Instruction: Generate impression based on medical findings.

Input: Reason: 60 yo F w/ hemoptysis, breast cancer, evaluate for worsening infiltrate History: hemoptysis Large loculated left hydropneumothorax with associated pleural thickening and atelectasis, not significantly changed.Extensive airspace opacity and atelectasis in the right lung. ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC. NG tube tip in the gastric antrum.Extensive skeletal metastases.

Output: Left loculated hydropneumothorax with extensive pulmonary and pleural abnormalities, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Female, 30 years old.Pleuritic chest pain, generalized weakness evaluate for infiltrate or acute chest. Sickle cell disease with crisis. Right chest port unchanged in position. Mild cardiomegaly, about the same. No pneumothorax or pleural fluid. Peripheral opacities suggestive of atelectasis and scarring in the left upper lobe have increased.

Output: New peripheral linear atelectasis, potentially related to in situ thrombus of acute chest though not specific. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.History of sickle cell disease Global enlargement of the cardiac silhouette.Signs of pulmonary venous hypertension.Persistent very low lung volumes and bilateral diffuse fine reticular opacities with vascular indistinctness. Bilateral lower lobe bandlike opacities represent focal areas of scarring, as previously noted.No pleural effusion or pneumothorax in this single AP projection.The right IJ central venous catheter has been placed in the interval and overlies to superior cavoatrial junction.Diffuse osseous sclerosis and deformity of vertebral bodies noted, stable from prior. Subchondral lucent and well defined lesion in the right glenoid is unchanged.Left upper quadrant calcification likely represents splenic calcification in the setting of sickle cell disease.

Output: Persistent signs of pulmonary venous hypertension and suggestion of chronic interstitial pulmonary edema.Bilateral basilar bandlike opacities may represent atelectasis or focal areas of scarring.Diffuse osseous scleroses and sequela of bilateral humeral head subchondral infarctions again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: s/p PICC insertion for TPN History: As above Basilar opacity suggestive of atelectasis, unchanged.Right PICC, tip at SVC/RA junction level.

Output: PICC placement. Unchanged basilar opacities suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: CT ICU post-op patient History: CT ICU post-op patient Patient has been extubated. Swan-Ganz catheter terminates in the pulmonary artery. Mediastinal drains again noted. Mild pulmonary edema. Improvement in patchy left basilar opacity.

Output: Improvement in patchy left basilar atelectasis or consolidation. Patient has been extubated.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: s/p icd procedure History: s/p icd procedure Right-sided ICD unchanged.Stable cardiac enlargement with evidence of an aortic valve replacement.Improved left basilar opacities compared to the prior exam.Probable small pleural effusions.No evidence of a pneumothorax.

Output: CHF. No evidence of postprocedural complications.


Instruction: Generate impression based on medical findings.

Input: 56-year-old male with history of non-Hodgkin lymphoma and auto-SCT. Reevaluate and compare to previous. CHEST:LUNGS AND PLEURA: Right upper lobe micronodule, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Retrosternal goiter as seen previously.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Fatty infiltration of the liver. No focal hepatic lesions identified.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: Ill-defined retroperitoneal lymph node adjacent to the left adrenal gland appears similar to prior study (series 3, image 99), measuring 2.8 x 1.2 centimeters (stable).BOWEL, MESENTERY: Soft tissue infiltration within the mesentery centrally compatible with patient's history of lymphoma (series 3, image 142 for example) is again noted and is unchanged.BONES, SOFT TISSUES: Degenerative changes of the spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable left para-aortic lymph node. No new lesions identified.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: rule out chest metastasis History: hx of renal cell carcinoma, sp partial nephrectomy 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: 45 years old Male. Reason: mucus plug History: mucus plug. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is diffuse mild bilateral interstitial edema. Retrocardiac consolidation is again noted. The hemodialysis catheter and feeding tube appear stable in position.

Output: The above findings are consistent with moderately severe congestive heart failure. However superimposed infection in the left lower lung cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: Evaluate for cardiopulmonary abnormality, pt with atypical left sided chest pain Posterior costophrenic angles are excluded from view on lateral radiograph. 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: Reason: post op, eval lung fields History: s/p MVR, TVR ET tube and Swan-Ganz catheter are unchanged.The balloon catheter is not clearly visible but probably in the proximal descending aorta.Small pleural effusions and basilar atelectasis, slightly increased on the left.

Output: Small effusions and basilar atelectasis, slightly increased on the left.


Instruction: Generate impression based on medical findings.

Input: 48 years, Female. Reason: abd pain/n/v/d, guarding on exam History: above Mild reticulonodular pattern in lung bases of uncertain significance however pulmonary metastases was seen on the CT scan. No focal opacities or effusion. No evidence of pneumothorax. Heart size normal.Normal bowel gas pattern no evidence of obstruction intramural air or free air.Known osseous metastases. Ostomy right lower quadrant.

Output: No evidence of obstruction. Osseous metastases. Prominent interstitial markings lung bases as discussed.


Instruction: Generate impression based on medical findings.

Input: 25-year-old male with history of left first rib resection. There has been interval resection of the left first rib. A surgical drain is present within the soft tissues of the left posterior neck with foci of adjacent subcutaneous gas indicating recent surgery. There is no evidence of pneumothorax. There is gaseous distention of the stomach.

Output: Postoperative changes of left first rib resection with no acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Bladder cancer status post cystectomy. Evaluate for metastatic disease. Unchanged upper lobe predominant emphysema and diffuse moderate reticular changes with scattered granulomas. No evidence of pleural effusion or pneumothorax.Unchanged scoliosis. Cardiomediastinal silhouette is within normal limits.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Reason: intubated History: intubated No change in basilar opacities are coarsened bronchopulmonary markings.

Output: Lower lobe opacities unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: Please evaluate for aspiration or pneumonia History: Continued fevers Enteric tube tip in distal stomach or proximal duodenum.Low lung volumes with basilar interstitial opacity which is nonspecific and may be due to aspiration, atelectasis or edema. No new focal opacities to suggest pneumonia.

Output: Low lung volumes with basilar interstitial opacity which is nonspecific and may be due to aspiration, atelectasis or edema. No new focal opacities to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: assess ETT position History: assess ETT position Upper lobe predominant coarse bronchiectasis and nodular opacities consistent with known cystic fibrosis, unchanged.No evidence of superimposed infection or edema.Numerous embolization sites are identified.ET tube tip approximately 2 cm above the carina.Right jugular catheter tip at cavoatrial junction.

Output: ET tube tip approximately 2 cm above the carina. Unchanged bronchiectasis and opacities secondary to known cystic fibrosis.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: right lung biopsy, pneumothorax. History: none Near complete resolution of right pneumothorax. Other findings stable.

Output: Near complete resolution of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with large B-cell lymphoma This study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Bilateral pleural effusions have decreased in size but persists. The effusion on the left side appears loculated with surrounding thick rim. Variation of the left lower lobe has improved, however, subsegmental atelectasis are still present.MEDIASTINUM AND HILA: Reference paratracheal lymph node is stable measuring 7 x 6 mm on image number 32, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Hypodense splenic lesion measures 14 x 14 mm image number 85, series number 3, stable.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable exophytic left renal cyst and left upper pole punctate calcification.RETROPERITONEUM, LYMPH NODES: Reference para-aortic lymph node on the left side is stable measuring 12 by 6 mm on image number 125, series number 3. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the bilateral pleural effusions, otherwise, stable study.


Instruction: Generate impression based on medical findings.

Input: Follow-up treated head and neck cancer. LUNGS AND PLEURA: A new nodule measuring 8 x 7 mm is noted in the left upper lobe, posterior apical segment (image 30, series 7), which abuts the major fissure. This lesion was not present on the prior CT performed in 4/2010.Other scattered, calcified and noncalcified micronodules in both lungs are unchanged. Right apical scarring, unchanged.Minimal centrilobular emphysema in the upper lobes.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal cardiac size. Moderate coronary calcifications. No pericardial effusion. Focal thickening in the epicardium, stable since 1/2010.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aortaBOWEL, MESENTERY: G-tube in placeBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. A new pulmonary nodule measuring 8 mm in the left upper lobe, compatible with metastasis, primary cannot be excluded. 3 months follow up CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: swan catheter History: swan placement The intra-aortic balloon pump is no longer visualized. The remaining support devices are unchanged in position.Cardiomegaly is stable. Increasing perihilar opacities suggestive of edema. No pneumothorax or significant pleural effusion.

Output: Intra-aortic balloon pump no longer visualized. Perihilar opacities suggestive of mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: r/o infection History: ams/hypoglycemia Cerclage wires again noted projecting over the midline neck. No new focal consolidation, pleural effusion or pneumothorax is evident. The cardiac and mediastinal contours are unchanged. Massive colonic distention is once again seen, the degree of which appears roughly similar to the prior examination, although the extent of which is not completely imaged.

Output: Massive colonic dilatation persists, incompletely imaged on this study. No focal consolidation to suggest acute pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval lung fields History: chest pain, history of pancreatic cancer Right port catheter tip in the right atrium.Interval resolution of left pleural effusion.The heart size is normal.No pleural effusion or pneumothorax. The lungs are clear.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant No focal lung consolidation. No pleural effusion or pneumothorax. Normal heart size. Diffuse bony sclerosis suggestive of renal osteodystrophy.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: placement of ET tube History: placement of ET tube Severe airspace opacities are unchanged consistent with ARDS or edema.Cardiomegaly stable.ET tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: New intubation. Stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female; 80 years old. Reason: S/P CABG, MVR, TVR. eval for pleural effusion History: SOB Unchanged cardiomegaly. Moderate left pleural effusion with associated retrocardiac atelectasis/consolidation, not significantly changed. Mild basilar interstitial opacities.Left subclavian ICD and mitral and tricuspid prostheses are unchanged. IVC filter again noted. Left chest tube has been removed. Left PICC coiled with tip possibly in a left superior intercostal vein.

Output: Unchanged mild pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.New fever, evaluate for cause. Right jugular central line tip at the SVC. Normal heart size.Nonspecific opacity in the right costophrenic angle region. There may be a small volume of adjacent pleural fluidMild subsegmental atelectasis at the left lung base.

Output: New, nonspecific, right basal opacity and possible pleural fluid. Unable to exclude infection.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: assess for fluid overload History: tachypneia Stable basilar opacities.Stable mild cardiomegaly.No pneumothorax.

Output: Stable basilar opacities. No interval change.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male with Hodgkin's lymphoma CHEST:LUNGS AND PLEURA: Previously described right upper lobe nodule measures approximately 8 x 5 mm, previously 10 x 5 mm (series 5; image 53).Scattered groundglass nodules are again seen. Calcified granulomas are unchanged.MEDIASTINUM AND HILA: Again seen is a right pleural based scar adjacent to a resection continues to decrease in size (series 5; image 61).Previously described reference precarinal lymph node measures 13 x 7 mm, previously 12 x 6 mm (series 3; image 44). Calcified subcarinal lymph nodeCHEST WALL: Right chest wall port has its tip in the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly remainsSPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Previously described left para-aortic lymph node at the level of the SMA (series 3; image 108) measures 9 x 6 mm, previously 9 x 7 mm.Previously described retrocrural lymph node (series 3; image 100) measures 5 x 5 mm, previously 12 x 5 mm.BOWEL, MESENTERY: Small hiatal herniaBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Previously described right external iliac conglomeration of lymph nodes measures 13 x 9 mm, previously 16 x 5 mm (series 3; image 199).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Patchy density in the pelvic bones remains.OTHER: No significant abnormality noted

Output: Stable to slight decreased in the reference nodal lesions


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Status post first rib resection evaluate pleural effusion. Subcutaneous emphysema in the left supraclavicular soft tissues improving.Normal heart size.Persistent moderate left pleural fluid collection. Nonspecific consolidation and compressive atelectasis in the left lung base persists.Surgical absence of the left first rib. Left apical extrapleural hematoma unchanged.

Output: No significant change in presumed left apical extrapleural hematoma, moderate left pleural fluid collection or nonspecific atelectasis/consolidation at the left lung base.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: intubated pt, increasing leukocytosis, eval for interval change History: see above Moderately severe cardiomegaly with bilateral opacity compatible with edema, atelectasis and moderate pleural effusions.ET tube tip approximately 2 cm above the carina. NG tube tip in the area of the GE junction.

Output: CHF with effusions, slightly increased. Proximal location of NG tube.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval IABP placement History: eval IABP placement The support devices are unchanged in position. Cardiomegaly is unchanged. Vascular redistribution without pulmonary edema. No pneumothorax.

Output: Stable pulmonary edema with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: eval for PNA History: AMS Widened superior mediastinum, highly worrisome for aortic pathology. Evaluation CTA has been subsequently performed. Small left-sided pleural effusion. Multiple left-sided skin folds. Mild cardiomegaly.

Output: Widened superior mediastinum, highly worrisome for aortic pathology. Evaluation CTA has been subsequently performed


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: eval infiltrate History: SOB Right Port-A-Cath with its tip in the SVC.Markedly decreased lung volumes with basilar atelectasis.Cardiac size normal with marked tortuosity of aorta.Multiple pulmonary nodules are identified bilaterally compatible with metastatic disease.No focal areas of consolidation.

Output: Numerous pulmonary nodules compatible with metastatic disease. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: heart failure History: heart failure Swan-Ganz catheter and aortic balloon catheter unchanged though blurred by motion artifact.Cardiomegaly with pulmonary edema and pleural effusions, increased compared to previous.

Output: Pulmonary edema and layering pleural effusions, slightly increased from previous.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: r/o PTX, effusion, PNA History: chest pain 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, 80 years old.Reason: check for ptx or hematoma History: mesothelioma s/p mediastinal biopsy Bilateral pleural effusions and pleural thickening consistent with known mesothelioma. Right chest port tip in SVC. S/P sternotomy/CABG. No pneumothorax.

Output: No pneumothorax or significant hematoma.


Instruction: Generate impression based on medical findings.

Input: Female 14 years old Reason: 14yoF with asthma and pneumothorax. Please evaluate evolution of pneumothorax after chest tube placement History: shortness of breathVIEW: Chest AP (one view) 10/4/2015 at 0333 hours. Left-sided chest tube and subcutaneous emphysema are again noted. Cardiac silhouette size is normal. No pneumothorax is present. Right middle lobe opacity is again noted.

Output: Persistent subcutaneous emphysema and right middle lobe opacity.


Instruction: Generate impression based on medical findings.

Input: Reason: pna? History: SIRS criteria, concern for sepsis Unremarkable cardiac and mediastinal silhouette.Portacatheter with its tip in the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: CP History: above Small lung volumes with nonspecific basilar opacities possibly artifact of underinflation.Heart size normal.No specific evidence of infection or edema.

Output: Small lung volumes, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Postoperative imaging. Aortic dissection. Endotracheal tube terminates proximally 4 cm above the carina. Unchanged Swan-Ganz catheter projects at the right pulmonary artery. Mediastinal chest tube, unchanged. Enlarged cardiomediastinal silhouette and widened mediastinum, unchanged from prior. Increased moderate layering bilateral pleural effusions and adjacent atelectasis.

Output: Increased moderate layering pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Tachycardia and desaturation. Patient has history of foot thoracic aortic aneurysm without rupture Extensive postsurgical changes and rib deformities with decreased volume on the left appears grossly unchanged. Specifically no new diffuse focal airspace process, however a more diffuse airspace opacity continues to suggest mild edema. These changes are less pronounced on the right lung which is mildly hyperexpandedEsophageal and aortic stents appear grossly similar position, however the esophageal stent may be mildly repositioned proximally; please correlate with recent procedure. Right jugular PICC line unchanged, tip extends into the proximal SVCContinued resolution and decreased left chest wall emphysema, however the entire chest was not visualized and complete resolution cannot be confirmedLeft clavicular fixation unchanged

Output: Stable aortic stent


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Ventricular tachycardia. SOB. Question effusion. Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level. Mediastinal drains in place. Peripheral catheter from the right terminates overlying the axilla, not in a central vein. Probable surgical drain with overlying surgical staples left lower chest wall. Sternotomy hardware similar in alignment.Unchanged postoperative mediastinal widening.Moderate volume of pleural fluid on the left and a possible small right pleural effusion have decreased in volume. Associated atelectasis is also improving, left greater than right.

Output: Moderate left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Unchanged mild volume loss elevated right hemidiaphragm and right basilar scarring. No discrete new superimposed focal airspace process or effusions.Mild cardiomegaly with moderate tortuosity aorta appear similar.Left subclavian single lead ICD unchanged in position. Midline sternotomy.

Output: Right basilar scarring without evidence of new superimposed acute cardiopulmonary findings


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Carcinoma of the neck with SOB evaluate for mediastinal compression. The thoracic trachea is deviated rightward and appears compressed on the frontal radiograph from the level of the thoracic inlet to just above the level of the carina, presumably due to paratracheal lymphadenopathy or mass. Right hilar lymph node enlargement. Left subclavian ICD with leads in the projection of the right atrium and right ventricle, and the ventricular lead is directed cranially, not towards the apex. A portion of the left lung is obscured by the pulse generator cannot be assessed. No visible pulmonary nodules by this technique. Retrocardiac atelectasis.

Output: Tracheal compression by left paratracheal lymphadenopathy or goiter, suggest correlation with CT neck.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old. Calcified left upper lobe granuloma. Asymmetric opacity peripheral right upper lobe which may represent early infection. Continued close interval follow-up is recommended. No pleural effusion or edema. Heart size is normal.

Output: Ill-defined opacity peripheral right upper zone represent early infection. Continued close interval follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: resp failure History: resp failure Moderate right pleural effusion and unchanged lower lung zone opacities.ET tube tip approximately 4 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Left subclavian catheter, tip in SVC.

Output: No change in right pleural effusion and pulmonary opacities. ET tube tip approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: interval eval for ARDS History: as above Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with bilateral mainly interstitial opacity compatible with pulmonary edema, unchanged or slightly improved compared to previous.No new findings.

Output: Slightly improved pulmonary edema/ARDS.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: patient with tachycardia, abnormal EKG findings History: none A right dual-lumen port catheter terminates in the midsuperior vena cava.Moderate right and small left layering pleural effusions. Ill-defined opacity at the right cardiophrenic angle is nonspecific. No pneumothorax. The cardiomediastinal silhouette is unremarkable.

Output: Ill-defined opacity at the right base which is nonspecific. In the setting of tachycardia, if there is high clinical suspicious suspicion for pulmonary embolus, consider CT PE examination.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with prostate cancer. Pain. CHEST:LUNGS/PLEURA: Mild paraseptal emphysema.MEDIASTINUM/ HILA: Prevascular lymph node measures 19 x 12 mm (series 21; image 33). A few subcentimeter mediastinal lymph nodes are also visualizedCHEST WALL: No significant abnormality.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodensity in segment IVA is unchanged from 2005.Extensive cholelithiasis without evidence of biliary ductal dilatation SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral benign renal cysts. No evidence for stones or obstruction.RETROPERITONEUM, LYMPH NODES: Enlarged porta hepatic lymph node measures 2.5 x 1.6 cm (series 21; image 89), previously 20 x 13 mm.Enlarged retrocaval lymph nodes have developed, with one measuring 16 x 14 mm (series 21; image 109) the previously 6 x 4 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Patchy bony density in the pelvis is unchangedOTHER: No significant abnormality noted

Output: Development of retrocaval adenopathy, highly suspicious for metastatic disease.Mildly enlarged porta hepatic and prevascular lymph nodes, nonspecific.


Instruction: Generate impression based on medical findings.

Input: Female, 89 years old.Reason: ? chest pain History: ? fluid vs PNA Mild basal interstitial opacities with few septal lines and blunting of costophrenic angles compatible with mild pulmonary edema. Marked cardiomegaly.Evidence of prior bilateral shoulder arthroplasty.

Output: Mild congestive heart failure.


Instruction: Generate impression based on medical findings.

Input: LVAD check Left chest tube again projects into the apex without associated significant pneumothorax. ICD, Swan-Ganz and LVAD are all otherwise not significantly changed.New retrocardiac opacity with questionably enlarging moderate left effusion with vascular redistribution likely partially exaggerated due to semiupright positioning

Output: New left lower lobe opacification, nonspecific. Concern for aspiration versus infection must be considered in addition to atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: Dobbhoff tube placement History: Dobbhoff tube placement There has been interval placement of a Dobbhoff tube with tip over the gastric body. The right internal jugular central venous catheter has been removed. Right PICC tip terminates in the subclavian vein. Multilevel vertebroplasty cement and clips from right axillary lymph node dissection noted. The cardiomediastinal silhouette appears normal.A small bilateral pleural effusion and bibasilar atelectasis appear stable.

Output: Dobbhoff tube tip in the stomach body.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: FemaleReason for Study: Reason: monitor pleural effusion History: asymptomatic Left-sided ICD unchanged.Stable cardiac enlargement with tortuosity of the aorta.Right pleural effusion similar to the prior exam.No new pulmonary opacities identified.

Output: Stable stable right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: CHF? History: swelling Mild to moderate cardiomegaly.No significant pulmonary or pleural abnormality.

Output: Cardiomegaly, but no evidence of edema or other findings associated with CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: Dyspnea with climbing steps. History: As above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: is there an infiltrate History: cough, congestion, fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Reason: free air pt is only able to sit up at a 45degree angle History: abd distension No visible free air.ET tube tip approximately 4 cm above the carina.Catheter tip in the SVC.Left lower lobe opacity compatible with atelectasis and consolidation.

Output: No visible free air on this suboptimal semierect radiograph.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: RIJ CVL placed; assess for PTX and placement History: as above Moderate cardiomegaly.No evidence of edema.Left lower lung zone subsegmental atelectasis.No significant pneumothorax.Right jugular catheter, tip at right atrial level.

Output: Cardiomegaly, and low right atrial catheter. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PTX History: s/p chest tube removal Interval removal of right chest tube with no significant residual pneumothorax.Small areas of focal subsegmental atelectasis or scarring bilaterally and moderate residual subcutaneous emphysema on the right.

Output: Interval chest tube removal with no residual pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: pulmonary edema? acute process? cardiomegaly? History: SOB, distended abdomen, h/o "liver dz" and CHF Decreased lung volumes with moderate cardiac enlargement.Right basilar opacity is compatible with mild atelectasis and probable small right pleural effusion.No focal areas of consolidation.No evidence of pulmonary edema.

Output: Cardiomegaly with right basilar atelectasis and probable small effusion. No specific evidence of acute infection or edema.


Instruction: Generate impression based on medical findings.

Input: Fever Left PICC line again extends into the proximal SVC. Right jugular catheter removed.No additional cardiopulmonary abnormality

Output: Right jugular catheter removed


Instruction: Generate impression based on medical findings.

Input: Female, 29 years old.Respiratory failure evaluate aspiration versus pneumonia versus ARDS. Right jugular catheter tip in the right atrium. Dobbhoff tube tip projects over the stomach which appears distended with airLow lung volumes, unchanged. Diffuse interstitial and airspace opacities with retrocardiac consolidation and slight progression in the right lung.

Output: Worsening nonspecific pulmonary opacities, favor ARDS. Gaseous dilatation of the stomach may indicate ileus or bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: re positioned ett .. reevaluate History: see aboveq Endotracheal tube 1 cm above carina.No change in right lung airspace opacities and small effusion.

Output: Repositioning of endotracheal tube as above. No change in right lung opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of hemoptysis, remote bladder ca History: tachycardia, hemoptysis Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval for volume overload History: crackles on exam Bilateral patchy lung opacities again noted. No evidence for left-sided heart failure. No pleural effusion pneumothorax. Feeding tube extends inferiorly off the field-of-view. Unchanged heart size.

Output: No evidence of overt left-sided heart failure. Patchy lung opacities again noted.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pneumonia, swan History: s/p swan placement, shortness of breath No Swan-Ganz catheter is visualized. Patient status post sternotomy, as before. Status post cholecystectomy. Heart size at upper limit of normal. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: s/p pacemaker History: s/p pacemaker Chronic appearing right hemidiaphragm elevation with overlying subsegmental atelectasis or scarring, unchanged.Right jugular catheter removed.Moderate cardiomegaly unchanged.New left subclavian dual-chamber pacemaker, leads in appropriate position with no pneumothorax.

Output: No pneumothorax following left subclavian pacemaker placement.


Instruction: Generate impression based on medical findings.

Input: 73 year-old female with recurrent bladder cancer.Additional history: Status post cystectomy with neobladder CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes are identified.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Several low-density hepatic foci are unchanged in size, the largest of which is a cyst in segment 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right and mild-moderate left hydronephrosis has developed. The right mid ureter is likely compressed by the reference right common iliac lymph node whereas the left ureter is compressed as it courses adjacent/through the 5-cm right iliac lymph node.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 1.4 x 0.8 cm (series 4; image 101), previously measuring 1.0 x 1.4 cm. The reference right common iliac lymph node measures 1.7 x 1.3 cm (series 4; image 132), previously measuring 19 x 14 mm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: Neobladder.LYMPH NODES: Large lymph node at the bifurcation of the common iliac vessels has increased in size, measuring 5.1 x 4.9 cm (series 4; image 149), previously 3.2 x 2.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of disease involving the largest iliac lymph node.Development of hydronephrosis, left greater than right, secondary to increased adenopathy, described aboveStable hepatic hypodensities, the largest of which is a cyst.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: eval for pneumothorax History: s/p right sided thora Line position stable.No change in pulmonary opacities and effusions.No pneumothorax visualized.

Output: No significant change in pulmonary opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: acute pathology History: chest pain and syncope Right-sided ICD with single lead in the area of the right ventricular apex.Stable cardiomediastinal silhouette.Low lung volumes. No focal airspace opacities or pleural effusions.

Output: No acute abnormality or interval change


Instruction: Generate impression based on medical findings.

Input: Bladder cancer No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: eval ETT, lung fields History: s/p ECMO ET tube with its tip 2 cm above the carina.Right IJ venous catheter with its tip in the right ventricle.Moderate cardiac enlargement.No focal areas of consolidation.

Output: Cardiac enlargement without evidence of edema. Right central venous catheter with its tip in the right ventricle.


Instruction: Generate impression based on medical findings.

Input: Kidney donor No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pre-op epicardial lead placement History: NA Mild cardiomegaly.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 56-year-old metastatic gastric cancer and chemo Holliday. Evaluate for tumor growth. CHEST:LUNGS AND PLEURA: No significant abnormality noted granuloma left lung. No nodules or effusions. Minimal scarring or atelectasis left costophrenic angle.MEDIASTINUM AND HILA: No significant esophageal dilatation. No pathologic size lymph nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged over 19 cm cephalocaudad. The liver lesions are irregular in shape and very small and not accurately measured. Previous index lesions are remeasured as follows:Punctate lesion in the dome of the liver series 3 image 85 measures 7.5 x 2 mm.Poorly delineated hypodensity in the inferior tip of the right lobe of the liver is measured on image 135 is 2.2 by the 0.9-CM. no new liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Small nodules seen in both adrenal glands probably unchanged. Previously measured index lesion anterior to the kidney may represent a node or an adrenal lesion. It is measured on series 3 image 106 is 1.9 x 1.7 cm.KIDNEYS, URETERS: Bilateral nephrolithiasis multifocal, unchanged.RETROPERITONEUM, LYMPH NODES: A the small retroperitoneal lymph nodes not pathologic by size criteria.BOWEL, MESENTERY: Carcinomatosis approximately unchanged. Ascites with diffuse fluid throughout the upper abdomen particularly in the porta hepatis gastrohepatic and perigastric area. The gastric stent remains in place and calcifications in the wall of the stomach probably represent tumoral calcification possibly mucinous nature.BONES, SOFT TISSUES: No lytic or blastic disease.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites in the dependent portion of the pelvis. This is approximately the same as on the prior exam.BONES, SOFT TISSUES: Minimal anasarca.OTHER: No significant abnormality noted

Output: Overall, probably stable disease.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: chest pain History: chest pain hx lung tx, now post op No significant change in left effusion and retrocardiac opacity. No change in edema of left lung. No pneumothorax.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: hx of CAD, CHF; eval for infiltrate, edema History: chest pain Improvement in lung volumes. No focal lung consolidation or evidence of overt left-sided heart failure. Normal heart size. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 30 year-old female with shortness of breath, evaluate for parenchymal disease LUNGS AND PLEURA: Mild bronchial wall thickening. No focal pulmonary opacities.No evidence of a pleural effusion.MEDIASTINUM AND HILA: Mild residual amount of thymic tissue in the anterior mediastinum.No evidence of hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Cholelithiasis.

Output: Mild bronchial wall thickening, which is compatible with bronchitis. No other pulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: eval new infiltrate or edema History: SOB Cardiomegaly with low lung volumes, pleural effusions and basilar edema, none of which have changed.

Output: Stable CHF with pulmonary edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection, edema, effusion History: cp, sob, pt is pregnant Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma. CHEST:LUNGS AND PLEURA: Moderate emphysema. Scattered calcified micronodules are unchanged.MEDIASTINUM AND HILA: Ectatic ascending aorta is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Large hepatic mass measures 22 .8 x 14.8 cm, unchanged from previous CT. the second lesion in the left lobe has significantly increased in the interval now measures 2.4 x 2.0 cm. previously closed measuring 8 x 8 mm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Soft tissue around the stump of the left renal artery is unchanged.RETROPERITONEUM, LYMPH NODES: Small lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior stabilization rods in the lumber spine secondary to metastatic disease in the lumber vertebral body are unchanged.OTHER: The amount of ascites is slightly increased.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small left external iliac lymph node measuring 13 x 10 mm is unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval increase of ascites. Large liver mass is unchanged. Interval significant increase in the size of the left lobe hepatic lesion from subcentimeter to 2-cm in diameter.


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Orthopnea evaluate for edema. Cardiac amyloidosis. Small pleural effusions with diffuse bronchial wall thickening and atelectasis, not significantly changed. Lung volumes slightly decreased compared to the prior study. Peribronchial opacities in the lung bases. Retrocardiac opacity on the left poorly visualized. No pneumothorax. Unchanged cardiomegaly and prominence of the central pulmonary vasculature.

Output: Small pleural effusions with at least a mild component of pulmonary edema. Chronic appearing bronchial wall thickening nonspecific and may be due to edema however follow-up chest radiograph after management of patient's fluid status is recommended to exclude underlying abnormality given patient's history.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Sickle cell disease, asthma presenting with thrombocytopenia and cough. Unchanged cardiomegaly. Parenchymal scarring consistent with history of sickle cell disease. No focal air space opacities. Basal atelectasis. Mild thickening and measures, but no conclusive signs of interstitial edema.

Output: Basal atelectasis, but no specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p right thoracentesis History: SOB Cardiomegaly with ICD leads and PICC line unchanged.Basilar opacity, greater on the left, compatible with atelectasis and effusions, slightly improved.No pneumothorax or other acute change.

Output: Pleural effusions and atelectasis, slightly improved.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: evaluate s/p TECAB History: post-op Unremarkable mediastinal contours and cardiac silhouette.Small left pleural effusion seen best on the lateral view.No specific evidence of infection or edema.

Output: Small pleural effusion, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with lung cancer status post bronchoscopy with stent placement. Recent GI bleed with EUS and AVMs. Please evaluate disease and placement of stent. CHEST:LUNGS AND PLEURA: Status post left upper lobectomy.Necrotic right upper lobe mass with adjacent atelectasis appears similar to prior study, measuring 86 x 60 mm (series 5, image 40); it previously measured 86 x 62 mm. Right upper and right middle lobe bronchi remain narrowed (series 5, images 40 and 50).Left lower lobe nodule (series 5, image 49) continues to increase in size, measuring 32 x 31 mm; previously measuring 31 x 28 mm on 7/8/2011 and measuring 23 x 23 mm on 4/29/2011. A satellite nodule lateral to this lesion (series 5, image 49) has increased in size over the prior studies as well.Left upper lobe nodule with irregular margins remains unchanged in size over multiple prior studies but is still suspicious for metastasis.MEDIASTINUM AND HILA: Numerous subcentimeter supraclavicular and mediastinal lymph nodes appear similar to prior study. Subcarinal lymphadenopathy is also unchanged (series 3, image 44). Previously mentioned right costophrenic angle lymph node is unchanged as well (series 3, image 76). Heart size normal without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Multiple subcentimeter hypoattenuating foci in the liver are too small to characterize but appear unchanged from prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measures 19 x 13 mm and is not significantly changed since initial CT from 4/16/2009; it likely represents a benign adenoma.KIDNEYS, URETERS: Small renal cysts bilaterally are too small to characterize but are unchanged from prior study.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic disease of the descending aorta and its major branch vessels.Multiple, small peri-celiac artery and porta hepatis lymph nodes have been present since April 2009, not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Necrotic right upper lobe mass not significantly changed with persistent narrowing of the right upper and right middle lobe bronchi.2. Left lower lobe nodule and a satellite lesion continue to increase in size since prior studies.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: hx of kidney cancer, evaluate for metastatic disease History: see above The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.No obvious metastases are identified.

Output: No acute cardiopulmonary process is identified. No obvious metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: SICU patient History: SICU patient. Ovarian cancer. Small lung volumes with patchy bilateral opacities, increased from previous, compatible with atelectasis and aspiration.Interval extubation.Catheter tip in the SVC.Small pleural effusions.

Output: Interval extubation with increased bilateral opacities consistent with atelectasis and aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: dobhoff pulled out partially, assess for location and aspiration as TFs were going History: as above Moderate sized pleural effusions and basilar opacities are unchanged.Moderate cardiomegaly is unchanged.Dobbhoff tube removed.

Output: No change in pleural effusions and basilar opacities since the Dobbhoff tube was removed, the findings suggestive of CHF/hypervolemia.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: The right-sided port terminates at the atriocaval junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Hypodense left adrenal nodule is unchanged, measuring 23 x 14 mm (series 5; image 86)KIDNEYS, URETERS: Incidental note of a circumaortic left renal vein.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: Heterogeneous appearance of the right iliac bone is unchanged and may be due to Paget's disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination without evidence of disease.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: sob History: sob Heart size within normal limits.Lungs clear.No pleural effusion. No pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: eval lung History: eval lung Tracheostomy tube and venous catheter are unchanged. Complete opacification of the right hemithorax status post right pneumonectomy with increase in volume compared to the left, unchanged.Left lower lobe focal airspace opacity suggestive of atelectasis and consolidation, unchanged

Output: No significant interval change status post right pneumonectomy with left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: f/u pleural effusion History: effusion Small to moderate residual left pleural effusion, decreased from previous, with a Pleurx catheter at the left base.  No other significant change.

Output: Decreased left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with metastatic neuroendocrine carcinoma. Presents with pain. Please compare to previous outside hospital CT. CHEST:LUNGS AND PLEURA: Scattered micronodules, some of which are calcified. No suspicious nodules, masses, or pleural effusion. Scarring in right middle lobe is seen on comparison study.Small apical bullae.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Blastic osseous metastases involving multiple ribs as well as the sternum. Possibly one in the proximal right humerus as well (series 3, image one)ABDOMEN:LIVER, BILIARY TRACT: Innumerable, peripherally enhancing lesions in the liver consistent with patient's history of metastatic neuroendocrine carcinoma; relatively unchanged on comparison to prior study. For reference, lesion in left hepatic lobe (series 3, image 88) measures 6.2 x 5.7 cm.Patent portal vasculature. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: Pancreatic tail mass extends into splenic hilum (see below); the splenic vein is small, the distal aspect of which is not able to be clearly identified.PANCREAS: A mass inseparable from the pancreatic tail is seen (series 3, image 96) with dystrophic calcifications. It appears similar to comparison study, measuring 3.7 x 3.6 cm. It extends into the splenic hilum.ADRENAL GLANDS: Left adrenal lesion (series 3, image 94) also appears similar to comparison study; measuring 2.7 x 2.4 cm.KIDNEYS, URETERS: Multiple hypoattenuating lesions seen in the kidneys on delayed phase imaging of comparison study are not currently visualized due to phase of contrast during imaging.A right renal cyst appears stable; nonobstructing right renal stone is also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous, blastic osseous metastatic lesions involves the spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous blastic osseous metastases involving the spine and pelvis.

Output: 1. Innumerable hepatic lesions consistent with patient's history; appearing similar to comparison study.2. Numerous blastic osseous metastases involving the ribs, sternum, spine, and pelvis.3. Multiple hypoattenuating lesions seen in the kidneys on delayed phase imaging of comparison study are not currently visualized due to phase of contrast during scanning.Upon discussion with the ordering service, it is agreed that the patient does not need to be called back to perform a triple phase CT scan at this time as requested. Service will obtain a triple phase CT scan for future studies.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Lupus flare with chest pain. Low lung volumes.Cardiothoracic ratio appears prominent, this may be exaggerated by underinflation and magnification from portable technique. More accurate assessment of cardiac size may be made with erect PA and lateral chest radiographs if required.The lung bases are obscured by diaphragmatic elevation.No focal airspace opacities are appreciated. No pneumothorax. No specific signs of pulmonary edema.

Output: Low lung volumes with apparent diaphragmatic elevation suspicious for SLE-related diaphragmatic dysfunction. No visible acute pulmonary abnormality. Consider erect PA and lateral chest radiographs at full inspiratory effort if patient symptoms persist.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: MaleReason for Study: Reason: status of pneumothorax History: needs pneumothorax eval Stable cardiomediastinal silhouette.Right pleural effusion and right basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Right pleural effusion and basilar atelectasis unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: shortness of breath Cardiomegaly with interstitial opacity compatible with scarring and possibly edema, with small pleural effusions. No new findings.

Output: Cardiomegaly and probable CHF with upper zone scarring and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: asthma exacerbation History: cough Very small pleural effusions best seen on the lateral view.No other significant pulmonary or pleural abnormality.Unremarkable mediastinal contours and cardiac silhouette.

Output: Small pleural effusions, nonspecific, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: please assess lung fields History: post op TECAB Small lung volumes with left chest tube in place.Basilar opacities compatible with subsegmental atelectasis and small pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: eval for pna History: fever Lower lung soft tissue artifact related to overlying chest wall prostheses. Cardiomediastinal silhouette is within normal limits. No focal pulmonary opacity to suggest pneumonia. No pleural effusions or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: ETT adjustment, Dobbhoff placement History: ETT adjustment, Dobbhoff placement Interval placement Dobbhoff tube with the tip in the lower esophagus. The NG tube tip extends off the inferior margin of the image. Endotracheal tube tip is approximately 5 cm above the carina. Right IJ central venous catheter tip is in the SVC.Moderate cardiomegaly and diffuse bilateral pulmonary opacities which may represent edema appear similar to the prior exam.

Output: 1.The Dobbhoff tube tip is in the lower esophagus. ET tube is in appropriate position.2.Unchanged diffuse bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: ppd positive History: Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 65 years old Reason: please evaluate for right sided diaphragmatic paralysis History: cough, significant radiographic findings, h/o CABG. Limited scout radiograph demonstrated sternotomy wires and surgical clips. The right hemidiaphragm is elevated. Bibasilar pulmonary air space opacities are noted. Please refer to recent chest radiograph for additional pulmonary findings.With inhalation and expiration, there was limited to absent movement of the right hemidiaphragm. There was normal caudal descent upon inhalation of the left hemidiaphragm. Fluoroscopy time: 59 seconds.

Output: Very limited/near complete absent movement of the right hemidiaphragm.


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with history of metastatic renal cell cancer This study is limited due to lack of IV contrastCHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. Patchy groundglass opacities in upper lobes are stable. Linear subsegmental atelectasis in the lower lobes are stable.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 17 x 13 mm image number 52, series number 3, stable. Other small mediastinal lymph nodes are also stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Previous described ill-defined hypodense lesion in the liver is not well seen on today's study. Lack of IV contrast severely limits optimal evaluation. MRI of the liver may be obtained for better evaluation of the liver, if clinically indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Small hypodense lesion in the lower pole left kidney is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions through the lower spine and pelvis are stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic lesions through the lumber spine and pelvis are stable.OTHER: No significant abnormality noted

Output: Previously described lesion in the liver is not seen on today's study. Lack of IV contrast severely limits opal evaluation of the liver. MRI of the liver may obtained for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Crackles on exam question pulmonary edema. Low lung volumes with basal atelectasis or scarring, right greater than left. Small right pleural fluid collection. No specific signs of pulmonary edema. Compressive atelectasis at the right lung base is probably exaggerated by elevation of the right hemidiaphragm and may be followed by serial plain films if clinically warranted.

Output: Small right pleural effusion, but no specific signs of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: R pleural effusion s/p thoracentesis History: As above Slight decrease in size of large right pleural effusion with improvement in right lung aeration. Left lung is unchanged. Unchanged heart size. No pneumothorax.

Output: No pneumothoraces status post right-sided thoracentesis.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: r/o infection History: cough and fever The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Septic shock with altered mental status Mildly improving perihilar and basilar interstitial opacities with cardiomegaly suggesting resolving diffuse mild edema. Persistent decreased lung volumesRight jugular dialysis catheter unchanged, tip extends into the right atrium

Output: Resolving mild edema


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: HX DAH/ HEMOPTYSIS History: SOB Stable mild cardiac enlargement.The lungs are clear.No pleural effusions.

Output: Mild cardiac enlargement without acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab No significant pulmonary or pleural abnormality.Heart size normal status post sternotomy.Right subclavian biventricular ICD, leads unchanged in position.No significant pneumothorax.

Output: No pneumothorax following recent ICD placement.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Swan-Ganz catheter Interval extubation. Other lines and tubes, unchanged and as expected. Low lung volumes makes detailed cardiopulmonary assessment difficult. Retrocardiac opacities, increased, likely atelectasis. No pneumothorax. Unchanged cardiomegaly.

Output: Interval extubation. Retrocardiac opacities, increased, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: SOB History: as above Streaky right basilar linear opacities are compatible with subsegmental atelectasis. No large pleural effusion or pneumothorax. The heart size is normal.

Output: Bibasilar linear subsegmental atelectasis without evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: FemaleReason for Study: Reason: chest pain, cough History: cough Stable cardiomediastinal silhouette.No focal air space opacities identified.No pleural effusions.Degenerative joint disease involving the glenohumeral joints bilaterally significantly progressed since the prior exam.

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


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: IRB 14-0593 History: Chugai protocol Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: ? fluid overload History: Intermittent dyspnea Moderate cardiomegaly with the suggestion of interstitial edema.No significant sized pleural effusions.

Output: Cardiomegaly with suggestion of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Cardiomegaly, widened mediastinum History: Syncope, chest tightness, Chest Pain rule out Cardiomegaly.Large lung volumes are consistent with COPD.No specific evidence of infection or edema.

Output: Cardiomegaly and COPD, but no acute abnormality. No evidence of mediastinal widening.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Reason: eval lung fields History: hx of CHF, s/p CABG Interval removal of a right IJ central venous catheter. No pneumothorax.Interval decrease in the left pleural effusion. Interval removal of the left-sided chest tube.Moderate edema bilaterally. Small to moderate right pleural effusion, unchanged.

Output: A right IJ central venous catheter and a left-sided chest tube have been removed. Improving left pleural effusion. No pneumothorax. Moderate pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Shortness of breath. Nonspecific but chronic-appearing right basilar interstitial opacity. Linear right basilar opacities most consistent with scarring/atelectasis. No large pleural effusion or pneumothorax. No new focal opacity to suggest acute infection.

Output: Nonspecific but chronic-appearing right basilar interstitial opacity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT placement History: ETT placement Left basilar subsegmental atelectasis and small pleural effusions, improved.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: ET tube tip approximately 3 cm above the carina. Improved basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Altered mental status. Unchanged cardiopulmonary appearance. No focal air space opacities. Mild atelectasis along the mildly elevated right hemidiaphragm.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Essential hypertension. Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: history of urothelial cell ca History: same No significant cardiopulmonary abnormality.Healed granulomatous disease.No evidence of metastases.Left subclavian biventricular ICD leads in appropriate position.

Output: No evidence of metastases, or other significant abnormality. Reference should be made to the follow-up abdomen CT report to evaluate the lung bases.


Instruction: Generate impression based on medical findings.

Input: History of recent pulmonary embolus, evaluate for progression. PULMONARY VASCULATURE: No pulmonary emboli are seen on this examination. Enlargement of the main pulmonary artery is seen suggestive of pulmonary hypertension.LUNGS AND PLEURA: Bibasilar dependent atelectasis.MEDIASTINUM AND HILA: Upper normal heart size , no pericardial effusion. No lymphadenopathy. Right thyroid hypodensity, likely a cyst unchanged. Small hiatal hernia.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: No significant abnormality noted.

Output: Resolution of previously noted bibasilar pulmonary emboli.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: device interrogation -- went off yesterday History: as above ICD is unchanged with leads in the right atrial appendage and right ventricle. No pleural effusion or pneumothorax. No focal pulmonary opacity. Right superior paratracheal mass is again demonstrated, previously described as heterogeneous right thyroid lobe. Mild cardiomegaly is unchanged.

Output: ICD unchanged. No other acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 44-year-old male with decreasing drain output, evaluate the abscess size. CHEST:LUNGS AND PLEURA: Dependent atelectasis in the lung bases are unchanged. Small left-sided pleural effusion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Mild periportal edema and moderate hepatomegaly are unchanged.SPLEEN: Moderate splenomegaly, unchanged. New focal hypodense area in the lower pole of the spleen representing a focal infarct.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Previous described collection inferior to the spleen is being drained with in the interval via percutaneous catheter. Moderate amount of ascites persists but no evidence of loculated abscess.Right lower quadrant ostomy. No evidence of bowel obstruction.Mildly dilated small bowel loops likely secondary to ileus.Mild wall thickening involving the small bowel loops it is secondary to ascites and/or patient's known chronic liver disease. This is a nonspecific finding. Ischemia cannot be excluded.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: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate ascites.

Output: Interval resolution of the previous described left-sided abdominal abscess, drained by a percutaneous catheter.Interval development of a small focal splenic infarct.Better splenomegaly unchanged. Moderate ascites.Mild ileus and diffuse wall thickening involving the bowel as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval lung fields History: s/p MVR Swan-Ganz catheter has been removed. Other lines and tubes, not substantially different. Unchanged mild pulmonary edema and patchy bibasilar pleural-parenchymal opacities. No significant pneumothorax. Unchanged cardiomegaly.

Output: Unchanged mild pulmonary edema and patchy bibasilar pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: pulmonary edema? effusion? PNA? History: leg swelling, shorntess of breath, COPD and CHF Cardiomegaly, unchanged.Right lower lung opacity, better characterized on the subsequent CT scan, consistent with right middle lobe airspace opacity and the cavitary lesion in the right lower lobe. Apparent interval change is at least partly attributable to differences in position and projection, though there may be some progression.

Output: Findings in the right lower lung compatible with pneumonia, and fluid containing cyst in the right lower lobe that may represent an infected bulla.


Instruction: Generate impression based on medical findings.

Input: Reason: fluid overload History: shortness of breath Heart size about upper normal with a tortuous calcified aorta compatible with age.Deviation of the trachea to the left at the thoracic inlet, unchanged, compatible with a large goiter.Mild nonspecific basilar interstitial opacity compatible with atelectasis and possibly mild edema.

Output: Basilar atelectasis and possibly mild interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Sepsis Exam limited due to patient positioning, semiupright positioning and head tilt obscuring the right upper chestWithin the limitation increased moderate edema-like findings are observed in both bases with layered moderate effusions. Borderline mild cardiomegalyETT has been placed terminating 3 cm above the carina

Output: Well-positioned ETT with increasing suspected pulmonary edema


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: pt with week of fevers and nonproductive cough, assess for PNA History: cough and fevers Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Lung transplant in 2013 Unchanged iatrogenic devices.Unchanged fibrosis and basilar opacities consistent with atelectasis/consolidation and pleural effusions in the native left lung.Layering pleural effusion in the right hemithorax.No pneumothorax.Cardiomediastinal silhouette is unchanged.

Output: Worsening edema with bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: r/o active TB History: none Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No active TB.

Output: No evidence of active TB, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Presenting with chest pain, evaluate. Cardiomediastinal silhouette is unchanged. No focal airspace opacities, pleural effusion, or pneumothorax are identified.

Output: No interval change, with no acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Check ETT ETT remains 3 cm above the carina. Mediastinal and bilateral basilar chest tubes, cannula and Swan-Ganz are all similar in position. Particular note is made of radiopaque marker related to gauze projected over the midline, also unchanged.Motion degrades sensitivity of the cardiopulmonary appearance. Layered right effusion with questionable diffuse edema is observed with probable mild cardiomegaly.

Output: Postsurgical changes and chest tubes unchanged. Particular note is made of a radiopaque marker related to suspected gauze. Please correlate with known history


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: s/p CABG; ? PTX History: SOB Chest/mediastinal tubes have been removed.There are decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities compatible with atelectasis and small effusions similar to the prior exam.Median sternotomy intact with evidence of prior CABG.No pneumothorax identified.

Output: Interval removal of chest tubes without evidence of a pneumothorax. Stable appearance of basilar atelectasis and small effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: asthma exacerbation, r/o pna History: above Mild bronchial wall thickening but no evidence of pneumonia.

Output: Mild bronchial wall thickening but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: s/p OLT History: s/p OLT ET tube with its tip 3 cm above the carina.NG tube is been markedly retracted with its side-port in the hypopharynx.Stable cardiac tonsillar.Decreased lung volumes with basilar atelectasis, small effusions, and left retrocardiac consolidation/atelectasis.

Output: NG tube with its tip in the proximal esophagus and side-port in the hypopharynx. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval volume History: worsening sob, oxygen requirement Catheter tip in the SVC.Hyperinflated left native lung consistent with emphysema.Volume loss with partial atelectasis in the right transplanted lung, not significantly changed.No specific evidence of pulmonary edema.

Output: No specific evidence of pulmonary edema or other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: Infiltrates History: fever Basilar opacities left greater than right are suggestive infection or aspiration.Heart size normal.No large pleural effusions.

Output: Basilar opacities suggestive of infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female, evaluate for aortic dissection, mesentery ischemia. Presenting with abdominal pain and septic shock Study is limited due to lack of IV contrastCHEST: Endotracheal tube is in place. I axil pleural effusions, small. Bilateral dependent atelectasis.Esophagus is dilated throughout its course.Limited evaluation of type B dissection starting distal to the left subclavian artery. Lack of IV contrast limits optimal evaluation.Mild cardiomegaly and small amount of pericardial effusion.ABDOMEN:Streak artifacts from barium and lack of IV contrast severely limits optimal evaluation of the abdomen.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Lack of IV contrast limits although evaluation of the liver. Lateral segment of the left lobe of the liver is diffusely hypodense compared to the rest of the liver. Etiology is unknown.Percutaneous cholecystostomy tube is in place.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic dissection extends into the abdominal aorta. It cannot be optimally evaluated due to lack of IV contrast.BOWEL, MESENTERY: Retained barium in the distal small bowel loops significantly limits evaluation of the bowel. Proximal small bowel loops are dilated measuring up to 4.9 cm. Distal small bowel loops in the pelvis are decompressed. These findings are compatible with distal small bowel obstruction.There is right inguinal hernia containing nonobstructed small bowel loops. No evidence of perforation.BONES, SOFT TISSUES: Streak artifacts from metallic orthopedic hardware.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: She see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: Left femoral line.

Output: Limited study due to lack of IV contrast, streak artifacts from barium and orthopedic hardware. CT finding suggestive of small bowel obstruction.Type B aortic dissection, incompletely evaluated.Right-sided inguinal hernia containing nonobstructive bowel loops.Bilateral pleural effusions, the pattern atelectasis, small pericardial effusion.Diffuse hypodensity of the lateral segment of the left lobe of the liver is of unknown etiology.Percutaneous cholecystostomy tube is in place.


Instruction: Generate impression based on medical findings.

Input: History of Takayasu disease presenting with chest pain radiating from back to the left side x 1 day. Dyspnea. Evaluate for pulmonary embolism. CHEST:LUNGS AND PLEURA: No significant abnormality noted. No suspicious nodules, masses, or pleural effusion is visualized. MEDIASTINUM AND HILA: No pulmonary embolus is noted. No significant mediastinal or hilar lymphadenopathy is seen. Heart size is normal without pericardial effusion.Reflux of contrast into the IVC may represent contrast overflow during bolus injection versus cardiac dysfunction.CHEST WALL: No significant abnormality noted.

Output: Negative PE study. Reflux of contrast into the IVC, representing overflow versus cardiac dysfunction.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: DOE History: crackles Mitral valve prosthesis remains in place. Sternotomy wires again noted. No new focal lung consolidation. No evidence for left-sided heart failure. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Patient fell, pain in chest, left knee, lower leg and left ankle. Chest: Persistent and increasing mild cardiomegaly, partially left ventricular with mild tortuosity of the aorta, the latter grossly unchanged. Prominent central pulmonary arteries suggest hypertension similar to prior. Lungs remain clear other than mild COPD changes.Knee and lower leg: Proximal fibular fracture in near anatomic alignment involving the proximal diaphysis. The demonstrates chondral calcinosis and moderate degenerative changes. Mild swelling. More distally, an additional oblique fibular fracture is also observed with mild overlying swelling.Ankle: Distal fibular fractures described above. Mild scattered degenerative changes and small calcaneal spurs

Output: 1. Both the proximal and distal acute fibular fractures2. Mild new cardiomegaly, see above


Instruction: Generate impression based on medical findings.

Input: 66-year-old male with atypical fibrous tumor in the region of the cervical spine. Evaluate for metastases. CHEST:LUNGS AND PLEURA: Small (right >left) pleural effusions and adjacent atelectasis, including focal round atelectasis at right lung base; appearing similar to prior study.Calcified pleural plaques compatible with prior asbestos exposure as seen previously.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications and ulcerated plaques again seen in the descending thoracic aorta (series 4, image 85).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: Cortical scarring at the left upper renal. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Mildly prominent pericaval and peripancreatic nodes come unchanged. Reference peripancreatic node (series 4, image 3) again measures 1.2 cm in short axis.Mildly prominent from the celiac artery also are similar to prior study.Atherosclerotic disease of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: High-density fluid uniformly fills the bladder, which is of unclear etiology or clinical significance. Please correlate for a prior examination or procedure utilizing intravenous contrast.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Pleural effusions and atelectasis, unchanged. Few prominent lymph nodes appearing similar to prior study without evidence of metastatic disease.2. High-density fluid uniformly fills the bladder, which is of unclear significance or etiology.


Instruction: Generate impression based on medical findings.

Input: Male, 21 years old.Right IJ temporary dialysis line. Catheter projecting over the right neck with distal tip well above the thoracic inlet.The cardiomediastinal silhouette is within normal limits. Hila pulmonary catheter is within normal limits. No opacity, pleural effusion or pneumothorax.

Output: Catheter projecting over right neck with distal tip well thoracic inlet. If this represents the temporary dialysis line, advancement to the SVC/RA junction is advised.


Instruction: Generate impression based on medical findings.

Input: Female, 99 years old.Reason: Pneumonia? History: Acute stroke Moderate cardiomegaly.Mild interstitial opacities are suggestive of edema.No specific evidence of infection.

Output: Mild CHF with edema, but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 80 yearsGender: FemaleReason for Study: Reason: ett History: ett ET tube, NG tube, and right IJ venous catheter unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Left pleural effusion/thickening and basilar atelectasis similar to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip 3 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: trach in place. eval airspaces History: asx Cardiomegaly with bilateral opacity compatible with edema and small pleural effusions.Cardiopulmonary monitoring and support devices, unchanged.No new findings.

Output: Pulmonary edema and pleural effusions with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT placement; lung infiltrate History: intubation Mild to moderate cardiomegaly.Interstitial and airspace opacities somewhat nodular on the left are suggestive of acute edema although aspiration is in the differential diagnosis.Right jugular catheter tip at right atrial level.ET tube tip approximately 2 cm above the carina.An NG tube extends below the lower margin of the image.

Output: Cardiomegaly and pulmonary opacities suggestive of edema although aspiration is in the differential diagnosis. Low ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: 55 yo w nec fasciitis, trach History: vent wean Right costophrenic angle is excluded from the field of view. Interval placement of a nasogastric tube that is coiled in the stomach. The remaining support devices are unchanged in position. Of note, the right IJ central catheter terminates within the mid right atrium.MID to lower zone opacities of edema and atelectasis unchanged. Moderate pleural effusions. No pneumothorax.

Output: Stable pulmonary edema and pleural effusions with retrocardiac consolidation.


Instruction: Generate impression based on medical findings.

Input: Reason: 55 y/o with stage IVB uterine cancer s/p surgery 3/3/16, shortness of breath, previously with pleural effusion History: shortness of breath Bilateral pleural effusions, greater on the left, with underlying atelectasis, slightly increased on the left side compared to the previous radiograph.Port catheter with its tip in the SVC.

Output: Large left pleural effusion, increased from previous and small right effusion, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.LUNG CA post right upper lobectomy with pneumothorax. Tubes and lines unchanged in position. Right apical pneumothorax with maximal pleural separation from the chest wall of 2-cm. Opacity caudal to the suture line may reflect postoperative contusion however is nonspecific and should be followed to complete radiographic resolution on subsequent studies.

Output: 2cm right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval for lesions History: s/p OLT 7/11/15 for HCV cirrhosis and HCC Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Surgical clips are projected over the left lateral chest wall and the upper abdomen.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male 55 years old Reason: Swan Ganz placement Interval placement of a Swan-Ganz catheter with the tip in the right main pulmonary artery. Right upper extremity PICC tip terminates at the cavoatrial junction. There are persistent basilar predominant interstitial and airspace opacities as well as septal lines compatible with pulmonary edema, not significantly changed from the prior exam. Possible layering right pleural effusion. Mild-to-moderate cardiomegaly.

Output: Swan-Ganz catheter tip in the right main pulmonary artery. Unchanged pulmonary edema secondary to CHF.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old. Left PICC line with distal tip in the SVC.Mild decreased lung volumes.The cardiomediastinal silhouette is unremarkable.Spinal pain stimulator identified.

Output: Placement of a left-sided PICC line without complication. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old with prosthetic heart valve, shortness of air. Interval removal of the mediastinal drain. Other support hardware remains in unchanged position. Slightly increased right lower lobe opacities. Small left apical pneumothorax. Persistent bilateral small pleural effusions.

Output: Slightly increased right lower lobe opacity likely suggestive of aspiration, atelectasis or pneumonia.


Instruction: Generate impression based on medical findings.

Input: 89-year-old male post device placement in EP lab. Pacemaker device with lead in the right atrial appendage and additional lead with tip in an uncertain location but projecting in the area of the right ventricle. No focal airspace opacities, pleural effusions or pneumothorax. Normal cardiomediastinal silhouette.

Output: Pacemaker device with one of the leads in an atypical position but projecting in the area of the right ventricle.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Cough, chills and wheezing. Upper normal heart size with highly tortuous thoracic aorta and enlargement of the left atrium. Minimal blunting of the right posterior costophrenic angle. The elevation of the left diaphragm with associated compressive atelectasis.

Output: No specific signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 31 yearsGender: MaleReason for Study: Reason: 31yyo M s/p chest tube placment History: as above Left-sided chest tube unchanged.Subcutaneous emphysema noted along left lateral chest wall.Left pleural effusion with foci of air compatible with a hydropneumothorax.Airspace interstitial opacities in left lung with left retrocardiac consolidation/atelectasis similar in appearance the prior exam.The right lung is clear.

Output: Large left-sided pleural effusion with foci of air unchanged from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: Is there pneumonia? History: dyspnea Cardiac silhouette is normal in size.Lungs are clear with no focal consolidation, sizable effusion or pneumothorax.

Output: No evidence of acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Reason: SOB in setting of rHF and thromboembolic disease History: SOB Moderate cardiomegaly with a tortuous aorta.Large lung volumes suggestive of COPD with chronic blunting of the right costophrenic angle suggestive of scarring.No significant change.

Output: Cardiomegaly and COPD with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: shortness of breath History: shortness of breath Cardiomegaly status post mitral valve replacement.Mild basilar interstitial opacities are suggestive of edema with a small right pleural effusion.Left subclavian pacemaker, leads unchanged in position.

Output: Cardiomegaly with the suggestion of edema and a small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male; 59 years old. Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT; ADMISSION TO ICU Dense bilateral air space opacities, slightly increased in the right lung since prior study. Stable widened mediastinum, consistent with postsurgical change. Stable pleural effusions.Interval removal of endoscopic instrument and enteric tube. Stable endotracheal tube, Swan-Ganz catheter, and bilateral chest tubes and drains. Mild bilateral chest wall subcutaneous emphysema, but no definite pneumothorax.

Output: Dense bilateral air space opacities, slightly increased in the right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: rhinovirus; stem cell transplant patient History: +rhinovirus Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right jugular and left subclavian catheters terminate in the SVC.Lumbar spine stabilization hardware incompletely imaged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Evaluate pneumothoraxVIEW: Chest AP 1/26/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right chest tube in place. The umbilical venous catheter tip in the right atrium. Cardiothymic silhouette normal. The small right pneumothorax has decreased in size. Diffuse lung haziness bilaterally.

Output: Right small pneumothorax has decreased in size in the interval.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p wedge biopsies History: see above Right chest tube in place with no significant pneumothorax. Subcutaneous emphysema in the right chest wall. Small lung volumes with chronic interstitial disease, previously characterized by CT scan.

Output: Chest tube in place with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pacemaker History: s/p pacemaker Pacemaker device with leads projected in the area of the right atrial appendage and superior to the right ventricular apex.No pneumothorax or other consultations.

Output: New pacemaker with no complications.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Status post AVR, MVR. Interval extubation.Swan-Ganz catheter and mediastinal drains similar in position.Postoperative mediastinal widening.Lung volumes remain low, with at least a small volume of pleural fluid bilaterally.Air in the sternotomy, hardware similar in alignment..

Output: Interval extubation. Lung volumes remain low.


Instruction: Generate impression based on medical findings.

Input: Age: 30 yearsGender: FemaleReason for Study: Reason: r/o PNA History: resp insufficiency NG tube unchanged with its side-port in the stomach.Left PICC line with its tip in the SVC.Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

Output: Interval change. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female 64 years old with history of COPD exacerbation, evaluate for pneumonia Increased lung volumes. Stable cardiomediastinal silhouette without evidence of focal airspace opacities, pneumothorax, or pleural effusions.

Output: Stable exam without acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: ? acute chest? History: lower o2 sats, sickle cell No focal lung opacity, pleural effusion, or pneumothorax. Stable cardiomegaly. Osseous stigmata of sickle cell disease.

Output: Stable cardiomegaly without evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: eval for PNA, pleural effusion History: SOB, h/o recurrent R pleural effusion Moderate cardiomegaly.Mild basilar interstitial opacities and enlarging right pleural effusion noted.Right basilar airspace opacity.Right subclavian dual chamber ICD, leads unchanged.

Output: Increasing basilar opacities and right pleural effusion suggestive of CHF/hypervolemia, although a right basilar pneumonia is in the differential diagnosis.