Instruction: Generate impression based on medical findings.

Input: Abdominal distention. Pain. Question effusion, pneumonia or free air. Low lung volumes with elevation of the right hemidiaphragm. Faint opacity in the right mid lung less well observed on the current study and could reflect residual scarring or other pathology. Right basal opacities are obscured by the elevated right hemidiaphragm. No acute abnormality on the left lung. Unchanged appearance of the cardiomediastinal silhouette.Severe degenerative changes of the glenohumeral joints with areas of sclerosis and deformity involving the right humeral head, probably the result of superimposed prior trauma.

Output: 1. Free intraperitoneal air cannot be effectively excluded on a supine radiograph, though no large air collections are appreciated.2. No visible pleural fluid or signs of pneumonia.3. Nonspecific opacity in the right upper lobe has incompletely cleared or for overlap from the scapular tip limits evaluation. Suggest correlation with erect PA and lateral chest radiographs when feasible to assess for resolution.


Instruction: Generate impression based on medical findings.

Input: 77 year old female non-Hodgkin's lymphoma follow-up CHEST:LUNGS AND PLEURA: A stable hazy micronodules right lower lobe and left upper lobe.MEDIASTINUM AND HILA: Small precarinal node series 2 image 35 measures 1.2 x 0.8 cm. coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy clips. No focal liver lesions.SPLEEN: Normal size no focal lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Minimal atherosclerotic changes aorta. No pathologic size lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified fibroid, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No interval change. Small mediastinal nodes. Micronodules lungs. Fibroid uterus. Diverticulosis colon.


Instruction: Generate impression based on medical findings.

Input: 64 years old Male. Reason: eval for PNA History: cough, weakness. There is a complete opacification of the left hemithorax with minimal shift of mediastinal to the right. There is a small right pleural effusion. The right Port-A-Cath and ICD device are stable in position.

Output: New complete opacification of left hemithorax, which can be due to large pleural effusion or complete collapse of the left lung. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: r/o PNA History: AMS/syncope Small lung volumes.No acute abnormality.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: chest tube place on water seal History: chest tube on water seal Two right chest tubes in unchanged position. Questionable small loculated right pneumothorax, with possible subpulmonic component.Moderate loculated right pleural effusion is not significantly changed accounting for differences in patient positioning.Patchy opacities throughout right lung field, compatible with edema or infection, unchanged.Stable chest wall subcutaneous emphysema.

Output: Right sided effusion and opacities appear stable. Questionable small loculated right pneumothorax, with possible subpulmonic component.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: cardiopulm process History: ams Possible retrocardiac opacity, the lungs otherwise unremarkable. Unremarkable mediastinal contours and cardiac silhouette.

Output: Possible retrocardiac opacity. If the patient is symptomatic for pneumonia this could represent early infection. Follow-up in 4-6 weeks is recommended or a CT at this time.


Instruction: Generate impression based on medical findings.

Input: Reason: eval CHF exacerbation History: worsening sob w/hx of CHF Severe cardiomegaly with a tortuous aorta, not appreciably changed.No specific evidence of pulmonary edema or visible effusions.

Output: Severe cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: chf History: new diagnosis of chf Markedly enlarged cardiac silhouette which may be secondary to cardiomyopathy or pericardial effusion.Nonspecific basilar airspace opacity compatible with atelectasis and possibly aspiration or infection.

Output: Markedly enlarged cardiac silhouette with nonspecific basilar opacity but no specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: pulmonary edema History: SOB when laying flat Low lung volumes.Chronically elevated right hemidiaphragm. Right basilar atelectasis.No focal airspace opacity pneumothorax, pleural effusion, or pulmonary edema.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: CT ICU post-op patient History: CT ICU post-op patient Iatrogenic devices are unchanged. Persistent patchy bibasilar opacities, slightly increased on the right, likely atelectasis. Unchanged cardiomegaly. No pneumothorax. No large pleural effusions.

Output: No substantial difference compared to last study.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: CP History: CP Median sternotomy, heart mildly enlarged.No specific evidence of infection or edema.

Output: Mild cardiomegaly, without acute edema or pneumonia, nor significant pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 51 year old female, follow-up on non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Irregular, spiculated left upper lobe nodule (series 5 image 17) not significantly changed, measuring 10 x 7 mm (previously 9 x 6 mm). Additional ground glass/nodular opacities and few micronodules, unchanged. No new lesions.MEDIASTINUM AND HILA: Index left supraclavicular lymph node (series 3 image 8) measures 16 x 11 mm, unchanged.Index right paratracheal lymph node (series 3 image 28) increased in size measuring 28 x 18 mm (previously 20 x 13 mm).Additional non-referenced mediastinal and hilar conglomerated lymph nodes more bulky than prior.No pericardial effusion.CHEST WALL: Chest wall and breast tissue is incompletely imaged. Asymmetric left axillary lymph nodes, largest measuring greater than 2 cm in diameter, not significantly changed. New diffuse skin thickening of the left breast. Multiple collateral vessels in the anterior chest wall, similar to prior.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Slight nodular fullness to the left adrenal gland, not significantly changed from prior scan though cannot exclude metastatic disease.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymph node (series 3, image 86) measures 15 x 9 mm, not significantly changed (15 x 11 mm on prior).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple small soft tissue densities in the anterior abdominal wall subcutaneous tissues as seen on prior, consistent with subcutaneous fluid injections. New larger soft tissue density in the left lower abdominal wall, also likely secondary to subcutaneous injection. Fat-containing umbilical hernia, similar to prior.OTHER: Moderate vascular calcifications of the abdominal aorta and its branches.

Output: 1) Marked increase in mediastinal metastatic disease. Lung lesions not significantly changed in size. 2) Left breast skin thickening with persistent asymmetric left axillary lymphadenopathy. Recommend correlation with mammography.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: pt with bronchiolitis obliterans, monitoring History: sob, tachypnea Small lung volumes with diffuse nonspecific airspace opacity and pleural effusions are unchanged. Venous catheter stable. No new opacity.

Output: Small lung volumes with diffuse nonspecific airspace opacity and pleural effusions are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: cause of SOB History: hx of CHF, presents with SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 23 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: Male, 87 years old.Reason: abd pain History: as above Prominent loops of bowel in the upper abdomen, increased from last study. Mild basilar reticulation again noted. No large pleural effusion or pneumothorax. Unchanged appearance of the mediastinum.

Output: Increase in bowel loops in the upper abdomen. Correlation with abdominal imaging is suggested.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with history of follicular lymphoma present in duodenum CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter scattered nodules in the right upper lobe on image number 50 and 49, series number 5.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts.SPLEEN: Borderline splenomegaly is unchanged. Spleen measures 13 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening involving the distal duodenum at the level of the ligament of Treitz is again noted. No significant change. Stranding of the fat around the duodenum and that location and small associate lymph nodes in the mesentery are also stable. The amount of proximal dilatation has significantly decreased.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: Wall thickening involving the distal duodenum and proximal jejunum and other associated changes are stable. the degree of proximal dilatation is significantly decreased.


Instruction: Generate impression based on medical findings.

Input: Age: 29 yearsGender: FemaleReason for Study: Reason: pericardial effusion History: SOB Interval increase in cardiac size and/or pericardial effusion.Nonspecific left basilar opacity compatible with atelectasis and possible small left pleural effusion.The right lung is clear.

Output: Increasing cardiac size and/or pericardial effusion


Instruction: Generate impression based on medical findings.

Input: Tachypnea Interval removal of the Swan-Ganz catheter in similar underlying cardiopulmonary appearance. Overall decreased lung volumes, scattered changes suggesting patchy edema greater on the right with associated small layered effusion. Cardiac and mediastinal contours are otherwise grossly unchanged

Output: Swan-Ganz removed


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: Sepsis Check Pulmonary Status History: Sepsis Check Pulmonary Status Worsening pulmonary opacities and enlarging pleural effusions particularly on the left.Status post extubation.NG tube looped in proximal stomach.

Output: Worsening pulmonary opacities and enlarging pleural effusions particularly on the left.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: FemaleReason for Study: Reason: interval change s/p bilateral lung transplant History: as above Support devices unchanged.Stable appearance of bilateral apical pneumothoraces.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

Output: Bilateral apical pneumothoraces without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o acute process History: weakness Small lung volumes with bilateral pleural effusions and nonspecific basilar opacity compatible with atelectasis and possibly aspiration.Fluid-filled distended gastric interposition extending to the right of the mediastinum.Catheter tip in the SVC.

Output: Pleural effusions and increase basilar opacity possibly due to aspiration.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: r/o infiltrate History: cough Right middle lobe and lingular airspace opacities.Heart size normal.No significant pleural effusions.

Output: Middle lobe and lingular airspace opacities consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: 49-year-old male with history of urothelial bladder cancer status post radiation therapy, radical cystoprostatectomy with neobladder, status post adjuvant chemotherapy. Evaluate for disease progression. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. Please note that lack of IV contrast significantly limits evaluation of solid organs. Given this limitation, the following observations are made:ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Previously seen subcentimeter liver lesions are not seen on this non-infused study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis and hydroureter with atrophy of the left kidney appear similar to prior study.RETROPERITONEUM, LYMPH NODES: Prominent left para-aortic lymph nodes appear similar to prior study (series 3, image 117).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Patient is status post cystoprostatectomy.BLADDER: Distended neobladder is intact. Status post radical cystectomy. LYMPH NODES: No pelvic lymphadenopathy noted. Previously noted mesenteric adenopathy adjacent to the neobladder is not seen on current study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat containing left inguinal hernia.

Output: Overall stable exam with no evidence of tumor recurrence


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: s/p thoracentesis History: SOB Additional clinical history includes tuberculosis. Enteric tube enters the stomach and continues out of the field-of-view. Right central line terminates in the left brachiocephalic vein. Right central line terminates in the SVC.Diffuse pulmonary miliary tuberculosis involvement, unchanged from prior. Tiny bilateral pleural effusions. No pneumothorax.

Output: Unchanged support devices and miliary tuberculosis pattern. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: s/p CV surg eval for effusion and pneumo History: as above Mild cardiomegaly with increased basilar atelectasis and small pleural effusions.No pneumothorax following left chest tube removal.Right jugular introducer removed.

Output: Cardiomegaly, with increased basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiomegaly, effusion History: ESRD, lupus on dialysis missed 2 appointments, sob, chest pain Moderate cardiomegaly with no significant pulmonary abnormalities.Catheter tip in the SVC.Vascular stents in the area of the right axilla.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: r/o infiltrate History: productive cough The heart appears slightly large but probably is related to the AP projection.No specific evidence of infection or edema.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Evaluate IABP IABP marker projects over the aortic arch. Left central venous catheter is unchanged. Stable cardiomegaly. Focal nodular opacity in the right lung base is unchanged compared to prior. No large pleural effusion or pneumothorax.

Output: IABP marker projects over the aortic arch. Otherwise, no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Altered mental status question pneumonia Patient is rotated, I am unable to assess for presence or degree of rightward mediastinal shift. Left jugular catheter tip projects over the left brachiocephalic vein to the right of midline. No focal airspace opacities. Low lung volumes, similar to previous.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Cardiac arrest Grossly similar bilateral perihilar and basilar opacities greater on the left with suspected small left effusion, however evaluation is limited due to marked rotation and motion. Subsequent exams reported.ETT removed veins 4 cm above the carina. NG incompletely visualized

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: eval for cardiomegaly History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Bilateral cervical ribs noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: IABP and swan placement History: as above Intra-aortic balloon pump has been superiorly repositioned now terminating 2 cm from the top the aortic arch. Swan-Ganz catheter in defibrillator lead, unchanged. Mild basilar opacities again noted. Small right pleural effusion. Unchanged cardiomegaly. No pneumothorax.

Output: Intra-aortic balloon pump has been superiorly repositioned now terminating 2 cm from the top the aortic arch. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Age: 69 yearsGender: MaleReason for Study: Reason: evaluate for pneumonia History: hypoxemia, DOE Increasing right upper lobe airspace and nodular interstitial opacities compared with prior exam but similar to recent CT.Small pleural effusions new from the prior exam.Perihilar interstitial opacities increased from the prior exam as well.The cardiomediastinal silhouette is unremarkable.

Output: Small pleural effusions and diffuse pulmonary opacities most prominent in right upper lobe are similar to the recent CT and are compatible with metastatic disease, however superimposed infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Atrial fibrillation. Line placement Bilateral jugular catheters, NG are all unchangedUnderlying cardiopulmonary appearance demonstrates mild improvement with diminishing atelectasis and minimally improved aeration in lungs again remain diminished in overall volume, likely partially semiupright portable technique

Output: Unchanged left jugular catheter


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: sepsis, trach in place History: sepsis, trach in place Left pleural effusion and left lower lobe consolidation unchanged.Tracheostomy tube tip 7 cm above the carina.Left jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

Output: Unchanged left pleural effusion and left basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Pneumothorax history Persistent small insignificant right pneumothorax with additional extensive postsurgical changes including small lung volumes and a single right chest tube projected towards the right apex along the midline.Extensive chest wall and neck emphysema with some gas tracking to the opposite side, this left sided emphysema is new

Output: Unchanged right chest tube and small right pneumothorax


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: assess ETT placement History: ETT reposition Upper and left lower lung zone opacities probably atelectasis.ET tube tip approximately 2 cm above the carina.A Dobbhoff tube terminates in the stomach.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: re-evaluate History: on vent Left basilar subsegmental atelectasis which may be from mucous plugging, the lungs otherwise unremarkable.Heart size upper normal.ET tube tip approximately 5 cm above the carina.Right PICC, tip in the SVC.An NG tube extends below the lower margin of the image.

Output: Left basilar subsegmental atelectasis, otherwise unremarkable. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: evaluate for changes/ new infiltrates History: sudden onset worsening shortness of breath Diffuse pulmonary fibrosis grossly similar in severity and distribution compared to prior CT given differences in technique. No focal areas of consolidation to suggest pneumonia.

Output: Diffuse pulmonary fibrosis grossly similar in severity and distribution compared to prior CT given differences in technique. No focal areas of consolidation to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.Reason: Eval for acute chest syndrome. History: CP w/ hx of sickle cell Mild scarring from known sickle cell disease.Otherwise, the lungs are unremarkable.Heart size normal, although there may be left atrial enlargement.

Output: No significant abnormality. No evidence of infection or infarction.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: 53 y/o male with head/neck CA; please eval for signs of aspiration/pna History: Fever No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

Output: No significant abnormality. No sign of infection/aspiration, or metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old with shortness of breath and tachypnea. The heart size is normal. Large lung volumes with flattening of the diaphragms suggestive of COPD. Right infrahilar opacity is compatible with either pneumonia or an underlying mass. Probable small bilateral pleural effusions. No pneumothorax.

Output: 1.Right infrahilar opacity compatible with either pneumonia or lung cancer. Contrast-enhanced chest CT is recommended.2.Findings suggestive of COPD.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Swan placement History: Swan placement Unchanged pleural effusions and mild left basilar atelectasis.Right jugular Swan-Ganz catheter tip in right pulmonary artery.Left jugular catheter, tip in SVC.

Output: Right jugular Swan-Ganz catheter tip in right pulmonary artery, unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: enlarged cardiac silhouette History: BLE swelling, CHF Stable mild cardiomegaly.Evidence of prior valvular surgery.The lungs are clear.No pleural effusions.Old rib fracture deformities bilaterally.

Output: Stable cardiomegaly without specific evidence of pulmonary edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: abd pain History: abd pain Amplatzer device is located at the anterior atrial septum.Progressive atelectasis of the right middle lobe with increasing right pleural effusion. The heart size remains stable.

Output: Increasing right pleural effusion and progressive right middle lobe atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Pneumothorax postop. Low lung volumes. Presumed abdominal drain projects near the level of the left hemidiaphragm. Moderate pleural effusions, about the same. Atelectasis and mild edema in the dependent lung fields. Near complete resolution of left pneumothorax with only a trace amount of air seen medially. Diffuse subcutaneous emphysema bilaterally.

Output: Trace left pneumothorax. Lung volumes remain low with significant atelectasis and moderate pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: s/p biopsy of a right lung mass, assess pneumothorax seen on post-procedure CT History: s/p biopsy of a right lung mass 16 mm right apical pneumothorax extending laterally towards the lung base.Unchanged pulmonary nodules and masses.Small right pleural effusion.Left subclavian catheter, tip in SVC.

Output: 16 mm right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: Eval for pulmonary edema History: DOE With cardiomegaly, vascular congestion and bilateral interstitial and airspace opacities, the findings most likely compatible with pulmonary edema. There is mild blunting of costophrenic angles. No pneumothorax.Support devices are stable. No pneumothorax.

Output: Cardiomegaly with increased vascular congestion and bilateral interstitial airspace opacities are most consistent with congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumothorax / hemothorax / fluid collection History: SOB; Post-PROCEDURE Pleuroscopy / Thorascopy (0400 following procedure) Persistent small right basilar pneumothorax, slightly decreased with increased accumulation of pleural fluid.Persistent moderate left effusion with underlying atelectasis.Right chest tube in place and pleural catheter projected over the right lung base.

Output: Decreased right basilar pneumothorax and increased accumulation of right pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Postsurgical abnormalities on the left compatible with previous upper lobectomy, unchanged.Pacemaker leads also unchanged.

Output: Postsurgical abnormalities with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: Pneumonia, effusion History: productive cough yellow sputum x 3 weeks, recently dx with rhinovirus infection at OSH 1 month ago. Worsening cough and chest pain. Mild inferior thoracic dextroscoliosis. The lungs and pleural spaces are clear. The cardia mediastinal silhouette is unremarkable.

Output: No evidence of active infection.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: post-chest tube manipulation History: chest tube Right chest tube kinked but now directed towards the apex, with a minimal right apical pneumothorax.Right jugular catheter, tip in SVC.

Output: S right chest tube reposition, still kinked.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: chest pain History: chest pain Ectatic ascending aorta with an usual configuration inferiorly; an aneurysm is possible.Mild aortic tortuosity elsewhere.Heart size normal.

Output: Abnormal appearing ascending aorta, a thoracic CT recommended to evaluate for aneurysm formation. Findings were discussed with Dr. Ward with the referring service 8:55 AM 7/31/2015.


Instruction: Generate impression based on medical findings.

Input: Reason: hx seminoma, sarcoidosis. evaluate for change in LAD History: sarcoidosis, testes ca Normal cardiac and mediastinal contours.Prominent hilar opacity on the lateral view consistent with moderate lymphadenopathy is shown on the previous CT scan.No significant pulmonary abnormalities.

Output: Mild hilar enlargement and increased opacity on the lateral view compatible with known lymphadenopathy which could be evaluated more accurately by CT scan.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.History: Interstitial lung disease Stable cardiomediastinal silhouette.Chronic diffuse reticular opacities with stable appearance of bibasilar fibrosis.No new focal pulmonary opacity. No pleural effusions or pneumothorax.

Output: Chronic interstitial lung disease without superimposed acute abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Status post right pleurectomy for epithelioid-type malignant mesothelioma. LUNGS AND PLEURA: Previously seen large right hydropneumothorax has decreased. Previously seen right lower and middle lobe consolidation, and right middle lobe edema have also decreased. Previously described nodularity of the right minor fissure is less prominent compared to the last study. Post operative right pleural thickening and a small amount of pleural effusion. Diaphragmatic pleural patch.The left lung is clear. MEDIASTINUM AND HILA: No lymphadenopathy. Heterogeneous enlargement of the left thyroid lobe with a cyst, unchanged.CHEST WALL: Metallic foreign body in the right lateral chest wall, unchanged. Previously described fat infiltration in the chest wall musculature is less prominent in comparison to the prior study, which is likely postoperative.UPPER ABDOMEN: LIVER AND SPLEEN: Peripheral areas of decreased attenuation in the liver seen on image 64 and 77 (series 3), incompletely characterized due to lack of adequate contrast, are unchanged. A punctate round cystlike lesion in the left lobe on image 91 (series 3) is unchanged.Slight dilatation of intrahepatic bile duct system.ADRENAL GLAND: No significant abnormality.KIDNEY, PANCREAS AND RETROPERITONEUM: Round isodense cystic lesions in the right kidney, on image 87 (8 mm) and image 97 (10-mm), are unchanged. A probable renal cyst and extrarenal pelvis on the left are also unchanged.

Output: 1. Resolving postoperative changes in the right thorax, with residual small hydropneumothorax.2. Previously described lesions in the liver and the right kidney are unchanged and likely benign findings.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Hx pHTN r/o pna vs pulm edema History: SOB Cardiomegaly with biventricular with 4 chamber enlargement. Prominent central pulmonary arterial vasculature. No specific evidence of infection or edema. Right lower zone reticular opacity. In the setting of prior pulmonary embolus in the right interlobar artery, this may represent pulmonary infarct. Subsegmental atelectasis can have a similar appearance. No significant pleural effusion or pneumothorax Metallic structure occupies the left upper abdominal quadrant. A Greenfield filter apex is visualized in the mid upper abdomen.

Output: Cardiomegaly with four-chamber enlargement. Right lower zone opacity that may represent pulmonary infarct in the setting of known right interlobar pulmonary embolus versus subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: where is IABP? History: IABp placed for CHF AICD present with leads unchanged. IABP marker stable in position.Unchanged cardiomediastinal silhouette. No focal air space opacities, pleural effusions or pneumothorax.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Esophageal leak. Right PICC is unchanged in position. No pneumothorax. Left basal atelectasis and effusion is unchanged.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: Post-Op wedge resection History: Right chest tube Right chest tube extending to the apex with no significant pneumothorax.Streaky opacity at the left base consistent with atelectasis.

Output: Chest tube in place with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with history of prostate cancer, new suspicious lesions on CT and bone scan in 2011 CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific sclerotic lesions in bilateral rips and thoracic vertebral bodies are stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Stable exam


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with bladder cancer CHEST:LUNGS AND PLEURA: Severe emphysematous changes with large bulla formation, not significant changed from previous study. Two subcentimeter nodules in the right middle lobe adjacent to the bulla . An index nodule measures 4-mm on image number 45 of series number 7.MEDIASTINUM AND HILA: Atelectatic lung abutting the right hilum, not significantly changed from previous study. Prevascular soft tissue density lesion measuring 3.7 by 1.3-cm on image number 49, series number 8. Previous studies did not include this lesion.And other borderline enlarged precarinal lymph node measures 9 by 8 mm on image number 47, series number 8.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: Small cyst in the lower pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Aortic stent graft is again noted. No evidence of endoleak. the aneurysm is smaller measuring 4.3 by 3 .5-cm on image number 132, series number 8, its largest axial dimension. BOWEL, MESENTERY: Left lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Bilateral inguinal hernias. The hernia on the right contains nonobstructed bowel segments.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Anterior mediastinal soft tissue density lesion, suspicious for adenopathy. Previous studies did not include this lesion.Interval decrease in the size of the stent grafted abdominal aortic aneurysm.Bilateral inguinal hernias.


Instruction: Generate impression based on medical findings.

Input: Left flank pain, fall on Coumadin, dropping hemoglobin. CHEST:LUNGS AND PLEURA: Small left-sided pleural effusion. Dependent atelectasis in the left lower lobe. Mild bronchiectasis. Nonspecific groundglass density in the left upper lobe.Linear deep tendon atelectasis.MEDIASTINUM AND HILA: Calcified adenopathy in the mediastinum and left hilum.CHEST WALL: There is a large left chest wall hematoma extending to the left flank. It measures 10.1 x 6.6 cm. Multiple rib fractures involving the T10 through T12 left posterior ribs. The left transverse process of L1 vertebral body is also likely fractured .ABDOMEN:The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: Ill-defined hypodense lesion in the posterior segment of the right lobe with peripheral calcifications indeterminate on this noncontrast CT. It measures 13 x 10 mm. No biliary dilatation.SPLEEN: There are multiple calcified granulomas in the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left chest wall and flank hematoma associated with posterior left rib fractures as described above. Fracture of the L1 left transverse process.No evidence of traumatic injury within the abdomen.Small left-sided pleural effusion and dependent atelectasis in the left lower lobe.These findings were discussed with the ER resident at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Cardiac surgery. History of pulmonary artery stenosis.VIEW: Chest AP (one view) 04/12/16, 1245 Endotracheal tube tip is below thoracic inlet. Right chest tube is in place. There is a right atrial line. Epicardial pacer leads are seen. Mediastinal surgical clips are noted.Cardiothymic silhouette is normal. No pneumothorax or pleural effusion is identified. No focal lung opacity is seen.

Output: No evidence of complication after heart surgery.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Chest pain Moderate elevation the right hemidiaphragm is present. The lungs are clear without consolidation, effusion, or edema. Heart size within normal limits.

Output: Moderate elevation of the right hemidiaphragm. Otherwise clear lungs.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: eval lung fields History: sob No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 58 years old Male. Reason: fever, hypoxia History: fever, hypoxia. Stable moderate cardiomegaly with interval improvement of the interstitial opacity. Stable bilateral small pleural effusions.

Output: The above findings are consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate pleural effusion History: pleural effusion Mild cardiomegaly status post median sternotomy.Mediastinal drain still in place with a small amount of pleural air deep in the right cardiophrenic sulcus.Small bilateral pleural effusions stable, as is basilar atelectasis.Increased basilar edema.Left PICC, tip in left subclavian.

Output: Small right cardiophrenic angle pneumothorax versus mediastinal air as there is still a chest tube in place.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: New fever. The cardiomediastinal silhouette is normal. There are calcified mediastinal lymph nodes. No acute cardiopulmonary process.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Respiratory failure status post trach. NGT has been replaced with a Dobbhoff tube, the tip is off the caudal margin of the film.Right jugular catheter at the superior cavoatrial junction similar in position. Tracheostomy tube tip at the clavicular head level. Sternotomy hardware similar in alignment.Unchanged cardiomegaly. Moderate pleural effusions, increased on the left. Severe pulmonary edema with patchy atelectasis in the left mid and right lower lungs. Worsening retrocardiac opacity on the left.

Output: Slight worsening of CHF and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Where is Swan located? History: He has a Swan. Interval retraction of Swan-Ganz catheter into most proximal aspect of right interlobar pulmonary artery. Other findings stable.

Output: Interval retraction of Swan-Ganz catheter into most proximal aspect of right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Mild basilar scarring, unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion near the dome of the liver is stable. Hypodense lesion near the falciform ligament is stable. Focal biliary dilatation involving the left lobe of the liver is stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant change in the hypodense infiltrative lesion in the fat caudal to the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stranding of the fat in the left lower quadrant which may indicate postsurgical changes in omental necrosis is slightly less prominent on today's study. Postsurgical changes involving the small bowel.BONES, SOFT TISSUES: Postsurgical changes involving the anterior abdominal wall. Previously described nodular enhancing density in the anterior abdominal wall is not visualized.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination other than resolution of anterior abdominal wall nodule and less prominent appearance of left lower quadrant fat stranding of the omentum.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval lungs History: eval lungs Line position stable. Support devices unchanged. No change in bilateral pleural effusions and lung opacities. No pneumothorax.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male presents with dyspnea. Right-sided central venous catheter has its tip overlying the right atrium.The cardiomediastinal silhouette is unchanged. Bibasilar streaky opacities, left greater than right, favored to represent atelectasis. No large pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath No pneumothorax.In numerable pulmonary nodules are identified as well as mediastinal lymphadenopathy.No specific evidence of infection or edema.

Output: No pneumothorax. Diffuse pulmonary and mediastinal metastases are present.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: daily CCU CXR, assess interval change History: advanced heart failure ICD with leads unchanged. Swan-Ganz catheter tip is in the right pulmonary artery. IABP superior marker is 3.5 cm below the aortic arch.Moderate cardiomegaly.No pleural effusion or pneumothorax.No focal pulmonary opacity.

Output: No significant interval change since the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 26 years old.Reason: sp PICC placement History: sp PICC placement No significant cardiopulmonary abnormality.Left PICC, tip in left subclavian vein.

Output: No significant abnormality. See above for PICC placement.


Instruction: Generate impression based on medical findings.

Input: Increased gait problems SHUNT DEVICE: Shunt device exits the skull via a right frontal burr hole courses down the right neck and chest wall before entering the abdomen, coursing down to the pelvis, and terminating in the left hemiabdomen. Portions of the shunt overlying the scalp are are radiopaque which limits its evaluation however within these limits, there is no evidence of shunt complication. The notch on the valve points inferiorly and posteriorly towards the course of the shunt. In 2014, the notch pointed superiorly.SKULL: No significant abnormality noted. Multiple dental fillings are noted.CERVICAL SPINE: Mild to moderate degenerative disc disease affects the cervical spine, particularly at C6-C7. This is similar to the prior exam.CHEST: The lungs are clear. The cardiomediastinal silhouette is normal.ABDOMEN: The bowel gas pattern is nonobstructive.

Output: No evidence of shunt complication.


Instruction: Generate impression based on medical findings.

Input: Age: 57 yearsGender: MaleReason for Study: Reason: evaluate SOB, atach History: SOB Stable cardiomediastinal silhouette.Minimal left basilar scarring.No focal airspace consolidation.No pleural effusions.Median sternotomy intact with evidence of a prior mitral valve replacement.

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


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: Please re-eval pleural effusions, and for pulm edema History: SOB, BLE edema, Interval removal of right jugular catheter. Lungs hypoinflated. Stable cardiomegaly with bilateral pleural effusions. Left pacemaker. Unchanged

Output: Lungs hypoinflated. Stable cardiomegaly with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Bilateral ankle swelling, history of pulmonary edema? Normal heart size. No pleural fluid or pneumothorax. Vascular unsharpness may indicate mild hypervolemia, though there are no specific signs of interstitial edema. Degenerative changes of the spine.

Output: No convincing evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: productive cough,heart transplant History: see above No new focal pleural parenchymal opacity. Mild basilar atelectasis or scarring again noted. Normal heart size. Patient again status post sternotomy. Surgical clips again noted bilaterally within the thorax. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ETT tube placement History: ETT placement Increasing left basilar opacity suggestive of atelectasis with left pleural effusion.ET tube low, cannulating the right main bronchus, subsequently repositioned.Dobbhoff tube tip in second portion of the duodenum.Left subclavian catheter, tip in SVC.

Output: Low ET tube, with developing atelectasis in the left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: pna? rib fx? CHF? History: fall, SOB Severe COPD.Chronic interstitial opacities and scarring.No reliable evidence of infection.Heart size normal. No displaced rib fracture identified.

Output: Severe COPD, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ptx History: ptx, 2 chest tubes on R Right chest tubes in place with a moderate pneumothorax, not significantly changed.Basilar opacities compatible with atelectasis.Subcutaneous emphysema on the right.

Output: Moderate right pneumothorax and basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Chest pain Increase in perihilar hazy opacities and bilateral pleural effusions with underlying atelectasis. Low lung volumes. No pneumothorax. Apparent enlargement of the cardiomediastinal silhouette is in part positional.

Output: Increased pleural fluid and perihilar opacities consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: 75 year old female with history of stage IIIB lung cancer status post chemo/radiotherapy (June 2004). Compare with old scan. CHEST:LUNGS AND PLEURA: No new or suspicious pulmonary nodules. Trace left pleural effusion.Stable paramediastinal fibrosis; right lower lobe granuloma unchanged.MEDIASTINUM AND HILA: Stable prevascular nodes. Previously referenced lymph node measures 6 mm on series 10285, image 24 (stable). Unchanged calcified mediastinal nodes. Coronary calcifications.CHEST WALL: Osseous non-union of left thoracotomy fracture fragments unchanged (series 10285 images 35 and 41).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Reidentification of renal cysts bilaterally.PANCREAS: Low-density lesions in the pancreas are again seen as well as mild localized dilatation (unchanged).RETROPERITONEUM, LYMPH NODES: IVC filter unchanged. Unable to evaluate for IVC thrombus without IV contrast.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative changes of the spine.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for pulmonary edema History: volume overload Cardiomediastinal silhouette within normal limits. Lungs clear. No pleural effusions. No pneumothorax.

Output: No specific evidence of infection or edema


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Reason: eval for infiltrate History: sob/chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Evaluate PICC line placed at outside hospital. Left upper cavity PICC terminates in the SVC/confluence of the brachiocephalic veins. A right internal jugular chest port catheter terminates at the superior atriocaval junction.No focal lung opacity, pleural effusion, or pneumothorax. Heart size is normal.Partially imaged abdominal pigtail catheter and IVC filter.

Output: Left upper extremity PICC terminates in the SVC/confluence of brachiocephalic veins. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male 28 years old Reason: hx of shunt. Expect from NSG requesting eval History: hx of VP shunt SHUNT DEVICE: Intracranial shunt catheter is seen exiting a left frontal parietal burr hole, coursing down the left scalp, neck, anterior chest, entering the abdomen with tip in the left upper quadrant. No evidence of discontinuity or kinking of the radiopaque portions of the shunt catheter. There are portions of the shunt catheter overlying the scalp which are radiolucent and, hence difficult to evaluate. There is orphaned shunt tubing overlying the chest wall and neck on the left, unchanged from the prior exam.SKULL: No significant abnormality noted.CERVICAL SPINE: Note that C6 and C7 are not well visualized secondary to overlying anatomy. No acute abnormality within the cervical spine. Disc spaces and vertebral body heights are maintained.CHEST: No acute cardiopulmonary abnormality.ABDOMEN: Nonobstructive bowel gas pattern.

Output: Shunt device with no evidence of complication and other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: status post lung biopsy. eval for ptx. History: No significant change in the large left pleural effusion and associated atelectasis. This obscures a known left lower lobe mass. No interval pneumothorax.

Output: No interval pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: assess ET tube placement History: intubated, sedated Small lung volumes with foci of atelectasis unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Right jugular catheter tip at cavoatrial junction.

Output: Unchanged foci of atelectasis. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Biopsy of R infrahilar lung mass s/p biopsy History: Right apical PTX Very small right apical pneumothorax again noted. Right-sided pigtail drain again noted. Bibasilar pleural parenchymal opacities, unchanged. No new focal left lung opacities. Unchanged heart size.

Output: Persistent very small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: fevers, eval for interval infiltrate History: see above Right pleural drain and small right subpulmonic pneumothorax.Stable right-sided pulmonary opacities with volume loss.Left lung unremarkable.Right subclavian catheter, tip in SVC.

Output: Right pleural drain with a right subpulmonic pneumothorax and unchanged right-sided opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 68 yearsGender: MaleReason for Study: Reason: assess for pneumonia History: weak, lethargic, diffuse rhonchi on auscultation Gastric tube has been removed.Multiple surgical clips in the neck again identified.The cardiac mediastinal silhouette is unremarkable.The lungs are clear.No pleural effusions.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: sob History: sob Normal heart size with a tortuous aorta.Small calcified nodules bilaterally compatible with previous infection.Large lung volumes with hypovascular areas consistent with emphysema and mild right upper lobe scarring.No sign of pneumonia or CHF.

Output: Severe emphysema with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o mets History: h/o RCC Unremarkable cardiac and mediastinal silhouette. Linear basilar scarring, unchanged.No sign of metastases or other new findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.History: Assault. Query rib fracture, pneumothorax. Right basilar pneumothorax.No obvious rib fracture or bony deformity/abnormality seen.Unremarkable cardiomediastinal silhouette.No focal pulmonary consolidation.No pleural effusions.

Output: Right pneumothorax. No obvious rib fracture, however dedicated rib views may be indicated.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: infection History: hypotension No focal consolidation, effusion, or pneumothorax. Unremarkable cardiomediastinal silhouette. Interval removal of right central venous catheter.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: IABP check The IABP marker remains 3 cm from the arch. The ICD and remaining cardiopulmonary appearance are also similar demonstrating the Swan-Ganz in the right pulmonary flow track and underlying mild edema with moderate nonspecific cardiomegaly.

Output: IABP unchanged


Instruction: Generate impression based on medical findings.

Input: 62 year-old female with ovarian cancer and lung and liver metastases. CHEST:LUNGS AND PLEURA: Bilateral lung metastases. Reference left lower lobe nodule measures 17 x 16 millimeter image number 63/194. Small left-sided pleural effusion/thickening.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Extensive bilobar metastatic disease in the liver. Reference right lobe lesion measures 4.9 x 4.6 cm image number 85/194.SPLEEN: Splenic hypodense lesions, suspicious for metastatic disease, measuring 14 x 60 mm image number 97.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis with a double-J stents extending from the proximal ureters into the bladder.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple peritoneal implants consistent with peritoneal carcinomatosis. A reference lesion measures 4.2 x 2.8 cm image number 158.BONES, SOFT TISSUES: Metastatic lesion in the subcutaneous tissue of anterior abdominal wall measures 2.2 x 2 .3 cm, image number 132/194.Small peri-incisional hernia containing nonobstructing small bowel segments.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is invaded by presumed metastatic disease. In the right adnexa. There is a large mass invading the right ureter, measuring 14.6 x 7.1 cm on image number one of 64. Air is noted within this mass. Communication with bowel or secondary infection cannot excluded. This mass encases the sigmoid colon.In the left adnexa. A large mass measures 14.2 x 7 cm, image number 169 encases the left ureter and extends into the left proximal thigh. The mass also invades the left external and internal iliac vessels. Left external iliac vein is thrombosed or invaded by the mass.Right internal iliac vessels are also invaded by the right adnexal mass.BLADDER: Double-J stents in the bladder.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: Extensive metastatic disease in the lungs, liver, peritoneal carcinomatosis and pelvic masses consistent with metastatic disease.Bilateral hydronephrosis despite bilateral double-J stents.Air in the right adnexal mass which may be secondary to a fistulous communication with bowel or secondary infection.


Instruction: Generate impression based on medical findings.

Input: Enteric tube advancement, history of subarachnoid hemorrhage Enteric tube seen with side-port located in gastric body. Mild to moderate gaseous gastric distention. Relative paucity of small bowel gas. Left femoral approach line seen overlying right L4 vertebral body.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: s/p 5/6 Left video-assisted thoracoscopy, Multiple pleural biopsies History: follow up Cardiomegaly unchanged. Small to moderate pleural effusion. Left lung base scarring. Bilateral calcified pleural plaques again noted.

Output: Small to moderate left pleural effusion. Stable bilateral calcified pleural plaques, suggestive of asbestos exposure.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with pancreatic cancer CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter possible intrapulmonary lymph node on image number 22, series 4, unchanged.MEDIASTINUM AND HILA: Right thyroid nodule is unchanged.CHEST WALL: Reference right axillary lymph node measures 10 x 7 minutes on image number 24, series number 3, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Index lesion in the caudate lobe is smaller and now measures 13 x 17 mm image number 68, series number 3. Right lobe lesion is unchanged measuring 9 x 8 mm on image number 65, series number 3. Narrowing of the extrahepatic main portal vein is unchanged. Cholelithiasis is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic head mass is enlarged measuring 4.3 x 4.8 cm. Metallic stent is in place. Dilated pancreatic duct is unchanged. Stomach is dilated. The mass invades the second and third portion of duodenum and likely causing gastric obstruction. This has progressed from previous CT.Venous collector is secondary to chronic invasion of the SMV is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the pancreatic head mass. One of the index hepatic metastases lesions is smaller.Invasion of the duodenum by the pancreatic head mass causing gastric outlet obstruction.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: SOb/Chest pain History: SOB/CP NG tube with its tip near the gastroesophageal junction.There are decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Right basilar opacities compatible with right pleural effusion and underlying atelectasis/consolidation.

Output: NG tube with its tip at the GE junction. Recommend advancement. New right pleural effusion and right basilar consolidation/atelectasis


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason for study: Incorrect surgical counts/missing lap pad.Surgery type: Right mastectomy with tissue expander placement.Surgical count: Incorrect. Right breast tissue expander and 2 right surgical drains noted. No unexpected radiopaque foreign body within the field of view.Patient is intubated. There is left basilar atelectasis but no focal pulmonary opacity.

Output: No unexpected radiopaque foreign body within the field of view. Findings were discussed with Dr. Park by phone at 15:50 on 10/24/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Evaluate for source of fever. Normal heart size. No focal pulmonary opacities, visible pleural fluid or pneumothorax.Presumed postoperative changes of the upper lumbar spine with absence of visualized posterior elements, small clips and apparent widening of the vertebral canal which may be related to syrinx/congenital abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia History: cough,fever Mild cardiomegaly, unchanged.Bronchial thickening and pleural calcification over the right upper lobe, unchanged.Coronary artery calcifications.Mild blunting of both posterior costophrenic angles compatible with small effusions or scarring, not significantly changed.

Output: Possible mild CHF but no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: COPD with increasing productive cough - evaluate for PNA History: increasing cough Right port tip in SVC.Left base slightly better aerated than on prior. No new opacity to suggest pneumonia.

Output: No new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 51-year-old female with history of non-Hodgkin lymphoma and left breast mass. CHEST:LUNGS AND PLEURA: Calcified left pulmonary nodule noted on series 4, image 85/105. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart sizenormal without pericardial effusion.Hypoattenuating focus is noticed in the right lobe of the thyroid on series 3, image 1/203.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Right ovarian cyst with fluid layering is seen on series 3, image 174/203. The fluid layering may be secondary to hemorrhage or debris. Ultrasound evaluation may help for further characterization.Multiple left adnexal cysts are also noted, best seen on coronal image 60/146.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1.No evidence of lymphadenopathy.2.Right ovarian cyst with fluid layering as detailed above as well as multiple left adnexal cysts. Sonographic evaluation may aid further characterization.


Instruction: Generate impression based on medical findings.

Input: 66 year old female with history of lymphoma CHEST:LUNGS AND PLEURA: Interval increase in the fibrosis involving most of the lower lobes. Extension of the peripheral fibrosis in the upper lobes. These findings are consistent with usual interstitial pneumonia.MEDIASTINUM AND HILA: Reference node anterior to the trachea measures 15 x 9 mm image number 38, series number 4, not significantly changed from previous CT. Other mediastinal lymph nodes are also relatively stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodensity in the right lobe is unchanged. Mild biliary prominence is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodense lesions, likely representing cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 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: Significant interval increase in the fibrosis in both lungs consistent with patient history of UIP. Mediastinal lymph nodes are stable.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: Post thoracentesis film - PTX, etc History: dyspnea, thoracentesis Improved left lower lobe consolidation with a smaller left pleural effusions and left basilar opacity.No significant pneumothorax.

Output: No pneumothorax following thoracentesis, with improved left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Fever, leukocytosis, increased secretions Enteric tube tip is in the distal gastric body. Moderate gaseous distention of the stomach.Cardiac silhouette is mildly enlarged. No pleural effusion or pneumothorax.No focal airspace opacity.

Output: No specific evidence of infection or aspiration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: edema History: epigastric pain Diffuse interstitial and airspace opacities consistent with edema, with pleural effusions right larger the left.Moderate cardiomegaly.Renal osteodystrophy noted.

Output: Severe pulmonary edema pattern with a right predominant pleural effusion and cardiomegaly, consistent with CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with nodule seen on outside chest x-ray. No related symptoms. Evaluate left lung nodule. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules identified. The largest nodule is in the superior segment of the right lower lobe (series 4, image 61), measuring 8 x 8 mm. A right lower lobe nodule is seen posteriorly on series 4, image 58, measuring 6 x 4 mm. A 4-mm nodule is identified in the left lower lobe (series 4, image 76). A calcified left upper lobe nodule is benign.Scattered micronodules and basilar scarring are noted bilaterally as well. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion..CHEST WALL: No significant abnormality noted.. UPPER ABDOMEN: Lobular contour to left kidney (series 3, image 17) may represent normal anatomy; however, contrast enhanced CT examination of the abdomen would aid further characterization and evaluation for underlying mass.

Output: 1. Multiple pulmonary nodules as described above. The largest is seen in the superior segment of the right lower lobe, measuring 8 x 8 mm. CT follow-up is recommended at 3 months.2. Lobulated contour to partially visualized left kidney may represent normal anatomy; however contrast enhanced CT examination of the abdomen would aid evaluation for underlying mass.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Eval lines/tubes/devices History: Eval lines/tubes/devices CHF No change in support hardware. IABP marker in proximal descending thoracic aorta. Interstitial edema unchanged.

Output: IABP marker in proximal descending thoracic aorta.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old. Catheter from the right arm extending to the SVC.No significant cardiopulmonary abnormalities.

Output: New catheter without complications.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulm abnormality History: chest pain Moderate cardiomegaly with small lung volumes.No sign of pulmonary edema or pneumonia.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Chest pain. Evaluate for pneumonia. Bilateral lower lobe subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax. Mildly enlarged cardiomediastinal silhouette. Status post cholecystectomy.

Output: No acute pulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old. Pneumoperitoneum on CT 12/18, serial eval History: serial eval No new focal airspace opacities. No pleural effusion or pneumothorax. Cardiomediastinal silhouette is unchanged.Nonobstructive bowel gas pattern. Residual enteric contrast within the colon from prior CT exam. No pneumatosis or portal venous gas. Trace free air is seen under the left hemidiaphragm, not as well seen compared to prior studies.

Output: No evidence of obstruction. Trace free air.


Instruction: Generate impression based on medical findings.

Input: Reason: infection History: c/f infection Cardiomegaly with small lung volumes.Bilateral pulmonary opacities compatible with edema and atelectasis with probable small pleural effusions.

Output: Probable CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: transfer from OSH, leukocytosis History: leukocytosis Focus of consolidation in the mid aspect right lung with small right pleural effusion. Mild cardiomegaly with tortuous thoracic aorta. Cardiac leads terminate within the right atrium and right ventricle. No pneumothorax. Stent noted within the mid aspect of the abdomen.

Output: Focus of consolidation within the mid aspect the right lung certainly consistent with pneumonia given history.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Reason: Pre-op clearance for gastric sleeve History: Globular cardiac silhouette. Mediastinal contour is unremarkable.No focal airspace opacity, pleural effusion, or pneumothorax.

Output: 1. Globular cardiac silhouette. Pericardial effusion cannot be excluded.2. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.History of cough for one month. The cardiomediastinal silhouette is normal.No focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 73-year-old female with metastatic breast cancer to the lungs, on endocrine therapy. Cardiomediastinal silhouette is normal.Known pulmonary metastasis have diminished in size and conspicuity since the prior study.No specific evidence of infection or edema.Left chest wall surgical clips are again noted.

Output: No acute cardiopulmonary abnormality. Interval improvement in pulmonary metastasis.


Instruction: Generate impression based on medical findings.

Input: Heart transplant Mild perihilar changes suggesting edema with left lower lobe consolidation and/or atelectasis is unchanged. Diminished lung volumes. Swan-Ganz mildly retracted, tip currently projects at the right left bifurcation. Abandoned ICD is unchanged

Output: Swan-Ganz repositioning


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Asymmetric, left greater than right, emphysema is again noted with hyperinflation of the left chest. Cardiomediastinal silhouette is unchanged. No pneumothorax or pleural effusion. No specific evidence of infection or edema. Evidence of prior granulomatous disease. Enlarged pulmonary vasculature indicates pulmonary hypertension.

Output: No specific evidence of infection or edema. Persistent asymmetric upper lobe predominant emphysema, left greater than right. Evidence of pulmonary artery hypertension.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: R-sided CP with inspiration History: R-sided inspiratory CP Unchanged PICC. Improvement in basilar opacities. Lungs are now nearly clear. Unchanged mild cardiomegaly. No large pleural effusion or pneumothorax.

Output: Improvement in patchy basilar opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: Intubation History: Procedural sedation New streaky opacities left lower lung zone suggestive of aspiration or mucous plugging.Heart size normal.ET tube tip approximately 2 cm above the carina.

Output: Slightly low ET tube. New left basilar opacity suggestive of aspiration or mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old, with history of CAD, atrial fibrillation, presenting short of breath. History of colon cancer. PULMONARY ARTERIES: Technically adequate exam. No PE.LUNGS AND PLEURA: Biapical scarring. Mild paraseptal and centrilobular emphysema. Subtle scattered ground glass nodules and bronchial wall thickening may reflect mild aspiration bronchiolitis or infection.No dense air space consolidation. No pleural fluid. Left lower lobe pulmonary micronodules (axial images 101 and 112/150) were present on a prior examination from 2007 and have not changed indicating a benign etiology. MEDIASTINUM AND HILA: Mild cardiomegaly. No pericardial fluid. Coronary and aortic atherosclerotic calcifications.No pathologically enlarged hilar or mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.No pulmonary embolus.2.Possible mild aspiration bronchiolitis or infection as above.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: pna History: above Some rotation of the projection is noted. However, the lungs are clear without consolidation, effusion, or edema. Heart size within normal limits. No pneumothorax.

Output: No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: 37 year old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small lymph node adjacent to cecum measures 7 mm on image number 160, series number 7, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized. Multiple small nodules within the small bowel mesentery in the pelvis are stable. Index nodule measures 1 x 1 cm on image number 174, series number 3. Ill-defined soft tissues adjacent to the vaginal cuff are also grossly stable. Their significance is indeterminate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: 66 yo M s/p R Thoracotomy decortication for pleural effusion, eval for pneumothorax History: 66 yo M s/p R Thoracotomy decortication for pleural effusion, eval for pneumothorax Right-sided chest tubes remain in place. Diffuse right lung opacities, unchanged. Right-sided pleural effusion/ thickening, as before. No significant pneumothorax. Right-sided subcutaneous, again noted. Left lung remains clear.

Output: Diffuse right lung opacities with right-sided pleural effusion/thickening unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p cardiac surgery History: s/p cardiac surgery Interval removal of a right jugular catheter.ICD leads and PICC line unchanged. Large layered out right pleural effusion and a smaller left pleural effusion with underlying pulmonary opacity compatible with edema and atelectasis.

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


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: assess for worsening pulmonary edema History: mechanically ventilated pt Line position stable. No change in extensive bilateral pulmonary opacities.

Output: No change in extensive bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: s/p LUL History: s/p LUL Left hemithorax postsurgical volume loss.No pneumothorax or other complication.

Output: No pneumothorax or other complication of recent left upper lobectomy.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: eval lung fields History: slurred speech No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: r/o infection History: ams Small lung volumes with borderline cardiomegaly.Prior granulomatous disease.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 66 years old Male. Reason: 66M s/p exploratory laparotomy, distal pancreatectomy w/ desaturations History: as above. There is a nodular opacity with the high density, which is new as compared with the recent SPECT-CT. Multiple high density foci are seen in the right lung hilum. There is a questionable small left pleural effusion. The cardiac silhouette is normal.

Output: New Nodular density in the right lower lung, which can be due to aspiration or pneumonia. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: intubated, hemoptysis History: as above Support devices unchanged.Left upper lobe cavity with internal debris and multiple embolic coils noted in the left upper hemithorax unchanged.Multifocal pulmonary opacities similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance including left upper lobe cavity with debris and diffuse pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: 83 year old female with history of lung cancer status post chemo and RT. Evaluate disease status. CHEST:LUNGS AND PLEURA: Volume loss, groundglass and reticular opacities with bronchial wall thickening and bronchiectasis in the right upper lobe appear similar to prior studies and likely reflect post therapy changes. No new or suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Multiple calcified lymph nodes, unchanged. Heart size normal without pericardial effusion. Marked coronary and aortic calcifications. Debris is noted within the trachea.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Left adrenal nodule, punctate calcifications in the liver and spleen, and left renal cyst, unchanged since prior studies.

Output: Posttherapy changes in the right upper lung, similar to prior studies. No evidence of disease recurrence or metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Pleuritic chest pain. Minimal pleural fluid on the left is new. Interval placement of sternotomy hardware and mediastinal clips.No focal airspace opacities.

Output: Small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Kidney donor No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 41-year-old female with pancreatic cancer status post biliary sepsis now status post drain. Assess for cause for fever CHEST:LUNGS AND PLEURA: Bilateral small pleural effusions and dependent atelectasis.New from previous CT.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration. Percutaneous transhepatic biliary catheter traverses the liver and extending to duodenum, unchanged from previous study. A new peripherally enhancing lesion in the left lobe measuring 17 x 11-mm on image number 84, series number 16 is cold associated with the patient's known pseudocyst and most like represents its extension, however, a metastatic lesion cannot be excluded. Follow-up imaging is recommended.SPLEEN: No significant abnormality noted.PANCREAS: Heterogeneity in the pancreatic head is decreased and a discrete mass cannot be measured. Mild dilatation of the pancreatic duct is improved. Pseudocyst superior to the pancreatic head is slightly smaller measuring 3.1 x 2.5 cm by demonstrates rim enhancement.Attenuation of the portal vein at its confluence with the SMV is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable portacaval, peripancreatic and mesenteric lymph nodes. A reference portacaval node measures 2.9 x 1.7 cm in image number 60, series number 14. It was measuring 2.5 x 13 mm image number 107, series number 12 on the previous study.BOWEL, MESENTERY: New small ascites.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: New, small ascites.

Output: No measurable mass in the pancreatic head. Patient's known pseudocyst is slightly smaller but now possibly extending into the liver. Pseudocyst demonstrates rim enhancement. Secondary infection cannot be excluded. Surrounding adenopathy is unchanged.New bilateral small pleural effusions and ascites and generalized anasarca.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.CT chest demonstrating pneumonia. Question interval change in location of ETT or appearance of pneumonia. ETT tip 3.5 cm above the level of the carina. There is presumably an open sternal wound or dehiscence to the left of the fixation hardware.Left subclavian ICD and an LVAD are noted.Left lower lobe/retrocardiac dense opacification unchanged from most recent previous studies but new from time of the CT scan (no evidence of pneumonia on CT scan).Layering pleural fluid bilaterally. Fluid in the fissures and atelectasis on the right.Dependent atelectasis, but no evidence of pulmonary edema.

Output: Dense left lower lobe opacity most likely represents collapsed lung given rapid appearance. Review of the lung windowed images from recent CT scan does not reveal pneumonia as clinically questioned.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: evaluate for pneumonia, aspiration History: cough, productive cough Streaky basilar subsegmental atelectasis is nonspecific but could be seen in anything ranging from aspirated secretions to pulmonary embolism. Heart size normal.No reliable evidence of edema or pneumonia.Right jugular catheter, tip in SVC.

Output: Nonspecific streaky basilar atelectasis, but no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.History of pneumothorax, chronic cough. Normal heart size. Mild blunting of the posterior costophrenic angles which may be due to trace pleural fluid. No signs of interstitial edema and no focal air space opacities. No pneumothorax.

Output: No pneumothorax. Trace pleural thickening or fluid in the posterior costophrenic angles, but no other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough No acute cardiopulmonary abnormality. Mild tortuosity of the aorta with calcified AP window lymph nodes consistent with old healed granulomatous disease exposure

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: ETT check and cardiac arrest ETT terminates 3 cm above the carina.Mildly decreased lung volumes with questionable borderline cardiomegaly. No discrete additional pulmonary abnormality in this limited view secondary to motion. See subsequent report

Output: ETT placed


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Stable right upper quadrant micronodules on image number 28, series number 4 and micronodular the left lower lobe on image number 72, series number 4 measuring 5-mm.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right nephrolithiasis is unchanged. Focal scarring in the midpole of the left kidney, stable.RETROPERITONEUM, LYMPH NODES: Reference retroperitoneal lymph node inferior to the aortic bifurcation stable. It measures 12 x 9 mm number 144, series number 3. Other retroperitoneal lymph nodes are also stable.BOWEL, MESENTERY: Mild haziness of the mesentery is stable. Multiple subcentimeter mesenteric lymph nodes are again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesions in the right iliac bone are stable.OTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: assess for ETT position, changes in lung fields History: respiratory failure s/p intubation Endotracheal tube is unchanged again high within the trachea approximately 8 cm from the carina. Enteric tube terminates just above the gastroesophageal junction. In addition, the enteric tube may be coiled within the hypopharynx. Consider direct inspection of the hypopharynx and/or removal of the enteric tube with replacement as necessary. Scarring or atelectasis at the lung bases. No acute cardiopulmonary process on radiography. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Enteric tube terminates just above the gastroesophageal junction. In addition, the enteric tube may be coiled within the hypopharynx. Consider direct inspection of the hypopharynx and/or removal of the enteric tube with replacement as necessary.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: eval device placement History: iabp, central picc Left PICC terminates in the cavoatrial junction. Superior margin of the IABP again noted overlying the descending thoracic aorta with slight medial angulation. Mild pulmonary edema again noted. Patchy left basilar opacity again noted at the left lung base. Unchanged heart size. No pneumothorax. Question of developing focal opacity in the mid aspect of the left lung. This area can be reevaluated on imaging follow-up.

Output: Iatrogenic device, as above. Questionable developing opacity in the mid aspect the left lung which can be reevaluated on imaging follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Status post cardiac arrest, intubated. Right mainstem bronchus intubation.Atelectasis on the left as well as a minimal amount at the right lung base.Low lung volumes.

Output: Right mainstem bronchus intubation.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: confirm stable hardware, s/p cath with transvenous pacer History: s/p OHT 3/16, s/p arrest in cath lab New IVC temporary pacemaker, lead tip in RV apex region.Left chest tubes with no significant pneumothorax.Nonspecific left mid and lower lung zone atelectasis.Prior PICC and Dobbhoff tubes have been removed.

Output: Temporary pacemaker placement without complication.


Instruction: Generate impression based on medical findings.

Input: Check ETT ETT terminates 2 cm above the carina. Chest tubes with extensive overlying chest wall and neck emphysema similar to prior. NG extends beyond the inferior edge of the image.Stable diffuse pulmonary nonspecific opacities. Cardiac and mediastinal contours are otherwise grossly within limits yet suggest minimal pneumomediastinum

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: 58-year-old female, wheelchair bound with new cough and relative hypoxemia. Evaluate for pneumonia. Posterior spinal stabilization hardware, unchanged. Small lung volumes with no cardiomediastinal silhouette. Previously seen bibasilar atelectasis has improved, and bilateral pleural effusions have resolved. No focal pulmonary opacity.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Chest pain and vomiting No focal airspace opacity, pleural effusion, or pneumothorax.The cardiomediastinal silhouette is within normal limits.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Shortness of breath. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: s/p minimally invasive esophagectomy, eval for pneumothorax History: sp minimally invasive esophagectomy, eval for pneumothorax Interval removal of right-sided chest tubes with minimal apical right pneumothorax. Bibasilar atelectasis with small bilateral pleural effusions.Cardiomediastinal silhouette is stable.

Output: Interval removal of right-sided chest tubes with minimal apical right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Asthma and COPD ETT remains 5 cm above the carina. NG tube coiled in the proximal stomachDiffuse mild interstitial changes, presumed chronic in nature without evidence of superimposed acute pulmonary abnormality.

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Reason: SOB History: SOB Marked cardiomegaly with mediastinal venous distention and probable moderate bilateral pleural effusions.Enlarged central pulmonary arteries consistent with pulmonary hypertension.Dense consolidation in the left lower lobe compatible with atelectasis.Probable interstitial edema.Right jugular catheter tip in the upper right atrium.

Output: CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: is there pul edema History: chest pain, +sob Normal heart size with a moderately tortuous aorta.No sign of pulmonary edema or other acute findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Positive TB skin test. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB identified.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.1 week post C-section with SOB, edema, bradycardia concern for postpartum cardiomyopathy or fluid overload. Cardiothoracic ratio and central pulmonary vasculature appear mildly enlarged. Small volume of pleural fluid bilaterally. Mild perihilar vascular unsharpness suggestive of minimal edema. Vascular redistribution is present.Mild thoracic scoliosis.

Output: Mild hypervolemia/CHF. Heart size is at least upper normal, with enlargement of the central pulmonary vasculature suspicious for pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: Concern for pneumomediastinum on portable film. Shortness of breath. No pneumomediastinum is identified, abnormality on prior radiograph was artifactual.Basilar scarring.Flattening of the diaphragm suggesting COPD/emphysema.Normal heart size. Tortuous thoracic aorta unchanged.

Output: No pneumomediastinum. Signs of COPD/emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.11 months status post management of stage IA squamous cell carcinoma. Unchanged appearance of the cardiomediastinal silhouette. Postoperative volume loss in the left from lower lobectomy. No suspicious pulmonary nodules or masses. Mild degenerative changes of the spine with loss of vertebral body height.

Output: No acute cardiopulmonary abnormality. No signs of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: pleural effusion, empyema History: s/p vats, decortication Jan 2016 The cardiomediastinal silhouette is stable.Interval removal of right chest tube.Right PICC projects over the axillary vesselsStable right mid lung scarring and underlying pleural thickening/fluid with mildly improved aeration of the right midlung.

Output: Mildly improved aeration of the right midlung with persistent scarring and pleural thickening/fluid.


Instruction: Generate impression based on medical findings.

Input: 10-week-old female with new nasojejunal tube.VIEW: Abdomen AP (one view) 4/4/15, 0214 Enteric tube with tip in the antropyloric region. Organized mildly dilated loops of bowel are seen within the abdomen. Left lower lobe pulmonary opacities are again seen.

Output: Enteric tube tip in the antropyloric region.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: admit for sepsis History: see above No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: central line placement History: heart failure Cardiomegaly with mild basilar edema pattern and right pleural effusion, unchanged, consistent with CHF/hypervolemia.Left jugular catheter, tip in left brachiocephalic vein to the left of midline.

Output: Unchanged edema and right pleural effusion. New left jugular catheter.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o fluid overload History: altered mental status Moderate cardiomegaly with small lung volumes, unchanged.No specific evidence of pulmonary edema or visible effusion.

Output: Cardiomegaly with no acute change.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.