Instruction: Generate impression based on medical findings.

Input: Chest pain. Fracture versus pneumonia. Normal heart size. Prominent central pulmonary vasculature . Biapical pleural thickening and scarring. Cranial hilar retraction bilaterally with upper zone scarring and right paratracheal contour abnormality suspicious for lymphadenopathy or a mass. Asymmetric scarring in the left upper lobe. Left costophrenic angle blunting, probably due to scarring. Faint nodularity especially in the left upper lobe.Please note that chest technique has a limited sensitivity for osseous pathology including fracture or dislocation. If clinically warranted, dedicated bone technique films of the are of interest would be recommended.

Output: No visible signs of pneumonia. Constellation of findings is most likely the result of pulmonary sarcoidosis with pulmonary hypertension. Recommend correlation with enhanced thoracic CT when feasible for further evaluation and given history of smoking to exclude possibility of nonbenign process, including neoplasm, as a right paratracheal mass cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: chest pain History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: esophageal fistula History: esophageal fistula Unchanged small right pleural effusion and minimal interstitial opacities suggestive of edema.Right jugular catheter, tip in SVC.Pericardial and mediastinal drains unchanged.

Output: No significant pneumothorax. Stable edema and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: cough History: cough Small lung volumes with dense right lower lobe airspace opacity, new since the previous radiograph, compatible with pneumonia in the appropriate clinical setting.Subsegmental atelectasis at the left base.Sclerotic right second rib, unchanged and likely benign.

Output: Right lower lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male; 33 years old. Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Interval removal of right jugular central venous catheter.Normal cardiac and mediastinal silhouettes.No abnormal pulmonary opacities. No pleural effusions.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: short of breath History: short of breath Mild cardiomegaly.Marked azygos vein distention suggestingHypervolemia. Mild basilar scarring , but no sign of infarction or pneumonia.Cholecystectomy clips identified.

Output: Cardiomegaly with increased fluid status. No evidence of acute edema, pneumonia or infarction.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male history of RCC. Pulmonary micronodules. CHEST:LUNGS AND PLEURA: The on the right side previously identified pulmonary micronodules seen on series 5 image 26, 42, 45, 49, 49, unchanged or less conspicuous. There are no nodules in the left lung. There are no new nodules.MEDIASTINUM AND HILA: Small pericardial effusion unchanged.CHEST WALL: Gynecomastia.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast, given that limitation, the following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy. Left kidney contour normal. Minimal perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis otherwise unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No interval change. Small pericardial effusion. Micronodules right lung. Small pericardial effusion. Gynecomastia.


Instruction: Generate impression based on medical findings.

Input: Female 71 years old Reason: to r/o pneumonia History: tachypnea and high lactic acid There is mass effect on the trachea and left stem bronchus. Large left pleural effusion with associated compressive atelectasis/consolidation, similar to slightly increased from prior exam. Cardiac silhouette size is difficult to evaluate. Right lung is clear.

Output: Mass effect on the trachea and left stem bronchus, suspicious for mass lesion or possibly aneurysm/hematoma.Persistent large left pleural effusion with compressive atelectasis/consolidation. Recommend thoracic CT.Findings discussed with Mindy Jacobs via phone at 9:05 AM on 6/26/2015.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: 61-year-old male with history mediastinal mass, staging workup. Chest and abdominal pain. Requesting triple phase liver protocol. We is strong suspicion for neuroendocrine malignancy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Extensive adenopathy is seen in the mediastinum with particularly large nodes involving the left paratracheal, prevascular, subcarinal areas and smaller nodes in the right hilum. Nodes extend into the superior mediastinum particularly on the left and are also nodes in the base of the neck on the left.For baseline purposes a cluster of nodes in the left paratracheal area measures 3.2 x 2.7 cm series 12 image 37.Right hilar node measures 1.2 x 1.2 cm series 12 image 48.Lobular soft tissue mass is seen expanding the esophagus series 12 image is 34-40 5/2019 suspicious for an esophageal carcinoma.Coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are several liver lesions with different enhancement patterns. Pre-IV contrast no calcifications are seen in the liver.In the dome of segment 4 A. there is a bright hypervascular lesion arterial phase series 9 image 19 which mildly retains contrast in the portal venous phase, series 12 image 86 and is essentially isodense with liver on delayed images series 13 image 20. Enhancing focus on the arterial phase measures 1.2 x .9 cm.A punctate area of blush is seen in the subcapsular portion of segment 4 A. on series 9 image 29 which becomes isodense with liver on all of the phases.Hypervascular lesion in segment 8 with central hypoattenuation, who is hypervascular component becomes isodense with liver but retains a central area of hypoattenuation in the portal and delayed images, series 12 image 95, is best measured on the arterial phase series 9 image 30, 1.6 x 1.5 cm excluding thick rim of enhancement which may represent vascular flow phenomenon in the surrounding liver.Punctate hypoattenuating lesion segment 8 nonspecific series 12 image 95, series 9 image 30, some is series 13 image 32.Other areas of wedge-shaped vascular flow phenomenon enhancement on the arterial phase with no discrete lesions associated with them.SPLEEN: No significant abnormality notedPANCREAS: Prominent soft tissue density and calcifications seen along the lateral aspect of the head of the pancreas. It is difficult to differentiate if this is in the pancreatic head or adjacent nodes. I favor this being soft tissue density extending from the pancreatic head. Other small calcifications are seen in the uncinate process and posterior margin of the pancreatic head. There is no evidence of pancreatic ductal dilatation. Calcified area of soft tissue density is best measured on the portal venous phase series 12 image 118 1.8 x 1.7 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate hypoattenuating foci too small to characterize likely cysts particularly in the left kidney.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal nodes. Atherosclerotic calcifications aorta with some small areas of mural thrombus along the aorta and common iliac arteries. No evidence of aneurysm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic changes.

Output: Esophageal mass. Extensive mediastinal adenopathy. Hyper and hypovascular liver lesions concerning for metastases. Calcified mass in a near head of pancreas and pancreatic calcifications. Correlate with clinical history for pancreatitis. Pancreatic primary malignancy is considered unlikely. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: pna/ History: seizure Minimal streaky basilar opacities may represent atelectasis or aspiration. Metallic density overlying left chest is nonspecific.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: cough, pleuritic CP History: as above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Evaluate for pneumothorax. History: chest pain with cough, left lateral ant axillary line. Exam limited by expiration. Cardiomediastinal silhouette is within normal limits. Bilateral increased haziness likely due to expiration. No focal pulmonary opacities. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary pathology.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: s/o thoracentesis History: s/p thoracentesis Lower lung zone edema with left lower lobe consolidation and pleural effusions, unchanged.No pneumothorax following thoracentesis.Gastric distention.

Output: No significant pneumothorax. No significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: aspiration pneumonia s/p seizure History: s/p seizure Endotracheal tube terminates 5 cm above the carina. Nasogastric tube terminates at the gastroduodenal junction. Several metallic coils are noted at the left thoracic inlet.Evidence of bilateral healed rib fractures. Lungs and pleural spaces are clear. The cardiomediastinal silhouette is unremarkable.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: Check dobhoff tube placement History: Check dobhoff tube placement Heart size normal.Lower lung zone bronchial wall thickening may indicate aspiration.Right PICC, tip in the SVC.Tracheostomy tube tip approximately 6 above the carina.A Dobbhoff tube terminates in the stomach.

Output: Tracheostomy tube tip approximately 6 above the carina. A Dobbhoff tube terminates in the stomach.


Instruction: Generate impression based on medical findings.

Input: Reason: 22yo F w/ resp failure History: as above ET tube tip approximately 3 cm above the carina.Left jugular catheter extending across the midline with the tip in the area of the right subclavian vein.NG tube tip in the stomach.Small lung volumes with diffuse airspace and interstitial opacities suggestive of edema.

Output: Findings suggestive of pulmonary edema with no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: 64F h\T\n cancer w lung mets, picc line placement History: picc line placement Venous catheter extending to the area of the SVC.Streaky opacity in the right middle and lower lobes that may be related to known lung cancer, with a component of atelectasis.Blunting of right costophrenic angle suggestive of small pleural effusion.Hypovascular upper lungs suggestive of emphysema.Surgical clips in the left side of the neck with narrowing of the subglottic portion of the trachea.

Output: Catheter extending to the SVC with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: line History: intubated central line Right IJ line terminates at the cavoatrial junction. No pneumothorax. Unchanged endotracheal tube. Bibasilar subsegmental atelectasis or scarring and small pleural effusions, left greater than right again noted. Unchanged heart size. No pneumothorax.

Output: Right IJ line placement without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: eval lung fields History: s/p CABG Intra-aortic balloon pump is not visualized. Lines and tubes are otherwise unchanged. Unchanged diffuse left pleural-parenchymal opacities. Right lung remains clear. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged diffuse left pleural-parenchymal opacities. Right lung remains clear.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female metastatic gastric cancer, status post 16 weeks 8 cycles XL880. Bidimensional measurements please compare. Status post right mastectomy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality noted. There is a left-sided venous access device. There is marked breast asymmetry, with the left smaller than the right. This patient is status post right mastectomy with reconstruction. ABDOMEN: LIVER, BILIARY TRACT: The there are 3 small hypodensities in the liver, unchanged with the index lesion in segment 7 seen on image 78/195 measuring 7 x 11 mm. Additionally there is a small cyst in the dome. There are two punctate lesions are located in the medial segment of left lobe.SPLEEN: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes upper abdomen. No evidence of local recurrence.BONES, SOFT TISSUES: No lytic or blastic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Multifocal cystic and solid lesions in the uterus unchanged compared to the prior exam. These likely represent uterine myomata.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: Small amount of fluid in the cul-de-sac persists.

Output: No interval change.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with headache, evaluate shunt SHUNT DEVICE: Again seen is a right parietal approach intracranial shunt device with the intracranial tip near the midline directed caudally. The shunt catheter courses down the right lateral skull, right neck, anterior lateral chest wall, and enters the abdomen. The intra-abdominal shunt tip is in the right upper abdominal quadrant similar to prior. There is no kink or discontinuity in the radiopaque portions of the shunt catheter. There is an orphaned tubing noted within the right neck and chest wall.SKULL: Two views of the skull show a slightly dysmorphic appearance of the skull as seen on prior CT scan. Aforementioned shunt device as described as aboveCERVICAL SPINE: Evaluation of the cervical spine is limited due to overlying anatomy and artifacts. No acute abnormality is evident.CHEST: A tracheostomy tube appears similar to that seen on prior study with its tip approximately at the level of the carina. Orthopedic hardware affixing the spine is similar to that seen on the prior study.ABDOMEN: A pigtail catheter overlies the left mid abdomen. Bowel gas pattern is unremarkable. An IVC filter and vascular coils are noted. Dysmorphic bones appears similar to those seen on prior studies and are incompletely imaged on this radiograph.

Output: No shunt kink or discontinuity, appearing similar to prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: pulmonary edema History: pulmonary edema s/p HD Status post lung transplant.Bilateral chest tubes are present, with a persistent pneumothorax medially in the right base and likely over the left apex, unchanged.Slight improvement in pulmonary opacities and improved inflation.Tracheostomy tube tip approximately 5 cm above the carina.An NG tube extends below the lower margin of the image.Left subclavian and left jugular catheters still terminate in the SVC.

Output: Slight improvement in pulmonary opacities and improved inflation. Persistent small pneumothoraces.


Instruction: Generate impression based on medical findings.

Input: Altered mental status, evaluate VP shunt. SHUNT DEVICE: An intracranial shunt exits the skull via a right frontal burr hole and courses down the soft tissues of the scalp, right neck, anterior chest wall, enters the abdomen, and terminates in the pelvis. Portions of the shunt overlying the skull are radiolucent and difficult to evaluate, but we see no radiographic evidence of complications.SKULL: The patient is edentulous.CERVICAL SPINE: Mild degenerative disc disease affects the cervical spine. The lower cervical spine is obscured by overlying soft tissue. The alignment appears normal.CHEST: There is mild cardiomegaly. A granuloma is present in the right lower lung.ABDOMEN: A nonobstructive bowel gas pattern is present. Moderate degenerative disc disease affects the lumbar spine and there is mild dextroscoliosis. Vascular calcifications noted anterior to the lumbar spine.

Output: VP shunt without radiographic evidence of complication. Degenerative disease of the cervical and lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: shortness of breath Diffuse interstitial and airspace opacity in the transplanted left lung suggestive of edema with a large left pleural effusion, increased from earlier radiographs.Volume loss and chronic interstitial disease in the native right lung, unchanged.Catheter tip in the SVC.

Output: Diffuse opacity in the left lung suggestive of edema, with a large pleural effusion, not significantly changed since the previous day but increased since 2/23/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: history of left breast cancer History: left rib pain Small lung volumes.No specific evidence of infection or edema.No evidence of metastases.

Output: No significant abnormality. No sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: ETT History: ETT No acute abnormality.Small lung volumes.Right jugular catheter, tip in SVC/RA junction level.ET tube tip approximately 3 cm above the carina.

Output: No acute abnormality. New intubation and catheter placement.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.History of cardiac surgery. Sternotomy changes. Left ICD, leads unchanged. Swan-Ganz catheter with tip in distribution of the pulmonary outflow tract, unchanged. Multiple surgical drains unchanged in position. LVAD device.Mild nonspecific basilar opacities, likely atelectasis or edema not significantly changed.Small right pleural effusion, unchanged. No pneumothorax.

Output: Postoperative changes without significant interval change.


Instruction: Generate impression based on medical findings.

Input: 91 years old Female. Reason: s/p R hip hemiarthroplasty History: see above. Right hip is status post hemiarthroplasty. Diffuse soft tissue swelling is noted in the right hip, which consistent with the postsurgical change. The hardware, right acetabulum, and right proximal femur are in good alignment.

Output: Status post right hip hemiarthroplasty.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: bilat transplant annual testing for 1 year History: annual testing, Minimal increased interstitial opacities left lung base, unchanged.No specific evidence of infection or edema.No specific evidence of rejection.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality. Status post bilateral lung transplant.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.NG tube, shortness of breath Interval placement of a nasogastric tube which terminates inferior to the caudal aspect of the image.Persistent left lower lobe subsegmental atelectasis. No interval pulmonary edema or consolidation. The heart size remains normal.

Output: Interval nasogastric tube placement. Stable left lower lobe subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p right lap nephrectomy for papillary type 2 RCC in 1/2012, assess for mets History: s/p right lap nephrectomy for papillary type 2 RCC in 1/2012, assess for mets Small lung volumes.Heart size normal.No sign metastases.

Output: No evidence of metastases, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough No acute or new cardiopulmonary abnormality. Near-complete resolution of previously described lingular pneumonia, minimal changes persist, possibly residual scarring

Output: Nearly resolved lingular pneumonia


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: ett placement History: intubated Endotracheal tube terminates approximately 9 cm from the carina. Enteric tube extends inferiorly off the field-of-view. Diffuse pulmonary opacities again noted. Unchanged cardiomegaly. Small pleural effusions. No pneumothorax.

Output: High endotracheal tube, as above. Diffuse pulmonary opacities and pleural effusions again noted.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Cough, shortness of breath. 16 weeks pregnant. Right middle lobe pneumonia. Mild cardiomegaly, likely related to increased volume status from pregnancy. Large patient body habitus. No pleural effusion or pneumothorax. No acute bony abnormality.

Output: Right middle lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: dyspnea History: dyspnea Kinked right vascular stent again noted overlying the right upper hemithorax. Low lung volumes with bibasilar subsegmental atelectasis or scarring. Unchanged cardiomegaly and aortic atherosclerosis. No large pleural effusion or pneumothorax.

Output: No substantial change.


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: Cough. Normal heart size with a moderately tortuous aorta.Mild basilar scarring and no acute disease.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval for infiltrate History: cough and SOB, hx of COPD The heart is normal in size.Very low lung volumes. Bilateral symmetric bandlike and consolidative opacities mainly involving both lower lobes, stable from prior chest CT dated 6/24/2016.Upper lobe predominant emphysema, more severe in the right upper lobe.No pleural effusion or pneumothorax.

Output: Signs of severe upper lobe predominant asymmetric emphysema. Bilateral lower lobe consolidative opacities with peripheral predominance are unchanged from priors and could represent sequela of chronic microaspiration or NSIP.Poorly defined right midlung subpleural opacity is concerning for a pulmonary nodule. Further assessment with nonemergent chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: 54 years old Male. Reason: evaluate etiology of SOB, infection History: SOB. Low lung volumes with mild streaky and patchy opacities within the right lung base which may represent atelectasis/or infection. No pneumothorax or large pleural effusion is identified. The cardiac silhouette is normal.

Output: Patchy opacity in the right lung base, which may represent atelectasis or infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p thora, eval for pneumothorax, effusion History: dyspnea, now s/p thora Pleural thickening and loculated effusion on the right with underlying pulmonary abnormalities, better characterized on recent CT scan. No visible pleural effusion on the left.Calcified granulomas bilaterally consistent with previous infection.No pneumothorax.

Output: Pleural thickening and loculated effusion on the right. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Chest pain, evaluate for cardiomegaly The cardiac and mediastinal silhouettes are normal without evidence of cardiomegaly.No specific evidence of infection, edema, or effusions.

Output: No cardiomegaly or acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.IABP IABP marker is not seen on this radiograph.Low lung volumes. Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.No focal airspace opacity.Faintly visible 3-4 mm micronodules which could be granulomas from healed infection but are incompletely characterized.

Output: IABP marker is not seen on this radiograph. Pulmonary micronodules incompletely evaluated but statistically most likely granulomas in a patient without a known history of malignancy.


Instruction: Generate impression based on medical findings.

Input: Age: 40 yearsGender: MaleReason for Study: Reason: intubated History: intubated ET tube with its tip 6 to 7 cm above the carina.Enteric tube is been repositioned with its tip beyond the margin of the image.Stable cardiomediastinal silhouette.Lungs are clear.

Output: ET tube in high position with its tip near the thoracic inlet. Interval repositioning of the enteric tube with its tip beyond the margin image. No acute cardiopulmonary abnormalities identified.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with metastatic gist tumor CHEST:LUNGS AND PLEURA: Emphysema. Pleural based nodule on the right side measures 10 x 11 mm number 92, series number 4, not significantly changed from previous study. Second small nodule is also unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the liver are unchanged. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES:Index aortocaval lymph node measures 18 x 18 mm over 120, series number 3, not significantly changed from previous study. Other smaller retroperitoneal lymph nodes are also unchanged.New soft tissue density anterior to the IVC at the level of the aortic bifurcation measures 2.2 x 1.2 cm in image number 149, series number 3.BOWEL, MESENTERY: Left upper quadrant mesenteric soft tissue mass is increased in size and now measures 2.9 x 4.6 cm, on image number 118, series number 3. Previously, it was measuring 2.2 x 1 .4 cm, image number 113, series number 3.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: Index lesion on the left side of the pelvis, abutting the sigmoid colon, measures 17 x 12 mm, image number 180, series number 3.Cluster of masses in the right lower quadrant mesentery has increased in size. Previously measured referenced lesion now measures 8.2 x 6 .5 cm, image number 173, series number 3. These masses extend into the pelvis between the bladder and rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the size of the pelvic masses with new retroperitoneal soft tissue nodule in the lower abdomen and interval increase in the left upper quadrant mesenteric mass..


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: PNA, Cardiomegaly, Effusion History: intermittent cp/sob x 1 week, decreased excercise tol, b/l le edema Stable mild cardiac enlargement with atherosclerotic changes of the aorta.Scarlike opacities in both lungs, unchanged.No new pulmonary opacities identified.No pleural effusions.Increased lung volumes compatible with COPD.

Output: No acute cardiopulmonary disease without interval change. No specific evidence of pulmonary edema or acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: IABP History: IABP IABP marker projects 4-cm below the top of the aortic arch. Left subclavian ICD unchanged in position. No focal pulmonary opacities.

Output: Unchanged position of IABP marker.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: eval for infection History: cerebral abscess No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Right upper lobe calcified granuloma.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: r/o acute infectious process History: 49826 No significant cardiopulmonary abnormality.Coronary calcifications noted.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Pulmonary edema History: swelling, r heart failure Mild cardiomegaly.Basilar subsegmental atelectasis, but no evidence of edema and no pleural effusions.

Output: Mild mild cardiomegaly and basilar subsegmental atelectasis, but no CHF.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: cough, sob History: cough, sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: IABP, swan, assess placement History: see above Cardiomegaly with lower lung zone opacities suggestive of edema and pleural effusions, unchanged.Left subclavian ICD, leads unchanged in position.IVC Swan-Ganz catheter tip in right main pulmonary artery.IABP catheter distal tip within 1 cm of the top of the aortic arch.

Output: No change in CHF and device positioning.


Instruction: Generate impression based on medical findings.

Input: 37-year-old male with muscle wasting and weight loss enlarged lymph nodes. Rule-out malignancy. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: The esophagus is mildly dilated in its proximal and mid portion without any evidence of mass detectable by CT. Triangular soft tissue in the thymic bed anteriorly may represent thymus, however, its unusual to see residual thymic tissue the age of the patient. No evidence of enlarged lymph nodes the mediastinum are bilateral hila.CHEST WALL: Bilateral borderline enlarged axillary lymph nodes largest measuring 20 x 11 mm in the left axilla on image number 14, series number 5.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. A reference left para-aortic lymph node measures 13 x 13 mm in image number 121, series number 5.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Generalized anasarca.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral borderline enlarged inguinal lymph nodes. A reference left inguinal lymph node measures 13 x 11 mm image number 2015, series number 5.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral axillary, inguinal and retroperitoneal borderline enlarged lymph nodes Mild dilatation of the proximal and midesophagus. Etiology is unknown.Soft tissue density triangular in shape in the anterior mediastinum most likely representing thymus. Given the age of the patient, appearance of thymic tissue is unusual. This may be secondary to at thymic rebound, however, although less likely a thymic neoplasm cannot be entirely excluded.Generalized anasarca


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: intubated History: as above Bilateral pleural effusions and basilar opacities unchanged, including edema and left lower lobe consolidation.ET tube tip approximately 5 cm above the carina.Left subclavian catheter terminates in the SVC.An NG tube extends below the lower margin of the image.Right PICC, tip in the SVC.

Output: No change in pleural effusions, basilar edema and left lower lobe consolidation. ET tube tip approximately 5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: ? pna History: neutropenic fever Right-sided PICC, unchanged. Low lung volumes. No new focal lung consolidation. New hazy opacity in the left lung, likely related to hypoventilation. No large pleural effusion or pneumothorax.

Output: Low lung volumes without new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: infiltrate History: seizure Lungs hypoinflated with minimal streaky basilar opacity likely due to atelectasis. No evidence of pneumonia.

Output: Lungs hypoinflated with minimal streaky basilar opacity likely due to atelectasis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: FemaleReason for Study: Reason: pna? CHF? History: SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormality identified without interval change. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Malignant Pleural Effusion History: dyspnea Right distal Port-A-Cath tip terminates at the cavoatrial junction. Tracheostomy cannula in place.Moderate left pleural effusion with associated compressive atelectasis similar to prior. Right basilar interstitial and airspace opacities are improved compared to the prior examination. There is no new focal consolidation or pleural effusion is evident.The cardiac contours are within normal limits for size.

Output: Unchanged left pleural effusion and associated atelectasis, with improved right basilar interstitial/airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Prescribed a clinical The cardiac and mediastinal contours are within normal limits.Lung volumes are normal. No abnormal focal lung parenchymal opacities.No pleural effusion or pneumothorax.No osseous lesions are present.

Output: No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.History of chest pain. The cardiomediastinal silhouette is normal.Lobulated, masslike opacity in the right middle lobe adjacent to the major fissure is again seen and unchanged from 3/2015. There are no new focal pulmonary opacities or pleural effusions.

Output: 1.No acute cardiopulmonary abnormality.2.Stable right middle lobe lobulated opacity, likely pleural scarring or loculated fluid.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: 64yo M w/ aspiration PNA, now w/ fever History: as above Enteric tubes and right central venous catheter unchanged. Decreased lung volumes with left basilar consolidation/atelectasis and small pleural effusions similar to the prior exam.No new pulmonary opacities noted.

Output: Persistent pleural effusions with basilar atelectasis/consolidation and edema.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with multiple myeloma, now with fevers. Evaluate for infectious source. LUNGS AND PLEURA: Interval resolution of bilateral pleural effusions and associated atelectasis. Minimal pleural thickening or residual pleural fluid at the right base.MEDIASTINUM AND HILA: No significant lymphadenopathy nodes.CHEST WALL: Loss of height of two thoracic vertebral bodies unchanged. Coarsened trabecular pattern, unchanged, probably related to patient's history of myeloma.UPPER ABDOMEN: No significant abnormalities noted.

Output: Interval resolution of bilateral pleural effusions. No obvious source of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: rule out infection History: upper abdominal pain Interval removal of left PICC. Dual right central venous catheters. One terminates in the SVC while the other terminates in the right atrium. No pleural effusion or pneumothorax. No focal pulmonary pneumonia. The cardiomediastinal silhouette is within normal limits.No evidence of free intraperitoneal air. IVC filter in place.

Output: No specific evidence to suggest etiology of patient's abdominal pain. Further evaluation with dedicated abdominal radiographs may be obtained if clinically warranted.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: 81-year-old female status post left chest wall biopsy. Evaluate for pneumothorax. Stable cardiomediastinal silhouette.Left suprahilar masslike opacity in the left upper lung that is again seen, similar to prior. Left upper lobe subsegmental atelectasis. No pleural effusion or pneumothorax.

Output: Left suprahilar masslike opacity. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: Patient w/ GI bleed intubated, please eval ET tube placement History: As above ET tube and right IJ venous catheter unchanged.Stable cardiomediastinal silhouette.Persistent left retrocardiac atelectasis.No new pulmonary opacities identified.

Output: Support devices unchanged with ET tube tip approximately 5 cm above the carina. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: ptx? pna? History: chest pain Cardiomediastinal unremarkable.No focal opacities or pleural effusions.No evidence of fracture or pneumothorax.

Output: No cardiopulmonary abnormalities.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: 65-year-old male with history of shortness of breath Blunting of the right costophrenic angle. Cardiomediastinal silhouette stable. No new pulmonary opacities.

Output: Right pleural effusion and/or thickening. No new pulmonary opacities identified.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: right sided pleural effusion on admission 2/2 CHF, now s/p diuresis, re-evaluate effusion History: as above Left-sided ICD unchanged.Stable cardiac enlargement.Right pleural effusion slightly decreased from the prior exam.No new pulmonary opacities identified.

Output: Moderate size right pleural effusion stable to slightly decreased in size compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: h/o chronic cough, h/o stroke high risk for aspiration, please r/o PNA History: see 1 Left lower lobe opacities of atelectasis and possible pneumonia. Small left pleural effusion. On the lateral view, there is subcarinal opacity suspicious for nodule or lymphadenopathy. Further evaluation with a CT thorax is recommended. Calcified lymph nodes are compatible with prior granulomatous infection.

Output: Left lower lobe consolidation and atelectasis with small pleural effusion. On the lateral view, there is subcarinal opacity that is suspicious for either lymphadenopathy or nodule. Further evaluation with a CT thorax is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: eval for pulm edema History: dyspnea, missed dialysis Cardiomegaly status post sternotomy.Bilateral pleural effusions and possible basilar edema, unchanged.Right jugular catheter, tip in SVC.Left subclavian pacemaker, leads unchanged in position.

Output: Small pleural effusions and basilar opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: breast cancer with pleural effusion with increased dyspnea History: see abvoe Right Port-A-Cath with its tip in the SVC.There is a moderate cardiac enlargement.Bilateral perihilar and basilar airspace opacities with pleural effusions, left greater than right.Multiple nodular opacities in the left lung are compatible with metastatic disease.

Output: Bilateral basilar consolidation/atelectasis, pulmonary nodules, and pleural effusions, left greater than right, compatible with metastatic disease. CT is recommended for better evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Reason: ro cardiopulm abnormality History: chest pain No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Left pleural catheter placed, with no pneumothorax but only a small reduction in the left pleural effusion volume.Left basilar atelectasis unchanged.Large lung volumes are consistent with COPD.

Output: No pneumothorax following pleural drain placement.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: lung nodule s/p biopsy History: lung nodule s/p biopsy Moderate right pneumothorax unchanged since the prior study, but extends around the entire lateral aspect of the lung, with 4 cm separation between pleural surfaces.Right-sided nodules unchanged.

Output: Moderate right pneumothorax unchanged since earlier today.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: Resp failure History: As above Interval removal of endotracheal tube. Lower lung volumes. Increase in diffuse pulmonary opacities. Small pleural effusions again noted. Marked cardiomegaly, unchanged.

Output: Increase in diffuse pulmonary opacities after removal of endotracheal tube. Close imaging reevaluation is suggested.


Instruction: Generate impression based on medical findings.

Input: 63-year-old female with metastatic breast cancer CHEST:LUNGS AND PLEURA: Previously described nodularity along the left lower lobe pleura is less prominence. Previously measured 5-mm pleural nodule now measures 3-mm image number 58, series number 4.MEDIASTINUM AND HILA: Prevascular index lymph node measures 15 by 9 mm on image number 32, series number 3. Left hilar index lesion measures 10 x 6 mm number 32, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval development of severe fatty infiltration of the liver, which makes the metastatic lesions more difficult to detect. Index lesion near the hepatic dome, measures 13 x 15 mm on image number 61, series number 3. Other liver lesions are also grossly stable in size and number. Second lesion more inferiorly in the right hepatic lobe measures 21 x 21 mm image number 74, series number 3. This lesion is now isodense to the liver due to fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole stone is unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged peripancreatic lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Interval decrease in the level of enhancement within the endometrial cavity and a small exophytic lesion anterior to the uterus. These lesions may represent metastatic disease versus a primary endometrial carcinoma. Histologic sampling is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bone lesion in the left iliac bone is stable.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the mediastinal and pleural lesions.Interval dome of fatty infiltration of the liver. Liver lesions are grossly stable.Interval decrease in the enhancement of the endometrial lesions. Histologic sampling is recommended to exclude the possibility of metastatic or primary endometrial cancer.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female history of NSC lung cancer status post 6 cycles of chemotherapy ended 4/08. History of right renal artery aneurysm. Any abnormalities, changes since prior CT. There are CHEST:LUNGS AND PLEURA: Right upper lobe mass with associated spiculation is increased in size. It measured on series 4 image 21 has 2.1 x 1.3 cm.Several small lung nodules on the right than on the left elsewhere are unchanged.Superior septal emphysema.No effusions.MEDIASTINUM AND HILA: Left hilar confluent adenopathy increased in size now measuring on series 3 image 32 as 2.5 x 2 cm. In compresses the right main bronchus and its trifurcation.No evidence of left hilar, anterior mediastinal, diaphragmatic or retrocrural adenopathy. No axillary nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: New multifocal hypodensities scattered in the left lobe of the liver and a few in the right lobe. Some of these have the appearance of metastases. Others have a somewhat geographic pattern particularly the one along the confluence of the hepatic veins in the gallbladder fossa with suggestion of vessels going through it and could represent fatty infiltration. I favor this representing a combination of new metastases in possibly areas of fatty infiltration. No evidence of biliary dilatation. No hepatic or portal venous thrombosis.SPLEEN: Massive splenomegaly, unchanged. Cephalocaudad dimension the spleen is 22 cm as seen on coronal image 55. Enlarged splenic and portal vein.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Infiltrative mass in the right kidney has markedly increased in extent. As seen on series 3 image 105 it measures 3.2 x 3.1 cm. the left kidney is normal. There is no evidence of thrombus in the renal veins or IVC.Two there are two right splenic artery aneurysms the largest of which is seen on series 3 image 104 measuring 2.1 x 1.7 cm approximately unchanged.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal adenopathy along the aortocaval and left para-aortic areas increased compared to the prior exam. A cluster of nodes in the left periaortic area seen on series 3 image 111 measures 2.5 x 1.7 cm. There is no appreciable adenopathy in this area on the prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mottled appearance to all the pelvic bones and both femora consistent with metastatic disease. This is probably unchanged from the CT of 11/23/07.OTHER: Small amount of free fluid

Output: Progression of disease. New sites of disease including liver and the retroperitoneum. Some of the liver lesions could represent geographic fatty infiltration. Increase in size of right renal lesion. Splenic artery aneurysms stable. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old, with history of mesothelioma. Evaluate for extent of disease. CHEST:LUNGS AND PLEURA: Calcified pleural plaques on the right compatible with asbestos exposure. Mesothelioma reference measurements as follows:Image 48/154 (level of the main pulmonary artery): 7 mm at the 11 o'clock position; 5 mm at the 9 o'clock position.Image 61/154 (level of the pulmonary veins): 6 mm at the 7 o'clock position; 5 mm at the 9 o'clock position.Image 73/154 (level of the dome of the liver): 7 mm at the 7 o'clock position; 7 mm at the 9 o'clock position.A right basilar paravertebral lesion measures 2.3 x 3.1 cm on axial image 83/154.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. Soft tissue density adjacent to the right hilum may represent mesothelioma involvement within the right major fissure.Prominent costophrenic (axial image 82/154) and paraesophageal (axial image 87/154) lymph nodes are evident. The cardiac size is normal. No significant pericardial effusion.CHEST WALL: Volume loss on the right compatible with mesothelioma.Left chest wall port catheter, tip in the left brachiocephalic vein.Mild wedging of an upper thoracic vertebral body (coronal image 72/131).ABDOMEN:LIVER, BILIARY TRACT: Hypodensity in the dome of the liver (axial image 73/154) is too small to characterize.SPLEEN: No significant abnormality notedADRENAL GLANDS: See below.KIDNEYS, URETERS: Left renal sinus cystic lesion, probably benign.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: An enhancing mass lesion in close association with the right adrenal gland measures 3.1 x 3.9 cm on axial image 112/154. Central low attenuation and a punctate focus of calcification are noted. This lesion does not clearly originate from the adrenal gland and is suspicious for a retroperitoneal metastatic focus.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Mesothelioma reference measurements as above with a possible retroperitoneal metastatic focus.


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: intubated History: intubated Support devices unchanged.Stable cardiomediastinal silhouette.Bilateral pleural effusions redemonstrated.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with moderate-sized pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old. Reason: shortness of breath History: shortness of breath Large left pneumothorax with mild mediastinal shift.Heart size appears normal.Right lung is clear. Degenerative changes affect the thoracic spine.

Output: Large left pneumothorax with mediastinal shift.Findings were discussed with the emergency department physician, Dr. Usman, at the 11:30 PM on 5/13/2016


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: assess for acute process including infection History: assess for acute process including infection No specific evidence of infection or edema.Slightly large lung volumes suggestive of COPD.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Pneumonia, one month ago. Follow-up Persistent or new recurrent patchy opacities observed in the superior segment of the left lower lobe along with a moderate associated effusion. Changes are superimposed upon previously observed and grossly stable fibrotic changes again more pronounced on the left and in both bases. Specifically no definite new focal abnormality observed in the right lungScattered calcified granuloma and grossly unchanged cardiac and mediastinal contours.

Output: Focal new opacity in the left lower lobe concerning for recurrent and/or residual infection and possible pneumoniaPager 9568 contacted


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: edema History: sob Patchy pulmonary opacities unchanged suggestive of edema or aspiration.Presternal ICD unchanged.Two right jugular catheters terminate at the cavoatrial junction.An NG tube terminates in the stomach. Right upper quadrant drainage catheter.Colon interposed between the right hemidiaphragm and liver is a normal variant.

Output: Unchanged pulmonary opacities. Stable support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Hypoxemia. The streaky bibasilar opacities most consistent with subsegmental atelectasis in the setting of low lung volumes. No evidence of pneumothorax. No large pleural effusion. Left PICC tip terminates at the confluence of the SVC.

Output: Low lung volumes with basilar atelectasis. Otherwise no significant interval change.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, 32 years old.Sickle cell disease with crisis. ACS. Basal reticular and nodular opacities present previously and are not appreciably changed. Scattered areas of scarring.Normal heart size. Prominent central pulmonary vasculature may indicate pulmonary hypertension. Probable mediastinal lipomatosis. No pneumothorax or pleural fluid.

Output: Low lung volumes with unchanged chronic appearing opacities, but no new findings. Short-term follow-up may be obtained if patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Female 44 years old Reason: perf, ileus History: abd pain, headache, nausea, vomiting acute onset after gastric bypass 3 days ago Dilated loop of small bowel in the midabdomen with air-fluid levels compatible with bowel obstruction.Moderate stool throughout the colon. No definite free intraperitoneal air. Clips are noted in the left upper abdomen.

Output: Bowel obstruction.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: on ventilator History: ventilated patient with AMS Support devices unchanged. Right pleural effusion and increasing right basilar opacity compatible with atelectasis/consolidation.Marked chest wall deformity with spinal stabilization hardware redemonstrated.Left abdominal drainage catheters in place.

Output: Right pleural effusion and increasing right basilar consolidation/atelectasis may represent aspiration.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: r/o infxn vs. vol overload History: SOB, CP Median sternotomy for CABG.Heart size normal.No specific evidence of infection or failure.

Output: Median sternotomy for CABG, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Age: 24 yearsGender: MaleReason for Study: Reason: s/p AVR, post-op study History: s/p AVR Chest/mediastinal tubes have been removed.No evidence of a pneumothorax.Aortic stent graft unchanged.Stable cardiomediastinal silhouette.Nonspecific right basilar opacities compatible with atelectasis and effusion.Median sternotomy intact without evidence of an AVR.

Output: Interval removal of chest/mediastinal tubes. No pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: cough and near syncope r/o PNA given immunocompromised History: cough The cardiomediastinal silhouette is unremarkable. The lungs are clear.No pleural effusions.Median sternotomy is intact.Surgical clips are identified in the right upper thorax .

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


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old. Reason: eval pulmonary edema History: ADHF Interval placement of enteric tube with tip in stomach. ET tube tip 3 cm above the carina.IABP tip at the level of the arch.ICD lead unchanged.Right central venous catheter with tip in the SVC.ECMO cannula from the IVC extending to the SVC, unchanged.Swan-Ganz catheter tip in the main pulmonary artery.Severe cardiomegaly.Significant improvement in the bilateral upper lobe opacities. Persistent lower lobes opacities with small pleural effusions.

Output: Significant improvement in the bilateral upper lobe opacities with persistent lower lobes opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: 79 yo M with known MRSA PNA/empyema + E. coli empyema; concern for mediastinal fluid from mediastinal hematoma vs pleural fluid connection appreciated on CT chest WO History: see above Pulmonary opacities and pleural effusions.Stable pleural drains with no pneumothorax.Tracheostomy tube tip 6 cm above the carina.Dobbhoff tube tip in gastric fundus.

Output: Unchanged pulmonary opacities and pleural effusions with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 41-year-old female status with history of uterine leiomyosarcoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Ill-defined soft tissue density in the anterior mediastinum likely represents thymic tissue. This is unchanged from previous CT.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy. 2.8 x 2.2 cm soft tissue density lesion anterior to the right psoas muscle in the pelvis is unchanged. This lesion is also unchanged from CT dated 5/20/2006 and may represent right ovary. Surgical correlation is recommended. Residual vaginal cuff is again prominent, unchanged.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: Prominent vaginal cuff and right-sided pelvic lesion are unchanged from previous CTs.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: ETT placement History: See above No significant cardiopulmonary abnormality. ET tube tip approximately 6 cm above the carina. An NG tube terminates in the stomach.

Output: ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p chest tube removal. r/o ptx History: s/p chest tube removal x3 PICC line tip in the SVC.Partial clearing of left lower lobe atelectasis.Right chest tube and orphaned cardiac electrode, unchanged.

Output: Partial clearing of left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain and hernia repair. Check for pneumonia Interval near complete collapse and opacity in the right upper lobe suggest postobstructive volume loss and atelectasis over infection, however serial imaging will be needed to confirm clearance.NG coiled the proximal stomach. ETT terminates 4 cm above the carina.Mild cardiomegaly

Output: New suspected atelectasis and volume loss in the right upper lobe. See description


Instruction: Generate impression based on medical findings.

Input: Reason: portable upright chest to r/o free air History: abdominal distention No sign of free air in the abdomen. Moderate cardiomegaly with vascular redistribution. Mild basilar interstitial opacity is probably chronic rather than due to edema.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: R/o infection History: DKA No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: AIDS, ams The cardiomediastinal silhouette is within normal limits. No pleural effusion or pneumothorax. The prior left basilar opacity is resolved. No focal pulmonary opacities.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: chest tube placement History: s/p L VATS wedge Chest tube extending to the left apex with no significant pneumothorax.Gastric interposition extending to the right of the mediastinum.Port catheter with its tip in the SVC.Mild basilar atelectasis.

Output: Slightly decreased lung volumes and no other significant change.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female, recently intubated. Evaluate ETT placement and assess for infection. Interval intubation with ET tube tip approximately 6 cm above the carina. Interval placement of left IJ central venous catheter with tip overlying the cavoatrial junction. Interval placement of enteric tube with tip out of field of view.Stable cardiomediastinal silhouette. Prominent pulmonary arteries redemonstrated compatible with pulmonary hypertension.Interval improvement of diffuse interstitial opacities with residual basilar interstitial and airspace opacities.Additionally, there is improvement of left pleural effusion with persistent small right pleural effusion.

Output: Interval improvement of pulmonary edema with residual small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: MaleReason for Study: Reason: respiratory distress History: respiratory distress ET tube and NG tube have been removed.The remaining support devices are unchanged with Swan-Ganz catheter tip in the right pulmonary artery.Stable cardiac enlargement.Pulmonary opacities similar to the prior exam.

Output: Interval extubation. Remaining support devices unchanged. Stable cardiopulmonary appearance with cardiomegaly, pleural effusions, and pulmonary opacities compatible with edema.


Instruction: Generate impression based on medical findings.

Input: PICC line placement Left PICC line placed with tip projected into the axilla. No associated complicationUnderlying cardiopulmonary appearance significant for mildly decreased lung volumes without distinct additional abnormalities.G-tube projects over left upper quadrant and partially visualized IVC filter

Output: Left PICC line placed


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Acute chest pain question pleural effusion or pneumothorax. Normal cardiomediastinal silhouette. No pleural fluid or pneumothorax. No focal airspace opacities. The lungs are well inflated.

Output: Normal chest.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: cough, eval PNA History: cough Small left pleural effusion with minimal left basilar opacity. Heart is at the upper limit of normal. Aortic atherosclerosis. No pneumothorax.

Output: Small left pleural effusion with minimal left basilar opacity which could represent early pneumonia. Consider close repeat imaging in 1-2 weeks if symptoms continue.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lung transplant History: lung transplant pt No visible pneumothorax on the current radiograph.Small lung volumes with basilar opacity compatible with atelectasis and effusions.Partial clearing of subcutaneous emphysema.No new findings.

Output: Resolution of pneumothorax with persistent pleural effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Newborn 25 week gestational age patient with line placement.VIEWS: Chest and abdomen AP (two views) 06/14/16, 0906 Endotracheal tube tip is in right mainstem bronchus. Right chest tube is in place. Umbilical venous line has its tip in a branch of left portal vein.Cardiothymic silhouette is normal in size. Cardiac apex and stomach are left-sided. No pneumothorax is identified. Hazy opacity is present bilaterally. Lung volumes are normal.Bowel gas pattern is normal.

Output: No pneumothorax identified. Hazy bilateral lung opacity. Normal bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Reason: Assess known pleural effusions History: B/l pleural effusions, chest tube in placeVIEW: Chest AP (one view) 1/13/2016 6:05 Left chest tube unchanged. Right-sided central venous side in the SVC. Surgical clips overlie the supraclavicular region. Stable left apical pneumothorax. Interval increase in left lung base pulmonary opacity. Stable small right pleural effusion.

Output: Interval increase in left lung base pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress in ex preemie. VIEWS: Chest and abdomen AP (2 views) 11/25/2015, 1346 The endotracheal tube tip is at the thoracic inlet. Enteric tube with tip in the gastric body. Right upper extremity PICC with tip at the right subclavian vein.Cardiothymic silhouette is obscured. Bilateral pulmonary opacities with lucencies throughout both lungs is consistent with pulmonary interstitial emphysema. There is volume loss on the left with mild interval improvement in aeration of the left lung. No pneumothorax.Bowel gas pattern is disorganized. No evidence of portal venous gas or pneumoperitoneum.

Output: 1.Mild interval improvement in aeration of the left lung. 2.Findings consistent with pulmonary interstitial emphysema.3.No evidence of NEC.


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Increased lethargy, unclear etiology rule out infection. The right costophrenic angle region is not visible. No specific signs of acute bacterial pneumonia elsewhere.Chronic appearing volume loss in the right middle lobe and lingula could be an indication of chronic atypical mycobacterial infection, nonspecific on portable plain film technique.Possible nodules versus summation artifact bilaterally, larger on the left than on the right, where the ribs and scapula intersect (level of the anterior fourth ribs).Mild scoliosis and degenerative changes of the shoulders and spine.Normal heart size.Atherosclerotic calcification of the thoracic aorta.

Output: No visible signs of a bacterial pneumonia; the right costophrenic angle region is not visible. Bilateral nodular opacities of indeterminate etiology may be assessed with erect PA and lateral chest films when feasible and could reflect summation artifact or intrapulmonary lesions including but not limited to atypical infection such as MAI or fungal pneumonia or metastases given the patient's advanced age. Given the relatively symmetric position, artifact is favored.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: eval for acute process History: SOB/wheezing, chest tightness Cardiomegaly.Small lung volumes with bronchial thickening consistent with asthma or bronchitis.No specific evidence of infection or edema.

Output: Bronchial wall thickening, consistent with asthma or bronchitis.


Instruction: Generate impression based on medical findings.

Input: 24-year-old male with history of mixed germ cell tumor of the testicle CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Prominent thymus is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: sob cause History: sob Pulmonary edema with small effusions and a heart size upper normal, unchanged since the previous examination.Left subclavian pacemaker, leads unchanged in position.

Output: Stable CHF with basilar edema and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Is PICC in correct position? Is there pneumothorax? Right PICC tip at the level of the right brachiocephalic vein and may be advanced. No pneumothorax. Cardiothoracic ratio unchanged. Small to moderate right pleural effusion.

Output: No pneumothorax. Right PICC tip cranial to the SVC and may be advanced.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ARDS 2/2 sepsis w unknown primary, intubated and paralyzed s/p proning, eval for interval change and ETT location. Unchanged position of support devices, although enteric tube tip is out of field of view. ETT tip is 4 cm above the carina.Improved lung volumes.Grossly stable multifocal hazy opacities worse in bilateral lower lobes, accounting for differences in technique and position.

Output: Grossly stable multifocal hazy opacities worse in bilateral lower lobes, accounting for differences in technique and position.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Hypoxemia, evaluate endotracheal tube. Endotracheal tube about 6 cm above the level of the carina. Other tubes and lines unchanged. Basal atelectasis. Probable small right pleural fluid collection. Subcutaneous emphysema left chest wall.

Output: High endotracheal tube, about 6 cm above the level of the carina. Basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: 62-year-old female with history of bilateral lung transplant (7/4/14) for COPD, surveillance Sternotomy hardware noted.Stable small pleural effusions and/or thickening.Eventration of the right hemidiaphragm not significantly changed from prior exam.No new focal airspace opacities or evidence of pneumothorax.Cholecystectomy clips noted.

Output: Stable small pleural effusions and/or thickening. No new focal airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Bilateral lower chest pain. Is there an infiltrate? Normal heart size. No pleural fluid or pneumothorax. No focal airspace opacities.

Output: Normal chest. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 44-year-old female with gastric adenocarcinoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small mediastinal lymph nodes. An index precarinal lymph node measures 10 by 7-mm image number 33, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach is significantly dilated. Mild wall thickening involving the antrum may represent patient's known history of adenocarcinoma.Fat stranding and nodular soft tissue densities in the greater omentum adjacent to the stomach may represent omental spread.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant gastric distention associated with antral wall thickening, compatible with patient known history of gastric adenocarcinoma. Fat stranding and nodular soft tissue densities in the greater omentum adjacent to the stomach may indicate peritoneal spread.


Instruction: Generate impression based on medical findings.

Input: Cardiac surgeryVIEW: Chest AP Cardiac apex and aorta are right-sided. Cardiothymic silhouette is upper limits of normal in size to mildly enlarged. Endotracheal tube tip is below thoracic inlet. Right internal jugular line tip is in a right-sided superior vena cava. Epicardial pacer leads and atrial line are again visualized. Right chest tube remains in place. Feeding tube tip is in gastric antrum of left-sided stomach. No evidence of pneumothorax.

Output: Minimal patchy atelectasis right lower lobe without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Status post MV repair. Assess volume status. Sternotomy hardware appears in alignment. Mitral prosthesis. Unchanged cardiomegaly. No pneumothorax or focal pulmonary opacity. No pleural fluid.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: Pt is a 64 yo female; potential stem cell donor History: evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Healed granulomatous disease noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with a history of metastatic thyroid cancer. Compare to previous. CHEST:LUNGS AND PLEURA: Significant reduction in number and size of diffuse pulmonary parenchymal metastases. Reference lesions measured are as follows:Right upper lobe (series 5, image 36) 0.6 x 0 .5 cm, compared with previous 0.7 x 0.7 cmRight perihilar (series 5, image 47) 1.0 x 0.9 cm compared with 1.5 x 1.5 cm previouslyLeft lower lobe (series 5, image 63) 1.1 x 1.3 cm compared with 1.9 x 2.2 cm previously.MEDIASTINUM AND HILA: The index precarinal lymph node (series 3 comment 43) is decreased in size now measuring 1.0 x 0.8 cm compared with previous 1.4 x 0.8 cm. The hilar lymph nodes have similarly decreased in size and now bilaterally appear subcentimeter.CHEST WALL: The pretracheal soft tissue nodule (series 3 x 13) has decreased in size now measuring 1.0 cm AP diameter compared with 1.9-cm previously. Small anterior sclerotic focus in T6 vertebral body unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lucencies in the left iliac bone again seen unchanged. Note other lesions are seen.OTHER: No significant abnormality noted.

Output: 1. Substantial reduction in size and number of diffuse pulmonary nodules. 2. Reduction in size of thoracic mediastinal and hilar lymph nodes. 3. No significant abdominal or pelvic pathology identified.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old. Desaturation. Intact median sternotomy wires. Status post aortic valve replacement. Severe calcification of the mitral anulus again noted.New left basilar homogeneous consolidative opacity may represent left lower lobe atelectasis by mucoid impaction or pneumonia in the appropriate clinical setting.No pneumothorax.There is a new enteric tube in place coursing below the diaphragm. The sidehole is obscured and the tip extends below the field of view.

Output: New signs of volume loss and consolidation of the left lower lobe with abrupt cut off the left mainstem bronchus. Findings may be secondary to postobstructive lobar atelectasis due to bronchial mucoid impaction or pneumonia in the appropriate clinical setting. Correlate with patient's history.New enteric tube in place coursing below the field-of-view.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.History: Chest pain and bilateral lower extremity edema. Left PICC line with tip in the SVC. Mild blunting of the right costophrenic angle, likely represents scarring although effusion cannot be excluded.Heart size upper limits normal. No pulmonary abnormalities. No pneumothorax.

Output: Mild right costophrenic angle blunting, compatible scarring or effusion.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Bilateral chest tubes, the left continues to project into the apex and right to the peripheral mid lung. Right jugular catheter sheath unchanged. TI PS stenting. Underlying bilateral rib deformities are similar to priorMildly decreased lung volumes with layered mild to moderate effusions greater on the left.

Output: Chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: evaluation of PM prior to MRI History: headaches, PM Left-sided pacemaker with lead wires in the right atrial appendage and right ventricle.Cardiomediastinal silhouette is unremarkable. The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female with past medical history of metastatic colon cancer with newly diagnosed METs to the liver. Patient with recent enteral Stent placement and went for stent revision on 3/30 unable to perform procedure likely secondary to extrinsic compression CHEST:LUNGS AND PLEURA: Mild scarring involving mostly the apical segments and para fertile aspect of bilateral lungs. Predominantly linear but somewhat nodular increased density in the right middle lobe, likely representing focal area of atelectasis. Follow-up imaging may be helpful for better characterization. MEDIASTINUM AND HILA: The tip of the port catheter is in the distal SVC. Punctate thrombus near the tip of the port catheter.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Extensive bilobar metastatic disease. Reference lesion in the right lobe measures 5.1 x 3.7 cm image number 105, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric stent is noted extending from the fourth portion of duodenum to the proximal jejunum. There is significant soft tissue density around the stent likely represents encasing mass. This mass also extends into the surrounding small bowel, mesentery. The mass is difficult to measure, since it concentrically encases the stent and the proximal jejunum. Proximal stomach is not dilated. Oral contrast freely passes into the distal small bowel. Multiple peritoneal soft tissue nodules consistent with peritoneal carcinomatosis.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: Extensive liver metastases.Proximal jejunal stent encased by significant soft tissue density, extending into the small bowel, mesentery. A primary small bowel adenocarcinoma versus metastatic disease can be considered. Follow-up chest CT imaging is recommended for further evaluation of the right middle lobe atelectatic segment.Mild scarring in the lungs as described above.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: is there pul edema History: hypertension . sob Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic colorectal cancer CHEST:LUNGS AND PLEURA: Interval increase in the size of the pulmonary nodules. Reference right upper lobe nodule now measures 11 mm x 11 mm image number 19, series number 6. Left upper lobe representative nodule measures 19 x 17 mm on image number 31, series number 6.MEDIASTINUM AND HILA: Reference right paratracheal adenopathies unchanged measuring 15 x 10 mm image number 36, series number 6.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval increase in the bilobar metastatic lesions in the liver. Reference lesion measures 11.4 x 12.8 cm image number 82, series number 6. Numerous new metastatic lesions in the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable nonobstructing subcentimeter left renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in the size of bilateral numerous pulmonary metastatic lesions. Interval increase in the size and number of hepatic metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: ett location History: as above Enteric tube terminates approximately 6.7 cm from the carina. Enteric tube terminates within the proximal aspect of the stomach and could be advanced if clinically indicated. Patchy bibasilar opacities with mild pulmonary edema again noted. Mild cardiomegaly, as before. Small pleural effusions. No pneumothorax.

Output: Enteric tube terminates in the proximal aspect of the stomach and could be advanced if clinically indicated. Mild interstitial pulmonary edema with small pleural effusions and patchy bibasilar opacities, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Shortness of breath, history of nasopharyngeal carcinoma Cardiomediastinal silhouette is normal.No pleural effusion or pneumothorax.Suture material in the right apex reflective of prior wedge resection. No focal airspace opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Chest pain evaluate lung fields and hiatal hernia. Left jugular chest port tip at the level of the right atrium. Cardiothoracic ratio unchanged. Hiatal hernia poorly visualized by this technique, containing internal fluid/debris and air, but not appreciably changed from recent previous exam.7 mm partially circumscribed nodular opacity projecting over the left midlung new from a prior chest CT dated 11/21/2014. Mild atelectasis adjacent to the hernia, but no focal airspace opacities. Surgical clips right chest wall. No pneumothorax or pneumomediastinum. No pleural fluid.Mild/moderate bronchial wall thickening.

Output: 1. 7 mm nodular opacity projecting over the left midlung suspicious for a new pulmonary nodule. A postinflammatory or postinfectious lesion is also possible. Follow-up chest radiographs recommended in 3 months.2. Mild to moderate bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: 48 year old female. Gastric cancer, status post resection in 4/2007. Evaluate disease status. CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bilobar benign hepatic cysts are stable. Some of the lesions are too small to characterize but are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of acute or metastatic process.


Instruction: Generate impression based on medical findings.

Input: Male 85 years old Reason: Infiltrates History: fever Stable cardiomediastinal silhouette with massive dilation of the right atrium. Chronic blunting of the left costophrenic angle is likely secondary to scarring. No new pulmonary opacity, pleural effusion or pneumothorax.

Output: Cardiomegaly, but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p CABG, c/b cardiogenic shock, known AAA. IABP in place History: asx IABP marker in the descending thoracic aorta, Swan-Ganz catheter tip in main pulmonary artery. Other support hardware stable.Bilateral pleural effusions and pulmonary edema. New small right sided pneumothorax.

Output: New small right sided pneumothorax.Findings communicated to Dr. Martin via text paging tool at the time of report.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: assess for pneumonia History: SOB Cardiomediastinal silhouette is unremarkable. No pleural lid or pneumothorax. Probable emphysema. Bronchial wall thickening, but no focal air space opacity.

Output: Bronchial wall thickening, but no conclusive signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: malignancy? History: weight loss The cardiac contours are within normal limits.Lung volumes are normal. No abnormal focal lung opacities.The pleural spaces and visualized bones are within normal limits.

Output: No abnormal radiographic findings. Consider further assessment with chest CT with IV contrast if there is further concern for intrathoracic malignancy, given limitations of conventional radiograph for detection of small mediastinal lesions and pulmonary nodules.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Fever and hypoxia question pneumonia. Persistence retrocardiac atelectasis on the left and mild basal compressive atelectasis or scarring bilaterally. Vascular unsharpness bilaterally unchanged. Decreased lung volumes compared to prior, with significant dependent atelectasis.

Output: Mild basal atelectasis. Hazy opacity in the dependent lung fields consistent with atelectasis and possibly aspirate.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Febrile status post bile duct excision. Lungs are clear. Heart normal in size. No pneumothorax. Surgical staples over the upper abdomen.

Output: No significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval lung fields History: IABP, PICC Cardiomegaly with mild pulmonary edema worse than on the prior study.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.IABP catheter proximal marker 3 cm below the top of the aortic arch.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly, and worsening edema. Stable tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Hypoxia, sickle cell disease history Patchy nonspecific streaky opacities in both lungs greater in both bases with mild cardiomegaly. Mild decreased lung volumes similar to prior and partially compatible with portable technique. No definite superimposed discrete air space process, however in light of the patient's history, superimposed changes related to acute chest and sickle cell disease cannot entirely be excluded. Serial imaging may be important to exclude.

Output: Nonspecific bilateral patchy opacities greater in both bases. See detail provided


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: r/o infection History: leukocytosis , Fever Cardiomediastinal silhouette is unremarkable.Large lung volumes with flattening of the diaphragms suggests COPD.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: COPD without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: rule out chest metastasis History: history of renal cell ca Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Healed granulomatous disease.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Evaluate for infiltrate, edema History: hypoxia Interval removal of the external defibrillator pads and right IJ sheath. The remaining support devices are unchanged in position.Persistent pulmonary edema with small pleural effusions and cardiomegaly. No interval pneumothorax.

Output: Persistent pulmonary edema with small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Check ETT Placement History: Check ETT Placement ET tube advanced, the tip within 1 cm of the carina subsequently repositioned.Dobbhoff tube placement.NG tube advanced.Stable right subclavian ICD.Basilar opacities left greater than right possible infection.

Output: Low ET tube, subsequently repositioned.


Instruction: Generate impression based on medical findings.

Input: Reason: 75F w/ ARDS s/p trach today, with c/f misplacement, History: air leak, unable to ventilate on trach New tracheostomy tube with its tip in about 5 cm above the carina.Catheter tip in the SVC.Small lung volumes with nonspecific interstitial and airspace opacity, improved compared to previous.

Output: New tracheostomy tube with no visible complications.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.History of diabetes now with nausea and vomiting. Unremarkable cardiomediastinal silhouette.Low lung volumes and mild basilar opacities compatible with atelectasis without additional focal opacities, pneumothorax, or pleural effusions.

Output: Low lung volumes without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 91 years old.Reason: pulmonary infiltrates intubation History: sob Unchanged cardiomegaly with mild edema and pleural effusions.Left lower lobe consolidation is also stable, consistent with compression atelectasis related infection.Left subclavian catheter tip low in the right atrium.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

Output: Unchanged pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Male, 10 years old, with AML, neutropenia and fever. Evaluate for infection. Patient will have stem cell transplant. CHEST:LUNGS AND PLEURA: Numerous scattered ground glass nodules throughout both lungs, the largest of which in the right middle lobe measures 8 x 8 mm (series 4, image 44), are nonspecific but could represent infection (possibly fungal) or less likely, septic emboli.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Left IJ central venous catheter, tip at the RA/SVC junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Trace pelvic ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Scattered groundglass opacities in both lungs may reflect infection, possibly fungal, or less likely, septic emboli.


Instruction: Generate impression based on medical findings.

Input: Male 67 years old; Reason: Abnormal uptake? History: thyroid cancer with extrathyroidal extension, multiple + cervical and mediastinal nodes There is a focus of increased activity in the thyroid bed consistent with residual functioning thyroid tissue. There is symmetric activity around the skull which may be due to artifact from perspiration and unlikely tumor activity. There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder.

Output: Residual functioning thyroid tissue as described above. Symmetric activity around the skull is likely artifact from perspiration and unlikely tumor.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: r/o acute process History: chest pain Lung volumes are lower which makes detailed pulmonary evaluation difficult. Right-sided pleural thickening again noted. Patchy right basilar atelectasis or scar again noted. Question of mild pulmonary edema. Heart size is difficult to assess due to low lung volumes. Surgical clips again noted in the right supraclavicular region and left axillary region.

Output: Difficult to assess radiograph due to low lung volumes. No new focal lung consolidation. Question mild pulmonary edema. Right-sided pleural thickening with associated subsegmental scarring or atelectasis again noted.