities noted.

Output: Cardiomegaly unchanged without evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ETT placement History: see above Increased basilar opacities and effusions.Line position stable.No pneumothorax.Postendoscopy clips now seen in the projection of the gastric fundus.

Output: 1. Increasing pleural effusions and basilar opacities2. Endoscopy clips now seen in projection of gastric fundus


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: r/o pna History: fever Interval removal of right central catheter. Stable position of left port catheter.Reticular opacities in the left lower zone compatible with subsegmental atelectasis. Blunting of bilateral costophrenic angles from scarring or trace pleural effusions. No interval pneumothorax. Heart size is shifted to the left, likely related to mild dextroscoliosis.

Output: Persistent basilar subsegmental atelectasis. No pneumothorax following right central catheter removal.


Instruction: Generate impression based on medical findings.

Input: 31 year-old female with metastatic colorectal cancer 1 cm right lower lobe nodule CHEST:LUNGS AND PLEURA: 10 x 9 mm nodule in the right lower lobe as seen in image number 62, series number 4. No other nodules.MEDIASTINUM AND HILA: 13 x 11 mm ill-defined soft tissue density encasing the right lower lobe bronchus suspicious for primary bronchogenic carcinoma.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: Left kidney is hydronephrotic secondary to compression of left ureter by metastatic retroperitoneal adenopathy. Adenopathy measures 2.2 x 2.2 cm on image number 122, series number 3. RETROPERITONEUM, LYMPH NODES: Metastatic adenopathy mostly left para-aortic as described above.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Not visualized. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small pelvis opacified and. Therefore recurrent pelvic lesions cannot be entirely excluded. Adjacent to the right pelvic sidewall there is a 3 x 1.3 cm hypodense area which cannot be distinguished from the surrounding nonopacified bowel loops which can be recurrent tumor versus nonopacified bowel loops. Small amount of free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Soft tissue density around the right lower lobe bronchus suspicious for primary versus metastatic neoplasm. Right lower lobe pulmonary nodule.Left-sided para-aortic adenopathy causing left hydronephrosis.Distal small bowel loops are not well opacified. Recurrent or residual mass in the pelvis cannot be entirely excluded descried above.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Evaluate ET tube positioning. History: See above. Lines and tubes are unchanged. Leftward patient rotation. Left lower lobe opacification again noted. Unchanged cardiomegaly.

Output: Persistent left lower lobe retrocardiac opacity which may represent atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of Hodgkin's lymphoma. Completed chemotherapy on 8/2008. CHEST:LUNGS AND PLEURA: No significant change in basilar fibrosis with traction bronchiectasis and volume loss. Focal scarring unchanged.MEDIASTINUM AND HILA: Previously measured hilar lymph node adjacent to the main pulmonary artery unchanged, now with 13 x 6 mm (image 46 series 3), previously 13 x 5 mm. Coronary artery calcifications are present. Port-A-Cath tip in SVC. Surgical clips in the superior mediastinum.CHEST WALL: Sternotomy wires. Right chest port with distal tip in right atrium.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly is unchanged. Nonspecific punctate hypodense liver lesions are unchanged.SPLEEN: Mild splenomegaly is unchanged. No focal splenic lesions.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesions in both kidneys are stable and likely represent cysts.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node again measures 10 x 7 mm (image 128, series number 3), unchanged.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Reason: 74M with history of bladder cancer s/p cystectomy with neobladder, surviellance imaging History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval for bleeding into chest History: dyspnea Dobbhoff tube, ET tube, bilateral chest tubes, ECMO cannulae, left jugular venous catheter, unchanged.Persistent pneumothorax on the right, not significantly changed in size.Dense airspace opacity and volume loss in the right lung unchanged. Left-sided interstitial opacity also stable.

Output: Dense airspace opacity and volume loss in the right lung unchanged. Left-sided interstitial opacity also stable.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Interval change in R sided lung opacities History: Intubated No change in dense consolidation of the majority of the right lung with an upper lung zone cavity or cyst.Stable emphysematous left lung status post endobronchial valve placement and multiple wedge excisions.

Output: No change in dense consolidation of the majority of the right lung.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: R shoulder pain radiating to r chest. smoker History: above The heart is normal in size.Assessment of both hila is limited by body habitus.No abnormal focal lung opacities, considering limitations for detection of pulmonary nodules by plain radiographs.The pleural spaces and visualized bones are within normal limits.

Output: No abnormal radiographic findings, considering limitations for detection of noncalcified pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old. New ET tube with its tip in the right main bronchus. This has been corrected on subsequent radiographs.Bilateral pulmonary opacity compatible with pulmonary edema with left lower lobe atelectasis, slightly increased.

Output: Distal location of ET tube.


Instruction: Generate impression based on medical findings.

Input: Reason: et position History: et moved Interval adjustment of the ET tube with the tip now about 3 cm above the carina.Catheter tip in the SVC.Extensive bilateral airspace opacity suggestive of aspiration and infection, not significantly changed.

Output: Interval adjustment of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Status post mitral valve replacement. Interval removal of the ET tube.Sternotomy hardware, surgical drains, and Swan-Ganz catheter are unchanged.Cardiomegaly, unchanged.Lower lung volumes with bibasilar atelectasis.No pneumothorax.

Output: Lower lung volumes with bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of uterine cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Borderline enlarged left supraclavicular lymph node measures 12 x 10 minutes and image number 10, series number 4, not significantly changed.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific left para-take lymph node is unchanged measuring 10 x 7 mm image number 121, series number 4.New cystic well-defined lesion in the right pericaval region measuring 5.2 x 6.6 cm image number 115, series number 4. Given the lack of a solid component this more likely represents a lymphocele.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Interval hysterectomy and oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: Interval development of a right retroperitoneal cystic lesion likely representing a lymphocele.Interval hysterectomy and salpingo-oophorectomy.No other significant change from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old, hypoxic and short of breath. Evaluate for PE. PULMONARY ARTERIES: Limited exam secondary to extensive motion artifact. No large saddle embolus is seen. Nondiagnostic beyond the main pulmonary arteries.LUNGS AND PLEURA: Right apical and lingular groundglass opacity is nonspecific and may reflect atelectasis, infection or hemorrhage. No pleural fluid.MEDIASTINUM AND HILA: The cardiac size is normal. No evidence of RV strain. No pericardial effusion. No pathologically enlarged hilar or mediastinal lymph nodes. A small hiatal hernia is noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Nonspecific hypodense lesion within segment VIII of the liver (image 239, series 10).

Output: 1.Nondiagnostic PE study. No large saddle embolus is seen.2.Nonspecific groundglass opacities as above.


Instruction: Generate impression based on medical findings.

Input: 84 year-old female past medical history of GIST Status post RFA to liver. Evaluate for response. CHEST: LUNGS AND PLEURA: Granuloma right lower lobe. Bibasilar atelectasis unchanged.MEDIASTINUM AND HILA: Left thyroid nodule unchanged. Numerous small mediastinal lymph nodes are stable with the largest pretracheal lymph node measuring approximate 1.4 x 1.0 cm (image 31; series 10).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The elliptical hypoattenuating area described on the prior examination which was suspicious for recurrent tumor is much smaller on today's exam but still present (image 33; series 8066). It previously had a maximal thickness of approximately 2.5 cm and currently has a maximal thickness of approximately 1.4 cm. This lesion is amenable to repeat percutaneous thermal ablation. There is a new second lesion adjacent to the gallbladder fossa, inferiorly in the right lobe which measures 2.4 x 2.4 cm (image 95; series 10) and an equivocal third lesion measuring 1.0 x 1.2 cm (image 31; series 7) in the medial segment left lobe. Replaced right and left hepatic arteries are normal variants. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few hypoattenuating lesions likely cysts. Some areas of scarring along the upper pole of the right kidney. These are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes stomach. No evidence of local recurrence along the suture margin. Few tiny perigastric lymph nodes are stable.BONES, SOFT TISSUES: Anterior abdominal scar.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: Diverticulosis. No evidence of diverticulitis. Surgical clips. No free or loculated fluid.BONES, SOFT TISSUES: Anterior abdominal scar. Degenerative changes in the bones. No lytic or blastic disease.OTHER: No significant abnormality noted.

Output: Multiple liver lesions as noted above. Findings discussed with Dr. Van Ha at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: 40yoF hx mm s/p open lingula biopsy History: s/p open lingula biopsy Lines and tubes are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in diffuse prominent opacities, possibly related to lower lung volumes. Unchanged heart size. No significant pneumothorax.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Increase in diffuse prominent opacities, possibly related to lower lung volumes.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: s/p chest wall reconstruction History: - Right basilar opacity unchanged consistent with pleural effusion and atelectasis/consolidation .No new pulmonary opacities identified.Stable cardiomediastinal silhouette.No pneumothorax identified.

Output: No interval change in the right basilar opacity compatible with consolidation/atelectasis and effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Nonspecific mixed interstitial airspace opacities in all 4 quadrants and greater in both bases. Mild cardiomegaly and small layered effusions also suspected it difficult to confirm and semiupright positioning.

Output: Nonspecific mixed interstitial and airspace opacities, concerning for possible edema and CHF however infection is also be considered.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: evaluate for pneumonia History: evaluate for pneumonia No significant change in pleural effusions right larger than left with right basilar predominant consolidation with volume loss.

Output: No change in pulmonary opacities suggestive of right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: 65F with CHF s/p IABP exchange. History: IABP placement Left PICC line with its tip in the SVC.IABP marker in the mid descending aorta.IVC catheter has been removed.Decreased lung volumes stable cardiomediastinal silhouette.Elevation left hemidiaphragm with adjacent left basilar subsegmental atelectasis redemonstrated.No new pulmonary opacities noted.Surgical clips identified in the left axilla.

Output: IABP marker in the mid descending aorta. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: eval pna, new high leukocytosis History: as above Right basilar opacity and right pleural effusion gradually improving consistent with continued infection.Heart size normal.Right jugular catheter, tip in SVC.

Output: Right basilar opacity and right effusion improved but still consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: MaleReason for Study: Reason: evaluate status of PTX History: recent PTX on CXR, lost to follow-up, now back. SOB continues Right apical pneumothorax similar to the prior exam.Cardiomediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: Small right apical pneumothorax similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: eval lung fields History: s/p ASD repair 7 mm right apical pneumothorax with right-sided chest tubes.Unchanged widening the right paratracheal stripe.Right jugular venous access sheath unchanged.

Output: Small right apical pneumothorax and persistent right paratracheal hematoma, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Ischemic cardiomyopathy. Interval removal of Swan-Ganz catheter. Right jugular introducer unchanged in position. Mediastinal drains and right chest tube in place. Small pleural effusions with associated atelectasis about the same. Hazy opacity in the lung bases may reflect aspirated secretions and atelectasis, unchanged.

Output: Interval removal of Swan-Ganz catheter. No acute change in pulmonary opacities or pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Mild basilar and apical interstitial changes, presumed chronic in nature without superimposed acute focal airspace abnormality. Serial imaging over will be important to confirm. No definite effusions.The cardiac and mediastinal contours are significant for mild tortuosity of the aorta.

Output: Suspected mild chronic interstitial changes without definite superimposed acute abnormality however exam limited without serial imaging


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Leukocytosis. Opacity at the medial left lung base suspicious for infection particularly given the history. Right lung is clear. Heart size within normal limits. No pneumothorax

Output: Medial left lung base opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: 71-year-old female with CHF, COPD presents with altered mental status, SOB and hypercarbic respiratory failure. LUNGS AND PLEURA: Endotracheal tube tip terminates at the level of the right mainstem bronchus; service contacted. This may account for the asymmetric bilateral basilar consolidation/atelectasis. The appearance is nonspecific and although possibly due to aspiration, infection must be considered.MEDIASTINUM AND HILA: Heart size within normal limits. Small pericardial effusion.CHEST WALL: Bilateral axillary lymph nodes are not enlarged by CT criteria.UPPER ABDOMEN: NG tube tip terminates in the stomach. No other significant abnormalities noted, however evaluation of solid organ pathology is limited secondary to lack of intravenous contrast.

Output: 1. Bilateral basilar consolidation/atelectasis possibly due to aspiration or infection.2. Endotracheal tube tip at the level of the right mainstem bronchus; the clinical service was notified at the time of interpretation by the radiology resident on call via stat consult.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Preop MVR History: Preop MVR Mild to moderate cardiomegaly.Very mild redistribution of the pulmonary blood flow is present.No specific evidence of infection or edema.

Output: Cardiomegaly,


Instruction: Generate impression based on medical findings.

Input: 75-year-old male. Metastatic duodenal adenocarcinoma on chemotherapy. Assess disease status. CHEST:LUNGS AND PLEURA: Increasing basal airspace disease may be related to aspiration. Correlate clinically. Multiple calcified granulomas in both lungs are unchanged. Peripheral atelectasis noted in both lungs. Reference right hilar adenopathy (image 42; series 3) is roughly stable measuring 1.4 x 2.2 cm.MEDIASTINUM AND HILA: Coronary artery calcification. T7 vertebral body collapse. Exaggerated thoracic kyphosis..CHEST WALL: Right-sided venous access port is in the expected position..ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are unchanged. No suspicious lesions are identified. No evidence of intrahepatic ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality notedd. Unchanged splenic granulomas.PANCREAS: Changes secondary to Whipple surgery..ADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: Right simple cyst is unchanged..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: Compression of the L1 vertebral body is unchanged..OTHER: New nodule noted adjacent to the splenic flexure which measures 1.2 x 1.1 cm (image 94; series 3) may represent an early implant should be followed.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Vertebral compression deformity at the L5 segment..OTHER: Fat containing left inguinal hernia..

Output: Possible early implant along the splenic flexure as noted above. Basilar and peripheral airspace disease; query aspiration. Hilar adenopathy and vertebral compression fractures stable.


Instruction: Generate impression based on medical findings.

Input: Reason: CT-ICU patient History: Atherosclerotic heart disease of native coronary arteries with angina pectoris. ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Cardiomegaly with bilateral opacity compatible with edema, atelectasis and pleural effusions. Multiple mediastinal drains and ECMO cannulae in place.Aortic balloon catheter marker in the descending aorta at the level of T7.Surgical sponges projected over the upper mediastinum, presumably in an open sternotomy wound.

Output: Multiple postsurgical findings with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pneumothorax s/p pigtail catheter in IR for large R sided pneumothorax History: s/p pigtail catheter in IR for large R sided pneumothorax Right pigtail catheter projected over the right upper lobe with marked interval reduction in the right pneumothorax. Extensive subcutaneous emphysema, mainly on the right and increased mediastinal emphysema.

Output: Minimal residual right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: s/p CABG History: SOB Median sternotomy with cardiomegaly and small lung volumes.Improvement in left lower lobe consolidation.No significant pneumothorax.

Output: Improvement in left lower lobe atelectasis. No new findings.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Cough. Assess for pneumonia. Right chest port tip terminates at the cavoatrial junction. Mild cardiomegaly, unchanged. No pleural effusion or pneumothorax. Persistent streaky bibasilar opacities which appear most consistent with subsegmental atelectasis.

Output: Streaky bibasilar opacities most consistent with subsegmental atelectasis. No new opacity to suggest acute infection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: PNA v URI History: AMS Mild cardiomegaly is stable.No evidence of infection or edema.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old with diffuse large B-cell lymphoma.Reason: LIJ port-a-cath placement History: s/p port-a-cath placement Interval placement of left chest wall Port-A-Cath terminates in the right atrium.Interval increase of bilateral pleural effusions, greater on the left. Low lung volumes with superimposed parenchymal bibasilar opacities.

Output: Interval placement of left chest wall port catheter with tip in the right atrium. Bilateral pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p R thoracotomy, wedge resection History: s/p R thoracotomy, wedge resection Cardiomediastinal silhouette is unchanged.Low lung volumes. Left perihilar opacity is unchanged. Right upper lobe opacity has significantly increased. Right mid lung zone patchy opacities are unchanged. No pneumothorax or large effusion.Interval removal of right chest tube.

Output: Left perihilar and right mid lung zone patchy opacities are unchanged. Right upper lobe opacity has significantly increased, likely representing post-procedural hematoma.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: infiltrate History: cough, sore throat Cardiomediastinal silhouette is normal. No large pleural effusion or pneumothorax.Bibasilar scarring/atelectasis. Interstitial changes bilaterally are increased since exam compatible with interstitial fibrosis. No focal pulmonary opacities.

Output: Bilateral interstitial changes are increased since the prior exam compatible with Insterstitial fibrosis better characterized on subsequent CT. No specific evidence for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: ETT position, change to pneumomediastinum History: esophageal tear Support devices are unchanged in position. Stable small bilateral pleural effusions and associated atelectasis. Mild cardiomegaly. No pneumothorax or significant pneumomediastinum.

Output: No pneumothorax or significant pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: 31-year-old male with tachycardia; evaluate for pulmonary embolus PULMONARY VASCULATURE: No evidence of pulmonary embolus. Technically adequate study.LUNGS AND PLEURA: Diffuse highly unusual pulmonary parenchymal appearance is present characterized by diffuse microcystic / emphysematous changes at the extreme periphery of both lungs along all the pleural surfaces including the fissures. The etiology is uncertain although may be related to the patient's inflammatory bowel disease or treatment. Small left greater than right pleural effusions are noted.There is a nonspecific subcentimeter nodule in the right lower lobe (series 8, image 67).MEDIASTINUM: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Free intraperitoneal fluid and expected postoperative free air. Please see report from CT abdomen/pelvis from same date for further details.

Output: No pulmonary embolus. Highly unusual diffuse pulmonary parenchymal appearance as detailed above of uncertain etiology but may may be related to the patient's inflammatory bowel disease or therapy.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Assess aortic balloon pump placement. Heart failure. IABP marker projects near the top of the aortic arch.Lobe lungs remain low. Moderate pulmonary edema with nonspecific pleural fluid and consolidation in the left lung base.Left subclavian ICD unchanged. Previously described right rib fractures not well visualized.

Output: IABP marker near the top of the aortic arch. Worsening pulmonary edema; correlate for signs of pneumonia on the left.


Instruction: Generate impression based on medical findings.

Input: Fever Motion degrade sensitivity. Specifically the small nodular opacity observed in the right lung base is currently not well appreciated however detail could be obscured. No definite effusions. Cardiac and mediastinal contours are grossly within limits

Output: No definite new acute pulmonary abnormality however exam is limited, see details provided


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: FemaleReason for Study: Reason: r/o pna History: ams Stable cardiac mediastinal silhouette with tortuosity aorta.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: assess for infiltrate History: as above NG tube identified with its side-port within the stomach.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: Interval placement of an NG tube. No acute cardiopulmonary abnormality is identified.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with shortness of breath, please rule out pneumonia/edema. Mitral valve prosthesis, unchanged. Cardiomegaly is unchanged from prior examination. There is mild elevation of the right hemidiaphragm, unchanged. No pleural effusion or pneumothorax. No focal pulmonary opacities to suggest infection. Orphaned right epicardial leads, unchanged.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: Line placement History: above Moderate cardiomegaly with pleural effusions, left retrocardiac consolidation and the suggestion of very mild pulmonary edema.Left jugular catheter placed, tip in the right atrium.Right PICC, tip in right subclavian.

Output: Pulmonary opacities and pleural effusions suggestive of CHF/hypervolemia. Status post line placement.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: 69 yo f w/ mmp, including copd, chf, afib, ESRD p/w shortness of breath, low grade fevers, nausea/vomiting History: sob, n, v Small pleural effusions.No specific evidence of infection or edema.Heart size upper normal.

Output: Very small pleural effusions, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male with history of Hodgkin's lymphoma. Completed chemotherapy on 8/2008. CHEST:LUNGS AND PLEURA: Nodular opacities in the right apex, some of which are ground glass attenuation, are new compared with the prior examination. Bibasilar interstitial disease with bronchiectasis within both lung bases and in the lingula, unchanged. Postsurgical changes in the lung bases also unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are reidentified. Left hilar lymph node adjacent to the main pulmonary artery has slightly increased in size, now measuring 1.6 x 1 cm (image 45/223 on series 4). This previously measured 1.4 x 0.8 cm. Coronary artery calcifications are unchanged.CHEST WALL: Right-sided port-a-cath tip is in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly is unchanged. Nonspecific punctate hypodense liver lesions are unchanged.SPLEEN: Mild splenomegaly is unchanged. No focal splenic lesions.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesions in the left kidney are stable and likely represent cysts.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 1.0 by 0.7 cm (image number 129/223, series number 4) unchanged.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: 1. Multiple nodules in the right upper lobe, some of which have a groundglass appearance. These most likely represent postinflammatory or infectious changes but are nonspecific on this examination.2. Minimal interval increase in size of a mediastinal lymph node with stable size of reference lymph node in the left periaortic region. This increase in size of the mediastinal node may be due to reaction from the process in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: cough History: cough No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: ECMO Swan-Ganz catheter, left jugular catheter, ECMO cannulae and right chest tube unchanged.Cardiomegaly with nonspecific bilateral opacity compatible with edema, atelectasis and effusions.Increased right effusion, partly loculated.No pneumothorax.:

Output: CHF with increased right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: eval PNA History: productive cough, chest pain Right basilar consolidation. Low lung volumes makes detailed cardiopulmonary assessment difficult. No large pleural effusion or pneumothorax. Heart size at the upper limit of normal given low lung volumes. Atherosclerotic aorta. Multiple moderate spinal curvature.

Output: Right basilar consolidation certainly consistent with aspiration or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Pleural effusion Overall improving diffuse edema with more mild to moderate changes persistent, however consolidation and/or complete opacification left lower lobe persists with diminished volumes, likely atelectasis and/or infection. Marked cardiomegaly

Output: Mildly improving previously observed edema


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: 65 y/o male with lung CA, s/p bronchoscopy on 6/7; please eval for pneumothorax, pleural effusion History: SOB, decreased O2 sat Further increase in size of a left pleural effusion and left basilar consolidation.Small right pleural effusion.Increasing interstitial edema like opacities right mid to lower lung zone.

Output: Large left pleural effusion and worsening left basilar consolidation. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: evaluate for tube placement, infection History: unresponsive, intubated Chronic appearing basilar interstitial opacities versus aspirated secretions.Mild cardiomegaly.ET tube tip approximately 1 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Low ET tube, subsequently repositioned. Basilar opacities could be chronic versus aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: Evidence of pneumonia History: Shortness of breath There is almost complete opacification of the right hemithorax with volume loss and extensive consolidation/mass, post radiation changes, and pleural thickening consistent with known neoplasia.Small pulmonary nodules in left lung are compatible with metastatic disease.No focal areas of consolidation within the left lung to indicate acute infection.No left pleural effusion.

Output: Considerable opacification of the right hemithorax representing known tumor, post radiation changes, and pleural thickening/effusion.No evidence of acute infection involving the left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: r/o infiltrate, effusion History: chest pain Improvement in pulmonary edema and cardiomegaly. Currently there is mild cardiomegaly. Probable small right subpulmonic effusion. Central venous catheter terminating at the cavoatrial junction. No pneumothorax. No acute bony abnormality.

Output: Small right subpulmonic pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Dysarthria question pneumonia. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Evaluate chest pain. Nausea and vomiting. Dobbhoff tube tip off the caudal margin of the film.Low lung volumes.Hazy opacity in the left midlung unchanged. Subsegmental atelectasis in the lingula.No pneumothorax or visible pneumomediastinum.

Output: Persistent opacity in the left lung may be due to recurrent aspiration or persistent infection. No pneumothorax or visible pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Check IABP marker IABP marker projects into the aortic arch unchanged. Left PICC line extends into the mid SVC similar position.Improved overall aeration with mildly decreased lung volume on the left with atelectasis and elevated hemidiaphragm. Basilar atelectasis without definite additional new superimposed focal airspace abnormalities

Output: IABP marker unchanged


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Stable micronodules. Reference right middle lobe nodule is stable in size, measuring 4 mm number 48, series number 33. Stable left upper lobe nodule. (Image number 40, series number 33). New paragraph. Stable right lower lobe index nodule.MEDIASTINUM AND HILA: Reference right hilar node measures 14 by 11-mm image number 50, series number 21, slight and smaller compared to previous study. Left infrahilar node measures 24 by 22-mm image number 60, series number 21, slightly decreased in size on image number 60/series number 21.. No new nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference lesion in segments 8, series number 21, image number 98, measures 16 x 20 mm, smaller compared to previous study. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic tail mass measures 21 x 21 mm image number 113, series number 21, not significantly changed.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is normal. Left kidney has been resected.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incisional hernia left posterior lateral wall containing loops of bowel, 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: No significant abnormality notedOTHER: No significant abnormality noted

Output: No new sites of disease. Stable or minimal decrease in the size of the index lesions.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: chest pain History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 59-year-old female with increased oxygen requirement. Evaluate suspected pneumonia. Right chest tube in the right lower lobe unchanged. Tracheostomy tube tip 5 cm above the carina. Enteric tube tip in the region of study. Left subclavian catheter tip in the proximal SVC.Bilateral multifocal patchy and confluent airspace opacities, left greater than right, corresponding to recent CT study and grossly unchanged. Small to moderate left sided pleural effusion. No pneumothorax.

Output: Bilateral multifocal airspace opacities suspicious for multifocal infection.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Abdominal pain and poor appetite; opiate abuse Stable bibasilar atelectasis. Vena cava filter. No bowel obstruction or free air.

Output: Stable bibasilar atelectasis. Vena cava filter. No bowel obstruction or free air.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: chest xray as preop workup History: SOB Mild cardiomegaly.Asymmetrically prominent right suprahilar vasculature; lymphadenopathy or a parenchymal lung abnormality is considered less likely.Mild basilar atelectasis or scarring.Mild scoliosis and degenerative changes of the thoracic spine.No evidence of CHF.

Output: Prominent right hilum at least part of which reflects vasculature. If the referring clinical service can obtain and submit remote outside prior studies, an addendum to this report can be provided. If unavailable, recommend short-term PA and lateral chest radiograph follow-up in 3-4 months.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: Evaluate ETT placement History: hypercarbic respiratory failure ETT 5 cm above the carina. Left internal jugular catheter tip in the SVC. Enteric tube tip projects beyond the field-of-view.Persistent cardiomegaly with signs of pulmonary hypertension.Low lung volumes and bibasilar subsegmental atelectasis/consolidation.No pneumothorax.

Output: Stable support devices as described above. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: respiratory distress, hx of chf History: respiratory distress, hypoxia Severe cardiomegaly with retrocardiac atelectasis and/or consolidation.Mild basilar edema.No large pleural effusion. No pneumothorax.

Output: Severe cardiomegaly with retrocardiac atelectasis and/or consolidation and mild basilar edema.


Instruction: Generate impression based on medical findings.

Input: 88-year-old female with history of ureteral cancer. Evaluate for metastatic disease. Cardiomediastinal silhouette is within normal limits with moderate aorta atherosclerotic disease. Mild tortuosity accentuated by scoliosis.No acute focal airway or airspace abnormality other than mild basilar scarring. Specifically no discrete nodules or masses are identified. No effusions.

Output: Mild scarring without acute change or new abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: 76F w/ EC fistula, verify PICC placement History: PICC line Unremarkable cardiomediastinal silhouette.PICC line seen at junction of superior vena cava and right atrium.Upper lobe opacity suggesting infection. Follow-up recommended.

Output: New right upper lobe opacity suggesting infection. Follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with history of bladder cancer. Status post cystectomy with ileal conduit CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Not enlarged, small mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Surgical clips in the gallbladder fossa, which may be secondary to cholecystectomy. Calcification in the gallbladder fossa represent residual stone in the cystic duct stump or calcified adenopathy. This is unchanged from previous study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephrectomy. No evidence of left hydronephrosis.RETROPERITONEUM, LYMPH NODES: Reference porta hepatis lymph nodes stable measuring 17 x 14 mm image number 84, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy. Ileal conduit is seen in the left lower quadrant.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Herniating bowel loops into the left lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: r/o acute process History: fever, ams Interval removal of endotracheal and enteric tubes.Stable cardiomediastinal silhouette.No new focal airspace opacities.No significant pleural effusions or pneumothorax.

Output: Interval extubation and removal of enteric tube. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Chest tube positioning. Dissection of aorta (type A). Tubes and lines unchanged in position. Mediastinal widening unchanged. Mild pulmonary edema. Bronchial wall thickening left upper lobe could indicate aspiration. Air filled tract in the lateral aspect of the liver with peripheral calcification relate with recent surgical history. Extrapleural fat deposition bilaterally.

Output: No chest tube is identified. Unchanged mediastinal widening. Air filled tract through the lateral aspect of the liver.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Cough and tachycardia evaluate for pneumonia. Chronic scarring in the right middle lobe and lingulaNo focal airspace opacities to suggest pneumonia. Patchy subsegmental atelectasis in the left lower lobe.Normal heart size. Chronic blunting of the left costophrenic angle.

Output: Patchy subsegmental atelectasis but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Left-sided chest pain. Normal heart size. No evidence of mediastinal widening. Low lung volumes. No pneumothorax. Vascular redistribution, but no specific signs of pulmonary edema. Bronchial wall thickening and reticulation in the lower lung fields with subtle focal airspace opacity in the left lower lobe. Faint calcification left neck could be in the carotid vasculature or thyroid gland and may be correlated with ultrasound if required.

Output: Basal opacity suspicious for bronchitis or aspiration with signs of infection on the left. Low lung volumes. Vascular redistribution suggests hypervolemia. Faint calcifications in the left neck may be in the carotid vasculature or thyroid gland and may be further localized with ultrasound if required.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.History of urothelial carcinoma status post cystectomy. Evaluate for metastatic disease. Normal cardiomediastinal silhouette. Low lung volumes with associated basilar subsegmental atelectasis and posterior basilar scarring as seen on recent CT abdomen and pelvis. No evidence of metastatic disease in the chest. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality or evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Pacemaker implantation 8/18/2016. Presence of pneumothorax, location of pacemaker leads. Interval removal of right jugular introducer, pericardial drain and left chest tube.Left subclavian dual-chamber pacemaker has been placed with leads in the projection of the right atrium and right ventricle.No pneumothorax.Decreased volume of pleural fluid on the left with near complete reexpansion of the lung at the base. Mild left basal paramediastinal atelectasis. Prosthesis in the aortic position. Sternotomy hardware similar in alignment.

Output: No pneumothorax; leads in appropriate position in the projection of the right atrium and right ventricle.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on excision. Cough Mild scarring without superimposed acute cardiopulmonary abnormality.Venous stenting overlies left axilla

Output: Minimal stable appearing scarring


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with fungal sinusitis (Fusarium). Evaluate for lung disease. LUNGS AND PLEURA: Few scattered nonspecific micronodules. Lungs are otherwise unremarkable.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Left subclavian central venous catheter terminates in the distal left subclavian vein. Bilateral axillary lymphadenopathy, similar to prior. Reference left axillary lymph node (series 2 image 16) measures 20 x 14 mm, unchanged.Left pectoralis major lipoma, unchanged.UPPER ABDOMEN: No significant abnormality noted.

Output: No cardiopulmonary abnormalities, prior right basilar opacity resolved. Bilateral axillary lymphadenopathy, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: see above Unremarkable cardiac and mediastinal silhouette. Severe mainly upper zone bullous emphysema.Focal scar like opacity in the left mid lung, partially obscured by overlying artifact. This could be better evaluated with erect PA and lateral radiographs when feasible.Port catheter with its tip in the SVC.Focal bulge in the right hemidiaphragm, possibly a Bochdalek hernia.

Output: 1. No sign of pneumonia.2. Focal nodular scarlike opacity in the left mid lung which could be better evaluated on erect PA and lateral radiographs.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male. Rectal cancer. Evaluate disease status. CHEST:LUNGS AND PLEURA: Bilateral emphysema unchanged. The reference left upper lobe lesion measures 17 by 17 mm on image number 51/122, series number 4. The reference right lower lobe lesion measures 21 x 15 mm on image number 88, series number 3. No new nodules. Other multiple metastatic lung nodules are unchanged.MEDIASTINUM AND HILA: Subcarinal adenopathy is grossly unchanged measuring 3.2 x 2.3 cm in image number 55, series number 3. CHEST WALL: Left chest port catheter with tip in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ileostomy is unchanged since the prior examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Thickwalled bladder. Pelvic sidewall mass possibly invades the right wall of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right pelvic sidewall implant is enlarged now measuring 4.9 x 3.2 cm in image number 183, series number 3. Left ischiorectal fossa mass measures 2.9 x 3.8 cm on image number 184, series number 3.

Output: Multiple bilateral lung masses are unchanged. Subcarinal adenopathy is unchanged.Right pelvic mass is increased in size. Soft tissue mass in the left ischiorectal fossa is increased in size.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Neutropenic fever. Minimal right pleural effusion. No pneumothorax or focal pulmonary opacity. Central venous catheter tip in the SVC. The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extra cardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

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


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant History: s/p lung transplant Small lung volumes with diffuse opacity compatible with edema, slightly improved.Chest tubes in place with no significant pneumothorax.Displaced fractures of the right and left third ribs related to recent surgery.No new findings.

Output: Resolving pulmonary opacity compatible with edema.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: assess for pleural effusion, has history History: history of lung cancer and pleural effusion drained 1 week ago on the R. QUestion of pneumothorax of R lung at OSH image report Right Port-A-Cath with the tip in the SVC.Large right pleural effusion increased from the prior exam.Stable cardiomediastinal silhouette.The left lung is clear.No evidence of a pneumothorax.

Output: Large right pleural effusion increased in size from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: pneumonia/organizing pneumonia? History: shortness of breath Normal cardiac and mediastinal contours.No pleural or parenchymal abnormalities.No focal opacities.

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


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated, assess ETT placement ET tube tip approximately 5 cm above the carina.Catheters, feeding tube and pleural drain unchanged.Subcutaneous emphysema on the right but no significant pneumothorax.Basilar consolidation and atelectasis, greater on the left, also unchanged.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: 91 yo F w/ AMS, r/o infection History: see above Unremarkable cardiac and mediastinal silhouette. Large calcified hilar lymph nodes compatible with previous infection.Moderate bilateral pleural effusions but no pneumothorax.Surgical drain in the right anterior chest wall. Well-defined left perihilar 9 mm nodule, probably represents an end on vessel or calcified granuloma and could be confirmed on subsequent chest radiographs.

Output: Postoperative pleural effusions. No evidence of pneumonia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Status post bronchoscopy ETT terminates 4 cm above the carina. NG extends beyond the inferior edge of the image.Cardiopulmonary appearance remains significant for a moderate left pleural effusion with underlying left lower lung opacities most likely represent compression atelectasis given volume loss.The cardiac and mediastinal contours are within limits.Right jugular single port unchanged

Output: ETT well-positioned


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.IABP and Swan placement. Right jugular Swan-Ganz catheter tip projects over the proximal right descending pulmonary artery. IABP marker 4.5 seen below the top of the aortic arch. Left subclavian ICD unchanged.Cardiomegaly and enlargement of the central pulmonary vasculature unchanged. Retrocardiac atelectasis.Small pleural effusions. Dependent atelectasis. No pneumothorax.

Output: Right jugular Swan-Ganz catheter tip has been advanced, now at the proximal right descending pulmonary artery level. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with shortness of breath, Afib with RVR, known right hilar mass. Evaluate for interval increase in effusion. Increasing right-sided pleural effusion with adjacent atelectasis/consolidation. Known right hilar mass and right upper lobe opacity are better evaluated on recent CT. Subsegmental atelectasis/scarring in the left lung base. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Slight increase in moderate right pleural effusion with adjacent atelectasis/consolidation. Known right hilar mass and right upper lobe opacity are better evaluated on recent CT.


Instruction: Generate impression based on medical findings.

Input: Painful swallowing and cough Mild COPD changes with suspected small pleural plaques involving both bases with scarring, greater on the right. No additional superimposed cardiopulmonary acute abnormality.Midline sternotomy

Output: Old scarring and COPD without evidence of interval new cardiopulmonary acute abnormality


Instruction: Generate impression based on medical findings.

Input: Reason: assess for pneumonia History: cough, wheeze, COPD The exam is markedly limited by morbid obesity.Grossly normal cardiac and mediastinal silhouette.No significant pulmonary or pleural abnormalities.

Output: Limited examination with no gross abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Altered mental status and weakness. Left-sided ICD in place.Cardiomegaly, unchanged. Stable cardiomediastinal silhouette.Probable small pleural effusions and bibasilar subsegmental atelectasis, similar to prior. No specific evidence of infection or interstitial edema.

Output: Small pleural effusions, without evidence of infection or interstitial edema.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: intubated patient History: intubated patient. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Linear densities are seen in the left lung base. The ET tube and NG tube are stable in position.

Output: Bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 65-year-old male with history of melanoma CHEST:LUNGS AND PLEURA: Subcentimeter nodule on image number 14, series number 5 in the right upper lobe is unchanged.MEDIASTINUM AND HILA: Descending aorta is ectatic measuring up to 4.3 cm, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic calcified granulomata are unchanged.SPLEEN: Calcified splenic granulomas are unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts are unchanged. There is a new 1.6 x 1 cm hypodense, ill-defined lesion in the upper pole of the left kidney, best seen on image number 107, series number 3. The etiology of this lesion is not certain.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: Right-sided inguinal hernia containing nonobstructed bowel segments is unchanged.

Output: New, small ill-defined hypodense lesion in the upper pole of the left kidney. This lesion cannot be characterized with this single phase CT. Follow-up CT or MR imaging in 6 months is recommended for further evaluation of this lesion.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: tachypnea History: tachypnea Increasing left mid and lower lung zone patchy opacities suggestive of infection or aspiration.Left chest tube unchanged with no pneumothorax.Esophageal stent traversed by Dobbhoff tube unchanged in position.

Output: Increasing left mid to lower lung zone patchy opacities suggestive of infection or aspiration. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: primary tumor? History: brain tumor? Right midlung scarring or subsegmental atelectasis, with nonspecific bronchial wall thickening.No specific evidence of tumor.Unremarkable mediastinal contours and cardiac silhouette.

Output: Mild bronchial wall thickening, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonitis, infection History: recent episodes of choking on food Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Heart failure, prior to cardiac transplant 3-lead left chest wall ICD with leads unchanged.Cardiac enlargement improved from the prior exam.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: Cardiomegaly without acute abnormality. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: evaluate for left sided ICD Cardiac leads terminate in expected location of the right atrial appendage and right ventricle. The study is limited by patient body habitus, there is no large pneumothorax. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: ICD leads, as above. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with a history of transitional cell carcinoma post chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver are unchanged. Cholelithiasis without biliary dilatation is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Both kidneys are enlarged with numerous cysts of various size and density. Lack of IV contrast limits optimal evaluation of these lesions. Punctate stone in the lower pole of the right kidney is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy. Neobladder is unremarkable.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Limited study to of IV contrast. No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: r/o pneumothorax History: chest pain Rib fractures on the right (9, 10, and 11). Minimal basilar atelectasis. No evidence of pneumothorax.

Output: Rib fractures on the right but no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.COPD on oxygen acutely short of breath, anxious and wheezing. New opacity at the right base adjacent to emphysema. Basal scarring, emphysema and minimal pleural fluid bilaterally.

Output: Right lower lobe opacity nonspecific and may reflect acute aspiration with superimposed edema. Pneumonia is not excluded.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection or effusion History: SOB Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: chest tube placement History: s/p right upper lobectomy Right chest tube in place following right upper lobectomy, with no pneumothorax or other complication.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval lung fields History: intubated, pulmonary edema Lines and tubes are unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Diffuse pulmonary opacities. Small pleural effusions again noted. Unchanged cardiomegaly.

Output: Congestive heart failure, unchanged.