Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: Evaluate for pneumonia, effusions, edema History: Cough New left upper lobe opacity and probable new focal opacity in the right apex consistent with pneumonia or aspiration. Biapical pleural-parenchymal scarring again noted. Moderate cardiomegaly again noted. No pneumothorax.

Output: New focal right apical opacity and new left upper lobe opacity consistent with pneumonia or aspiration. Chest radiographic follow-up in 8 weeks is suggested to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: infection, pneumo History: chest pain Mild bronchial wall thickening, which could indicate asthma or bronchitis, otherwise unremarkable.No specific evidence of infection or edema.No significant pneumothorax.

Output: Bronchial wall thickening suggestive of asthma or chronic bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: central line History: central line Endotracheal tube terminates 3 cm above the carina. Right subclavian catheter has been placed, terminating at the superior caval atrial junction. Nasogastric tube has been placed with the side hole positioned at the GE junction.Progression of the predominantly perihilar airspace and interstitial opacities. Small associated pleural effusions unchanged. No pneumothorax.

Output: Advancement of the nasogastric tube is recommended. Progressive bilateral perihilar airspace disease.


Instruction: Generate impression based on medical findings.

Input: CLL staging CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Calcified mediastinal and right hilar nodes.CHEST WALL: Prominent bilateral axillary lymph nodes are stable from 7/18/09.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cyst in segment two. Unchanged subcentimeter hepatic hypodensity in segment 7 is also (series 3, image 84) stable, since 2006. Punctate calcified granuloma near the dome.SPLEEN: The spleen is normal in size with several calcified granulomas. Punctate hypointensity in the mid spleen (series 3, image 79) is stable. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable prominent axillary nodes bilaterally.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: eval for acute process History: prod cough x 1 mo 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: Age: 90 yearsGender: FemaleReason for Study: Reason: new hypoxia, h/o afib History: see above Decreased lung volumes with stable cardiac enlargement.Nonspecific perihilar/basilar opacities compatible with atelectasis unchanged.No new pulmonary opacities identified.No large pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: CP History: CP Chronic mild basilar streaky opacities likely secondary to scarring or atelectasis. Mild COPD changes.Mild cardiomegaly with tortuous aorta. Right jugular dialysis catheter tip in the SVC.Degenerative disease of the thoracic spine.

Output: Chronic basilar scarring and mild COPD changes. No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: History of pneumonia, COPD with current exacerbation. Check for acute disease Essentially unchanged large lung volumes with persistent bilateral largely basilar interstitial changes suggesting old scarring and diverted pulmonary vasculature given extensive apical emphysema. No distinct superimposed focal airspace abnormality given the improved technique and patient's semiupright positioning

Output: Suspected baseline exam with diverted vascularity and chronic changes superimposed upon extensive COPD and emphysema


Instruction: Generate impression based on medical findings.

Input: Female 78 years old Reason: eval for edema History: SOB, crackles. Previous history of right breast cancer. Surgical clips overlie the right axilla from prior lymph node dissection. The heart is enlarged. The mediastinum is within normal limits. There is volume loss bilaterally but more prominent in the right lung. Increased bilateral perihilar interstitial opacities with probable bronchial wall thickening. Calcified lymph node are present in the hila. There is blunting of the right costophrenic angle but no large pleural effusion. No specific evidence of pulmonary edema, infection or pneumothorax.

Output: Increasing perihilar interstitial opacities and bronchial wall thickening possibly representing edema, however accentuated by low lung volumes.. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: ro pneumonia History: hx of LUL resection, tracheostomy, with increased secretions Interval decrease in right pleural effusion.The patchy lower lobe opacities can represent infection or aspiration.Heart size normal.Stable appearance of dual-lumen power port.Tracheostomy in projection of trachea.

Output: 1. Interval decrease in right pleural effusion2. Patchy lower lobe opacities can represent infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 32 yearsGender: MaleReason for Study: Reason: eval lung fields History: eval lung fields - s/p lung transplant Status post bilateral lung transplants. Tracheostomy tube, left central venous catheter, and left PICC line unchanged.Stable cardiomediastinal silhouette.Extensive pulmonary opacities and pleural effusions similar in appearance prior exam.No new pulmonary opacities identified.

Output: Extensive pulmonary opacities and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: eval lung fields History: increasing vent requirements Right IJ Swan-Ganz now looped in the region of the azygos vein with its tip advanced into the pulmonary artery.Remaining support devices unchanged.Cardiac enlargement with basilar opacities compatible with pleural effusions and edema/atelectasis.No new pulmonary opacities identified.

Output: ] IJ venous catheter looped within the region of the azygos vein and tip advanced into the pulmonary artery. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: Patient Diagnosis Lung Transplant Evaluation History: SOB Dyspnea Diffuse nonspecific reticulonodular interstitial opacity with airspace disease and volume loss in the right lower lung, increased compared to previous. Interval resolution of a small right pneumothorax.Normal heart size with vascular stents in the area of the left coronary artery.

Output: Diffuse nonspecific severe interstitial and airspace disease, considerably increased since the previous chest radiograph. A CT scan is recommended at one has not been performed recently.


Instruction: Generate impression based on medical findings.

Input: Female, 99 years old.Reason: PNA, cardiomegaly, effusion History: 99yoF acute onset weakness 4am this morning. r/o urosepsis Mild cardiomegaly. Large lung volumes suggestive of COPD.No pleural effusion or pneumothorax.Bibasilar scarring. No focal pulmonary opacities to suggest infection.Mild rightward curvature of the thoracic spine.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: pulmonary edema History: SOB Large lung volumes. Cardiomegaly is stable. Progressive interstitial and airspace opacities suggestive of edema. Loss of the left hemidiaphragm suggestive of progressive atelectasis. No pneumothorax.

Output: Progressive airspace and interstitial opacities of edema with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: History of esophageal cancer. Images through the skull base and cavernous sinus questionable lucencies in the clivus.Examination demonstrates innumerous lytic lesions in the cervical and thoracic spine, ribs, clavicles, sternum and scapula.There is no definite evidence of mass or pathologic adenopathy in the neck. The airway is patent. Heavily calcified bilaterally internal carotid artery are again identified. Bilateral thyroid glands appear normal.Limited view of the chest shows left pulmonary opacity, pacification of the aortic arch and multiple lytic lesions.

Output: 1.Innumerous lytic lesions in the cervical and thoracic spine, ribs, clavicles, sternum and scapula and questionably in the clivus.2.No evidence of a mass or pathologic lymphadenopathy in the neck.3.Please refer to dedicated chest CT for pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: check placement L IJ TLC History: check placement L IJ TLC Left IJ line terminates just above the cavoatrial junction. Feeding tube extends inferiorly off the field-of-view. Unchanged right-sided PICC. Worsening diffuse pulmonary opacities. Unchanged heart size. No pneumothorax.

Output: Left IJ line, as above without evidence of pneumothorax. Worsening pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Congestive heart failure Marked nonspecific artery mainly with an LVAD unchanged. Lungs otherwise remain clear. No effusions. Old healed granulomatous disease exposure

Output: Cardiomegaly without evidence of active failure


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p chest surgery History: see above Interval resolution of left lower zone opacities with streaky scar or subsegmental atelectasis remaining. The right lung is fully inflated and clear. Heart size is normal.

Output: Resolution of previous left pleural effusion with scarlike opacities remaining.


Instruction: Generate impression based on medical findings.

Input: 9-day-old male with hepatomegaly. Evaluate for abdominal pathology.VIEW: Chest and Abdomen AP (two view) 1/11/2016 5:31 Right IJ central venous catheter tip at the SVC, ET tube tip below the thoracic inlet and above the carina. Enteric tube tip in the stomach. Foley catheter within the bladder.Bibasilar opacities, right greater than left, superimposed on diffuse lung disease and is unchanged. Cardiothymic silhouette is normal.Disorganized bowel gas pattern with a featureless bowel loop in the left upper quadrant. No pneumatosis intestinalis, pneumoperitoneum or portal venous gas.

Output: 1. No interval change in pulmonary opacities.2. Disorganized bowel gas with a featureless bowel loop in the left upper quadrant. No pneumoperitoneum, pneumatosis intestinalis or portal venous gas.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: assess PM leads. Noise noted on atrial lead History: noise on atrial lead Right-sided pacemaker with lead wires and right atrial appendage and right ventricle.Complete opacification right hemithorax with shift of the trachea from left to right compatible with large effusion and atelectasis.The left lung is clear.Marked deformity of the right eighth rib.

Output: Opacification right hemithorax with volume loss compatible with atelectasis and probable accompanying large effusion. Correlate clinically in reference to possible prior pneumonectomy. Marked deformity of the right eighth rib.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: indeterminate QuantiFeron Gold. Plans to start Remicade when recovers form surgery. History: indeterminate QuantiFeron gold Cardiomediastinal silhouette is unchanged. No pleural effusion or pneumothorax. Bibasilar atelectasis. No focal areas of consolidation..

Output: Bibasilar atelectasis without specific evidence for infection.


Instruction: Generate impression based on medical findings.

Input: DKA rule out infection. No focal airspace opacities, pleural fluid or pneumothorax. Normal heart size.

Output: No acute pulmonary abnormality. Normal chest.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Nausea, vomiting Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Shortness of breath with CHF, known CAD History: SOB Mild cardiomegaly with basilar interstitial opacities suggestive of edema.No evidence of infection.No large pleural effusions.

Output: CHF with cardiomegaly and interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Pt is a 75 yo male w/ hx of CLL; pre-auto sct evaluation History: evaluate No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: eval PNA History: Fever Lungs hypoinflated though there is no new focal opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 46 yearsGender: FemaleReason for Study: Reason: evaluate for infiltrates History: short of breath The cardiomediastinal silhouette is unremarkable.The lungs are clear.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: Female, 56 years old.Reason: s/p left VATS, upper wedge resections History: s/p left VATS, upper wedge resections Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of tumor resection following VATS biopsy.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Multifocal lung opacity, as on prior. No evidence of pneumothorax.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: assess ETT positioning History: s/p intubation Tracheostomy tube tip at thoracic inlet. Venous catheter tip at RA/SVC junction.Persistent findings of ARDS.

Output: Tracheostomy tube tip at thoracic inlet.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: Check Pulmonary Status History: Check Pulmonary Status Decreased right lung volume suggestive of atelectasis as well as a possible right pleural effusion although the costophrenic angle is not included.Heart size normal, the aorta tortuous.ET tube tip approximately 5 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 5 cm above the carina. Increased right-sided atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: Evaluate pleural effusion History: SOB Left subclavian dual-chamber ICD is unchanged. Status post median sternotomy and likely CABG surgery. Partially visualized drain overlying the upper abdomen.Stable borderline enlarged cardiac silhouette.Low lung volumes with mild left retrocardiac atelectasis and question trace pleural effusions. No pneumothorax.

Output: No significant interval changes.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: ETT placement History: n/a The heart is normal in size.Interval intubation. ET tube localized approximately 3 cm of the carina. Retraction at least 1 cm recommended. Enteric tube courses below the diaphragm.Right midlung bandlike opacities suggestive of subsegmental atelectasis of the anterior segment of the right upper lobe. Correlate with history to determine etiology.No signs of pleural effusion or pneumothorax.

Output: ET tube localized approximately 3 cm above the carina. Consider retraction 1 cm.Right midlung bandlike opacities suggestive of subsegmental atelectasis of indeterminate nature. Correlate with history.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: ett placement Endotracheal tube tip approximately 3 cm above the carina. Right central catheter with tip in the right atrium. NG tube tip below the caudal margin of this image. Contrast overlying spine likely from myelogram.Bibasilar opacities and effusions unchanged. Cardiomediastinal silhouette is not significantly changed.

Output: Bilateral pulmonary opacities and pleural effusions not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old. Tracheostomy tube, right Checker cannula, feeding tube and catheter from the left arm, unchanged.Diffuse severe interstitial opacity compatible with clinical diagnosis of a RDS, without significant interval change.No new findings.

Output: Catheter tip in left axillary vein. Other devices, unchanged.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with large pulmonary abscess. LUNGS AND PLEURA: Right upper lobe cavitating lesion is grossly unchanged in size with some interval decrease in wall thickness. Enhancing chest wall invasion and bony destruction is most suggestive of a cavitating malignant lesion. Slight interval increase in intra-cavitary fluid. New left upper and left lower lobe groundglass opacities becoming near air space opacity in some locations may reflect soiling from contralateral cavitary material. Infection may also be considered but would be atypical for pneumonia other than viral.Right upper lobe tree-in-bud opacity with diffuse, fine centrilobular nodularity in both lungs may represent chronic aspiration and bronchiolitis.Anterior right upper lobe atelectasis is unchanged.MEDIASTINUM AND HILA: Right superior mediastinal lymph node is unchanged and measures 1.2 x 1.5 cm on axial image 8/100. A pretracheal lymph node is also unchanged measuring 2.5 x 1.7 cm on axial image 39/100.Cardiac size is normal with no pericardial effusion.CHEST WALL: The bony destruction of the second, third and fourth right posterior ribs adjacent to the cavitating lesion has progressed slightly in the interval.UPPER ABDOMEN: Right renal calculus and small cystlike lesion unchanged.

Output: 1.Right upper lobe cavitating lesion as above most suggestive of a malignant process.2.New left lung groundglass opacities may reflect soiling from cavitary material.3.Diffuse bilateral centrilobular nodularity is unchanged and may reflect chronic aspiration and bronchiolitis.4.Stable mediastinal lymphadenopathy.5.Slight progression of bony destruction as above.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of malignant melanoma CHEST:LUNGS AND PLEURA: Bilateral metastatic lung lesions. Index left lower lobe nodule measures 1.9 by 1.3 cm on image number 51, series number 4, not significantly changed. Index right upper lobe lesion measures 2.5 by 1.9 cm on image number 37, series number 4, not significantly changed. Other lung nodules are also stable. Another index nodule in the right upper lobe measuring 5 mm is also stable on image number 24, series number 4.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Stable index right axillary lymph node measuring 1.3 by 1.1 cm on image number 18, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia secondary to biliary stent is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Metastatic soft tissue density occupying the lesser sac causing biliary dilatation and effacing the fat planes between the stomach and pancreas is grossly unchanged.ADRENAL GLANDS: Bilateral adrenal metastases. Index left adrenal mass measures 5.4 by 3.4 cm on image number 87, series number 3, not significantly changed.KIDNEYS, URETERS: Bilateral renal metastases lesions, larger involving the right kidney are stable.RETROPERITONEUM, LYMPH NODES: Stable retroperitoneal adenopathy.BOWEL, MESENTERY: Significant diffuse wall thickening of the stomach and extensive peritoneal carcinomatosis is unchanged. Previously measured index peritoneal nodule is unchanged measuring 1.7 x 1.5 cm on image number 103, series number 3. Numerous retroperitoneal metastatic nodules lateral to the iliopsoas muscles are stable.BONES, SOFT TISSUES: Metastatic lesions in the anterior abdominal wall are stable. Right anterior abdominal wall mass is best seen on image number 117, series number 3.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal soft tissue mass and presacral soft tissue mass as well as multiple other soft tissue mass in the pelvis consistent with peritoneal carcinomatosis. Index left adnexal lesion now measures 4.1 x 3.3 cm on image number 161, series number 3.BLADDER: Nodular focus within the bladder is unchanged.LYMPH NODES: Right operator lymph node is stable measuring 2.1 x 1.2 cm on image number 166, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extensive metastatic disease involving the chest abdomen and pelvis are grossly stable.


Instruction: Generate impression based on medical findings.

Input: Reason: neutropenic fever History: dry cough, hypoxia Unremarkable cardiac and mediastinal silhouette. Bilateral patchy airspace opacities, better shown on a subsequent CT scan, suggestive of infection.Skin folds bilaterally but no pneumothorax.Catheter tip in the left axilla.

Output: Bilateral airspace opacities compatible with infection but nonspecific.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress Minimal basilar atelectasis and/or scarring without discrete superimposed acute cardiopulmonary abnormality. Mild hyperinflation and COPD changes cannot be excludedThe cardiac silhouette is within limits with a moderate tortuosity of the aorta, not incompatible with patient ageBilateral shoulder severe osteoarthritic changes

Output: Scattered atelectasis and/or scarring without definite superimposed additional acute abnormality


Instruction: Generate impression based on medical findings.

Input: 73 years old Male. Reason: lung eval History: lung eval. Loculated pneumothorax at the right apex, unchanged.Diffuse nonspecific pulmonary opacity suggestive of edema with probable pleural effusions on both sides.ET tuber and catheters and drains unchanged.

Output: Pneumothorax, edema and effusions with no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Eval for cardiopulmonary disease. History: Rhonchi on exam. Median sternotomy, heart size normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: evaluate lung fields History: worsening hypoxia, ards Diffuse pulmonary opacities, unchanged. Left pleural effusion again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged diffuse pulmonary opacities and cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Cardiomegaly status post OHT. Normal heart size. Sternotomy hardware unchanged in alignment, the lowermost sternal wire is fragmented.No pneumothorax or pleural fluid.Right apical suture line from prior wedge biopsy or resection.Bulla in the left lower lobe costophrenic angle region.

Output: No acute pulmonary abnormality. Heart size appears normal.


Instruction: Generate impression based on medical findings.

Input: Reason: assess chest tube History: chest tube Interval insertion of a right chest tube with marked decrease in the right pneumothorax.Right upper lobe bullous emphysema and basilar atelectasis.Status post median sternotomy.

Output: Decreased right pneumothorax following chest tube insertion.


Instruction: Generate impression based on medical findings.

Input: 48-year-old man status post MVA. Evaluate for fractures. Normal cardiomediastinal silhouette. Mild bibasilar subsegmental atelectasis/scarring. No pneumothorax. No evidence of fracture.

Output: No acute cardiopulmonary abnormality. No evidence of fracture, however please note that dedicated rib radiographs are more sensitive in the detection of fractures and could be considered if there is high clinical suspicion.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: post cardiac transplant, eval for effusion / pneumo History: as above Chest tubes removed following sternotomy with moderate cardiomegaly.Unchanged left pleural effusion and basilar edema.No significant pneumothorax.

Output: No pneumothorax following removal of multiple chest tubes.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: NGT placement History: as above NG tube not seen in its entirety though the tip is likely in stomach as the side-port is just below the GE junction. Other findings stable.

Output: NG tube not seen in its entirety though the tip is likely in stomach as the side-port is just below the GE junction. Other findings stable.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Status post thyroidectomy Lungs are underinflated. Retrocardiac opacity may reflect atelectasis or consolidation. ET tube is 3 cm above the carina. Surgical drain and a left paratracheal distribution.

Output: Underinflated lungs with retrocardiac opacity suggestive of atelectasis or area of consolidation. ET tube 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old. Left-sided ICD and right IJ Swan-Ganz unchanged.Right PICC line with its tip in the right axilla.Stable cardiac enlargement with diffuse perihilar and basilar interstitial opacities compatible with edema.Evidence of mitral valve replacement with median sternotomy intact.

Output: Support devices unchanged. Stable cardiopulmonary appearance with cardiac enlargement and interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Wheezing. Evaluate lung fields. Mild interval decrease in a left pleural effusion with otherwise stable right upper/midlung and bibasilar opacities. The heart size is stable.Interval removal of a right IJ catheter.

Output: Mildly decreased left pleural effusion with stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: Evaluate opacities, disorientation Heart size is at the upper limit of normal.New patchy airspace opacities in the right upper lobe and left midlung, consistent with pneumonia or acute aspiration.Mild chronic elevation of the right hemidiaphragm.No pneumothorax.

Output: Findings consistent with acute aspiration and/or pneumonia, new since the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: assess swan placement History: s/p swan Tip of Swan-Ganz catheter projection of the main left pulmonary artery. No other change in line position. Cardiomegaly and signs of severe pulmonary hypertension again noted.Stable moderate right pleural effusion. No pneumothorax.Right lower lobe subsegmental atelectasis again noted.

Output: Stable line position. No change in right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: pt with sob, risk of aspiration History: tachypnea Moderate cardiomegaly.Small lung volumes without acute edema or pneumonia.Status post extubation.Left jugular catheter removed.Left subclavian ICD, leads unchanged in position.

Output: Moderate cardiomegaly. No new findings following extubation and catheter removal.


Instruction: Generate impression based on medical findings.

Input: Reason: COPD exacerbation History: wheezing Interval extubation.No significant pulmonary abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old.Reason: eval for effusions History: ETT present Interval removal of right chest tube. Endotracheal tube and right central catheter unchanged in position.Apparent rounded opacity at the left third /fourth rib interspace is likely artifact. The lungs and pleural spaces remain clear. The heart size is normal. No pneumothorax.

Output: Lungs and pleural spaces remain clear.


Instruction: Generate impression based on medical findings.

Input: History pneumonitis. Aortic valve disorder Unchanged bilateral basilar interstitial and mixed in air space opacities in both lung bases. Again concern for edema versus superimposed infection remains high. Small effusions. Scoliosis.

Output: Essentially unchanged nonspecific basilar opacities


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with history of diffuse large B cell non-Hodgkins lymphoma. Compare with previous. Evaluate disease status. CHEST:LUNGS AND PLEURA: Unchanged scattered micronodules. No suspicious nodules, masses, or pleural effusion. Stable pleural fibrotic changes.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Left chest pacemaker.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: Nonobstructing left renal stone as seen previouslyRETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications of the aorta and iliac arteries as well as the mesenteric branch vessels. There is eccentric aneurysmal dilatation of the infrarenal abdominal aorta, best seen on series 80212, coronal image 59.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcifications.BLADDER: Diffuse bladder wall thickening as seen previously.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked degenerative changes of the spine and scoliosis.

Output: Stable exam


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: assess for aspiration pneumonia History: SOB, febrile, trach, history of aspiration Stable cardiomediastinal silhouette.Streaky opacities in the left lower lobe are new from the prior exam. No pleural effusions.

Output: Left lower lobe opacities,consistent with infection due aspiration given the clinical history.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: Palpitations History: Palpitations Cardiomegaly with a prominent left atrium causing a double density shadow over the right atrium.Minimal interstitial edema but no evidence of infection.Mild subsegmental atelectasis or scarring left mid lung.Right jugular catheter, tip in SVC.

Output: Cardiomegaly with subtle pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.PVAD, cardiogenic shock. Patient is currently stable per resident. The aortic knob appears somewhat larger when compared to earlier radiographs, though this could be related to differences in technique, correlate for possibility of mediastinal hematoma or other complication.Cardiopulmonary monitoring and support devices unchanged in position. No visible pneumothorax. Cardiomegaly. Interval worsening of edema and atelectasis on the left. Right pleural effusion probably similar.

Output: Apparent increase in size of the aortic knob, which potentially could be due to differences in patient volume status, positioning and technique, as the patient is clinically stable. As long as the patient is stable conservative follow-up films may be obtained. Differential diagnosis discussed with Dr. Perkins at the time of interpretation.


Instruction: Generate impression based on medical findings.

Input: 81-year-old male with shortness of breath. History of DVT. Evaluate for PE. CHEST:PULMONARY VASCULATURE: No PE. Study is of diagnostic quality.LUNGS AND PLEURA: Numerous scattered micronodules, nonspecific. No suspicious nodules, masses, or pleural effusion. Mild posterior pleural thickening.Moderate paraseptal emphysema. Mild left basilar scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size mildly enlarged without pericardial effusion. Coronary and aortic calcifications. Calcified aortic valve. LAD stent.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Emphysema without acute cardiopulmonary abnormality.2. No evidence of pulmonary embolism.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o cough History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 87 years old.Hypoxia. Pneumonia. Large layering pleural effusions with associated atelectasis and consolidation. Persistent dependent airspace opacities, most pronounced in the right upper lobe, compatible with pneumonia.

Output: No significant change in pneumonia, atelectasis and pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab No significant cardiopulmonary abnormality.Median sternotomy.Left subclavian pacemaker, leads unchanged in position.

Output: No pneumothorax following recent left subclavian pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval pulm edema, pleural effusions History: eval pulm edema Small lung volumes with bilateral opacity compatible with atelectasis, edema and pleural effusions.No new findings.

Output: Pulmonary edema, effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: 72 years old Male. Reason: eval for pneumonia History: cough,. Large lung volumes compatible with COPD. Dilated esophagus, appearing similar to the prior study. Unchanged airspace opacity in the posterobasal segment of the left lower lobe consistent with chronic aspiration. Nodular opacity in the left lower para-aortic region again seen. New focal right lower lobe opacity which may represent aspiration and/or infection. New small right pleural effusion.

Output: New focal right lower lobe opacity which may represent aspiration and/or infection. New small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Shortness of breath. There is severe cardiomegaly. There is mild pulmonary edema and probable small right pleural effusion.

Output: Severe cardiomegaly and mild pulmonary edema with probable small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Right lower lobe crackles and tachycardia. Evaluate line placement. Left-sided central venous catheter with tip in the right atrium. Enlarged cardiomediastinal silhouette. Bilateral basilar opacities, greater on the left compatible with bilateral pleural effusions with retrocardiac consolidation. No pneumothorax.

Output: 1.Left central venous catheter tip in the right atrium. 2.Retrocardiac consolidation.3.Findings compatible with pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: Malignant neoplasm of hilus of lung, unspecified laterality History: Malignant neoplasm of hilus of lung, unspecified laterality Right hemithorax volume loss from prior surgery.Median sternotomy.Status post aortic valve replacement.

Output: No complication of relatively recent surgery. No evidence of tumor recurrence.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male 13 months status post left excision of metastatic melanoma and left upper lobectomy for adenocarcinoma stage IA. CHEST:LUNGS AND PLEURA: New nodular opacity in the left lower lobe measuring 18 x 17 mm on image 8 series 5 suspicious for metastatic disease. Interval decrease in left pleural effusion. Stable subpleural nodularity.MEDIASTINUM AND HILA: Reference right hilar lymph node is unchanged measuring 16 x 9 mm on image 52 (in comparison to 16 x 9 mm on prior exam). 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: Stable subcentimeter nonobstructing left renal stones.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged portacaval lymph nodesBOWEL, MESENTERY: Hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New nodule in the left lower lobe suspicious for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: s/p bronch, assesment for any effusion or plugging History: SOB Left subclavian catheter tip in the right atrium.Bilateral pleural effusions with associated airspace disease, likely reflecting atelectasis rather than infection.Stable cardiomediastinal silhouette.No significant interval changes.

Output: Bilateral pleural effusions and/or atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Reason: asthma, hypoxia History: asthma, hypoxia Unremarkable cardiac and mediastinal silhouette. Mild scarring at left base.No acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: evaluate lung fields History: s/p CABG Moderate to severe cardiomegaly status post sternotomy and aortic valve replacement.Small lung volumes but no reliable evidence of edema or pneumonia.A right jugular introducer is seen at the upper margin of the image.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Back pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: concern for aspiration pneum History: concern for aspiration pneumon Right chest wall port catheter tip in the right atrium. Tunneled right IJ catheter tip in the right atrium. Tracheostomy again noted.No new focal pulmonary opacity, significant pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: 44yo M w/ hx left pleural effusion, evaluate for interval change History: as above Tracheostomy tube with its tip approximately 5 cm above the carina.Left tube with its tip in the stomach.Right IJ venous catheter with its tip in the SVC.There are decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities are compatible atelectasis and effusions increased from the prior exam.

Output: Interval increase in the pleural effusions and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Pectus excavatum.EXAMINATION: CT chest 01/10/11 Pectus excavatum is present. The Haller index is 4.0.

Output: Pectus excavatum.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Intubated, evaluate lung fields. Hypoxemia. Dobbhoff tube has been advanced but remains coiled within the stomach. Tip is near the GE junction.Enteric tube (NGT or OGT) tip just beyond the GE junction. Embolization coils project over the left upper quadrant.Endotracheal tube tip 5 cm above the level of the carina. Right jugular catheter unchanged in position.Lung volumes remain low with basal atelectasis and layering pleural fluid. Motion artifact.

Output: No significant change in cardiopulmonary appearance. ETT tip 5 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: FemaleReason for Study: Reason: infection History: cuogh The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Worsening shortness of breath assess for edema, infiltrate or evidence of COPD. History of left upper lobe squamous cell carcinoma in 2013 per electronic record. Right subclavian ICD unchanged in position. Scarring at the right lung base. Scarring in the left hilum with chronic volume loss consistent with upper lobectomy. No specific signs of pulmonary edema or visible signs of pneumonia. Right basal atelectasis or scarring with associated mild bronchial wall thickening.

Output: No specific signs of pneumonia. Atelectasis or scarring in the right lower lobe could potentially be due to prior aspiration event.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: persistent cough, psych clearance History: cough Upper lung zone predominant interstitial opacities consisting of reticulation and possible cyst formation.Heart size upper normal.No pleural effusions.

Output: Chronic appearing interstitial lung disease, and interstitial lung disease thoracic CT recommended. The differential diagnosis includes pulmonary Langerhans cell histiocytosis, hypersensitivity pneumonitis or drug reaction. Alternatively, atypical or viral infection could present in this pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Chest tube placement. Interval placement of a left chest tube which terminates at the level of the 6th/7th posterior rib interspace. Near complete reexpansion of the left lung with a small residual pneumothorax.Right chest tube unchanged in position with a small hydropneumothorax. Right chest wall subcutaneous emphysema about the same. Diffuse pulmonary opacities on the right unchanged. Right jugular catheter similar in position.

Output: Left chest tube placement with near complete reexpansion of the left lung.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: FemaleReason for Study: Reason: eval lung fields, hx sickle cell History: cp Right Port-A-Cath with its tip in the SVC.Cardiac mediastinal silhouette is unremarkable.Lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: Eval Pleural effusions History: Symptomatic Pleural effusions post op Enlarging right pleural effusion with increasing right lower lung zone consolidation.Enlarging small left pleural effusion.Heart size normal status post aortic valve replacement.

Output: Enlarging right pleural effusion and small left, status post aortic valve replacement.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male status post nephrectomy POD # 1 with tachypnea. Bilateral small pleural effusions, left greater than right, with adjacent compressive atelectasis. No pneumothorax. Normal cardiomediastinal silhouette.

Output: Small pleural effusions with adjacent atelectasis which is expected in the recent postoperative setting.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female with Hospital sarcoma of the left leg LUNGS AND PLEURA: No pulmonary or pleural masses are identified. There are scattered micronodules some that are calcifiedMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: There is no evidence of metastatic disease within the chest.


Instruction: Generate impression based on medical findings.

Input: Male 72 years old Reason: eval lung fields History: cp Very small left pleural effusion or atelectasis/scarring. No focal opacity or pneumothorax. Mild cardiomegaly.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval pna History: dizziness Right basilar subsegmental atelectasis, otherwise unremarkable.No reliable evidence of infection.

Output: Subsegmental atelectasis, otherwise unremarkable. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: cough Interstitial opacity with bronchial thickening and volume loss in the right upper lobe, unchanged from recent previous radiographs.NG tube tip in the distal esophagus.

Output: Right upper lobe opacity and volume loss which is likely at least partially chronic though there may be superimposed acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: PTX s/p chest tube placement, eval for change History: hypoxemia Improvement in right pneumothorax following right chest tube placement.Stable left chest tube with small left pneumothorax.Extensive soft tissue emphysema unchanged.Stable pneumomediastinum.ETT tip 6 cm above the carina.An NG tube extends to the stomach.Right subclavian catheter tip in SVC.

Output: Right chest tube placed, near completely alleviating the right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with stage II colorectal cancer. Status post chemotherapy. Please evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: Small right middle lobe nodule appears minimally reduced, measures 3.6 mm (image 29, series 6), compared to 4.6 mm on the previous exam. There is compressive atelectasis of the lingula.MEDIASTINUM AND HILA: Cardiomegaly with calcifications of the coronary arteries, aortic root and mitral annulus.A catheter is noted in the left and right brachiocephalic veins.Heterogeneous enhancement of right thyroid gland with calcification, unchanged. Multiple multiple surgical clips noted inferior to the thyroid gland.Multiple prominent lymph nodes, not enlarged by CT criteria noted in the anterior mediastinum, prevascular space, pretracheal, subcarinal region, best seen on image 27, series 4CHEST WALL: No significant abnormality noted..ABDOMEN:LIVER, BILIARY TRACT: Multiple calcified granulomas are redemonstrated. Minimal periportal cuffing noted. There is diffuse heterogeneous enhancing pattern without any obvious focal lesions throughout the liver, this could be due to difference in timing of contrast injection. Minimal biliary prominence noted in the left lobe (image 71, series 4). Common bile duct appears slightly dilated, measuring up to 10 mm, in the midportion and distal portion, with gradual tapering into the ampulla, mostly unchanged in comparison to prior study. Cholecystectomy clips noted. Hepatic vessels appear patent. SPLEEN: Splenule noted in the splenic hilum.PANCREAS: Multiple, at least 3 low attenuation lesions noted in within the head and uncinate process of the pancreas (image hundred, series 4), image 125, series 4) but are not completely evaluated. Pancreatic duct is not dilated. No other lesions in the body and tail of pancreas. No peripancreatic fat stranding. Cannot comment whether these lesions were seen on prior exam, probably seen on 9/14/09 (noncontrast study).ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Dense calcification at the origin of bilateral renal arteries. No obvious focal lesions within the kidneys.RETROPERITONEUM, LYMPH NODES: Multiple subcentimeter not enlarged retroperitoneal lymph nodes. A reference left aortic lymph node is mildly decreased in size and measures 1.1 x 0.7 cm (image 126, series 4), previously measured 0.9 cm x 1.3 cm.BOWEL, MESENTERY: Multiple diverticuli in the colon without evidence of diverticulitis. Minimal fat stranding noted within the mesentery throughout the abdomen, nonspecific..BONES, SOFT TISSUES: No significant abnormality noted.OTHER:Atherosclerosis of the aorta and its branches with dense calcification at the origin of celiac axis, and renal arteries and SMA..PELVIS:UTERUS, ADNEXAENo significant abnormality noted...BLADDERNo significant abnormality noted...LYMPH NODESNo significant abnormality noted...BOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitisBONES, SOFT TISSUES: Few degenerative changes in the thoracic spine.OTHERNo significant abnormality noted...

Output: 1.Slight decrease in size of subcentimeter retroperitoneal lymph nodes2.minimal biliary prominence in the left lobe. Common bile duct is dilated up to 10 mm, unchanged. At least 3 low attenuation lesions within the head of the pancreas, probably seen on prior imaging (not convincing due to lack of IV contrast), no evidence of pancreatic ductal dilatation.3.Atherosclerotic changes of abdominal aorta and its branches, with dense calcification at the origin of bilateral renal arteries, unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.sob and pain, history of small cell lung carcinoma Redemonstration of near complete opacification of the left upper lobe, consistent with known large left upper lobe mass. Left basilar opacity. Left cardiac border is obscured.

Output: Redemonstration of large left upper lobe mass.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: r/o infiltrate History: cough. Shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.Left jugular catheter, tip at right atrial level.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Head and neck cancer with persistent cough and dyspnea on exertion evaluate for infection. Volume loss right upper lobe. Solid nodule cranial to the minor fissure was present previously and is probably a similar in size. Peripheral groundglass opacities and scarring probably similar to recent CT.Tortuous thoracic aorta with opacity abutting the descending segment which most likely represents atelectatic lung however is new from prior and infection is not entirely excluded. Costophrenic angle blunting favored to represent scarring. No pleural fluid. Normal heart size. Mediastinal and chest wall surgical clips. Sternal wires. Aortic stent graft.

Output: No conclusive evidence of pneumonia however the extensive pulmonary findings are may reflect evolving interstitial lung disease or drug reaction. Consider ILD protocol thoracic CT. Left lower paramediastinal opacity favored to represent atelectatic lung or infection and can be followed with conventional chest radiographs if there is persistent suspicion for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old. Reason: eval volume overload/pna History: sob. hx of chf Slight increase in diffuse pulmonary opacities with new focal opacity at the right lung base. Small pleural effusions again noted. Marked cardiomegaly, unchanged. No pneumothorax.

Output: Slight worsening in pulmonary edema pattern with new focal opacity at the right lung base, possibly aspiration or pneumonia. Marked cardiomegaly again noted.


Instruction: Generate impression based on medical findings.

Input: Heart failure LVAD, mediastinal and left basilar chest tubes and ICD are all otherwise unchangedCardiomegaly is similar without new airspace abnormality. Retrocardiac patchy opacities again suggest atelectasis

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: evaluate for infiltrate, pulmonary edema History: URI symptoms, ACS rule out Stable cardiac mediastinal silhouette.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history of cough. Evaluate for infection. The cardiomediastinal silhouette is unchanged. No focal air space opacities, pleural effusions, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: 66 yo F s/p thoracotomy decortication for pleural effusion History: 66 yo F s/p thoracotomy decortication for pleural effusion Removal of right-sided chest tubes. Near complete resolution of right-sided subcutaneous emphysema. No significant right-sided pneumothorax. Questionable loculated pneumothorax along the anterior aspect of the mediastinum best seen on lateral radiograph. Small right pleural effusion and right basilar lung atelectasis and/or scarring, unchanged. No new focal pleural parenchymal opacity. Unchanged heart size.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: CXR preop for OLT History: as above No acute cardiopulmonary abnormality. Scattered calcified granulomas.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval SOB History: see above Interstitial opacities unchanged with worsening left mid lung zone consolidation and stable moderate-sized left pleural effusion.Pericardial drain unchanged.Right jugular catheter tip at cavoatrial junction.

Output: Worsening airspace opacity, unchanged edema and moderate left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Dizziness/palpitations. Unchanged basilar atelectasis/scarring. Calcified pulmonary granulomata. No focal pulmonary opacities to suggest infection. No pleural effusion. Cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: cough History: cough Increased retrocardiac consolidation projected behind the descending tortuous aorta suggestive of infection.Subsegmental atelectasis right lower lung zone.No large pleural effusions.Heart size normal status poststernotomy.

Output: Left lower lobe consolidation, possibly atelectasis but infection also in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: r/o infection History: hypoxia New nonspecific patchy interstitial opacities are present.Moderate cardiomegaly.Increased widening of the superior mediastinum could be vascular if there is significant collateral flow in this region, but lymphadenopathy is possible as well.Cholecystectomy clips.IVC filter partially visualized.

Output: Nonspecific interstitial opacities with cardiomegaly suggestive of edema or atypical infection. Widening the mediastinum could be vascular although lymphadenopathy is also in the differential diagnosis. A thoracic CT is recommended to assess both of these findings.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: S/p dual-chamber ICD - r/o complication History: None External defibrillator pads are no longer visualized. Tracheostomy tube is unchanged in position. Interval placement of a left pacemaker with atrial electrode directed cranially. The right ventricular electrode is directed toward the left axilla. A percutaneous gastrostomy balloon is visualized in left upper abdominal quadrant.The lungs and pleural spaces are clear. No pneumothorax. The heart size is normal.

Output: No complication following left pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: Eval for Effusion and Pneumothorax History: S/P Chest tube removal Median sternotomy, with borderline cardiomegaly.Chest tubes been removed and there is no significant pneumothorax.Unchanged basilar opacities with pleural effusions.Left subclavian pacemaker, leads unchanged in position.

Output: No pneumothorax following chest tube removal. Stable basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: lung abnml History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old male with lung cancer status post chemotherapy. Please compare to prior study evaluate treatment response. CHEST:LUNGS AND PLEURA: Reference right middle lobe mass measures 2.1 x 3.1 cm (series 5, image 59); which is stable since prior study accounting for differences in technique. Adjacent micronodules in the right middle lobe again may represent metastases and are stable since prior study.Left upper lobe scarring along the major fissure as seen previously.MEDIASTINUM AND HILA: Right infrahilar mass is minimally smaller since prior study, measuring 2 x 4.2 cm (series 3, image 55); previously measuring 2.4 x 4.5 cm. Heart size normal without pericardial effusion.CHEST WALL: T10 vertebral compression fracture, unchanged. ABDOMEN: LIVER, BILIARY TRACT: Hypoattenuating lesion in the hepatic dome is too small to characterize but appears similar to prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Prominent mural nodularity along lesser curvature of the stomach as previously described. Few sigmoid diverticula without acute inflammation.BONES, SOFT TISSUES: Superior endplate depression and sclerosis of the L3 vertebral body similar to prior study.

Output: 1. Stable right middle lobe mass with adjacent micronodules appearing similar to prior study.2. Minimal decrease in size of right infrahilar mass as above.


Instruction: Generate impression based on medical findings.

Input: Cough Motion degrades sensitivity.Patchy nonspecific densities in both bases likely partially atelectasis, however aspiration or even early edema cannot entirely be excluded. Mild cardiomegaly.

Output: Suspected atelectasis, however early edema and or even aspiration cannot be excluded


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with renal sac cancer, status post left nephrectomy and colectomy, suspicious lung nodules CHEST:LUNGS AND PLEURA: Previously described right upper and lower lobe ground glass opacity persist but appear less dense. Bilateral small pleural effusions.MEDIASTINUM AND HILA: Cardiomegaly. Small pericardial effusion, unchanged.CHEST WALL: No significant change in the appearance of the expansile right anterior liver lesion with sclerosisABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly with numerous liver metastases replacing the normal liver parenchyma. Index mass in the right lobe measures 8.6 by 6.9 cm on image number 119, series number 4, not significantly changed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland is unchanged.KIDNEYS, URETERS: Status post right nephrectomy. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.PELVIS: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: Small amount of ascites.

Output: Previously described groundglass opacities in the right lung appears slightly less dense, otherwise no significant change from previous study


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.History of cardiogenic shock. IABP marker, left PICC, and sternotomy sutures unchanged.Stable cardiomegaly.Moderate right pleural effusion with right basilar opacity unchanged.

Output: Stable examination with right pleural effusion and atelectasis.


Instruction: Generate impression based on medical findings.

Input: 43 years, Male. Reason: Obstruction? History: emesis Chest: The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax. No intra-abdominal free air.Abdomen: Suture material overlies the right upper quadrant. Midline skin staples are in place. There is gaseous distention of small bowel loops measuring up to 5.5 cm in diameter with air-fluid levels seen on the upright radiograph. A small amount of gas and stool is present within the right colon. No pneumatosis intestinalis, pneumoperitoneum, or portal venous gas is identified.

Output: Findings of a high grade incomplete small bowel obstruction possibly near the surgical anastomosis. No evidence of intra-abdominal free air.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: evaluate etiology of hypoxemia History: hypoxemia, intubated, anasarca New pleural effusions and basilar opacities suggestive of CHF/hypervolemia.ET tube high, the tip 9 cm above the carina.An NG tube extends below the lower margin of the image.Two right jugular catheters terminate in the right atrium.Left jugular catheter, tip in SVC.

Output: New pleural effusions and basilar opacities suggestive of CHF/hypervolemia. High ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: acute path History: chest pain Severe cardiomegaly with mild interstitial opacities suggestive of edema.No specific evidence of infection.Left subclavian ICD, leads unchanged in position.

Output: No interval change


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.History of shortness of breath. 2 defibrillator leads are noted at the apex of the right ventricle, one of which may be disconnected from the generator.The cardiac silhouette is enlarged but stable. Aortic calcifications noted.There are no focal pulmonary opacities or large pleural effusions.

Output: Cardiomegaly without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Ileus, tube feed residuals Enteric tube seen with side-port in satisfactory location overlying gastric fundus/body. Overall paucity of small and large bowel gas. Please note that the diffusely thickened large bowel seen on prior CT imaging is not well appreciated on the current study. No definitive evidence of bowel obstruction. Please refer to same day chest radiography for additional findings.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: MaleReason for Study: Reason: History of ewings sarcoma with lung metastasis, total body radiation and transplant. PFTs show mild restriction. Wheezing and chest congestion yearly from oct-mar History: History of ewings sarcoma with lung metastasis, total body radiation and transplant. PFTs show mild restriction. Wheezing and chest congestion yearly from oct-mar The cardiomediastinal silhouette is unremarkable.Is minimal scarring/discoid atelectasis at the lung bases.No focal areas of consolidation.No suspicious pulmonary nodules or masses.No pleural effusions.Mild scoliosis of the thoracic spine unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Status post aortic valve replacement. Bioprosthetic aortic valve in expected position. Sternal plate unchanged in position. Cardiothoracic ratio within normal limits. Subsegmental atelectasis in the right middle lobe. Small nonspecific right greater than left pleural fluid collections unchanged. Mild basal atelectasis.

Output: Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: CVA Patient History: R sided weakness Right central catheter terminates in the mid right atrium.The patient is angled and rotated toward the left. Mild bronchial wall thickening appropriate for age. No focal pneumonia or pneumothorax. Heart size is normal.

Output: No evidence of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: daily cxr History: Chronic systolic heart failure. Swan-Ganz catheter and chest tubes unchanged.Opacity in the left hemithorax consistent with atelectasis and possibly effusion.No new findings.

Output: Nonspecific opacity compatible with atelectasis, consolidation and effusion on the left without significant change.


Instruction: Generate impression based on medical findings.

Input: 20 year-old female with history of Crohn's disease presenting with abdominal pain that is not improving on IV steroids. CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, low-attenuation hepatic dome lesion is unchanged. Gallbladder is normal. No evidence of intra-or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Residual wall thickening of the terminal ileum, cecum, and proximal ascending colon with prominent adjacent lymph nodes. No evidence of obstruction or stricturing. Findings are consistent with patient's known history of Crohn's disease and are overall improved on comparison to prior study.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Mild residual inflammatory changes in the rectum.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Residual inflammatory changes in the terminal ileum, cecum, and proximal ascending colon which has improved on comparison to prior study from 3/10/2008. No evidence of obstruction, stricturing, or abnormal fluid collections.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: lung transplant History: lung transplant Bilateral chest tubes and ET tube unchanged.Right IJ venous catheter with tip in the IJ.Enteric tube has been removed.Evidence of bilateral lung transplants.No significant pneumothorax identified.Basilar opacities are compatible with atelectasis and pleural effusions.Moderate gaseous distention of bowel in the upper abdomen.

Output: Enteric tube removed. Decreased lung volumes with with increasing basilar atelectasis.Dilated air filled loops of bowel.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: hx of testicular cancer, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for infiltrate History: cough Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p STEMI, 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: Age: 59 yearsGender: FemaleReason for Study: Reason: possible infiltrate on previous CXR, coarse breath sounds History: tachypnea Right central venous catheter with its tip at the SVC/RA junction.There decreased lines.Stable cardiomediastinal silhouette.Mild basilar atelectasis.No large pleural effusions.Numerous overlying wire opacities obscure some anatomic detail in the right upper lobe.Biliary stent noted in the right upper abdomen.

Output: Mild basilar atelectasis. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: New onset hypoxia. Fluid overload. Extensive interstitial and airspace opacities bilaterally with areas of consolidation near the lung apices and in the deep lower lobes, especially on the left. There has been minimal worsening of opacities in the right upper lobe but elsewhere the abnormality is without significant change.

Output: Severe CHF with interval worsening of opacities in the right upper lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Rule out pna History: tachy Previously seen left-sided loculated air-fluid collection is no longer present.Possible right basilar opacity extending behind the diaphragm, more likely just subsegmental atelectasis.Right jugular catheter, tip in SVC.

Output: Possible right lower lobe opacity such as infection behind the diaphragm, more likely simple atelectasis. PA and lateral would resolve this question.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p myxoma removal History: s/p myxoma removal Pleural effusions and basilar consolidation left greater than right, unchanged.Status post sternotomy with a normal-sized heart.

Output: Unchanged pleural effusions and basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Rule-out pneumonia. Chest pain. The cardiomediastinal silhouette is within normal limits. Hila and pulmonary vascular also within normal limits. There is no airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: weight loss History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: MaleReason for Study: Reason: bladder cancer- History: bladder cancer- The cardiomediastinal silhouette is unremarkable.Mild basilar atelectasis/scarring on the right.No suspicious pulmonary nodules or masses.Multiple surgical clips noted in the right upper abdomen with right nephrostomy tube identified.Stable compression fracture of midthoracic vertebrae.Fracture of inferior sternotomy wire unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: cough History: cough/told she has pneumonia/ Right middle and right lower lobe opacity. Mild left basilar opacity. Unchanged heart size. Aortic atherosclerosis again noted. No large pleural effusion or pneumothorax.

Output: Bibasilar opacities, right greater than left, not as severe as on study from 12/2014. The chronicity of this opacity is indeterminate and certainly may represent aspiration or pneumonia. Chest radiographic follow-up in 8 weeks after treatment is suggested to ensure resolution.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.On chronic steroids with fever at home. Low lung volumes. Normal heart size. No pneumothorax or pleural fluid. No focal airspace opacity.Multilevel degenerative changes of the spine. Please note that visualization of the spine is inadequate to exclude discitis or osteomyelitis.

Output: No signs of pneumonia or other acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP placement History: see above The proximal aortic balloon catheter marker is in the ascending aorta, and the distal marker is in the descending aorta at the level of T12, with the balloon traversing the aortic arch.Moderate cardiomegaly with mild basilar atelectasis or scarring, unchanged.

Output: Proximal end of the aortic balloon catheter in the ascending aorta.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA? History: diffuse pain and elevated WBC Heart size about upper normal or mildly enlarged with no evidence of CHF or infection.Catheter tip in the SVC.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: 76M s/p valve repair and now with VAP History: - Interval removal of right IJ sheath. Trachea stomach cannula and partially visualized feeding tube remain unchanged. Status post median sternotomy, CABG surgery, tricuspid valve repair and mitral valve replacement.Cardiac silhouette is again obscured.Stable aeration of the lungs with extensive diffuse interstitial and airspace opacities, left greater than right, and associated pleural effusions. No pneumothorax.

Output: Stable aeration of the bilateral lungs with diffuse interstitial and airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Check ET tube ETT remains 3 cm above the carina. Dobbhoff projects beyond the inferior to the image. Left jugular catheter terminates in the innominate.Underlying cardiopulmonary appearance is otherwise similar given changes in positioning, rotation and motion.

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: 42M with CHF and IABP History: IABP AICD, lead in unchanged position. IABP marker in the proximal descending thoracic aorta, unchanged.Stable cardiomegaly.Low lung volumes. No new focal air space abnormality.

Output: IABP marker in the proximal descending thoracic aorta, unchanged.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with metastatic renal cell carcinoma, presenting with shortness of breath. ABDOMEN:LUNG BASES: Bilateral lung metastases.LIVER, BILIARY TRACT: Hepatic cyst is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Hypodensity in the upper pole of The left kidney and multiple small cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach is significantly distended. First and second portion of duodenum is mildly distended and the distal third portion of duodenum is decompressed. Bowel loops are unremarkable.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: Significantly distended stomach. The etiology is unknown. This maybe secondary to compression of the duodenum between the SMA and aorta, however, other etiologies cannot be excluded by CT. Upper endoscopy is recommended.Left renal lesions are unchanged.Lung metastases are unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: MaleReason for Study: Reason: chest pain, hemoptysis History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Dyspnea No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Empyema. Chest tube.VIEW: Chest AP (one view) 04/14/15, 0512 Left upper extremity PICC tip is in superior vena cava. Right chest tube remains in place. Right-sided subcutaneous emphysema is a new finding.Almost complete opacification of right hemithorax continues. Right peri-hilar lucencies are noted. These are either within normally aerated lung or may represent areas of necrotic lung. Mediastinum is slightly shifted to left. Left lung is normal in appearance. Cardiac silhouette size is probably normal.

Output: Possible increase in size of right pleural effusion; shift of mediastinum to left.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant 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, 89 years old.CAD of acute chest pain. Moderate cardiomegaly with tortuosity of the thoracic aorta/great vessels and distention of the SVC appearing unchanged over multiple prior studies.Possible small pleural effusions. Chronic appearing pulmonary opacities. Faint peripheral opacity in the left lung suggestive of atelectasis.Humeral prostheses incompletely visualized. Mild scoliosis.

Output: Low normal lung volumes with atelectasis and possible mild superimposed edema. Cardiomegaly and mildly ectatic thoracic aorta unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.S.O.B. History of bilateral pleural effusions. Interval enlargement of left pleural fluid collection now occupying nearly the entire left hemithorax. Large right pleural fluid collection has also increased in volume. Compressive atelectasis on the right. No specific signs of pulmonary edema.

Output: Enlarging pleural effusions with collapse or consolidation of the left lung.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p thoracentesis; blood fluid aspirated back History: s/p thoracentesis; blood fluid aspirated back Right IJ central venous catheter remains unchanged.Partially obscured cardiac intestinal silhouette is grossly stable.Interval decrease in volume of large left-sided hemothorax and improved associated compressive atelectasis. Interval improvement in right basilar atelectasis. No pneumothorax.

Output: No evidence of pneumothorax status post left thoracocentesis.


Instruction: Generate impression based on medical findings.

Input: 75-year-old female with history of non-Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: LAD stent.CHEST WALL: Port terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: CholelithiasisSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small mesenteric and retroperitoneal nodes have not significantly changed. Reference para-aortic lymph node measures 18 x 8 mm, previously 20 x 11 mm (series 5; image 127).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic versus absent uterus.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 examination.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o PTX vs. mucous plugging, or other causes for hypoxia History: Acute hypoxia Bilateral basilar opacity compatible with consolidation and atelectasis, possibly secondary to aspiration.Moderate right pleural effusion, increased compared to previous.Mild cardiomegaly with a tortuous calcified aorta.No sign of pneumothorax.

Output: 1. Moderate cardiomegaly with right pleural effusion, which may be due to CHF.2.Basilar nonspecific air space opacity and atelectasis suggestive of aspiration.


Instruction: Generate impression based on medical findings.

Input: Reason: 63yo m s/p IABP, assess for location History: as above Balloon catheter marker in the descending aorta projected about 2 cm below the top of the aortic arch.Bilateral lower lobe subsegmental atelectasis.

Output: Balloon catheter in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Chest pain. Sickle cell disease. Left lower lobe consolidation. Persistent left lower lobe consolidation. Streaky right basilar atelectasis.No new focal airspace opacity.Stable cardiomediastinal silhouette.

Output: Left basilar consolidation without significant change.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female with collagenous colitis. R/O perforation. No contrast, ARF. Hypotension. CHEST:LUNGS AND PLEURA: Fibrotic changes particularly peripherally apices and bases with no discrete nodules or effusions.MEDIASTINUM AND HILA: Atherosclerotic changes. Coronary artery calcification. Small right paratracheal node. Mildly dilated esophagus correlate for motility abnormality. Probable hiatal hernia.CHEST WALL: Right shoulder prosthesis. ABDOMEN: The exam is not sensitive for detecting lesions in the bowel or solid organs due to the lack of oral or intravenous contrast.LIVER, BILIARY TRACT: No significant abnormality noted. Assuming no prior surgery hypoplastic left lobe of the liver. The appearance is unchanged from CT of June 2004.SPLEEN: No significant abnormality noted.PANCREAS: Somewhat atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical thinning with focal scarring left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileostomy right lower quadrant. No evidence of bowel obstruction. No ascites. No intramural air or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Foley catheterLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the region of the cecum. Ileostomy right lower quadrant. No ascites. No intramural air or free air.BONES, SOFT TISSUES: Midline surgical scar. Degenerative changes and discogenic disease diffusely lumbar spine. No lytic or blastic disease.OTHER: No significant abnormality noted.

Output: No evidence of perforation.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: Pt with fever, eval for pna History: Pt with fever, eval for pna 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: Female, 71 years old.Reason: RIJ trialysis placement History: as above Pulmonary edema pattern with the right pleural effusion, the latter improved. Mild cardiomegaly status post sternotomy.Right jugular catheter, tip in SVC.

Output: Right jugular catheter, tip in SVC. Improvement in right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: worsening hypoxia in setting of HF History: SOB Moderate cardiomegaly with patchy left base atelectasis and possible small left pleural effusion.No reliable evidence of edema or pneumonia.Right jugular catheter, tip at cavoatrial junction level. An NG tube extends below the lower margin of the image.

Output: Left basilar atelectasis and small left pleural effusion, possibly the result of aspirated secretions. No reliable evidence of edema on today's image.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: check pulmonary status History: check pulmonary status Cardiomegaly with moderate sized bilateral pleural effusions, lower lung zone edema and basilar consolidation, unchanged.ET tube tip approximately 4 cm above the carina.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: No change in pleural effusions and pulmonary opacities consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: empyema s/p chest tube History: see above Right IJ venous catheter with its tip the SVC.Dobbhoff tube with its tip in the stomach.Right thoracic catheter in place.No evidence of a pneumothorax.Extensive pulmonary opacities in the right lung, pleural effusions, and left retrocardiac consolidation/atelectasis similar in appearance the prior exam.

Output: Stable cardiopulmonary appearance with diffuse pulmonary opacities, pleural effusions, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: Eval for PNA History: Productive cough Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Linear scarring left upper lobe.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: History of rectal cancer. Status post resection of liver METs. Increased CEA level. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previously described right lobe peripheral low attenuation lesion is smaller in size and now measures 2.8 x 2.4 cm on image number 93/209.Previously described lesion near the dome of the liver is more ill-defined and is slightly increased in size compared to previous CT and now measures 3.6 x 3.3 cm on image number 7 to 6/209. No new hepatic lesions are visualized.Cholelithiasis is present without evidence of biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal mass measures 2.9 by 1.7-cm and is unchanged from previous CT. Left adrenal gland is unremarkable.KIDNEYS, 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: Prostate gland is enlarged.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: Interval increase in the size of the one of the hepatic lesions near the dome of the liver. This lesion is very ill-defined and its borders cannot be well visualized. MRI of the liver may be helpful for further evaluation of this lesion.Stable right adrenal mass.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o ptx History: pacemaker placement Pacemaker leads projected in the area the right atrial appendage and right ventricular apex.No pneumothorax or other complications.

Output: Pacemaker leads in expected locations with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: et in place? History: intubated Interstitial predominant opacities are unchanged.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: Stable pulmonary opacities possibly ARDS. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: assess ETT placement History: malpositioned ETT Endotracheal tube terminates approximately 4.5 cm from the carina. Other lines and tubes are unchanged. No substantial change in pleural parenchymal opacity since previous study. Unchanged heart size. No pneumothorax.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: MaleReason for Study: Reason: evaluate for pneumonia History: fatigue, fever/chills The cardiomediastinal silhouette is unremarkable.The lungs are clear.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: CHF Mild cardiomegaly without additional cardiopulmonary acute abnormality. Specifically no findings of CHF. Well-positioned 3-lead left subclavian ICD, lead tips are in the expected locations

Output: Cardiomegaly without superimposed acute abnormality


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: eval for pna or pulm edema History: shortness of breath There are decreased lung volumes with elevation of the left hemidiaphragm.Left sided Port-A-Cath with its tip in the SVC.Cardiomediastinal silhouette is unremarkable.Left basilar atelectasis with probable small effusions.Median sternotomy Zantac.

Output: Decreased lung volumes with basilar atelectasis and possible small effusions. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: trach, s/p endobronchial valves evaluate for improvement in RLL emphsema and RUL expansion History: as above Tracheostomy tube, NG tube and left PICC line unchanged.There are increased lung find compatible with COPD.Emphysema redemonstrated and atelectasis the right lung with endobronchial valves stable.

Output: Support devices unchanged including endobronchial valves. Stable cardiopulmonary appearance with emphysema and subsegmental right upper lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: sob, sepsis History: sob, sepsis Subsegmental atelectasis right lung base periphery, otherwise unremarkable.No specific evidence of infection or edema.Gas-distended stomach.

Output: No specific evidence of infection. Right basilar subsegmental atelectasis noted.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Post-extubation History: Post-extubation Interval extubation. PICC line, unchanged. Low lung volumes makes detailed cardiopulmonary assessment difficult. Dense retrocardiac opacity, unchanged. Small left greater than right pleural effusions, as before. Unchanged heart size.

Output: Dense retrocardiac opacity, unchanged. Small left greater than right pleural effusions, as before


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: 55 yo F intubated for COPD exacerbation, s/p episode of agitation, pls eval location of tube Side port of the enteric tube at the gastroesophageal junction. Endotracheal tube, unchanged. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: Lines and tubes, as above.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: s/p SQ ICD History: pain Presternal ICD unchanged except for slight counterclockwise rotation of the generator on the lateral view by about 30 degrees. Heart size normal.No specific evidence of infection or edema.

Output: Unchanged presternal ICD lead, with slight counterclockwise rotation of the generator on the lateral view.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: s/p chest tube removal History: NA Improved pulmonary edema and pleural effusions. No significant pneumothorax.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Patient with cough, sputum and fever. History of follicular lymphoma. Rule-out pneumonia. History: Shortness of breath, cough, sputum, fever The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: cough and fever for several days History: cough and fever for several day Lingular opacity compatible with pneumonia. Remaining lungs are clear of airspace opacities. No pneumothorax. No pleural effusions. The cardiomediastinal silhouette is normal.

Output: Lingular pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: PNA History: sepsis Right pleural effusion and increasing basilar opacities.Moderate to severe cardiomegaly.Surgical clips are projected over the thyroid region.

Output: Findings suggestive of CHF/hypervolemia, more so than pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Retrocardiac opacity new from prior examination. No significant pleural effusions or pneumothorax. Surgical staple projects overlying the right paratracheal stripe. The cardiomediastinal silhouette is within normal limits.

Output: New retrocardiac opacity in the context of severe bronchiectasis. This may represent fluid in dilated bronchi and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Line placement Interval right jugular catheter placement with tip projected into the right atrium. The ETT, NG and left jugular catheters are otherwise unchanged, the NG demonstrates a side port 4 cm above the GE junction.Underlying cardiopulmonary appearance is otherwise similar with a mixed interstitial and airspace abnormality in all 4 quadrants, most concerning for ARDS. Moderate nonspecific cardiac megaly

Output: Right jugular catheter placed


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: s/p open RUL after induction therapy History: s/p open RUL after induction therapy Right chest tubes in place, unchanged in position. No residual pneumothorax.Persistent mild elevation of the right hemidiaphragm. Left basilar discoid atelectasis again noted.Right apical suture in place. No new abnormal focal lung opacities.The heart is normal in size.

Output: No residual pneumothorax. Stable position of right apical chest tubes.


Instruction: Generate impression based on medical findings.

Input: Reason: ?congestive heart failure History: dyspnea on exertion Normal heart size with a tortuous aorta.Blunting of both costophrenic angles consistent with scarring, and left healed rib fractures, consistent with previous left lower lobectomy, not significantly changed from previous.Poorly defined right upper lobe nodule, suspicious for primary adenocarcinoma, better defined on previous CT scans.

Output: Presumed right upper lobe primary carcinoma and scarring with no specific evidence of CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o pancreatic cancer, wheezing on exam, assess for infiltrate History: see above Unremarkable cardiac and mediastinal silhouette. Port catheter with its tip in the SVC.Focal subsegmental atelectasis.No sign of pneumonia or other acute findings

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: hypoxia, evidence of pulmonary edema vs infection History: hypoxia Enteric tube with its tip in the stomach.Decreased lung volumes with stable cardiomediastinal silhouette.Perihilar/basilar opacities, pleural effusions, and basilar atelectasis similar to the prior exam.

Output: Enteric tube with its tip in the stomach. Stable cardiopulmonary appearance with pulmonary edema, small effusions, and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female, chest tube removal Interval removal of right chest tube with no significant pneumothorax. Persistent bilateral airspace and interstitial opacities without significant interval change. Probable small effusions.Cardiomediastinal silhouette unremarkable.

Output: Chest tube removed with no significant pneumothorax. Persistent bilateral airspace and interstitial opacities without significant interval change.