Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.History of shortness of breath, effusions Left chest tube with tip in the left apex unchanged. Right chest port unchanged. Esophageal stent and right upper quadrant drainage catheter again noted.Cardiac silhouette is unchanged in size.Left basilar consolidation with small left pleural effusion not significantly changed. Nonspecific patchy airspace opacities appear increased. No pneumothorax.

Output: Increased nonspecific patchy airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: evaluate for aspiration History: elevated white count Streaky retrocardiac opacity likely atelectasis, but no other specific evidence of pneumonia.Small lung volumes.An NG tube terminates in the stomach.Left PICC, tip at right atrial level.ET tube tip approximately 2 cm above the carina.

Output: Nonspecific retrocardiac opacity could be from aspirated secretions or mucous plugging. No further evidence of pneumonia, however.


Instruction: Generate impression based on medical findings.

Input: Female 77 years old Reason: Acute dyspnea, increased 02 requirement s/p thoracentesis earlier today Right internal jugular central venous catheter tip terminates at the cavoatrial junction. There is a small stable right pleural effusion, and left pleural effusion which has decreased in size, with persistent underlying interstitial opacities compatible with pulmonary edema. Unchanged cardiomegaly. Bilateral nephrostomy tubes are in place. There are bilateral nephrostomy tubes in place.

Output: Decreased left and unchanged right pleural effusions with persistent underlying pulmonary edema similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: esophageal perforation, mediastinitis History: hx of multiple esophageal surgeries. complaining of dysphagia Distal esophageal stent, all above the diaphragm level.Large lung volumes consistent with COPD.No pneumothorax or pneumomediastinum visible.

Output: Distal esophageal stent. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease, prekidney transplant No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Colon cancer. Check for metastases. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Previously mentioned left para-aortic lymph node is unchanged still measuring 14 x 10 mm on image number 118/212. Multiple other non-enlarged retroperitoneal lymph nodes are again noted, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is significantly enlarged.BLADDER: No significant abnormality notedLYMPH NODES: unremarkableBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Unchanged retroperitoneal lymph nodes. Enlarged prostate gland.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: abdominal distension, no N/V/C/D, etio? History: see above Multiple distended loops of small bowel and colon, compatible with generalized ileus versus partial small bowel obstruction. Pulmonary nodularity seen on prior CT not well detected on current examination. There is no evidence of intraperitoneal free air. Bibasilar atelectasis and small left pleural effusion.

Output: Generalized ileus versus partial small bowel obstruction. No evidence of intraperitoneal free air.


Instruction: Generate impression based on medical findings.

Input: Age: 97 yearsGender: FemaleReason for Study: Reason: r/o pna, edema, effusion History: altered mental status Is mild cardiac enlargement with atherosclerotic changes of the aorta.Right midlung cyst noted.No focal areas of consolidation.Evidence of bronchial wall thickening.No large pleural effusions.

Output: Right midlung cyst. No specific evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: pna? History: syncope Limited assessment of the mediastinum secondary to thoracolumbar scoliosis.Bilateral basilar bandlike opacities may represent subsegmental atelectasis, although assessment for bronchopneumonia is limited.No signs of pleural effusion or pneumothorax, considering the limitations of a single AP projection.

Output: Limited assessment for bronchopneumonia. Bilateral basilar bandlike opacities may represent subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: Evaluate for pleural effusion, atelectasis Left central venous line tip in the right atrium. Hazy opacity on the right consistent with a layered out pleural effusion and underlying atelectasis. Probable small left pleural effusion. Surgical clips overlie the upper abdomen. Right upper quadrant drains in place.

Output: Right pleural effusion and underlying atelectasis without significant change. Probable small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Right facial droop and slurred speech. Normal heart size. No mediastinal widening. Mild atherosclerotic calcification of the thoracic aorta at the level of the arch.No visible pleural fluid or pneumothorax. No focal airspace opacities.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Altered mental status and weakness. Low normal lung volumes, unchanged. Mild bronchial wall thickening. No visible pleural fluid, pneumothorax or focal airspace opacity.Cardiomediastinal appearance similar to the film of 2/24/2011, differences between the current and last exam likely due to rotation.

Output: Mild central bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: Female, 99 years old.Status post fall with weakness. Concern for infection or dehydration. Left subclavian single lead pacemaker is unchanged.The cardiomediastinal silhouette is unremarkable. Low lung volumes with slight increase in basilar predominant bronchial wall thickening and scarring. No pleural effusion, pneumothorax, or specific evidence of infection.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: central line History: above Right IJ central venous catheter with tip overlying the cavoatrial junction.Cardiac silhouette appears borderline enlarged.There is mild perihilar vascular congestion without frank edema. No focal consolidation, sizable effusion or pneumothorax. Of note, right lateral costophrenic angle is not entirely included on the examination. No pneumothorax.

Output: Right IJ central venous catheter in place with tip overlying the cavoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: eval for pneumonia History: fever Cardiomegaly. No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: fever likely 2/2 cholangitis, but assess for possible pneumonia History: fever No focal opacity to suggest pneumonia. Minimal streaky bibasilar subsegmental atelectasis.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: assess swan placement History: swan, IABP Median sternotomy, with mild cardiomegaly.Unchanged right basilar opacities with a right pleural effusion.Right jugular Swan-Ganz catheter now directed towards the left descending pulmonary artery or double back into the right ventricular outflow tract.Right subclavian IABP unchanged in position.Left subclavian ICD, leads unchanged in position.

Output: Unchanged pulmonary opacities and pleural effusion. Swan-Ganz catheter now directed towards the left descending pulmonary artery or doubled back in the right ventricular outflow tract.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: evaluate for effusion or opacity History: shortness of breath, afib w RVR, cough Slight increase in left basilar opacity. Question small left pleural effusion. No pneumothorax. Mild cardiomegaly, as before. Aortic atherosclerosis, unchanged.

Output: Slight increase in left basilar opacity which may represent atelectasis and/or consolidated lung. Question small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with Ewing's sarcoma with osseous metastases. Now with shortness of breath.IMAGE ACQUISITION:After administration of 100 mL of intravenous contrast material (Omnipaque 350), the chest was scanned from the base of the neck to the upper abdomen. LUNGS AND PLEURA: Post surgical findings in the left lung base are again seen, and associated with elevation of the left hemidiaphragm.Several nodular opacities in the left lung base are new since the prior exam. The largest nodule measures 9 x 9 mm (image 60; series 5). Several smaller adjacent nodules measure 4 mm or less (images 64, 62, and 57; series 5).A 5-mm ground glass nodule in the right middle lobe is also new since the previous exam.No pleural effusions are noted.MEDIASTINUM AND HILA: No significant mediastinal, hilar, or axillary lymphadenopathy is evident. The cardiac size is within normal limits. No pericardial effusion is seen.CHEST WALL: Postsurgical findings in the left eighth, ninth, and tenth posterior ribs are again seen. Multiple lytic lesions are seen throughout the sternum, thoracic vertebra, ribs, and right humeral head. These lesions are new since the previous exam.A right subclavian catheter tip is in the SVC.UPPER ABDOMEN:Limited views of the liver, spleen, adrenal glands, kidneys, pancreas, and bowel are within normal limits.

Output: Disease progression with multiple osseous metastases in the thorax and probable lung metastases.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for abnormal lung sounds. History: abnormal lung sounds. Normal heart size with evidence of previous median sternotomy and a retained ICD coil in the SVC.Calcified lymph nodes in the left hilum compatible with previous infection.No significant pulmonary abnormalities and no change.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pulmonary edema? History: eval for cause of dyspnea Cardiomegaly with basilar subsegmental atelectasis or scarring, unchanged.No specific evidence of infection or edema.

Output: Cardiomegaly with chronic appearing basilar opacities, but no reliable evidence of edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old. Reason: eval for PNA History: cough and SOB for a couple weeks, getting worse. Cardiomediastinal silhouette is within normal limits.No focal opacity, pneumothorax, or significant pleural effusion.Low lung volumes.

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


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: pneumonia History: fever No significant cardiopulmonary abnormality.Left PICC, tip in subclavian.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Daily CXR History: S/p LVAD and RVAD Interval extubation. Remaining lines are stable in position.No change in basilar opacities. No pneumothorax.

Output: No change in basilar opacities. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Biopsy of anterior mediastinal mass No cardiopulmonary acute abnormality. Specifically no postprocedural complication. Mild basilar interstitial change, likely chronic

Output: No acute postprocedural complication


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Eval pleural effusion History: SOB, heart failure No change in large right pleural effusion. Stable cardiomegaly with pulmonary edema.

Output: No change in large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: Pleural effusion History: Pleural effusion Small left effusion and patchy patchy and left basilar opacity again noted. Mild right basilar subsegmental atelectasis, unchanged. Normal heart size. No definite pneumothorax.

Output: No substantial difference compared to last study.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: check pulmonary status History: check pulmonary status Tracheostomy identified with its tip approximately 6 cm above the carina.NG tube with its side port at the GE junction.Right IJ venous catheter with its tip in the SVC.Decreased lung volumes with mild cardiac enlargement.Basilar opacities are compatible with atelectasis.

Output: Bilateral basilar opacities compatible with atelectasis and may be secondary to aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: fatigue, long term smoking history; evaluate for malignancy. History: fatigue, long term smoking history; evaluate for malignancy. Surgical clips project over the left axilla left hemithorax. Bibasilar predominant interstitial opacities consistent with sequela of smoking and or interstitial lung disease. This could be confirmed with serial imaging. Pleural thickening most conspicuous at the apices. No focal pulmonary opacity suggestive of pneumonia or malignancy. No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary disease. No evidence of malignancy. Interstitial lung changes appear chronic although prior radiographs are not available.


Instruction: Generate impression based on medical findings.

Input: SICU patient intubated. ETT tip 5 cm above the level of the carina. Right jugular catheter tip at the SVC level. Enteric tube sidehole beyond the GE junction, the tip is beyond the caudal margin of the radiograph. Tubing projects over the midline upper abdomen, incompletely visualized.Moderate pleural fluid collections about the same. Retrocardiac opacity on the left consistent with sublobar atelectasis. Significant atelectasis of the dependent right lung unchanged. No convincing evidence of pulmonary edema. No pneumothorax.

Output: No acute change in cardiopulmonary appearance with pleural fluid and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: pre-op TECAB History: NA Cardiac silhouette is at the upper limits of normal in size. Coronary artery calcifications. Calcified aortic arch.No focal consolidation, sizable effusion or pneumothorax. Question bulla overlying the heart on the lateral view only.Widening of the bilateral lower paraspinal lines likely postsurgical in nature in the setting of posterior thoracolumbar fusion.

Output: No radiographic evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with thymoma CHEST:LUNGS AND PLEURA: Large centrally necrotic mass with peripheral irregular enhancement replacing the left lower lobe measures 12 0.4 x 8 .7-cm in image number 48, series number 3. Small amount of air trapped in this centrally necrotic mass.Separate pleural-based mass in the left lower lobe measures 6.1 x 2.6 cm image number 73, series number 3.Right lower lobe parenchymal mass measuring 3.4 x 3.1 cm image number 67, series number 3.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. Index precarinal node measures 13 x 9 mm image number 33, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 9-mm heterogeneous lesion on image number 103, series number 3 in the upper pole of the right kidney. This lesion cannot be optimally characterized the to small size. Due to presence of enhancement within the lesion follow-up imaging is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Large centrally necrotic left lower lobe mass replacing most of the left lower lobe. Small amount of air trapped in the necrotic mass. Secondary infection cannot be excluded. Mediastinal adenopathy.Separate pleural-based enhancing mass in the left lower lobe.Right lower lobe metastatic lesion.Follow-up imaging is recommended for heterogeneous subcentimeter focal lesion in the upper pole of the right kidney.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for interval change History: intubated Lower lobe consolidation and left pleural effusion unchanged. Right lung unremarkable.Tubes and devices are stable.

Output: Unchanged left lower lobe consolidation and left pleural effusion. Unchanged tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: balloon pump placement History: balloon pump No significant cardiopulmonary abnormality.Left subclavian ICD, leads unchanged in position.Right jugular catheter, tip in SVC.IABP catheter marker within 2 cm the top of the aortic arch.

Output: Unchanged IABP. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic breast cancer on chemotherapy CHEST:LUNGS AND PLEURA: Stable loculated left-sided pleural effusion and paramediastinal and apical fibrotic changes.New nodular density in the left upper lobe on image number 17, series number 3 measuring 7 x 7 mm. This lesion is suspicious for metastatic disease. Left lower lobe atelectatic changes.Right apical scarring. Bilateral emphysematous changes. New, moderate right-sided pleural effusion.MEDIASTINUM AND HILA: Stable appearance of the right paratracheal ill-defined soft tissue density in measuring 18 x 10 mm image number 29, series number 3.CHEST WALL: Right axillary referenced node now with measures 11 by 8mm image number 28, series number 3, is stable. Previously seen subpectoral soft tissue density is now smaller.ABDOMEN:LIVER, BILIARY TRACT: Reference segment 8 lesion is now significantly larger measuring 6.1 x 4.8 cm on image number 83, series number 3. Several other smaller hypodense lesions have also developed within the interval in the liver.SPLEEN: Subcentimeter hypodense lesions are stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign-appearing bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy is increased in size and number.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: Right sacral lesion is unchanged.OTHER: No significant abnormality noted.

Output: Progression of disease with interval increase in the size and number of hepatic metastatic lesions and new left upper lobe nodule and moderate right-sided pleural effusion. Interval increase in the size and number of retroperitoneal enlarged lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: eval for interval change in patient with cough History: productive cough Nonspecific basilar interstitial opacities suggestive of early edema or fibrosis.Heart size upper normal.No specific evidence of infection.Left upper lobe scarring.

Output: No specific evidence of infection. Equivocal edema.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: Pt is a 29 yo male; potential stem cell donor History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: FemaleReason for Study: Reason: 56 yo F with productive cough, evaluate for paryenchmal lung disease History: as above The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Moderate degenerative changes of the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Presenting with tachypnea and desaturation. Patient is rotated rightward. The right costophrenic angle is excluded from field-of-view. Right-sided diffuse interstitial and airspace opacity. The left lung is relatively normal. Heart size is normal. No left pleural effusion or pneumothorax is visualized.

Output: Right-sided interstitial and airspace opacity suspicious for recurrent aspiration and infection possibly with a component of CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ards, intubated History: ards influenza, intubated Diffuse interstitial and airspace opacities with pleural effusions are unchanged.Stable cardiomegaly.ET tube tip approximately 4 cm above the carina. An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Unchanged pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old. R IJ. Dialysis catheter placement confirmation. Interval insertion of right jugular catheter, tip in the SVC. ETT tip 1 to 2 cm above the carina.IABP marker in the proximal descending thoracic aorta. Swan ganz catheter tip in the left descending pulmonary artery.Cardiomegaly with pulmonary edema and atelectasis with likely pleural effusions, stable to mildly increased.

Output: Right IJ catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: confirm that patient's central line in SVC as line was placed outside hospital History: patient getting TPN through central line Two right central venous catheters terminating in the right atrium. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity.

Output: Both right central venous catheters terminate in appropriate position. No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.History: Status post coronary artery bypass graft x4 using left internal mammary artery and left saphenous vein graft, left atrial appendage ligation, patent foreman ovale closure. Query retained foreign object one surgical needle not accounted for upon closing. Esophageal probe and bilateral chest tubes. IABP marker in the descending aorta. Swan-Ganz catheter with tip in the main pulmonary artery. No pneumothorax.New blunting of bilateral costophrenic angles and bibasilar interstitial opacities, compatible with atelectasis.Right linear opacity representing subsegmental atelectasis.

Output: No retained needle within the visualized field.Findings discussed with surgical team over the telephone.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: intubated History: intubated Cardiomegaly, with pulmonary opacities suggestive of edema and/or aspiration.New tracheostomy tube, tip at the thoracic inlet level. An NG tube extends below the lower margin of the image.

Output: New tracheostomy tube placement. Pulmonary opacities are now present suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: 28-year-old male with history of Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Confluent mediastinal hilar adenopathy is again noted. Index measurement of the anterior mediastinal adenopathy is 4.6 x 2.2 cm image number 48, series number 3, slightly compared to previous study. Other mediastinal and hilar adenopathy is also slightly smaller however it is difficult to measure due to its confluent nature.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval decrease in the size of the confluent mediastinal and hilar adenopathy.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: chest pain History: chest pain hx sickle cell disease Interval large left and small right pleural effusions with left upper and right lower lobe opacities. Cardiomegaly with the left ventricular apex obscured by overlying opacities. No pneumothorax.

Output: Cardiomegaly with large left and small right pleural effusions. Pulmonary opacities greater on the left compatible with acute chest syndrome.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: assess central line position, pulmonary edema, pneumonia History: hypoxia Catheter tip in the SVC.Small lung volumes with bilateral opacity compatible with atelectasis and small pleural effusions, not significantly changed.

Output: Catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Age: 87 yearsGender: FemaleReason for Study: Reason: eval for pneumonia History: leukocytosis Left-sided ICD unchanged.Right PICC line with its tip in the subclavian vein.Stable cardiomediastinal silhouette.Small pleural effusions new from the prior exam.No focal airspace opacities or evidence of edema.Evidence for prior granulomatous disease.

Output: Small pleural effusions new from the prior exam. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: 56 years, Male. Reason: volvulus? History: abd pain There are significantly dilated loops of colon with associated air-fluid levels suggestive of a distal obstruction. There is no evidence of pneumoperitoneum. There is no reliable evidence of volvulus.

Output: Findings suggestive of a distal colonic obstruction. Please see subsequent CT report for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: Eval ETT placement History: None Diffuse pulmonary opacities again noted. Lines and tubes are unchanged. Unchanged cardiomegaly. No pneumothorax. Status post cholecystectomy.

Output: Diffuse pulmonary opacities again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: new diagnosis of ALL w cough and low grade fever. Eval for pna History: cough Small lung volumes with diffuse airspace opacities consistent with infection, edema and or leukemic infiltration.Small left pleural effusion.Moderate cardiomegaly.Right jugular catheter tip at RA level.

Output: Diffuse pulmonary opacities consistent with infection, edema and/or direct leukemic infiltration.


Instruction: Generate impression based on medical findings.

Input: 67 years old Male. Reason: looking for intrathoracic process including dissection heart enlargement, pneumo History: chest pain. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. A patchy opacity is seen in the right lower lobe, which can be due to infection or inflammatory change. The cardiomediastinal silhouette is normal.

Output: Patchy opacity in the right lower lobe, which can be due to infection or inflammatory change. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: r/o infectious etiology History: chest pain Moderate cardiomegaly.No specific evidence of infection or edema.Right subclavian pacemaker leads unchanged.

Output: Moderate cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: patient desatted to 70s, please evaluate for lung pathology History: patient desatted to 70s, please evaluate for lung pathology Lower lung zone edema with pleural effusions consistent with CHF/hypervolemia, new or progressed since the prior study.Heart size within normal limits.

Output: Pulmonary edema with pleural effusions consistent with CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: Chest tube placement, pneumothorax History: as above Support devices unchanged.Persistent loculated lateral pneumothorax on the left.Cardiac enlargement and pulmonary opacities similar to the prior exam.

Output: No interval change in the small left-sided pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Cough. Four days of fever. Pneumonia?VIEWS: Chest AP/lateral (two views) 08/24/16 Cardiothymic silhouette and pulmonary vascularity are normal. The aortic arch, cardiac apex, and stomach are left-sided. No focal lung opacity is present. Lung volumes are slightly increased with increased AP diameter of the chest and bowing of the sternum.

Output: Airway hyperreactivity/bronchiolitis pattern. No pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: eval line placement History: line Endotracheal tube terminates about 3 cm above the level of the carina. Right IJ central venous catheter terminates in the right atrium. Low lung volumes. No significant change in left greater than right pleural effusions with perihilar interstitial and airspace opacities. Stable cardiomegaly. Presternal ICD. No pneumothorax.

Output: Interval placement of right jugular central venous catheter terminating the low right atrium, recommend repositioning. Unchanged pulmonary edema pattern.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: Metastatic melanoma CHEST:LUNGS AND PLEURA: Left lower lobe mass measures 6.4 x 3.6 cm number 52, series number 3, grossly stable. No pleural effusions. No new pulmonary nodules.MEDIASTINUM AND HILA: Reference AP window lymph nodes are stable measuring 21 x 16 mm on image number 29, series number 3. Stable mildly prominent left hilar lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference mesentery lymph node is stable measuring 16 by 8mm image number 123, series number 3.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: Grossly stable examination


Instruction: Generate impression based on medical findings.

Input: IABP in place. IABP marker about 5 cm below the top of the aortic arch.Presternal ICD in place.No pneumothorax or pleural fluid.Patchy atelectasis at the lung bases, increased on the left. No visible pleural fluid or pneumothorax. No signs of CHF.

Output: Slight increase in atelectasis. IABP marker 5 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Liver transplant Interval removal of the right jugular sheath and mediastinal chest tubes. No postprocedural complication. Placement of a right PICC line is observed, tip projects into the axilla.Moderate nonspecific cardiomegaly with otherwise grossly clear lungs without interval new superimposed abnormalities

Output: Mediastinal chest tubes and right jugular sheath removed. Right PICC line placed


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: pleural effusions History: pleural effusions, SOB Cardiomegaly status post aortic valve replacement, with a small right pleural effusion and small lung volumes.An NG tube extends below the lower margin of the image.Right PICC, tip in the SVC.

Output: Persistent small right pleural effusion. No new findings.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: sob History: above Small lung volumes with a perihilar and basilar interstitial abnormality suggestive of edema although aspiration is possible.Hilar lymphadenopathy may be present.Heart size normal.No specific evidence of infection.

Output: Edema or aspiration, with possible hilar lymphadenopathy versus PA hypertension. If symptoms and findings persist a thoracic CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: s/p stem cell tranpslant presenting with fluid overload History: crackles at bases Right IJ venous catheter tip at the cavoatrial junction.Mild cardiomegaly with perihilar interstitial opacities and pleural effusions not significantly changed. No new focal airspace opacities. No pneumothorax.

Output: Mild edema and small effusions are unchanged with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: iabp History: iabp Moderate to severe cardiomegaly is present without pulmonary edema.IABP catheter proximal marker projects over the aortic arch.Left subclavian ICD unchanged.

Output: Stable tubes and devices. Severe cardiomegaly without edema.


Instruction: Generate impression based on medical findings.

Input: Check for pneumothorax. Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old. Reason: ILD, Lung TRansplant work-up History: SOB Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus revealed mild compression of the esophagus by the right mainstem bronchus similar to prior study. The distal esophagus was mildly patulous similar to prior study. There was breakup of the primary peristaltic wave with proximal escape at the level of the aortic arch with mild retention of barium in the distal esophagus. There is no morphologic abnormalities of the gastric mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Contrast flowed freely into the small bowel. TOTAL FLUOROSCOPY TIME: 4:53 minutes.

Output: 1.Mild esophageal motor abnormality.2.No evidence of gastroesophageal reflux or gastritis.3.Mild compression of the midesophagus by the right mainstem bronchus similar to prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Status post-post port and tunneled line removal, asystole briefly in OR with chest compressions. There has been interval removal of a right-sided chest port catheter and left internal jugular central venous catheter. No evidence of pneumothorax. An enteric tube extends below the level of the diaphragm out of the field of view. No evidence of new rib fractures. Small left basilar pleural effusion and bibasilar atelectasis. The heart size is within normal limits.

Output: No evidence of new rib fractures. Interval removal of a left-sided central venous catheter and right chest port catheter. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: cough Normal heart size and mediastinal contours with elevation of the left hilum, unchanged.Moderate elevation of the left hemidiaphragm, also unchanged from previous.Bilateral mammoplasties and surgical clips in the chest wall and axillae. No acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR, CABG Interval extubation.Swan-Ganz catheter tip in the right main pulmonary artery.Marked cardiomegaly with perihilar opacities compatible with edema and atelectasis.No new findings.

Output: Interval extubation and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: confirm placement of right PICC and left PICC History: see above Bilateral PICCs terminate within their ipsilateral brachiocephalic veins. Mild left basilar atelectasis or scarring. No new focal pleural parenchymal opacity. Mild left-sided pleural scarring versus small effusion. No pneumothorax. Unchanged heart size.

Output: Bilateral PICCS terminate within their ipsilateral brachiocephalic veins. No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pna, edema, effusion, fracture History: sternal chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: post op hypoxia History: as above Small lung volumes with minimal streaky basilar subsegmental atelectasis, otherwise unremarkable.Heart size normal.Spinal stabilization hardware.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for interval change; ETT placement History: intubated; hx of aspiration ET tube tip approximately 3 cm above the carina.Partial clearing of air space opacities compatible with edema and aspiration.NG tube coiled in the stomach.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: 61yoM hx ICM s/p swan, confirm location History: s/p swan Lines and tubes are unchanged. Overlying life vest device again noted. Scarlike opacities again noted within the left lung. Right lung remains clear. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 31 years old Female. Reason: is there signs of acs? New opacities History: sob. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Evaluate for bowel obstruction No free air on upright imaging. However small pneumoperitoneum suggested in pelvis. Mildly dilated left-sided small bowel loops measuring up to 3.2 cm. Otherwise overall paucity of small bowel as well as large bowel gas. Multiple midline skin staples.

Output: A partial SBO cannot be excluded on the basis of this exam, details above. No free air on upright imaging. However small pneumoperitoneum suggested in pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Sharp right-sided chest pain sudden onset yesterday, evaluate for hemorrhage versus consolidation. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute cardiopulmonary abnormality. Specifically, no signs of pulmonary hemorrhage or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: IABP in place History: IABP in place Radiopaque marker for an intra-aortic aortic balloon pump projects approximately 3 cm below the expected top of the aortic arch. Changes of a prior median sternotomy again noted. A left chest ICD has its tips overlying the coronary sinus, right ventricular apex, and right atrial appendage; unchanged. Surgical clips project over the right upper quadrant of the abdomen consistent with a prior cholecystectomy.The cardiomediastinal silhouette is unchanged. No new focal opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax.

Output: IAPB marker projects approximately 3 cm below the top of the expected aortic arch. Otherwise, stable appearance of the chest.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p MVR Left-sided pacemaker and chest/mediastinal tubes unchanged.Swan-Ganz catheter has been removed.Stable cardiac enlargement.Pleural effusions and basilar atelectasis similar to the prior exam.Small residual right subpulmonic pneumothorax.

Output: Swan-Ganz catheter removed. Remaining support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: r/o infiltrate History: cough; AMS; f/c Cardiomegaly.No specific evidence of infection or edema.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: pulmonary edema, ET tube position History: Intubated Pleural effusions and basilar consolidation as well as fluid accumulating around the right hilum, unchanged.ET tube tip approximately 1 cm above the carina.Right jugular catheter, tip in SVC.Left jugular catheter, tip in SVC.An NG tube terminates in the stomach.

Output: Low ET tube. Unchanged pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: eval ETT, lung fields History: s/p lead placement New right IJ venous catheter.Interval placement of an ET tube with its tip approximately 4 cm above the carina.Interval rotation of right-sided pacemaker generator and lead wires unchanged.Left-sided chest tube placed without evidence of a pneumothorax.Stable cardiomediastinal silhouette.Mild perihilar interstitial opacities compatible with edema.

Output: Interval intubation with ET tube in satisfactory position. Placement of left-sided chest tube without evidence of a pneumothorax. Interval rotation of right-sided pacemaker generator.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: Pt having CP and thoracic pain History: CP radiating to thoracic area Clear lungs. No pleural effusion or pneumothorax. Normal heart size. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography. If symptoms continue, consider further evaluation with chest CT/CTA.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA, edema History: hypoxia Bilateral patchy and nodular opacities, most obvious in the right upper lobe area, more suggestive of infection than pulmonary edema. Unremarkable cardiac and mediastinal silhouette.

Output: Patchy nodular bilateral pulmonary opacities suggestive of infection.


Instruction: Generate impression based on medical findings.

Input: Check for edema. Shortness of breath No appreciable cardiopulmonary abnormality given semiupright portable technique. Chronic silhouette is borderline in overall size yet thought to be largely artifactual.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old with hypoxemia. Evaluate for pulmonary edema. Interval extubation and removal of NG tube and right IJ catheter. Dobbhoff tube extends into the stomach and off the inferior margin of the image.Stable cardiomediastinal. Left greater than right basilar opacity compatible with atelectasis and possible small effusion is unchanged. No new pulmonary opacity or pneumothorax.

Output: Mild basal atelectasis. No specific signs of edema.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB, chest pain History: As above Heart size but upper normal with a tortuous aorta.Status post median sternotomy.Increased basilar interstitial opacity compatible with atelectasis, confirmed on a subsequent CT scan.

Output: Increased basilar interstitial opacity accentuated by under inflation, compatible with atelectasis.


Instruction: Generate impression based on medical findings.

Input: HypoxiaEXAMINATION: Chest AP (1 views) 3/15/16 at 2109 Aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. Low lung volumes without focal lung opacity. No pleural effusion or pneumothorax.

Output: Low lung volumes without focal opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: NGT location History: NGT placement, prior NGT removed Pulmonary opacities with a nodular appearance consistent with infection although follow up to resolution is recommended to exclude malignancy.Dobbhoff tube removed from the right lung on the tip now in the distal stomach.

Output: Dobbhoff tube removed from the lung with no pneumothorax. Unchanged pulmonary opacities which should be followed for resolution.


Instruction: Generate impression based on medical findings.

Input: Metastatic melanoma CHEST:LUNGS AND PLEURA: Lower lobe, peripheral subsegmental atelectasis and fibrosis are stable in both lungs.MEDIASTINUM AND HILA: Calcified mediastinal adenopathy is unchanged.CHEST WALL: Previously described left axillary adenopathy has significantly smaller, now measuring 7 x 8 mm on image number 36, series number 4.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral numerous cysts, suggestive of adult onset both cystic kidney disease, stable. No definite enhancing masses in both kidneys.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: Previous described right inguinal lymph node has resolved.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval resolution of the right inguinal lymph node and significant interval decrease in the size of the left axillary lymph node. Other findings are stable


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Status post IVC filter removal. Moderate cardiomegaly and enlargement of the central pulmonary vasculature compatible with pulmonary hypertension. Massive enlargement of the right descending pulmonary artery. No pneumothorax. Atelectasis along the right hemidiaphragm.

Output: No pneumothorax post filter removal.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: sepsis History: sepsis Cardiomegaly with moderate perihilar edema and pleural effusions. No specific evidence of infection.ET tube tip approximately 5 cm above the carina.Two left jugular catheters terminate at the SVC/artery junction level.A Dobbhoff tube extends below the lower margin of the image.Right axillary vascular stent.

Output: Cardiomegaly with pulmonary edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Infiltrates History: fever The heart size is normal. Tortuous thoracic aorta. Bibasilar subsegmental atelectasis/scarring. Multiple calcified hilar granulomas. No focal pulmonary opacities, large pleural effusion, or pneumothorax. Degenerative changes affect the right shoulder.

Output: No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female, evaluate nodule seen on chest x-ray. LUNGS AND PLEURA: 21 x 20 mm spiculated pulmonary nodule in the right middle lobe along the minor fissure (image 41, series 7), likely correlates with the abnormality identified on the previous chest x-ray. Linear atelectasis in the anterior right middle lobe. No pleural effusion. Nonspecific interlobular septal thickening at the lung bases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild to moderate atherosclerotic calcifications of the coronary arteries and aortic root.CHEST WALL: Degenerative changes with kyphosis affects the thoracic spine.UPPER ABDOMEN: Large amount of debris in the stomach and duodenum, correlate for gastroparesis. Atherosclerotic disease of the aorta and its branches.

Output: Spiculated right middle lobe nodule as described above is highly suggestive of primary lung cancer. Follow up is recommended.


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: Is there pneumonia? History: Fever Right PICC line with its tip in the RA.Stable cardiomediastinal silhouette.Increasing basilar opacities compatible with atelectasis and small effusions.

Output: Interval increase in basilar opacities compatible with atelectasis and effusions which may be related to aspiration. Concomitant infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: FemaleReason for Study: Reason: Pneumonia, CHF History: cough, history of heart/kidney transplant Stable moderate cardiac enlargement .No focal airspace opacities.No pleural effusions.Median sternotomy is intact.

Output: Stable cardiac enlargement without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: FemaleReason for Study: Reason: sp MV AV replacement History: - ET tube has been removed.Remaining support devices are unchanged.Stable cardiomediastinal silhouette.Perihilar and basilar opacities with small effusions similar to the prior exam. No new pulmonary opacities identified.

Output: Interval extubation. Stable cardiopulmonary appearance with small effusions, pulmonary edema, and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Right upper lobe wedge resection Right chest tube again projects towards the apex with pain insignificant small pneumothorax. Interval increasing chest wall emphysema however is observed and of uncertain significance.Underlying cardiopulmonary appearance is otherwise similar with postsurgical changes and suture line observed in the mid right lung along with minimal lower zone edema and mild cardiomegaly. Small effusions cannot be excluded

Output: Right chest tube unchanged with mild overlying increasing chest wall emphysema


Instruction: Generate impression based on medical findings.

Input: Reason: chf with iabp History: iabp placement Balloon catheter and ICD leads unchanged.Stent in the area of the left coronary artery.No significant cardiopulmonary abnormalities.

Output: Balloon catheter marker 2 cm below the top of the aortic arch with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: pneumonia, cardiomegaly, effusion History: pre op cxr for fragility fracture left hip No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Staging of CLL prior to treatment CHEST:LUNGS AND PLEURA: Mild emphysema.MEDIASTINUM AND HILA: Extensive mediastinal adenopathy. Adenopathy is more prominent in the superior mediastinum. A reference precarinal adenopathy measures 19 x 12 mm in image number 13, series number 3.Thyroid gland is enlarged. Right lobe of the thyroid gland and extends retrosternally.CHEST WALL: Extensive bilateral axillary adenopathy. A reference left axillary lymph node measures 2.1 x 2.6 cm image number 23, series number 3. Extensive bilateral adenopathy in the neck and supraclavicular regions.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of biliary dilatation. 12-mm hypodense lesion in left lobe liver, cannot be accurately characterized due to lack of IV contrast. Liver is enlarged measuring 22.7-cm.SPLEEN: Spleen is enlarged measuring 21-cm vertically.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 3.8 cm cyst in the upper pole the right kidney. Subcentimeter exophytic lesion in the upper pole of the right kidney anteriorly is too small to accurate characterize and has slightly high density which may represent a complex cyst, however, cannot be optimally characterized due to lack of IV contrast.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and mesenteric adenopathy. A reference a left para-aortic adenopathy measures 3.4 x 2.4 cm in image number 122, series number 3.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: Bilateral pelvic adenopathy. The right obturator reference adenopathy measures 2.6 x 1.9 cm image number 167, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extensive mediastinal, bilateral axillary, neck, retroperitoneal, mesenteric and pelvic adenopathy.Hepato- splenomegaly.Cholelithiasis without biliary dilatation.Indeterminate hepatic and right renal lesion.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old. Interval placement of right internal jugular venous line with tip in the projection of right atrial SVC junction.No pneumothorax.No change in appearance of the subcutaneous emphysema seen in the right supraclavicular region.Line position stable.No change in appearance of bilateral interstitial opacities and pulmonary cysts.

Output: 1. No pneumothorax following placement of right internal jugular venous line.2. Cardiopulmonary findings are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.History of intubation. ET tube tip 2.5 cm above the carina. Right upper extremity PICC with tip at the cavoatrial junction. Enteric feeding tube tip extends beyond the inferior margin of the image. Cardiopulmonary appearance is similar compared to prior examination. Again noted is a large mediastinal mass and mild basilar opacity, left greater than right, consistent with effusion and atelectasis.

Output: ET tube tip 2.5 cm above the carina. Other cardiopulmonary findings appear similar compared to prior.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: eval pna History: cough, wheeze The cardiac mediastinal silhouette is unremarkable.There are decreased lung volumes with mild basilar atelectasis.No focal areas of consolidation.No pleural effusions.Multiple surgical clips in the right upper abdomen.

Output: Mild left basilar atelectasis without specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with history of pulmonary nodules. Evaluate for interval progression. CHEST:LUNGS AND PLEURA: Multiple nodules and micronodules, some of which are calcified, are seen scattered diffusely throughout the lungs, unchanged from prior study. No new suspicious nodules, masses, or pleural effusion.Thickening of the right major fissure peripherally is also unchanged and likely represents scarring.Bibasilar ground glass opacities and atelectasis, also unchanged. Mosaic attenuation of the lungs is also noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Severe calcifications in the left circumflex artery. Mild calcifications affect the right coronary and left anterior descending arteries. Calcified mitral annulus.CHEST WALL: Compression deformity of T7 vertebral body, unchanged. UPPER ABDOMEN: No significant abnormality noted.

Output: Overall stable exam:1. Stable pulmonary nodules without new suspicious nodules.2. Basilar predominant interstitial lung disease, again in a pattern consistent with NSIP or hypersensitivity pneumonitis, unchanged.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with non-Hodgkin's lymphoma 60 days post stem cell transplant. Restage. CHEST:LUNGS AND PLEURA: Bilateral apical scarring with nodular opacity appearing similar to previously identified lesion on series 5, image 17115.MEDIASTINUM AND HILA: Interval decrease of mediastinal lymph nodes in the paratracheal, precarinal and carinal lymph nodes. Previously identified pretracheal lymph node, S3 Image 45/230, 1.0 x .9cm (previously on series 4, image 39/223, measured 1.9 x 1.6 cm).CHEST WALL: Right port catheter with tip in the distal SVC/right atrium junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Significantly decrease in size of enlarged spleen, now measures 17.8cm on coronal image 53/113.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes are significantly decreased compared to the prior exam - none are pathologic in size. A reference left para-aortic lymph node is barely measurable on S3 Im 122/230, .6 x .4 cm (previously measured 1.2 x 2.0 cm, on series 4, image 117/223).BOWEL, MESENTERY: Mesenteric lymph nodes are also decreased. None are pathologic in size.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: Decrease in size of all measurable disease. Decrease in size of spleen. No new sites of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 90 years old. History: CHF, asthma. Presented with dyspnea and cough. Mediastinal silhouette expanded by tortuous aorta.Redemonstrated is elevation of the right hemidiaphragm, similar to prior study.No pulmonary or pleural disease.

Output: 1. Persistent elevation of the right hemidiaphragm.2. No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: r/o PNA History: SOB Sternotomy hardware remains well aligned. A chronic fracture of the most superior wire is again noted. There is evidence of prior coronary arterial revascularization.There is calcification of the left internal carotid artery. Cardiomegaly is not significantly changed. Streaky basilar opacities which may represent aspiration. No consolidation, significant pleural effusion or pneumothorax.

Output: Cardiomegaly. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with history of colon rectal cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Anterior ventral hernia containing nonobstructing bowel segments unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female 33 years old; Reason: assess for ileus and free air History: abdominal pain Nonobstructive bowel gas pattern. No evidence of pneumoperitoneum. Surgical clips are visualized in the right abdomen.

Output: No evidence of obstruction, ileus or free air.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: resp failure History: prolonged mechanical ventilation Left IJ central catheter is coiled at the base of the left neck. The additional support devices are unchanged in position.Progressive mid to lower zone opacities of progressive edema with moderate pleural effusions and atelectasis. No interval pneumothorax. Interval aspiration cannot be excluded.

Output: Progressive mid to lower zone opacities of edema with right greater than left pleural effusions. Interval aspiration is also a consideration.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: sob History: sob Unchanged cardiomediastinal silhouette.Basilar atelectasis, which is improved when compared to prior study.No focal consolidation or large pleural effusions.

Output: No specific evidence of infection or failure.


Instruction: Generate impression based on medical findings.

Input: Female 11 months old f/u extubation, right sided chest tube, previous left pleural effusion.VIEW: Chest AP (one view) 4/14/2016 at 04:27 The patient has been extubated. Right central venous catheter tip is in the left innominate vein. Right chest tube, right atrial line, epicardial pacer leads and mediastinal clips are unchanged in position.Normal cardiothymic silhouette. New hazy left lung opacities compatible with layering effusion. No pneumothorax or right pleural effusion.

Output: Reaccumulation of left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: possible aspiration History: as above Basilar opacities, right greater than left with multiple loculated right pleural effusions.Heart size normal.Nasogastric tube coiled in gastric fundus.

Output: Basilar opacities right greater than left with loculated right effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Please evaluate lungs, has shortness of breath History: Dyspnea Left upper quadrant surgical drain with small air-fluid level. Left basilar atelectasis. Small bilateral pleural effusions, right greater than left. Compressive atelectasis on the right

Output: Left basilar atelectasis. Small bilateral pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: 54 year old male with cough, syncope. No focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: interval changes History: as above Balloon pump catheter with its distal marker at the level of T10 and the descending aorta.Swan-Ganz catheter tip in the main pulmonary artery.ICD leads unchanged.Severe cardiomegaly with bilateral lower zone opacity compatible with edema, atelectasis and pleural effusions. No new findings.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: pna History: chest pain Mild cardiomegaly. No large pleural effusion or pneumothorax.No focal pulmonary opacities. Right middle lobe patchy opacity may represent an early pneumonia.Dense coronary artery calcification.

Output: Right middle lobe patchy opacity may represent an early pneumonia.


Instruction: Generate impression based on medical findings.

Input: 65 year old female status post liver transplant with Epstein-Barr viremia, evaluate for masses or lymphadenopathy CHEST:LUNGS AND PLEURA: Large right, moderate left-sided pleural effusions, new from previous study. Dependent atelectasis in the lung bases and in the right middle lobe.MEDIASTINUM AND HILA: Cardiomegaly.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Changes secondary to liver transplant. Hepatic vasculature or focal liver lesions cannot be evaluated due to lack of IV contrast.SPLEEN: Splenomegaly, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney with double J stent with its tip in the proximal right ureter. Previous identified hydronephrosis has almost completely resolved. Fluid density in the upper pole may represent dilated calyx versus a cyst.Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The amount of ascites has increased within the interval. Mild wall thickening of the small bowel loops in the pelvis likely secondary to radiation is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Tip of the double J stent is in the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Changes secondary to bilateral avascular necrosis, unchanged.OTHER: No significant abnormality noted.

Output: Interval development of bilateral pleural effusions, interval increase in the amount of ascites. Mild wall thickening of the small bowel loops in the pelvis is unchanged.Focal dilatation of right upper pole calyx versus a cyst.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Mildly improving overall lung volumes without significant change in the underlying nonspecific patchy opacities greater on the right and lung bases, greater on the left. Although probable edema, however diffuse infection or even early ARDS cannot be excluded. Mild cardiomegaly.ETT remains 2 cm above the carina. NG coiled in the proximal stomach. Right jugular catheter terminates in the SVC near the RA junction

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: 72-year-old female presenting with metastatic renal cell carcinoma. The lack of IV contrast limits evaluation of solid organ lesions.CHEST:LUNGS AND PLEURA: There are patchy areas of dense opacities in bilateral lower lobes. Given that air bronchograms can be identified through these opacities, an infectious process is favored over metastatic involvement.Previously identified right base metastatic lesion is larger compared to the prior study and measures 17 x 17 mm (series 5, image 94), previously 11 x 15 mm.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There are multiple hypodense hepatic lesions, which have increased in size and number, consistent with worsening metastatic disease. Reference lesion measures 3.6 x 3.4 cm (series 4, image 114).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy. Left upper pole cyst is unchanged compared to the prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is an expansile and lytic lesion involving the lateral aspect of the right third rib, consistent with metastasis. Postoperative changes of a right hip arthroplasty are completely visualized on this study.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac node measures 12 x 7 mm, unchanged compared to the prior study (series 4, image 153).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Total right hip arthroplasty is incompletely visualized on this study. Degenerative disease affects the lumbar spine and left hip.OTHER: No significant abnormality noted.

Output: 1.Multiple hepatic lesions increasing in size and number and right base pulmonary nodule increasing in size, consistent with worsening metastatic disease.2.Bilateral lung bases with patchy consolidations and air bronchograms, new since the prior study. These findings likely represent an infectious process as opposed to metastatic involvement. Close interval followup is suggested.3.Expansile and lytic lesion of the lateral aspect of the right third rib, consistent with new metastasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for edema History: SOB, hx of CHF Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

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


Instruction: Generate impression based on medical findings.

Input: Age: 50 yearsGender: MaleReason for Study: Reason: 50M intubated in CCU with VA-ECMO, Swan, HD catheter, and IABP, pleural effusions/pneumonia, ?placement, ?pneumonia progression History: 50M intubated in CCU with VA-ECMO, Swan, HD catheter, and IABP, pleural effusions/pneumonia, ?placement, ?pneumonia progression Support devices unchanged with IABP marker in the proximal descending aorta and Swan-Ganz catheter tip in the pulmonary artery.Decreased lung volumes with stable cardiac enlargement.Perihilar opacities and left retrocardiac consolidation/atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with multifocal pulmonary opacities compatible with infection/aspiration.


Instruction: Generate impression based on medical findings.

Input: Chemical ventilation. Shortness of breath ETT remains 2 cm above the carina. NG coiled within the proximal stomach.Persistent decreased lung volumes with mixed interstitial and patchy opacities in all 4 quadrants with relative sparing of the right lower lobe. Small effusions cannot be excluded. Stable borderline cardiac silhouette

Output: ETT unchanged and persistent cardiopulmonary appearance raising concern for ARDS


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for pna, confusion History: eval for pna, confusion Heart size is upper limits of normal, accentuated by portable technique. No consolidation, pulmonary edema or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 94 years old.Presenting with wheezing and shortness of breath. No definite pleural effusion. No pneumothorax. Redemonstration of bibasilar patchy opacity consistent with scarring. Aortic calcification. Status post right shoulder surgery. Heart size is difficult to analyze with leftward patient rotation. No focal lung opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old s/p right upper extremity PICC placement Interval PICC placement with tip projecting over the right subclavian vein lateral to the ribs.Stable cardiomediastinal silhouette. Bibasilar atelectasis without focal consolidation. No pleural effusions or pneumothorax.

Output: Interval PICC placement with tip projecting over the right subclavian vein lateral to the ribs. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Chest tube in place with air leak. Small left apical pneumothorax. Left-sided chest tube in place, unchanged in position. Extensive subcutaneous emphysema, unchanged. Low lung volumes. Left basilar scarring/atelectasis unchanged. No large pleural effusion. The cardiomediastinal silhouette appears similar to the prior study.

Output: Small left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: evaluate ETT History: see above Mild cardiomegaly.Interstitial and airspace opacities not significantly changed consistent with edema or aspiration.ET tube tip approximately 2 cm above the carina.An NG tube extends below the lower margin of the image.

Output: ET tube tip approximately 2 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: pt with critical aortic stenosis, needs PA/Lateral film History: syncope Cardiomediastinal silhouette is unremarkable. Bilateral subsegmental atelectasis is unchanged. No pleural effusion or pneumothorax.

Output: Bibasilar atelectasis with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: LVAD in place History: LVAD in place Support devices unchanged.Marked cardiac enlargement with perihilar/basilar pulmonary opacities similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Support devices are unchanged. Stable cardiopulmonary appearance with marked cardiac enlargement and pulmonary opacities compatible with edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Shortness of breath for 3 days, history of severe sarcoidosis, tracheostomy in place Tracheostomy is in place.The cardiac and mediastinal silhouette is unremarkable.Low lung volumes with mid and lower lung zone interstitial opacities most suggestive of fibrosis and scarring.No pleural effusions.

Output: Mid and lower lung zone interstitial opacities most suggestive of fibrosis and scarring without specific evidence of a superimposed acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: new PICC placement History: see above Right IJ Swan-Ganz and left IJ venous catheter have been removed.New right PICC line with its tip extending retrograde into the left innominate vein.Stable cardiac enlargement.Basilar opacities and small pleural effusions unchanged.

Output: Right PICC line extending retrograde into the left innominate vein.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: acute path History: high risk chest pain, h/o aaa and aortobifem graft Improvement in bibasilar subsegmental atelectasis. No focal lung consolidation. No pneumothorax or pleural effusion. Mild cardiomegaly again noted. Atherosclerotic aorta, as before.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Pleural effusions Nasogastric tube projects into the proximal stomach. Dobbhoff has been removed. Right jugular catheter/port extends in the proximal SVC near the RA junction.Suspected enlarging bilateral pleural effusions observed bilaterally with basilar suspected atelectasis and mild cardiomegaly. Decreased lung volumes

Output: Suspected enlarging pleural effusions although appearance may be partially due to more semiupright positioning


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: 68F s/p open incisional hernia repair w/ AMS History: AMS Decreased lung volumes.No focal airspace opacities.Cardiomediastinal silhouette stable.No significant pleural effusions.

Output: No acute cardiopulmonary abnormalities. No interval change from prior exam.


Instruction: Generate impression based on medical findings.

Input: Reason: Hx of DLBCL s/p auto-transplant, t-MDS s/p MRD transplant Day 150 History: Hypoxia Normal heart size with a tortuous calcified aorta.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Ewing sarcoma of right scapula CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter nodule on image number 124, series number 5 in the left lower lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Permeative, lytic lesions in the right scapula associated with soft tissue mass more prominent anterior to the scapula consistent with patient's known history of right scapular Ewing sarcoma.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.Mass in the right scapula consistent with patient's known Ewing's sarcoma.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old. ETT repositioning. EPIC: history of interstitial lung disease ETT tip within 1 cm of the carina.Right jugular catheter tip at the cavoatrial junction.Mild basilar atelectasis on background of chronic appearing interstitial opacities. Left lung sutures.Right upper quadrant surgical clips.

Output: ETT tip within 1 cm of the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: MaleReason for Study: Reason: r/o pneumothorax History: r sided chest pain Normal cardiomediastinal silhouette appearDecreased lung volumes with very minimal basilar atelectasis.No focal areas of consolidation.No pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities identified without interval change. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Post thoracentesis evaluate for pneumothorax. No pneumothorax. Slight decrease in volume of left pleural fluid. Unchanged appearance of the right lung and volume of pleural fluid on the right.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Apical mass resection. Chest tube placement. Right chest tube projects over the lateral aspect of the third rib interspace. Right chest wall and upper extremity subcutaneous emphysema.Lung volumes remain low.Basal opacities suggestive of atelectasis and aspirated secretions, right greater than left.Dense opacity at the left apex may reflect postoperative hematoma.5 mm right apical pneumothorax.

Output: 5 mm right apical pneumothorax. No acute change in basal atelectasis and opacities suggesting aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Male, 14 years old.Injury. Evaluate for radiopaque foreign object. Metallic densities projected over the axillary and right chest areas are presumably external to the patient, not seen on follow-up study.No evidence of a radiopaque foreign object.Left pneumothorax, small to moderate size.ET tube tip approximately 5 cm above the carina.

Output: No radiopaque foreign object. Left pneumothorax, a follow-up chest radiograph showing a chest tube placed. Findings were conveyed by the radiology resident on call to the attending surgeon, Dr. Loeff, by telephone at 7:29 a.m., 1/20/2015.


Instruction: Generate impression based on medical findings.

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

Output: No measurable disease.


Instruction: Generate impression based on medical findings.

Input: Reason: ? pna History: weakness Large lung volumes suggestive of COPD.No sign of pneumonia.Port catheter with its tip in the SVC.

Output: COPD with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: concern for hemoptysis History: hemoptysis Unchanged moderate cardiomegaly.No pleural or parenchymal abnormalities.

Output: Unchanged cardiomegaly; no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Pt chest tube, w/ increase SOB History: SOB Large right pleural effusion extending above the level of the hilum with underlying atelectasis.Pleural drain projected over the right lung base. Opacity at the left lung base consistent with effusion and atelectasis.Catheter tip in the SVC.

Output: Large right pleural effusion and smaller left effusion, questionably increased on the right compared to previous.


Instruction: Generate impression based on medical findings.

Input: 76-year-old male with right lower quadrant pain, evaluate for appendicitis. CHEST:LUNG BASES: Atelectasis affects both lung bases, left greater than right.ABDOMEN:LIVER, BILIARY TRACT: There are multiple hypodense liver lesions, which are too characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypodensity in the lower pole of left kidney likely represents a cyst; however, it is too small to characterize. Additionally, there is nonspecific perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: There is a retro-crural lymph node, which is not enlarged by CT criteria. BOWEL, MESENTERY: Dilatation of the proximal/distal jejunum and proximal ileum, measuring 4.2 cm in diameter with a transition point possibly in the right mid abdomen adjacent to several surgical clips, consistent with a partial small bowel obstruction. The ascending colon and cecum are not well visualized, correlate with right lower quadrant surgical history.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The left hemidiaphragm is elevated, likely due to compression from dilated small bowel.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine.OTHER: No other significant abnormality noted.

Output: 1. Partial small bowel obstruction, with the transition point appearing to be in the right mid abdomen adjacent to several surgical clips, is likely due to adhesions from prior surgery. There is no evidence of SMA thrombosis or bowel ischemia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Eval for PNA. History: SOB New interstitial opacities with a heart size normal, and no large pleural effusions.No focal consolidation.

Output: Diffuse interstitial opacities consistent with edema although atypical infection is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: fx History: pain Circular opacity at the right apex appears to be related to scarring. No evidence of pneumonia or edema. Tortuosity of the descending thoracic aorta. Heart size remains normal. No evidence of displaced rib fracture.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Sudden onset SOB tonight with tachypnea. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: IABP, impella, eval position History: IABP Patchy perihilar predominant air space opacities are consistent with aspiration; this has improved in the left lung periphery, but may extend slightly more into the left upper lobe than before.Moderate cardiomegaly is stable.A small right pleural effusion has gradually enlarged over the last two days, and there is minimal basilar edema. Left PICC, tip in the SVC.Right jugular Swan-Ganz catheter, tip still in the right interlobar pulmonary artery.IABP catheter proximal marker now 4 cm below the top of the aortic arch, slightly lower compared to two days ago.Impella Cardiac Assist device unchanged in position, the tip projected over the LV apex region.

Output: Patchy pulmonary opacities in general unchanged since yesterday, slightly redistributed, consistent with aspiration. Underlying edema and infection are possible. Stable tubes and devices since yesterday, the IABP marker slightly lower compared to two days ago.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old with diarrhea and vomiting rule out obstruction. Abdomen: Nonobstructive bowel gas pattern. Surgical clips noted to the left of midline and in the right lower quadrant. There is average stool burden.Chest: No acute cardiopulmonary pathology. Previously known emphysematous changes.

Output: Nonobstructive bowel gas, average stool burden.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: FemaleReason for Study: Reason: Hx organizing pneumonia History: Sob Left-sided pacemaker unchanged.Stable cardiac mediastinal silhouette with evidence of an aortic valve prosthesis.Reticular peripherally located interstitial opacities similar to prior exam and compatible fibrosis.No new focal air space opacities.No pleural effusions

Output: Chronic appearing interstitial opacities compatible with fibrosis. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Presenting with cough and fevers. No pleural effusion or pneumothorax. No focal pulmonary opacity. Cardiomediastinal silhouette is within normal limits.

Output: No cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 37 year-old female with elevated d-dimer and atrial flutter. Technically adequate exam.PULMONARY ARTERIES: No PE.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Evaluation of solid organs is limited by arterial phase enhanced imaging. No significant abnormality noted.

Output: No PE. No other significant findings.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.History: Lung cancer, evaluate pleural effusion. Right upper lobe opacity similar to prior.Right subpulmonic effusion with overlying atelectasis, increased from previous study. Redemonstrated right posterior eighth and ninth rib metastases.Interval resolution of left pleural effusion.Unchanged cardiomediastinal silhouette.

Output: Right apical opacity consistent with known primary lung cancer, rib metastases and right subpulmonic effusion, similar to prior.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: chest pain, heart failure History: above Cardiomegaly status post sternotomy.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.Unchanged spinal stimulator.

Output: Cardiomegaly, otherwise unremarkable. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Evaluate pneumothoraxVIEW: Chest AP 1/14/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. There are three chest tubes on the right. The left PICC is unchanged. The large right pneumothorax minimally increased in the interval. There is mediastinal shift from right to left. Cardiothymic silhouette cannot be evaluated. There is complete opacification of the left lung. Metabolic bone disease of prematurity again noted.

Output: Large right pneumothorax minimally increased in the interval.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: IABP placement History: IABP placement IABP, unchanged with its superior margin approximately 1.5 cm from the top of the aortic arch. Unchanged cardiac leads. No new focal lung consolidation. No pneumothorax or pleural effusion. Unchanged heart size.

Output: No substantial change.


Instruction: Generate impression based on medical findings.

Input: 54 year-old female with history of COPD, sarcoidosis with left-sided chest pain post injury. Rule out rib fracture. Severe chronic interstitial opacities with areas of scarring or atelectasis compatible with sarcoidosis. No new focal air space opacities. No pleural effusion or pneumothorax.No displaced rib fractures.

Output: Severe chronic interstitial lung disease. No displaced rib fractures.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: eval for PNA History: fever, cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Female 25 years old Reason: eval shunt History: headache SHUNT DEVICE: Again seen is an intracranial shunt that exits the skull via a right posterior parietal burr hole. It courses down the scalp, neck and anterior chest wall entering the abdomen and coiling in the pelvis. Portions of the shunt overlying the skull are relatively radiolucent and hence difficult to evaluate but we see no evidence of complication. The notch on the pressure valve points anteriorly with a performance level of 1.0, similar to prior study.Again seen is a spinal shunt with its tip coiled at the level of the L1. It courses caudally and exits the spinal canal at the level of L3-L4. It then courses along the right flank. It terminates high in the right upper quadrant and the tip is projected over the dome of the liver. Portions of the shunt are relatively radiolucent and difficult to evaluate but are similar to prior. The notch of the pressure valve points to the 12 o'clock position with a pressure of 200 mm of water, similar to prior study.SKULL: Evaluation is limited by overlying artifact from patient's braids. No abnormality is identified. Impacted molars are noted and appear similar to prior study.CERVICAL SPINE: There is a defect in the posterior arch of C1 which is presumably postoperative. CHEST: The lungs are clear.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Shunt device is as described above appearing similar to prior study.


Instruction: Generate impression based on medical findings.

Input: Age: 71 yearsGender: MaleReason for Study: Reason: evaluate shortness of breath History: shortness of breath Right IJ venous catheter with its tip in the RA.Stable cardiomediastinal silhouette. Lung bilateral pleural effusions and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: No significant interval change in the moderate-sized pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: check pulmonary status History: check pulmonary status Enteric tube extends inferiorly off the field-of-view. Mild basilar atelectasis or scarring again noted. Small pleural effusions. Focal nodule again noted in the upper aspect of the right lung. Unchanged cardiomegaly. No pneumothorax

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement. The previously seen IABP radiodense marker seen on the prior chest radiograph at time stamp 1906 is no longer visualized on the current study and presumably repositioned. The lower abdomen and pelvis are excluded from the field-of-view.

Output: IABP marker not definitively seen and presumably repositioned.


Instruction: Generate impression based on medical findings.

Input: 46 years old Male. Reason: Assess ETT History: PEA arrest intubated. Endotracheal tube tip is approximately 2 cm above the carina. Additional lines and support devices are not significantly changed. Bibasilar subsegmental atelectasis and right midlung streaky opacity. Mild cardiomegaly. Spinal fixation hardware is stable in position.

Output: Suboptimal position of the endotracheal tube. Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: r/o PNA History: altered mental status Bilateral multifocal nodular airspace opacities, markedly increased from the prior exam, likely representing progression of metastatic disease.Mild pulmonary edema.Stable cardiomediastinal silhouette.

Output: Interval progression of metastatic disease with mild edema but no signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: desaturations History: desaturations The heart size but upper normal with bilateral airspace and interstitial opacity compatible with edema, slightly increased.PICC line tip in the area of the left subclavian vein.

Output: Increased pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Evaluate for pneumonia History: Neutropenic, ?SIRS Left-sided PICC is looped on itself within the left subclavian vein. No focal lung consolidation or evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. Unchanged heart size. Aortic atherosclerosis again noted. Stigmata of previous granulomatous disease.

Output: Left-sided PICC is looped on itself within the left subclavian vein. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female status post device placement in EP lab. Evaluate for pneumothorax. Interval placement of left chest wall AICD with sternal lead in place. Adjacent subcutaneous edema extending to the left chest wall and neck.Slightly decreasing bibasilar opacities and pleural effusions. Bilateral opacities suggestive of interstitial disease similar to prior. No pneumothorax. Unchanged enlarged cardiac mediastinal silhouette.

Output: No pneumothorax post pacemaker device placement. Subcutaneous emphysema. Improving bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulm abn? History: chest pressure Normal heart size with a prominent left pericardial fat pad, but no evidence of pleural effusion or air space opacity.Mild eventration of the right hemidiaphragm.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: eval volume status History: fever Stable borderline cardiac enlargement.Low lung volumes with basilar atelectasis.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Shortness of breath. No pulmonary opacities, pleural effusions, or pneumothorax.Mild cardiomegaly.

Output: Mild cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Status post mitral valve replacement for mitral stenosis, rheumatic mitral valve disease Status post mitral valve replacement.Mild cardiomegaly is unchanged.Stable bibasilar atelectasis/scarring and nodular thickening along the right apex.No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.