Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p anterior mediastinal mass resection Small lung volumes with basilar atelectasis.Chest tubes in place with no significant pneumothorax.Right jugular catheter tip in the area of the right innominate vein.

Output: Postoperative basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: hypoxia History: hypoxia Cardiomegaly with moderate edema like opacities versus aspiration, left side predominant.Left subclavian ICD, leads unchanged in position.

Output: Persistent pulmonary opacities suggestive of edema and/or aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o mets History: Renal cell carcinoma Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size at the upper limit of normal.

Output: No acute cardiopulmonary process on radiography. No convincing evidence of metastatic disease within the thorax on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: 76 year old woman wiht history of cardiac surgery complicated by sternal wound infection History: - Stable line position. No change in postoperative changes. No specific evidence of infection or edema. No pneumothorax.

Output: Stable line position. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: assess for pulm edema, pna History: lvad patient, dizziness, CP/abd pain, SOB Patient is status post sternotomy. Left-sided ICD lead, mitral valve prosthesis, and LVAD components are seen. Right IJ central venous catheter tip in the right atrium. Fractured wire in the right neck again demonstrated. Coronary stents are again seen. Surgical clips seen overlying the mediastinum and right upper lung.Marked cardiomegaly unchanged. No large pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with cholangiocarcinoma. Fever, tachycardia The examination is limited by lack of IV contrast.CHEST:LUNGS AND PLEURA: Calcified mediastinal lymph nodes and right upper lobe granuloma.A few nodular opacities have developed in the superior segments of the lower lobes.MEDIASTINUM AND HILA: Calcified mediastinal node. Cardiophrenic node is now enlarged (series 4; image 72)Coronary artery calcifications.Visualization of the cardiac walls suggest mild anemia.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: A metallic biliary stent drains the left biliary system and extends into the duodenum. Expected pneumobilia is seen. Mild biliary ductal dilatation is not grossly changed on this noncontrast study.Multiple ill-defined hypodense lesions are seen throughout the liver, increased in size. Hepatomegaly. Two foci of capsular retraction are now seen, likely due to treatment.SPLEEN: Splenic granulomata.PANCREAS: Pancreatic lipoma.ADRENAL GLANDS: No significant abnormality.KIDNEYS, URETERS: Hypodensity in the midpole the right kidney is unchanged, consistent with a cyst. Incidental note is made of a retroaortic left renal veinRETROPERITONEUM, LYMPH NODES: The reference portacaval lymph node measures approximately 2.5 x 1.8 cm (series 4; image 105), not significantly changed. Mildly enlarged gastrohepatic lymph nodes are again identified.Index aortocaval lymph node measures 10 x 8 mm (series 4; image 110), not significant changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Infrarenal atherosclerotic disease.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hypodensities within the liver have increased, compatible with progression of disease. Patchy lower lobe opacities suggestive of aspiration, though infection could provide a similar appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op fever History: post-op fever Unremarkable cardiac and mediastinal silhouette. Focal scar like opacity in the left base but no sign of pneumonia or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Cough, CHF, AMS. Evaluate edema/infiltrate. Interval removal of right jugular catheter.Lung volumes remain low with basal atelectasis or scarring.Retrocardiac atelectasis.No convincing evidence of pneumonia or pulmonary edema.

Output: No specific signs of pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male 63 years old Reason: Evaluate for edema, pna History: Hypoxia, hx of ILD Chronic appearing basilar predominant interstitial opacities appear similar to the prior study, without new superimposed consolidation. No pleural effusion or pneumothorax is evident. The cardiomediastinal contours are unchanged.

Output: Chronic interstitial opacities consistent with fibrosis appearing similar to the prior study.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Eval for cardiopulmonary disease. History: CP No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old. Dobbhoff tube tip in the stomach.Moderate cardiomegaly with basilar opacity compatible with effusions and atelectasis possibly slightly increased but accentuated by differences in projection and position.Dense calcification in the mitral annulus.

Output: Dobbhoff tube tip in the stomach.


Instruction: Generate impression based on medical findings.

Input: Reason: LVAD History: LVAD placement Swan-Ganz catheter tip in the area of the main or proximal left pulmonary artery with the tip blurred by pulsation artifact.Other devices unchanged.Marked cardiomegaly with subsegmental atelectasis or scarring at the left base and no acute change.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: fever Tracheostomy tube in place.Severe scoliosis.No sign of pneumonia or other acute pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Questionable bleeding in thorax post VAD. Lung evaluation. Layering fluid collection in the right hemithorax slightly improved. Adjacent atelectasis, also improved. Right basal chest tube may have been repositioned slightly, but other hardware and devices appear similar.

Output: Slight improvement in nonspecific pleural fluid and atelectasis on the right.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: hx of hemoptysis vs regurgitation of blood x 2 days. Eval for lesion/nodule, TB or infiltrate. History: hemoptysis No pleural effusion or pneumothorax. Left apical scarlike opacity. Otherwise, no focal pulmonary opacities. The cardiac mediastinal silhouette is within normal limits. Ectatic descending thoracic aorta.

Output: No acute cardiopulmonary abnormality. If hemoptysis persists, further evaluation with chest CT may be warranted.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity.Marked nonspecific cardiomegaly without superimposed new acute disease observed. Lung volumes are mildly larger yet remain decreased

Output: Cardiomegaly without new acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval infection History: chest discomfort New 1 cm nodule in between the anterior fifth and sixth ribs, best seen on bone subtraction images. This lesion demonstrates a probable correlate on the lateral radiograph overlying the anterior aspect of the heart. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: New 1 cm nodule within the right middle lobe. Further evaluation with chest CT is suggested. Findings were verbally discussed with Dr. Sridharan at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o cardiopulm abnormality History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: is there an infiltrate History: cough, history lupus Heart normal.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Tracheostomy tube placement. The tracheostomy tip is between 7 and 8 cm above the carina. LVAD position is unchanged. Moderate cardiomegaly. Persistent tiny bilateral pleural effusions with bilateral multifocal atelectasis.

Output: Tiny bilateral pleural effusion with multifocal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: assess swan History: swan Right jugular catheter tip in the area of the jugular vein at its junction with the brachiocephalic vein, and interval removal of the Swan-Ganz catheter.Small lung volumes with nonspecific basilar opacities compatible with atelectasis and consolidation, not significantly changed.No new findings.

Output: Catheter tip in the area of the right jugular vein.


Instruction: Generate impression based on medical findings.

Input: ETT check ETT terminates 3 cm above the carina. NG and right jugular catheters appear unchangedRetrocardiac opacity representing partial consolidation versus suspected collapse and atelectasis, mixed with nonspecific changes suggesting superimposed edema and small effusions are again observed. Borderline cardiomegaly

Output: Persistent cardiopulmonary appearance with more suspected collapse and atelectasis of the left lower lobe; however again serial imaging is needed to confirm clearance and absence of the left lower lobe more acute process


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Status post sternotomy, malignant neoplasm of mediastinum, evaluate lung fields. Mediastinal drains and bilateral chest tubes in place. Right subclavian chest port tip at the SVC/RA junction. A right jugular introducer terminates at the confluence of the brachiocephalic veins. No significant pneumothorax. Mild atelectasis or pulmonary contusion, left greater than right. Minimal pneumomediastinum with subcutaneous emphysema extending to the neck.

Output: No significant pneumothorax. Mild pulmonary opacities may be the result of intraoperative contusion or atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.History of breast malignancy Outside radiograph dated 3/23/2016 from Porter regional Hospital and chest the cardiomediastinal silhouette to be unremarkable.There is tortuosity of the aorta.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: pna? delirium History: delirium The cardiomediastinal silhouette is unremarkable.Minimal scarring/discoid atelectasis at the left lung base.No focal areas of consolidation.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: Eval Swan placement History: ADHF Right IJ Swan-Ganz catheter is now looped in the right atrium, terminating in the pulmonary outflow tract. This has been successfully repositioned on subsequent radiograph.Basilar opacities not significantly changed, greater on the right, likely resolving edema. Trace right pleural effusion. No pneumothorax.

Output: Right IJ Swan-Ganz catheter is coiled in the right atrium, successfully repositioned on subsequent radiograph.


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited in range of coverage and field of view.LUNGS AND PLEURA: No consolidation, pleural effusion, or pneumothorax are identified in the visualized portion of the lungs.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy is identified.CHEST WALL: No abnormalities are noted within the visualized portion of the chest wall.UPPER ABDOMEN: Kidneys enhance symmetrically. No significant abnormalities identified within the visualized portion of the upper abdomen.

Output: 1.No significant abnormalities in the visualized extra cardiovascular structures.2.Please refer to the cardiology report for interpretation of the images of the heart and aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: hx CVA, here with respiratory failure, s/p ett History: ett in place, respiratory failure ET tube tip 5 cm above carina. Venous catheter tip at RA/SVC junction. NG tube tip in stomach.Increasing opacity on the right. Hyperlucency with sharp contrast along right mediastinal margin may represent an anteromedial pneumothorax, continued follow-up is recommended.

Output: Increasing opacity on the right. Hyperlucency with sharp contrast along right mediastinal margin may represent an anteromedial pneumothorax, continued follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval lung consolidation/effusion Moderate left pleural effusion again noted, stable in appearance from prior. Stable position of right pigtail pleural catheter. No residual pneumothorax.Stable position of tracheostomy cannula and right IJ central venous catheter overlying the distal SVC. The left subclavian central venous catheter overlies the superior cavoatrial junction.The cardiac and mediastinal contours are obscured. Assessment of the lungs is limited. Left basilar consolidative opacities may represent passive atelectasis.

Output: Persistent moderate left pleural effusion with passive left basilar subsegmental atelectasis. Assessment of the lungs limited by presence of pleural fluid.Stable position of support apparatus. No residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: pre-op History: pre-op Stable cardiomediastinal silhouette. Calcified aortic knob.Nonspecific evidence of infection or edema. No large pleural effusion or pneumothorax.Stable scoliotic curvature of the thoracolumbar spine.

Output: Stable appearance of the chest with no evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Tracheostomy tube Tracheostomy tube remains 4 cm above the carina. Right PICC line extends into the proximal SVC.Underlying cardiopulmonary appearance is also similar with a moderate right and smaller left effusion with underlying compression atelectasis. No discrete new superimposed focal airspace process in this limited evaluation

Output: Unchanged tracheostomy tube


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: SOB History: SOB Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: ETT placement History: ETT present Unchanged pulmonary opacities and pleural effusions, right greater than left.ET tube tip approximately 5 cm above the carina.

Output: ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: s/p cardiac surgery - eval lung fields History: s/p cardiac surgery Small lung volumes with diffuse nonspecific opacity consistent with edema or aspiration, stable to slightly increased.

Output: Small lung volumes with diffuse nonspecific opacity consistent with edema or aspiration, stable to slightly increased.


Instruction: Generate impression based on medical findings.

Input: PICC line placement New left PICC line projects into the mid subclavian. Right jugular catheter unchangedUnderlying cardiopulmonary appearance is essentially similar with only mild improved aeration in the left lower lung. Bilateral nonspecific opacities persist with effusions

Output: New left PICC line


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: assess for effusion, consolidation s/p EVAR day #10, now hypotensive History: hypotension Status post TAVR.Small lung volumes with basilar atelectasis left greater than right, minimally improved.No new findings.Lumbar spinal stabilization hardware unchanged.

Output: Minimal improvement in left basilar atelectasis. Status post TAVR.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: 38yo F w/ NSIP and dyspnea, please eval for infiltrate History: dyspnea Coarse bilateral interstitial opacities suggestive of chronic fibrosis are again noted. There is increased opacity in the left lung base, suggestive of interval worsening of fibrotic lung process. Superimposed infection is considered less likely. These findings are better evaluated on subsequent CT. Stable cardiomediastinal silhouette.

Output: Findings of chronic fibrosis are redemonstrated, with likely worsening in the left lower lobe. Superimposed infection in the left lower lobe is considered less likely. These findings are better evaluated on subsequent CT.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: MaleReason for Study: Reason: aspiration History: aspiration ET tube and NG tube have been removed.Stable cardiomediastinal silhouette.Mild basilar atelectasis unchanged.No new pulmonary opacities identified.

Output: Interval extubation. Stable cardiopulmonary appearance without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 79-year-old female history of FL. Please restage. Makes sure to include right axillary masses fully. CHEST:LUNGS AND PLEURA: Emphysematous changes apical pleural thickening calcifications redemonstrated. There is a small right pleural effusion, decreased compared to the prior exam.MEDIASTINUM AND HILA: Scattered nodes seen in the superior and middle mediastinum, right cardiophrenic area and right hilum. Index precarinal nodes measure 28.5 x 2.5 mm in cyst image 46. Previously measured 28.3 x 18.2 mm.CHEST WALL: A Multifocal right axillary masses some cystic in nature. The previously measured index mass in the right axilla is completely included in the scan field-of-view MR accurately measured on this exam as 58.7 x 42.3 mm as seen on series 3 image 37 although the long axis cannot be compared with in the short axis, it increased in size somewhat.There are clusters of small left axillary nodes minimally more prominent.Port-A-Cath right chest wall.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: Extensive retroperitoneal adenopathy redemonstrated. Reference left periaortic node is present image 125 measures 21.5 x 15.6 mm. Previously measured 22.3 x 18.2 mm.Node in the portacaval region is very irregular in shape. It is estimated at 22.2 x 8.9 mm on series 2 image 126. Previously measured 21.6 x 10.9 mm.Single discrete left periaortic node measures 17.8 x 12.1 mm in series 3 image 136 compared to 18.7 x 10.9 mm the prior exam. Visually, the overall extent of the confluent retroperitoneal adenopathy is similar to the heart or prior exam. It extends caudally to involve the common iliac chains as well.BOWEL, MESENTERY: Scattered nodes and mesenteric pathologic in size and clustering but stable compared to the prior exam.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: Bilateral common iliac adenopathy unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No new sites of disease. Measurements as above.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Intubated and sedated, assess position of balloon pump. IABP marker projects of the proximal descending thoracic aorta approximately 2-cm below the top of the aortic arch. Left subclavian ICD unchanged in position. No focal pulmonary opacities.

Output: IABP projects over the proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: evaluate for pneumothorax and resolution of effusion s/p thorac History: SOB, tachypnea The cardiomediastinal silhouette is obscured.Interval decrease in moderate to large right pleural effusion with adjacent compressive atelectasis. Small left pleural effusion and left basilar atelectasis appears similar to prior. No pneumothorax.

Output: Interval decrease in right pleural effusion with adjacent compressive atelectasis. Small left pleural effusion and left basilar atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.ETT. Endotracheal tube approximately 2.5-cm above the level of the carina. A nasogastric tube is present. Esophageal probe projects over the lower cervical esophagus.Hazy opacities in the lung bases, left greater than right, about the same suggestive of scarring and superimposed aspirate.

Output: No acute change in pulmonary findings. ETT 2.5-cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Cough, neutropenic, evaluate for pneumonia. Lung volumes remain low with significant atelectasis and dependent changes. Unchanged appearance of the cardiomediastinal silhouette. Right apical/paramediastinal lesion unchanged.

Output: No significant change in right upper lobe consolidation which remains highly suspicious for fungal pneumonia.


Instruction: Generate impression based on medical findings.

Input: ETT placement ETT placed, tip projects into the left mainstem bronchus. Subsequent images demonstrate repositioning. NG tube projects. Inferior to the image, side port not visualized and presumed inferiorNonspecific mixed interstitial and airspace opacities greater on the right in a perihilar distribution. Concern for infection versus edema is high. See subsequent reports

Output: ETT projects in the left mainstem bronchus


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: Eval for pneumothorax History: S/P Pericardial Stripping Left chest tubes with no pneumothorax. Unchanged patchy basilar opacities.Left jugular introducer removed.Right jugular catheter, tip at right atrial level.

Output: Unchanged pulmonary opacities. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 14 year old female history of sickle cell disease, now with pre-stem cell transplant evaluation.EXAMINATION: CT chest/abdomen/pelvis 02/10/11 CHEST:LUNGS AND PLEURA: No focal pulmonary opacities or pleural effusions are noted.MEDIASTINUM AND HILA: The cardiac size is within normal limits. No pericardial effusion is noted. No significant abnormalities are noted of the aorta or great vessels. No significant mediastinal or hilar lymphadenopathy is noted.CHEST WALL: The osseous and soft tissue structures are within normal limits.Small subcentimeter lymph nodes are seen in the axillas.ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder are within normal limits.SPLEEN: The spleen is normal in size, and measures 10 cm in superior-inferior dimension.PANCREAS: The pancreas is within normal limits.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: No significant abnormality of the kidneys or ureters is notedRETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy is noted.BOWEL, MESENTERY: No significant abnormality of the bowel or mesentery is noted.BONES, SOFT TISSUES: No significant abnormality of the osseous or soft tissue is noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality is noted.BLADDER: No significant abnormality is noted.LYMPH NODES: No significant lymphadenopathy is noted.BOWEL, MESENTERY: No significant abnormality is noted.BONES, SOFT TISSUES: No significant abnormality is noted.OTHER: No significant abnormality noted.

Output: Normal exam of the chest, abdomen, and pelvis.


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with history of metastatic prostate cancer, status post treatment with drug induced pneumonitis CHEST:LUNGS AND PLEURA: One bilateral numerous, patchy foci of ground glass opacity in both lungs still persists, however, decreased in severity, size and number.MEDIASTINUM AND HILA: Index prevascular lymph node is significantly smaller and now measures 1.3 by 0.7 cm on image number 32, series number 3. Other mediastinal and hilar lymph nodes are also smaller.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: Index left para-aortic retroperitoneal lymph node is smaller measuring 2.1 by 1.3 cm on image number 119, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis.

Output: Interval decrease in the size of the mediastinal and retroperitoneal index lymph nodes.Interval decrease in the size, severity and number of bilateral patchy, groundglass opacities in both lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval for evidence of PNA History: cough Increasing retrocardiac consolidation with a left pleural effusion. Heart is size upper normal.Left PICC, tip at the SVC/RA junction level.Right jugular catheter tip in or at level.Tracheostomy tube tip approximately 5 cm above the carina.

Output: Increasing left lower lobe consolidation and left pleural effusion, consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Malignant neoplasm of lung, unspecified/H/O of right lobectomy History: Malignant neoplasm of lung, unspecified/H/O of right lobectomy Heart size upper normal.No evidence of new or recurrent tumor status post right lower lobectomy.Left subclavian pacemaker, leads unchanged in position.

Output: No evidence of new or recurrent tumor, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: effusions History: effusions Lower lung zone opacities with pleural effusions unchanged.Tracheostomy tube tip approximately 3 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

Output: Unchanged basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 71-year-old man with metastatic melanoma and lung cancer. Staging exam. CHEST:LUNGS AND PLEURA: Small pulmonary nodule in the posterior aspect of the right upper lobe as seen on image 47/120. Postoperative changes in the left hemithorax with a loculated effusion anteriorly and a moderate sized posterior effusion.MEDIASTINUM AND HILA: Mediastinal and hilar lymphadenopathy of indeterminate etiology with reference node as seen on image 51/231 measuring 1.6 x 0.9 cm in size.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No parenchymal lesions in the liver. The gallbladder appears normal in appearance. No evidence of intrahepatic or extrahepatic ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small nonobstructive calculus in the left kidney. No evidence of hydronephrosis.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: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Multiple diverticula noted in the large bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Hilar and mediastinal lymphadenopathy of indeterminate etiology. Otherwise, no evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Hypoxia. Bilateral laterally airspace lower lung opacities may reflect aspiration/infection. Small left pleural effusion. No pneumothorax. Right jugular catheter tip over the SVC. ET tube is 4 cm above the carina. NG tube overlies the stomach. Heart size within normal limits.

Output: Bilateral lower lobe opacities suggestive of aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: evaluate central line placementAlso c/f PNA History: see above Left chest ICD and ICD lead are unchanged. Interval placement of right central catheter with tip in SVC. No pneumothorax or large pleural effusion. Increased interstitial opacity and bronchial wall thickening in the lung bases secondary to edema.

Output: Right internal jugular catheter with tip in the SVC. Increased interstitial opacity and bronchial wall thickening in the lung bases may be secondary to edema.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: eval for pna/edema/effusion History: chest pain Poorly-defined right apical 3.4 x 4.2 cm mass. No pleural effusion or pneumothorax. Normal heart size. No acute bony abnormality.

Output: Probable right apical lung cancer. Correlation with chest CT is suggested. Dr. Sachedina was informed of this expected finding at 8:55 AM on 10/29/2015.


Instruction: Generate impression based on medical findings.

Input: Reason: Size of pericaridal effusion? History: pericardial effusion on TTE Normal heart size and mediastinal contours, not significantly changed from previous.Status post median sternotomy.No significant pulmonary abnormalities.

Output: No evidence of a large pericardial effusion or other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: pna? History: chest tightness, SOB, bad asthma history, multiple intubations Stable cardiomediastinal silhouette. Streaky bibasilar airspace opacities, unchanged. No pleural effusion or pneumothorax.

Output: Streaky left basilar airspace opacity, consistent with subsegmental atelectasis, stable compared to prior exams.


Instruction: Generate impression based on medical findings.

Input: Female 19 years old; Reason: Evaluate for acute chest syndrome or other cardiopulmonary process. History: Patient with known sickle cell disease who presents with chest pain and shortness of breath.VIEWS: Chest AP/lateral (two views) 82,016 at 1017 The cardiomediastinal silhouette is at the upper limit of normal. Mild prominence of pulmonary vasculature remains unchanged. No focal airspace opacities, pleural effusion or pneumothorax is seen. Surgical clips are seen in the right upper quadrant.

Output: No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: s/p lung biopsy, evaluate pneumothorax History: s/p biopsy Small right pleural drain with a small to moderate right pneumothorax following recent biopsy.Dense pulmonary fibrosis unchanged.

Output: Small to moderate right pneumothorax following biopsy.


Instruction: Generate impression based on medical findings.

Input: 72-year-old male with metastatic squamous cell carcinoma CHEST:LUNGS AND PLEURA: Emphysema, unchanged. Scattered micronodules unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Index left axillary lymph node measures 2.3 by 1.5-cm image number 16, series number 3, minimally increased in size compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Multiple cysts in the liver are unchanged. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm with small intramural thrombus is unchanged measuring 3.5 x 3.2 cm in its largest axial dimensions.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: 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: Minimal interval increase in the size of the left axillary lymph node otherwise no other significant change.


Instruction: Generate impression based on medical findings.

Input: Female 27 years old Reason: pneumonia History: diminished lung sounds right. History HIV No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old, concern for pneumonia with history of flu-like symptoms and productive cough. No significant pulmonary or pleural disease. No evidence of pneumonia.Cardiac size is at the upper limits of normal. There is stable tortuosity of the thoracic aorta.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: s/p dual chamber pacemaker r/o pneumothorax History: s/p dual chamber pacemaker r/o pneumothorax New left-sided dual chamber pacemaker with leads in the right atrial appendage and right ventricular apex. No evidence of pneumothorax. Other findings stable.

Output: New left-sided dual chamber pacemaker with leads in the right atrial appendage and right ventricular apex. No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: s/p ICD placement History: s/p ICD placement Moderate cardiomegaly with small lung volumes.New left subclavian single chamber ICD placed without complication.

Output: Uncomplicated ICD placement.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: post thoracentesis r/o pneumothorax History: s/p thoracentesis Cardiopulmonary monitoring and support devices are unchanged.Interval increase in near-complete opacification of the left hemithorax with dense superior consolidation and moderate left pleural effusion.Persistent right upper lobe opacities, with increased right basilar opacity, suggestive of atelectasis.No pneumothorax is identified.

Output: Interval increase in near complete opacification of the left hemithorax compatible with large effusion and progressive collapse of the left lung, without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: MaleReason for Study: Reason: r/o pleural effusions History: shortness of breath The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: 75 years old Male. Reason: desat History: desat. Hypoinflated lungs with bibasilar atelectasis which are new as compared with the prior study. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardia silhouette is not remarkable.

Output: Hypoinflated lungs is bibasilar atelectasis, new as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: right chest pain History: right chest pain Left-sided ICD unchanged.Stable cardiomediastinal silhouette.Increased lung volumes are compatible with COPD.Lungs are clear without focal opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: empyemaVIEW: Chest AP Right upper extremity PICC with tip in the right atrium. Left chest tube in place. Cardiothymic silhouette normal. There is patchy opacities in the left lung not significantly changed. The left basal pneumothorax has increased. There is a small left-sided pleural effusion unchanged. Mediastinal shift from left to right again noted. There is extensive subcutaneous emphysema at the left supraclavicular region and left lateral chest wall.

Output: Left basal pneumothorax has increased from prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p graft removal History: s/p iabp graft removal Radiopaque gauze/packing material is noted overlying the left chest.Right venous catheter tip in right brachiocephalic vein. Small pleural effusions and basilar atelectasis are stable.

Output: Radiopaque gauze/packing material is noted overlying the left chest.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: Assess for aspiration, infiltrate History: syncope, vomiting, wheezing, hypoxia No significant cardiopulmonary abnormality.A drain appears to traverse the esophagus down to the level of the diaphragms, have been percutaneously.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: eval for pulmonary edema History: dyspnea Basilar opacities and pleural effusions are nonspecific. Heart size normal.

Output: Nonspecific basilar opacities with pleural effusions, which could be the result of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: FemaleReason for Study: Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT POD#2 Status post right lung transplant.ET tube and Swan-Ganz catheter have been removed with right IJ introducer in place.Right-sided chest tubes unchanged.No evidence of a pneumothorax with subcutaneous emphysema noted along the right lateral chest wall.Stable cardiomediastinal silhouette.Mild interstitial opacities in the right lung and the prior exam.Emphysema in the native left lung redemonstrated.

Output: Interval extubation and removal of Swan-Ganz catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Desaturation, trach, inhalational injury. Lung volumes remain low. Tracheostomy tube 6 cm above the level of the carina. Dobbhoff and nasogastric tubes terminate off the caudal margin of the film but can be partially visualized looped in the left upper quadrant overlying the stomach.Basal and dependent atelectasis with hazy opacity suggesting mild pulmonary edema. Persistent retrocardiac consolidation. No pneumothorax.

Output: Mild pulmonary edema. Left lower lobe consolidation, correlate for signs of pneumonia. Dependent atelectasis. ETT 6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate History: hypoxemic resp failure Small lung volumes with diffuse nonspecific airspace and interstitial opacity consistent with chronic interstitial lung disease, as shown on a previous CT scan, possibly with superimposed edema or infection.No significant interval change.

Output: Diffuse chronic interstitial disease with possible superimposed edema or acute exacerbation


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: trach, rhonchorous breath sounds History: trach No significant change in basilar opacities. Stable mild cardiomegaly.Stable line position.No pneumothorax.No change in appearance of dilated bowel below the diaphragm.

Output: No significant interval change in basilar opacities. Dilated bowel again noted. Abdominal series suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Chronic airway obstruction check pulmonary status. Multifocal atelectasis. Moderate volume of pleural fluid bilaterally, right greater than left with associated atelectasis. Right jugular catheter unchanged in position. Interval extubation removal of feeding tube.Partially visualized catheter and staples in the upper abdomen.

Output: Pleural effusions and multifocal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.History of type B dissection. The distance between the lateral margin of the aortic arch and lateral margin of the aortic stent measures approximately 1 cm.On lateral view, the distance between the distal posterior superior aspect of the aortic arch and the aortic stent is approximately 2.2 cm.Mild left basilar subsegmental atelectasis or scarring. Mild cardiomegaly.

Output: Evaluation of dissection on radiography is quite difficult. This would be better evaluated using contrast-enhanced thoracic CTA.Chest radiographic evidence of type B aortic dissection with vascular stent likely within one of the lumens. No comparisons are available for review which makes it impossible to discern whether the dissection has worsened since previous studies.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: right lung biopsy, is there pneumothorax? History: none Trace right apex pneumothorax. Pigtail chest tube directed towards right apex.Extensive emphysema. Right sided lung mass.

Output: Trace right apex pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: f/u CXR History: f/u CXR Enteric tube has been removed. Other devices are substantially different. Mild pulmonary edema again noted. Patchy bibasilar opacities and pleural effusions, unchanged. Unchanged heart size.

Output: Interval removal of enteric tube. No change in mild pulmonary edema and patchy bibasilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male 74 years old Reason: icu History: icu Interval extubation and removal of right IJ Swan-Ganz catheter, the sheath remains in place.Sternotomy hardware, right chest tube and mediastinal drains are unchanged in position.Stable cardiomediastinal silhouette.Bibasilar atelectasis, small left and loculated right pleural effusion appear similar to the prior exams.

Output: Interval extubation and removal of Swan-Ganz catheter. Atelectasis and pleural effusions are not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Reason: Lung Transplant Evaluation History: sob The comparison chest radiograph performed on 8/6/2015 demonstrates interstitial opacities compatible with known pulmonary fibrosis. There is more severe disease in the left lower lobe.The ventilation images show mild decreased ventilation at the bilateral lung apices. There is no abnormal Xe-133 retention during the wash-out phase. Decreased perfusion of the right upper lobe and left lung, particularly lower lobe.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 39.1% (upper segment 6.0%; middle segment 18.5%; lower segment 14.7%)Right lung: 60.9% (upper segment 12.2%; middle segments 30.3%; lower segment 18.4%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 17.3% (upper segment 7.8%; middle segment 7.1%; lower segment 2.3%)Right lung: 82.7% (upper segment 13.8%; middle segments 39.6%; lower segment 29.3%)

Output: Marked decrease perfusion of the left lung, particularly lower lobe. Quantification as above.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Cough. Evaluate for pneumonia. Cardiomediastinal silhouette is normal. Large lung volumes suggestive of COPD. No focal pulmonary opacities or pneumothorax. Bilateral small pleural effusions. Right lower lobe nodular opacities favored to represent costochondral junction rather than a pulmonary nodule, as demonstrated on substracted images.

Output: Bilateral small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: r/o infection History: weakness Left Port-A-Cath with its tip in the SVC.Stable cardiomediastinal silhouette.Multiple pulmonary nodules compatible with known metastatic disease.Increasing right upper lobe and perihilar opacity palpable with tumor progression.Apical pleural thickening without evidence of pleural effusions.

Output: Redemonstration of extensive pulmonary metastatic disease with interval increase in right upper lobe/perihilar mass. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Malignant pleural effusion status post chest tube. Mesothelioma of pericardium. Cardiomegaly unchanged. Straightening of the lateral left mediastinal border consistent with pericardial fluid.Patchy basal opacities, left greater than right, unchanged.Left chest tube unchanged in position directed inferiorly in the cardiophrenic angle. No measurable pneumothorax.

Output: No measurable pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: central line placement History: central line - RIJ Mild leftward patient rotation. Mild bibasilar subsegmental atelectasis or scarring. Heart is likely normal. No large pleural effusion. No pneumothorax.

Output: Right IJ line placement without evidence of pneumothorax. Mild bibasilar subsegmental atelectasis or scar.


Instruction: Generate impression based on medical findings.

Input: Age: 41 yearsGender: MaleReason for Study: Reason: r/o acute process History: sob There is mild cardiac enlargement with pulmonary vascular redistribution.Perihilar interstitial opacities and bronchial wall thickening are noted.No focal areas consolidation.No pleural effusions.

Output: Mild cardiac enlargement, pulmonary vascular redistribution, and perihilar interstitial opacities with bronchial wall thickening may represent edema or less likely infection. ED was notified by phone at 9:15 AM.


Instruction: Generate impression based on medical findings.

Input: 40 year-old female with autoimmune hemolytic anemia with new night sweats, weight loss, wheezing. The infection the lymphadenopathy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small nodes not pathologic by size criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Splenomegaly to 15.1 cm as seen on coronal image 47/115 slightly more prominent on the prior exam when the spleen measured 13.2 cm on coronal image 35/96. Note that the accessory spleen is also increased in size and measures about 2.2 cm in diameter and coronal image 75/115 with on the prior exam it measured 1.6 cm on coronal image 5/96.Wedge-shaped hypoattenuating infarct is decreased in size. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Sub-centimeter hyperattenuating foci too small to characterize likely cysts and unchanged.RETROPERITONEUM, LYMPH NODES: Shotty portacaval and retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Prominent left ovary possibly due to a hypoattenuating lesion consistent with a cyst. Right ovary is normal. Uterus normal.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: Increase in size of spleen. Probable right adnexal cyst.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: COPD, CHF, lung CA increasing oxygen requirement. Large right pleural fluid collection, increased from prior. Masslike opacity in the right upper lobe similar to a recent CT scan.. Left paramediastinal opacity suggestive of evolving radiation reaction. Left chest port partially obscures the underlying lung parenchyma. Port tip at the level of the SVC. Right subclavian dual-chamber pacemaker unchanged. Small volume of pleural fluid on the left similar to prior.

Output: Large right pleural fluid collection, increased from the prior study. This could be the result of underlying metastatic disease or superimposed acute pathology such as a pulmonary embolus.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Recent Swan-Ganz catheter placement. The right IJ Swan-Ganz catheter has been retracted and now overlies the distal right pulmonary artery.Very low-lying ET tube recently placed, overlying the carina. Recommend retraction at least 4 cm.Moderate right pleural effusion, unchanged.Trace bilateral basilar interstitial pulmonary edema.

Output: Recommend retraction of ET tube which overlies the carina.Adequate repositioning of Swan-Ganz catheter, now overlying the distal right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: is there pul edema History: chest pain Heart size about upper normal.No sign of pulmonary edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and fever Mild nonspecific cardiomegaly without additional cardiopulmonary abnormality

Output: Borderline mild cardiomegaly, decreased from prior study, likely representing decreased circulating volumes


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: assess for ETT position, changes in pulmonary opacities History: s/p intubation, chronic necrotizing aspergillosis Endotracheal tube approximately 4 cm above the carina. Additional lines and support devices, unchanged.Unremarkable cardiomediastinal silhouette.Severe emphysema. Right upper lobe cavity and mycetoma, not significantly changed. Nonspecific patchy basilar and left midlung zone patchy opacities compatible with infection/aspiration, not significantly changed.

Output: Basilar predominant opacities compatible with aspiration/infection, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Intubated on ECMO please evaluate lines. Endotracheal tube tip 4 cm above the level of the carina. Right jugular Swan-Ganz catheter tip at the pulmonary outflow tract near the main pulmonary artery level. Mediastinal drains and a left basal chest tube are unchanged in position. ECMO cannula from an IVC approach can be visualized to the superior cavoatrial junction level with side ports at the cranial aspect of the right atrium. Left subclavian IABP marker projects 4 cm below the top of the aortic arch.Moderate perihilar edema. Right middle lobe atelectasis. Retrocardiac opacity on the left unchanged.

Output: Tubes and lines similar in position; the Swan-Ganz catheter has been slightly pulled back, in the right ventricular outflow tract near the main pulmonary artery. Edema and atelectasis about the same.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: assess for infiltrate History: cough Questionable opacity at the left lung base likely represents confluence of shadows. Incidental note made of azygous lobe. Normal heart size. No large pleural effusion or pneumothorax.

Output: Questionable opacity at the left lung base likely represents confluence of shadows.


Instruction: Generate impression based on medical findings.

Input: DKA No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: Mitral Valve repair History: Mitral Valve repair Interval removal of a Swan-Ganz catheter.Cardiomegaly with basilar opacity consistent with atelectasis and small effusions. No pneumothorax or other acute change.

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fluid overload, PNA History: SOB, known COPD New lower zone interstitial and airspace opacity with blunting of the costophrenic angles consistent with small pleural effusions.Normal heart size with an aneurysm of the descending aorta, not appreciably changed.Evidence of previous left thoracotomy.No sign of pneumonia.

Output: Basilar opacity and pleural effusions consistent with fluid overload.


Instruction: Generate impression based on medical findings.

Input: ETT check Bilateral moderate to large right over left pleural effusions with underlying diffuse changes suggesting CHFRight jugular catheter, left subclavian PICC line NG and ETT are all otherwise unchanged. Swan-Ganz from an inferior approach extends into the main pulmonary outflow tract

Output: Swan-Ganz placement


Instruction: Generate impression based on medical findings.

Input: Metastatic rectal cancer. CHEST:LUNGS AND PLEURA: Right-sided pleural effusion is unchanged. Left-sided pleural effusion is minimally increased. Air in the loculated right sided pleural effusion has resolved in the interval.Interval increase in the size of the numerous lung metastases. Left lower lobe reference lesion has increased in size. Now it measures 19 x 12 millimeter on image number 64, series number 4. Reference lesion in the right upper lobe measures 22 x 17 mm on image number 35, series number 3 previously this lesion was measuring 18 x 14 mm on image number 33, series number 3. This lesion is also increased in size. Pleural-based mass in the right lung apex now measures 3.3 x 2.4 cm, on image number 27, series number 3 not significantly changed from previous study.MEDIASTINUM AND HILA: Extensive metastatic adenopathy throughout the mediastinum. Subcarinal lymph node measures 5 x 3.8 cm on image number 49, series number 3.Bilateral hilar adenopathy causes progressive circumferential narrowing of the right and left pulmonary arteries.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval increase in the size and number O. the hepatic metastases. Reference left lobe mass now measures 11 x 4.5 cm number 86, series number 3. Previously measured second reference lesion represents a cyst therefore it's unchanged in size.SPLEEN: New subcentimeter lesion in the inferior pole of the spleen which may represent metastatic disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right-sided hydronephrosis and hydroureter is unchanged. The ureter is dilated up to the level of the pelvis where its invaded by metastatic disease. Subcentimeter lesions in the kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: Confluent metastatic adenopathy in the portacaval region 4.7 x 4.8 cm image number 105, series number 3, not significantly changed.BOWEL, MESENTERY: Peritoneal carcinomatosis most prominent in the right lower quadrant is grossly unchanged. Multiple enlarged mesenteric lymph nodes are unchanged.Right lower quadrant ileostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Peritoneal carcinomatosis also affects the pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Previously described right sacral abscess is now larger measuring 5.6 x 2.6 cm. associated presacral soft tissue density may represent inflammation versus tumor involvement.

Output: Interval progression of disease with increase in the lung metastases and liver metastases and possible splenic metastases.Retroperitoneal adenopathy peritoneal carcinomatosis are grossly unchanged.Interval increase in the size of the pelvic abscess. Right-sided hydroureter and hydronephrosis is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Shortness of breath. Stable global cardiomegaly. Single lead ICD terminates at the apex of the right ventricle.Persistent signs of pulmonary venous hypertension. No signs of pulmonary edema.The pleural spaces are within normal limits.Moderate degenerative changes of the thoracolumbar spine.

Output: Cardiomegaly and signs of pulmonary venous hypertension. No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: hypoxia History: hypoxia Tracheostomy tube in place.Small lung volumes with diffuse nonspecific opacity compatible with edema, atelectasis and left pleural effusion.No significant interval change for differences in position and projection.

Output: Diffuse nonspecific pulmonary opacity with no significant interval change


Instruction: Generate impression based on medical findings.

Input: Testicular cancer CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion in the left lobe of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable examination without acute or metastatic process.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: cat P? History: yellow productive cough; fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old, with chronic pancreatitis and history of clots. Multiple DVTs in IVC filter in 2001. Right IJ thrombectomy in 2008. Now with swelling in the right neck and right hand. LUNGS AND PLEURA: Scattered patches of groundglass and air space opacity, most prominent in the left lower lobe, are nonspecific but may reflect aspiration or infection. Right apical and basilar scarring/atelectasis. No pleural fluid.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. The cardiac size is normal. No pericardial fluid. The esophagus is dilated.The right subclavian, brachiocephalic and internal jugular veins do not opacify. The SVC reconstitutes with inflow from a dilated azygos and left brachiocephalic vein. The left brachiocephalic vein reconstitutes with inflow from a dilated hemiazygos vein. Distal to this point, the left brachiocephalic vein is attenuated and shows only discontinuous opacification. Numerous collateral vessels are evident within the right neck, the upper extremities, and the chest wall.CHEST WALL: Status post median sternotomy.UPPER ABDOMEN: Surgical clips in the gallbladder fossa.

Output: 1.Evidence of thrombosis or stenosis of the right internal jugular vein as well as the subclavian and brachiocephalic veins bilaterally. 2.Pulmonary opacities as described above compatible with aspiration or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p thoracoscopy on right, evaluation pleural effusion History: effusion Right Pleurx catheter with an enlarging right pleural effusion, and stable left effusion.Basilar compression atelectasis unchanged.

Output: Slight enlargement of right pleural effusion despite a right Pleurx catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p esophagectomy, RUL Pneumothorax, follow up film History: s/p esophagectomy, RUL Pneumothorax, follow up film Persistent small right apical pneumothorax.Unchanged patchy pulmonary opacities.NG tube tip still at the hemidiaphragm level.

Output: Stable small right apical pneumothorax and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 19 years old.Reason: pneumonia History: cough Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Thoracentesis, and known small pneumothorax. Significant decrease in pleural fluid volume on the right, now moderate. Right apical pneumothorax component now measures 6-mm from the chest wall. There is incomplete expansion of the medial and lateral segments of the right middle lobe.

Output: 6-mm right apical pneumothorax. Improved volume of pleural fluid on the right with persistent atelectasis involving the right middle lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: 49y/o with past h/o myelofibrosis s/p stem cell transplant and donor lymphocyte infusion complicated by graft versus host disease. Currently on immunosuppressive therapy with s6teroids and prograf. Has new cough. Please evaluate for filtrates History: cough, stuffy nose, no fever, no shortness of breath Left basilar scarring or subsegmental atelectasis and chronic blunting of the left costophrenic angle.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 old male with history of bladder cancer with liver lesions. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Subcentimeter pretracheal lymph node on image number 23, series number 4.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: This study is severely limited for evaluation of the liver lesions do to lack of IV contrast. However, there are multiple large liver lesions that are slightly hypodense compared tourists of the liver. One of them measures 8.5 x 8.0-cm on image number 76, series number 4. This lesion cannot optimally measure to characterize and lack of IV contrast. Other smaller liver lesions are enlarged and there are other multiple the liver lesions. Further evaluation of the liver with MRI is recommended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydronephrosis and dilated right ureter throughout its course is unchanged.RETROPERITONEUM, LYMPH NODES: Reference peripancreatic lymph node measures 18 x 11 mm in image number 86, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Pelvis images are limited due to metal artifacts from the right hip prosthesis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy. Neobladder with ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left inguinal hernia containing unobstructed sigmoid colon. Small perincisonal hernia containing nonobstructing small bowel segments. Right lower quadrant ileostomy.BONES, SOFT TISSUES: Fat stranding posterior to the sacrum which may be secondary to decubitus ulcers. Clinical correlation is recommended.OTHER: Small amount of free fluid in the pelvis.

Output: A significant interval increase in the size and number of the liver lesions suspicious for metastatic disease. These lesions cannot be optimally evaluated on this noncontrast CT. right-sided moderate hydronephrosis and right hydroureter unchanged.Midline perincisonal and left inguinal hernia sacs containing unobstructed bowel segments.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.ETT. ETT terminates at the right mainstem bronchus orifice.Bilateral airspace opacities and a left pleural fluid collection are unchanged. Nasogastric tube projects over the stomach. Right PICC tip overlying the right atrium.

Output: Right mainstem bronchus intubation. No acute change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: et repositioned History: none Minimal retrocardiac atelectasis, the lungs otherwise unremarkable.ET tube tip approximately 4 cm above the carina.An NG tube terminates in the stomach.Left jugular catheter, tip in SVC.

Output: ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with history of smoking and asthma. Complains of 2 weeks of productive cough, fever/chills and rhinorrhea. Cardiomediastinal silhouette within normal limits.Moderately tortuous aorta consistent with hypertension, unchanged.No acute focal airspace opacity.No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: eval for acute process History: cough, fever x 2 weeks No pleural effusion or pneumothorax. No focal pulmonary abnormality. The mediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.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, 29 years old.Reason: chest pain. History: cough, fever/chills Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: OG tube placement History: OG tube Bilateral pulmonary opacities and pleural effusions are essentially unchanged. Line position stable. No pneumothorax.

Output: No change in the extensive bilateral pleural effusions and pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Fever, evaluate for pneumonia Unremarkable cardiac and mediastinal contours.No significant pleural or parenchymal abnormalities.

Output: No sign of pneumonia or other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female presenting with renal cell cancer. Please evaluate for progression. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Hypoattenuating nodule in the left thyroid is only partially visualized on this study. Patient is status partial right thyroidectomy.CHEST WALL: Lytic lesion in the superior sternum is unchanged. ABDOMEN:LIVER, BILIARY TRACT: Right lobe metastatic lesion appears slightly less prominent compared to the prior study and measures 1.6 x 1.5 cm (series 3, image 65), previously measuring 2.1 x 2.4 cm. No other suspicious lesions are identified. Gallbladder sludge is noted.SPLEEN: Punctate subcentimeter hypodensity in the spleen appears unchanged (series 3, image 78).PANCREAS: Enhancing nodularity within the tail of the pancreas appears similar to the prior study and likely represents additional metastatic lesions (series 3, image 84). While these lesions appear similar to the 8/16/2011 study, it is difficult to determine when these lesions developed as this patient has had several non-contrast studies prior to 8/2011.ADRENAL GLANDS: Left adrenal adenoma measuring 1.4 x 1.3 cm is stable dating back to 2009 (series 3, image 87). Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephrectomy. The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Reference retrocaval lymph node measures 0.9 x 1.2 cm and is unchanged (series 3, image 124).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the vertebral bodies of T9, T10, T12, L1, L2, L4, and L5 appear similar to the prior study. Sclerotic lesions in the right and left ilium, sacrum, and right femoral neck also appear similar to the study.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: Sclerotic lesions in vertebral bodies of L1, L2, L4, and L5, the sacrum, bilateral iliac bones, and right femoral neck also appear similar to the prior study. Moderate to severe degenerative disease also affects the L5-S1 level.OTHER: No significant abnormality noted.

Output: 1.Stable intra-abdominal disease. Liver metastatic lesion is smaller compared to the prior study. Nodularity of the pancreas, likely representing metastatic lesions, is also stable. Reference lymph nodes are unchanged.2.Multiple bone metastases throughout the sternum, spine, bony pelvis, and proximal right femur are unchanged. Please correlate with nuclear medicine bone scan as a bone scan is more sensitive for evaluation of bony metastasis.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: IABP placement The lung catheter marker in the proximal descending aorta about 2 cm below the top of the arch.ICD lead and venous catheter unchanged.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: eval for congestion History: ventilated, persistent frothy secretions Feeding tube extends inferiorly off the field-of-view. Other lines and tubes, unchanged. Increased patchy basilar opacities. Probable mild pulmonary edema, as before. Unchanged cardiomegaly. Query small pleural effusions. No pneumothorax.

Output: Probable mild pulmonary edema. Increased basilar opacities and probable small pleural effusions. Unchanged cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: chest pain History: chest pain Stable position left pulse generator with ICD electrodes.No significant interval change. No specific evidence of infection or edema. The heart size remains normal.

Output: No interval edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: 60yo female with advanced stage carcinosarcoma of uterus, rule out chest metastases History: none Lungs are hypoinflated with mild bibasilar atelectasis, mildly increased compared to the prior exam. Cardiomediastinal silhouette is unchanged. No specific evidence of pulmonary metastases.

Output: Mildly increased bibasilar atelectasis compared to the prior exam. No specific evidence of pulmonary metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: r/o pneumonia History: sob, new DKA No evidence of pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.Fever to 102, rule out infection. Sickle cell disease without crisis. Apparent worsening of cardiomegaly and mediastinal widening could be related to technique as the cardiothoracic ratio appears similar to prior on a same-day CT scan. Signs of pulmonary hypertension. No focal airspace opacities to suggest pneumonia.

Output: No signs of pneumonia. Cardiomediastinal silhouette can be conservatively monitored by portable plain film as long as the patient remains stable.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: drain placement History: s/p right open RLL lobectomy Lines and tubes are unchanged. Unchanged right bibasilar opacities, right greater than left. No large pneumothorax. Unchanged heart size. Small amount of pneumomediastinum again noted.

Output: Unchanged bibasilar opacities. Unchanged lines and tubes.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: SOB History: eval for other etiology, here with NSTEMI Moderate cardiomegaly.Tortuous aorta; a distal thoracic aortic dissection was noted on a CT yesterday, however.No specific evidence of infection or edema.

Output: Cardiomegaly. No specific evidence of infection or edema. Little radiographic evidence of a known dissection.


Instruction: Generate impression based on medical findings.

Input: History of left lumpectomy with axillary node dissection. XRT and chemotherapy. Right-sided pulmonary nodules on the last CT. LUNGS AND PLEURA: 6 x 4 mm nodule in the right upper lobe (19/113), unchanged or slightly decreased from previous.Linear small scarlike opacity in the anterior segment of the right upper lobe at the site of a previously described nodular opacity.Severe diffuse centrilobular emphysema calcified bilateral granulomas.MEDIASTINUM AND HILA: Nonspecific lower right paratracheal lymph node measuring 14 x 11 mm, not significantly changed.Moderate coronary artery calcifications. CHEST WALL: Moderately enlarged left axillary lymph node with a short axis measurement of 11 mm, not significantly changed.Small lipoma in the left posterior chest wall, unchanged.UPPER ABDOMEN: No significant abnormality noted.

Output: Interval resolution of an anterior right upper lobe nodular opacity that was probably due to infection, and stability of another small indeterminate right upper lobe nodule. No other specific evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Left lower quadrant pain, evaluate for bowel structure or ileus, no bowel movement in 5 days Nonobstructive bowel gas pattern. Above average stool burden.

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


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Preop history of thoracic lesion. Unspecified disease of spinal cord. Mild elevation of the right hemidiaphragm. Normal heart size. No suspicious pulmonary nodules or masses are appreciated. No pleural fluid. Degenerative changes of the spine.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Device placement Left subclavian ICD appears similar, specifically the abandoned lead again projects from the chest wall into the proximal SVC.Mild cardiomegaly with bilateral small to moderate effusions and basilar atelectasis unchanged

Output: Stable ICD placement


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: dialysis, SOB History: as above Cardiomegaly, mild-to-moderate pulmonary edema, but no pleural effusions.Superior mediastinal widening likely due to a combination of tortuous brachiocephalic vessels, azygos arch distention and mediastinal fat deposition.No specific evidence of infection.Renal osteodystrophy noted.

Output: CHF or hypervolemia, with cardiomegaly and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: CP History: above Unremarkable cardiac and mediastinal silhouette.Lobulated right hemidiaphragm consistent with focal eventration.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: urethral cancer - s/p anterior exenteration with ileal conduit urianry diversion History: urethral cancer - s/p anterior exenteration with ileal conduit urianry diversion The cardiac mediastinal silhouette is unremarkable.Considerable elevation right hemidiaphragm unchanged.Right upper lobe nodule on current CT abdomen/pelvis cannot be identified on this exam.No pleural effusions.

Output: Persistent elevation of the right hemidiaphragm. Right upper lobe nodule noted on current CT abdomen/pelvis cannot be identified on this exam.


Instruction: Generate impression based on medical findings.

Input: Images are somewhat limited by patient motion. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.At L2-L3, there is a focal left foraminal disc protrusion.At L3-L4, there are shallow biforaminal disc protrusions.There is multilevel facet arthropathy and ligamentum flavum thickening which is progressed since the prior exam, especially along the lower lumbar spine. This results in mild left foraminal narrowing at L5-S1, with impingement of the exiting left L5 nerve root.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine.

Output: Motion limited exam. Mild progression of mid to lower lumbar spondylosis mostly due to facet arthropathy and ligamentum flavum thickening, with impingement of the exiting left L5 nerve root due to the hypertrophied left facet. Associated mild left foraminal narrowing at this level.


Instruction: Generate impression based on medical findings.

Input: Female 65 years old Reason: positive TB test Chronic basilar interstitial opacities appear similar to prior exam. Blunting of the left costophrenic angle may be due to scarring. No specific evidence of infection or edema. Cardiac size is normal. Tortuous aorta.

Output: Chronic basilar interstitial opacities, otherwise no acute abnormality. No evidence of active TB.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: Chest tube placementVIEW: Chest AP 1/20/15 ET tube tip below thoracic inlet and above the carina. Interval placement of a left chest tube. The pneumothorax on the left has decreased in size. Cardiothymic silhouette normal. Left upper lobe opacity may represent pulmonary contusion or hemorrhage.

Output: Placement of a left chest tube with interval decrease in size of the left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: lung transplant History: sob Status post right lung transplant, with marked emphysema in the native left lung.No specific evidence of infection or failure.Heart size normal.

Output: Status post right lung transplant, No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old, with lung cancer. CHEST:LUNGS AND PLEURA: A left upper lobe reference micronodule measures 5 x 5 mm on axial image 24/109 and is unchanged. A lingular opacity anterior to the cardiac margin on axial image 64/109 is new but may represent a scar. Scar like opacities at the medial left base are unchanged. Scattered additional micronodules, some of which are calcified, are unchanged. Mild centrilobular emphysema is noted.MEDIASTINUM AND HILA: A reference precarinal node measures 10 mm in short axis diameter on axial image 36/150, not significantly changed. Scattered small mediastinal lymph nodes, some calcified, are unchanged.The cardiac size is normal. No pericardial fluid. Coronary and aortic atherosclerotic calcifications are evident.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Splenic calcifications likely reflect prior granulomatous disease.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive aortic atherosclerotic calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No definite evidence of disease progression.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: LIJ cordis History: LIJ Cordis Small lung volumes with nonspecific interstitial opacities, unchanged.Mild cardiomegaly with a tortuous aorta.New left jugular catheter place, tip in the left brachiocephalic vein at the midline.An NG tube terminates in the stomach.

Output: Left jugular catheter placement. No other change.


Instruction: Generate impression based on medical findings.

Input: 4-month-old with respiratory failure, pneumothorax, ARDS, and multiple chest tubes.VIEW: Chest AP (one view) December, 0521 Endotracheal tube tip is in the orifice of the right mainstem bronchus. Enteric tube has its tip in stomach. Right internal jugular line tip is in superior vena cava. There are three right chest tubes.Moderate soft tissue edema is noted.Small right pneumothorax is identified with pleural edge in the apex and hyperlucency in the lateral base. Hazy opacities are noted in right lung. Focal opacity is seen in left lower lobe and mid lung. Cardiothymic silhouette is normal. Mediastinum is slightly shifted to the left.

Output: Small right pneumothorax. Continued lung opacities.


Instruction: Generate impression based on medical findings.

Input: 48-year-old male with diffuse large B-cell lymphoma. Status post chemotherapy, completed 8/08. Evaluate disease status. CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Stable subtle ground glass opacity in the lingula medially is nonspecific. Right middle lobe scarring and ground glass opacities are unchanged.MEDIASTINUM AND HILA: Small thyroid nodules are unchanged. Index subcarinal lymph node is unchanged measuring 16 x 9 mm image number 38, series number 3. Other smaller lymph nodes are also unchanged.CHEST WALL: Right sided venous access device. Status post median sternotomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenectomy. Accessory spleen is unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign-appearing renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appendix in the RLQ. BONES, SOFT TISSUES: Diffuse ill-defined sclerotic changes in bones are stable. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis. BONES, SOFT TISSUES: Diffuse ill-defined predominantly sclerotic lesions throughout the pelvis, and especially the sacrum, are stable. OTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: 11 days of cough with fever, assess for PNA History: 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: Age: 70 yearsGender: MaleReason for Study: Reason: chest pain History: shortness of breath Cardiac enlargement with pulmonary vascular redistribution.Small bilateral pleural effusions with basilar atelectasis.No focal areas of consolidation.Median sternotomy is intact without evidence of a prior CABG.

Output: Cardiomegaly, pulmonary vascular redistribution, and small pleural effusions suggestive of CHF/volume overload.


Instruction: Generate impression based on medical findings.

Input: Reason: swan position History: swan in place Swan-Ganz catheter tip in the right descending pulmonary artery. ICD leads unchanged.Cardiomegaly with diffuse chronic interstitial disease as recently characterized by CT scan.

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


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Heart failure with reduced ejection fraction s/p CRT-D with h/o lead dislodgement History: sob Moderate cardiomegaly. ICD leads in place including one in the right atrial appendage, right ventricle, and 2 epicardial leads within the coronary sinus terminating anteriorly and posteriorly. These leads appear intact. Bilateral pleural effusions. Right lung opacity likely corresponds to loculated pleural fluid. Mild cardiomegaly. Sternotomy hardware intact. Right upper quadrant surgical staples.

Output: ICD leads in place as above. Findings compatible with CHF and pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: poss PNA History: abd pain , back pain There is mild interval progression of the right lower lung and mid lung opacities with associated volume loss. While consistent with patient's known lung cancer and metastatic pleural disease, these findings may represent either progression of disease or superimposed infection.Heart size normal.No pneumothorax.Stable appearance of single lumen PowerPort.

Output: Mild interval progression of the right lower lung and mid lung opacities with volume loss. Progression of known liver disease versus superimposed infection should be considered.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Chest pain. History: None given. Moderate cardiomegaly.No acute focal airspace opacity. Mild interstitial opacities appear grossly stable relative to abdominal radiograph dated 12/4/09. No pneumothorax or large pleural effusion.Surgical clips overlying the right axilla.

Output: Moderate cardiomegaly with chronic mild interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Evaluate for infection or effusion History: leukocytosis Cardiomegaly. Lungs hypoinflated but there is no new opacity to suggest pneumonia.

Output: Lungs hypoinflated but there is no new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old. Reason: weight loss r/o abnormality History: weight loss r/o abnormality Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: chest pain History: chest pain Right internal jugular catheter has been removed. Stable cardiomediastinal silhouette and low lung volumes. No new focal pulmonary opacities. No pneumothorax or large pleural effusions.Status post median sternotomy.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: HD, assess volume status History: above Mild elevation of the left hemidiaphragm again noted. Mild left basilar opacity likely atelectasis or scarring. No large pleural effusion or pneumothorax. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.New fever, evaluate for cause. New airspace opacity and atelectasis at the left lung base. To a lesser extent, there is also atelectasis/consolidation in the right posterior costophrenic angle.Chronic blunting of the left costophrenic angle consistent with known loculated pleural fluid, elevation of left hemidiaphragm and large fat pad in the area.Right chest port tip at the SVC. Sternotomy hardware appears intact. No pneumothorax.

Output: Left greater than right basal airspace opacities suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Male, 18 years old.Syncope, shortness of breath, evaluate for cardiomegaly. Normal heart size. No focal air space opacities, pleural fluid or pneumothorax. Calcified nodule in the right upper lobe statistically most likely reflects a healed granuloma.

Output: Low normal lung volumes, but no acute pulmonary abnormality. Heart size is normal.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary acute abnormality, however mild fullness to the right hilar region may represent minimal lymphadenopathy. Comparison with prior outside studies if available would be helpful. Specifically no distinct air space abnormality.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: patient with vasculitis History: Rash The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Seizures status post intubation. ETT tip at the right mainstem bronchus orifice.Enteric tube sidehole above the GE junction, suggest advancement.Asymmetric nodular opacity projecting over the right mid lung may be on the chest wall, possibly asymmetric nipple shadow artifact, correlate with physical examination.The lungs are otherwise clear.

Output: ETT tip at right mainstem bronchus orifice. High enteric tube.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: Infiltrates History: Fever Right lower lobe opacity suggestive of infection or organizing pneumonia may be slightly improved medially, however there are more opacities laterally suggesting progression of active infection in those segments.Cardiomediastinal silhouette is unremarkable.Small right pleural effusion.Diffuse lytic bone lesions consistent with history of multiple myeloma. Subacute right seventh rib fracture laterally.

Output: Mixed change with improvement in medial right lower lobe opacity, however the opacities have now progressed to involve the lateral aspect of the lower lobe and a new pleural effusion is present. Follow-up PA and lateral chest radiographs may be obtained in 2-3 weeks.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: rule out infection History: 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: Male, 60 years old.Reason: s/p MVR History: f/u chest tube removal Lines and tubes have been removed. Pulmonary edema pattern with bibasilar opacities and pleural effusion and marked cardiomegaly again noted.

Output: Interval removal of lines and tubes. Persistent pulmonary edema, bibasilar opacities and pleural effusions. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: eval for acute process History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Shortness of breath. Basilar opacities suggestive of subsegmental atelectasis/aspirated secretions. Mediastinal clips, sternotomy wires and right PICC in place, unchanged. No significant interval change in size of the cardiomediastinal silhouette. Biliary stent in place. Stable right lower lung nodule.

Output: Bibasilar atelectasis/aspirated secretions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: chest pain, sob History: chest pain, sob Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Cervical spinal fusion hardware noted.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: swan placement History: abnml wave form Cardiomegaly status post what appears to be bypass surgery.No significant pulmonary or pleural abnormality.Left subclavian ICD, leads unchanged in position.Right jugular Swan-Ganz catheter tip advanced to the right interlobar pulmonary artery.

Output: Swan-Ganz catheter, tip advanced into the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 88-year-old male presents for pre-op evaluation. Mild cardiomegaly. Tortuous aorta.Chronic-appearing bibasilar interstitial opacities. No pleural effusion, or pneumothorax.ICD overlies the left chest wall with leads in the right atrial appendage, coronary sinus, and left ventricle.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 56-year-old female with diminished breath sounds bilaterally and cough Electronic device overlies the right upper quadrant.Cardiomediastinal silhouette is unremarkable.No focal opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: eval for pulmonary congestion History: hypoxia No significant cardiopulmonary abnormality, except for mild perihilar bronchial wall thickening.Right jugular catheter, tip in SVC.

Output: Mild bronchial wall thickening, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Reason: eval for hernia or abnormality History: SOB with lying down, episgastric discomfort, CP Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Mild cardiomegaly.

Output: No acute cardiopulmonary process on radiography. Mild cardiomegaly. No convincing evidence of hernia on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: is there a pneumothorax History: altercation, chest wall pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.History of shortness of breath. No acute pulmonary or pleural abnormality. A small asymmetry in the contour of the left hemidiaphragm likely relates to epicardial fat seen on CT. Small surgical clips project over the right breast. Heart size is within normal limits. No pneumothorax.

Output: No significant acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with colorectal cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: A right-sided port terminates at the atriocaval junction. Small bilateral axillary lymph nodes remain, not pathologically enlarged.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lobulated masses are again identified throughout the liver, unchanged in size and number. Reference lesion in the anterior segment of the right lobe measures 5.3 x 4.7 cm (series 4; image 86), previously 5.4 x 4.6 cm.Mild central intrahepatic biliary ductal dilatation is unchangedSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter gastrohepatic lymph nodes are unchanged.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: Diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable hepatic metastases


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Cough, fever, tachycardia, crackles Chronic medium right pleural effusion is stable. Lungs are otherwise clear. No pneumothorax.

Output: Stable chronic right medium pleural effusion.