Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: r/o acute process History: sob Median sternotomy with mild cardiomegaly.COPD. Nonspecific basilar opacities most likely are chronic and unchanged.

Output: COPD and chronic basilar interstitial opacities, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: swan in right place? History: ccu pt Swan-Ganz catheter tip in the main pulmonary artery.Interval removal of aortic balloon catheter.Perihilar streaky opacities compatible with subsegmental atelectasis, unchanged.

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


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.SOB question pneumothorax. Moderate right pneumothorax is larger, now with maximal pleural separation from the chest wall laterally of 2.3 cm. A pigtail catheter extends into the pneumothorax collection.Severe emphysema with upper lobe bullae. Minimal pleural fluid on the right.

Output: Interval increase in size of right pneumothorax, now with 2.3 cm of pleural separation from the chest wall.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: eval for pathology, pre op planning History: intracranial aneurysm, headache, No significant cardiopulmonary abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old. Right IJ venous catheter with its tip in the SVC.Stable cardiac enlargement.Extensive interstitial and airspace opacities similar to the prior exam.No new pulmonary opacities identified.No pneumothorax.

Output: Interval placement of right IJ venous catheter without complication. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: evaluate for pna History: productive cough Patient is slightly rotated. Cardiomediastinal silhouette appears within normal limits. There is moderate basilar predominant atelectasis in a pattern suggestive of aspiration without specific evidence of pneumonia.No pleural effusions or pneumothorax.Right chest port with tip at the cavoatrial junction.

Output: Basilar aspiration without evidence of pneumonia. Suggest follow up.


Instruction: Generate impression based on medical findings.

Input: Follow-up pneumothorax Interval removal of the remaining right basilar chest tube with persistent mild loss of volume on the right and moderate chest wall and neck emphysema, unchanged. The small subpulmonic pneumothorax, most evident along the medial aspect remains unchangedLeft lung remains clear and free of new superimposed focal abnormality.Retained contrast within the splenic flexure.

Output: Chest tube removed


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: PNA History: same Stable pulmonary edema and right pleural effusion. Left-sided consolidation slightly improved. Venous catheter unchanged.

Output: Stable pulmonary edema. Consolidation slightly improved.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent moderate nonspecific cardiomegaly without additional superimposed acute airspace abnormality. Mild COPD changes

Output: Cardiomegaly without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old. History of bladder cancer status post cystectomy with ileal conduit.Evaluate for ileus versus small bowel obstruction. Left-sided PICC tip overlies the mid SVC. Enteric tube tip overlies the antrum. IVC filter. JP Surgical drain overlying the pelvis. Numerous surgical clips overlying the mid abdomen and right lower quadrant. Numerous corkscrew staples over right abdomen consistent with prior laparoscopic surgeryBlunted costophrenic angles. No focal consolidation or pneumothorax. Aortic arch vascular calcifications.There is persistent marked gaseous distention of the small bowel up to 6.9 cm. No colonic air is seen at this time.

Output: Persistent marked gaseous distention of the small bowel without colonic air. This may reflect a persistent ileus given POD #4, however a developing obstruction cannot be excluded.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: Evaluate extent of disease. 60 year old woman with breast cancerstatus post lumpectomy in 2007. Cervical cancer status post radical TAH with chemo andRT. Third cancer, illegible. Finished chemo. CHEST:LUNGS AND PLEURA: . Scarring in the right lung base, unchanged. 7-mm pleural-based nodulein the left lung base, unchanged (image 92; series 9). MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Segments 4 portal vein thrombosis with associated hypoattenuation onvenous images (image 13; series 80776). No focal hepatic lesions. Biliary stent in placewith the distal tip in the third segment of duodenum. Mild intrahepatic biliary ductaldilatation, stable with prominent enhancement of bile duct walls. Contractedgallbladder. 3-mm soft tissue density nodule in the fundus of the gallbladder isnonspecific and may represent a stone or polyp as described previously.SPLEEN: No significant abnormality notedPANCREAS: As noted previously, there is diffuse dilatation of the proximal pancreatic ductwith abrupt termination of the duct at the pancreatic head. No discrete mass isidentified and ill-defined soft tissue density in the pancreatic head is unchangedmeasuring 27 x 18 mm (image 41; series 8). There is associated soft tissue densityinfiltration in the porta hepatis and around the portal vein as noted previously withnarrowing/mass effect on the SMV at the confluence. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nodules in the left kidney are again noted with a hyperdense nodule atthe midpole medially. This measures 60HU and pre-enhanced images (image 48; series 3),51HU on arterial weighted images (image 51; series 8), and an approximately 71HU on venousimages (image 117; series 11) suggesting that this represents a hyperdense cyst. Continued surveillance is recommended. RETROPERITONEUM, LYMPH NODES: Reference peripancreatic lymph node measures 14 x 11 mm butis difficult to evaluate on today's exam due to slight motion artifact (image 104; series11).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Uterus not visualized.BLADDER: Bladder is collapsed and difficult to evaluate.LYMPH NODES: Few small lymph nodes are not enlarged using CT size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.

Output: New segment 4 portal vein thrombosis. Stable ill-defined pancreatic headmass. Stable subcentimeter left basilar pulmonary nodule. Trace pelvic ascites. Probable left complex cyst also unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: s/p IJ catheter placement, confirm location, r/o pneumothorax History: s/p HD catheter placement New right IJ line terminates in the RA without evidence of pneumothorax. Otherwise, no substantial change.

Output: New right IJ line terminates in the RA without evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 48 yearsGender: FemaleReason for Study: Reason: Eval IABP placement History: None Left-sided ICD unchanged.IVP and the proximal to mid descending aorta.Cardiomediastinal silhouette is unremarkable.The lungs are clear.Multiple surgical clips in the right axillary region.

Output: IVP marker in the proximal and mid descending aorta. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old. No unexpected radiopaque foreign body. Multiple cardiopulmonary support devices in place with the ET tube about 7 cm above the carina.New Swan-Ganz catheter with its tip in the right main pulmonary artery.Endoscope tip projected in the area of the mid esophagus.Mediastinal widening, basilar atelectasis and small pleural effusions, unchanged.

Output: No unexpected radiopaque foreign body. The findings were discussed with the attending surgeon Dr. Song, by the resident on call at 1027 hours on 6/19/2016.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath. Status post pneumonia (decreased white blood cells with antibiotics). Questionable mass on chest radiograph. On Coumadin for DVT. LUNGS AND PLEURA: Increasing bilateral pleural effusions, more on the left with loculated fluid along the major fissure and peripheral left upper lobe.Multiple air space opacities with air bronchograms in the left upper lobe and lingula, likely due to infectious process.Irregularly shaped opacity in the left lower lobe (image 44/series 6), which also shows air bronchograms, is also likely from infectious process.An isolated cyst is noted in the right upper lobe. Subsegmental atelectasis/scarring in the right middle lobe. A calcified nodule in the left upper lobe, likely a granuloma.MEDIASTINUM AND HILA: Severe calcifications along coronary vasculature. Extensive aortic calcification. Cardiac enlargement with small pericardial effusion. CHEST WALL: Anasarca. Diffuse mottled appearance in the vertebral bodies, which could be due to multiple myeloma.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Multiple airspace opacities on the left, consistent with infection. 2. Cardiomegaly. Increasing bilateral pleural effusions, left greater than right.3. Diffuse mottled appearance of the bones, which could be due to multiple myeloma.


Instruction: Generate impression based on medical findings.

Input: Age: 83 yearsGender: MaleReason for Study: Reason: s/p chest tube removal History: as above Right-sided chest tubes have been removed.Right IJ venous catheter unchanged.Stable cardiac enlargement.Small pleural effusions and basilar scarring/atelectasis similar in appearance to the prior exam.No evidence of a pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Palpitations status post recent AVR/MVR evaluate for pulmonary edema. Cardiomegaly with heavily calcified thoracic aorta unchanged. No convincing evidence of pulmonary edema. Surgical hardware unchanged.

Output: No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Concern for worsening pneumonia. Persistent postobstructive consolidation of the right upper lobe.Diffuse bilateral reticular nodular opacities and septal lines, progressed from recent comparisons and raising concern for lymphangitic carcinomatosis in the setting of advanced primary lung neoplasm.Moderate right and small left pleural effusions again noted.

Output: No interval change in postobstructive right upper lobe consolidation in the setting of known primary lung neoplasm.Diffuse bilateral reticular nodular opacities may represent underlying pulmonary edema, although the possibility of lymphangitic carcinomatosis is raised.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: hypotension, previous pericardial effusion w/ tamponade History: hypotension Tracheostomy tube, left internal jugular central venous catheter, right internal jugular central venous catheter, two enteric tubes, and pericardial drain are unchanged in position.Cardiac silhouette appears decreased in size when compared to the prior exam.Improved bilateral moderate, left greater than right pleural effusions with adjacent atelectasis/consolidation. No pneumothorax.

Output: Interval decrease in left pleural effusion and increased aeration of the left lung.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with history of lung carcinoma status post resection presenting with 15-pound weight loss in the past 6 months and severe epigastric and left-sided chest pain. Please evaluate for recurrence of malignancy. CHEST:LUNGS AND PLEURA: Previously noted punctate subpleural nodules remain stable.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Enlarged heart size without pericardial effusion.CHEST WALL: No significant abnormality noted. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Absent uterus and ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: No evidence to suggest cancer recurrence or any findings to explain patient's clinical symptoms.Findings were discussed with the primary clinical service including Dr. Jeskey-Sabuda (pager: 2777).


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Concern for pneumonia The cardiac contours are within normal limits. Tracheostomy cannula in place. The right IJ port catheter overlies the superior cavoatrial junction.No abnormal lung parenchymal opacities.Possible trace right pleural effusion. No pneumothorax.

Output: No abnormal radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: shortness of breath History: shortness of breath The heart size is normal. Large lung volumes. The lungs are clear. No pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: vad History: Congestive heart failure. Cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly with small lung volumes.Left lower lobe opacification consistent with atelectasis and consolidation. Moderate left pleural effusion that may be organized or loculated.

Output: Pleural effusion and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: 48F s/p right lung transplant, left chest tube, eval for left PTX History: left chest tube Left chest tube with pleural air seen over the apex and around the lung base with lateral chest wall soft tissue emphysema.Extensive left-sided lucency and increased hemithorax volume could indicate anteriorly located pneumothorax which CT would be needed to ascertain the presence of.Increased markings on the right partly from low lung volumes but likely mild edema with a small right pleural effusion.Right jugular catheter, tip at cavoatrial junction level.

Output: Left pneumothorax, possibly with a sizable anterior located component, CT recommended. This was discussed with the clinical service.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with liver mass with hepatitis C. CHEST:LUNGS AND PLEURA: Scattered calcified granulomata.The segmental lower lobe pulmonary arteries demonstrate intraluminal filling defects, compatible with pulmonary emboli (series 11; image 55)MEDIASTINUM AND HILA: Calcified mediastinal and bilateral hilar nodes are identified.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver is seen.A large transient hepatic attenuation difference is seen in the anterior segment of the right lobe of the liver. It is difficult to measure the tumor size within this vascular region. A focal lesion which bulges the capsule is seen in segment 5, measuring 3.0 x 1.9 cm (series 10; image 37). Additional infiltrating lesion is suspected throughout the region of the THAD. Enhancing tumor thrombus involves the anterior branch of the right portal and right hepatic veins as well as their peripheral branches.A small arterially enhancing focus in segment 6 of the liver (series 10; image 53) becomes isodense on subsequent phases and could represent a transient hepatic attenuation difference.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cyst in the upper pole of the left kidney.RETROPERITONEUM, LYMPH NODES: Portahepatic/portacaval/gastrohepatic adenopathy is seen, the largest measuring 2.3 x 1.4 cm (series 11; image 91)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left lower lobe pulmonary emboli. Infiltrating lesion in the right lobe of the liver with tumor thrombus involving the right hepatic vein and right portal vein, consistent with HCC.An attempt was made to page the hematology/oncology on call resident/fellow.


Instruction: Generate impression based on medical findings.

Input: 77 years old Male. Reason: eval for effusions, ? Heart failure History: as above. Curvilinear calcifications are noted in the pericardium as demonstrated on the prior chest CT on 10/28/2015. Decreased volume of right hemithorax with small right pleural effusion/thickening. There is a small left pleural effusion. There is a prominence of the right atrium.

Output: Curvilinear calcification in the pericardium with prominence of the right atrium, which may be due to chronic pericarditis. Small bilateral pleural effusion/thickening.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with stage III ovarian cancer CHEST:LUNGS AND PLEURA: Small right-sided effusion is unchanged. There is suggestion of pleural based nodules, causing contour lobulation of the pleural effusion better seen on today's study. One of these nodules measures 12 x 9 mm on image number 72, series number 3. These nodules cannot be optimally measured due to their similar density to the pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previous described small anterior abdominal wall hematomas. Smaller.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically removed.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: Right-sided pleural effusion is unchanged. Multiple nodular areas within the right pleura are poorly imaged by CT, due to their similar density to the effusion. PET CT or MRI may be helpful for better characterization of these right-sided possible pleural nodules.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: interval RIJ TLC History: RIJ TLC placement Interval placement right IJ central catheter that terminates within the mid right atrium.Low lung volumes with basilar opacities of atelectasis and pleural effusions. Ovoid opacity at the right mid zone not well visualized on immediate prior. Recommend repeat upright PA radiograph when the patient can tolerate for further evaluation. No significant pneumothorax.

Output: Persistent low lung volumes with basilar opacities of atelectasis and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 83 years old.Reason: rule out PTX History: Fall Cardiomegaly and mild interstitial opacities suggestive of edema.Pleural thickening in the right mid chest may indicate underlying rib fractures although no displaced fractures identified.

Output: Right pleural thickening possibly associated with underlying rib fractures, although none are clearly identified. If clinical indicated, CT could be more specific. No evidence of pneumothorax, however.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: LVAD History: LVAD Median sternotomy, heart size normal.No specific evidence of infection or edema.Pleural effusions are resolved since the prior study.LVAD unchanged in position.

Output: Stable LVAD. No significant pulmonary or pleural abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Birt Hogg Dube syndrome. Normal heart size. No pleural fluid or focal air space opacities. Central pulmonary vasculature appears at least upper normal in caliber. No pneumothorax.

Output: No acute pulmonary abnormality. Central pulmonary vasculature at least upper normal caliber. It is unlikely that it cystic lung disease, if present, would be visible by this technique. Thoracic CT may be of use if further evaluation is required.


Instruction: Generate impression based on medical findings.

Input: Age: 56 yearsGender: MaleReason for Study: Reason: sepsis History: sepsis Support devices unchanged.Decreased lung volumes with stable cardiomediastinal silhouette.Pleural effusions with perihilar and basilar opacities compatible with edema.Left retrocardiac consolidation/atelectasis similar to the prior exam.

Output: Support devices unchanged. Stable cardiopulmonary appearance with pleural effusions, edema, and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 41 years old.Reason: intubated, confirm ETT position History: see above Lines and tubes are unchanged. Unchanged diffuse pulmonary opacities. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: No change in pulmonary opacities. Line position stable.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Shortness of breath for 4 days. Leg edema. On previous chest radiograph and CT there was a spiculated left upper lobe nodule, highly suspicious for lung cancer. On the current radiograph this region is not as well visualized although it is uncertain if this is due to interval resection or overlying artifact.Elsewhere the lungs are essentially clear without acute consolidation, effusion, or evidence of significant interstitial edema. Severe cardiomegaly again noted.

Output: 1.Previous highly suspicious left upper lobe nodule not as well visualized currently. Please correlate with possible outside surgical history. Repeat chest CT may be useful.2.Otherwise stable cardiomegaly but no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: uncontrolled pruritus refractory to treatment, screening for lymphoma and other malignancy History: pruritus Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male status post minimally invasive esophagectomy (MIE) for esophageal cancer complicated by the anastomotic leak status post IR drainage, EGD/stenting/decortication. Please assess for retained contrast post esophagram study last week/loculated fluid collection in right chest. CHEST:LUNGS AND PLEURA: Interval decrease in right-sided fluid collections. Small amount of loculated fluid persists in the right apex. Residual loculated fluid right fissure. Minimal residual right pneumothorax.Interval decrease in patchy peripheral ground glass opacities in the left upper lobe.MEDIASTINUM AND HILA: Status post gastric pull up with pooling of contrast in the most dependent portion of the gastric pull up. The intrathoracic stomach appears to be fluid-filled, suggesting ineffective emptying. Pneumomediastinum as well as subcutaneous emphysema along medial right chest wall (series 5, images 2, 15, and 22 for example). Air in th esoft tissues is noted adjacent to the esophageal stent, extending anteriorly (series 7, images 13-22). A small esophageal leak is therefore a consideration which would be better evaluated with a contrast study. Note is made of a recent esophagram on 2/10/2009.Esophageal stent is fluid-filled. Tracheostomy tube. Central line catheter tip in SVC. Median sternotomy wires.CHEST WALL: Subcutaneous emphysema in anterior chest wall. Displaced, right seventh rib fracture. Inflammatory changes, fluid, and subcutaneous air noted within the region of prior chest tubes (series 5, images 61-68).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Stable left renal calculus.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. J-tube. Small umbilical hernia, unchanged. Minimal inspissated barium is also noted in the distal portions of the bowel, suggesting some passage of contrast.BONES, SOFT TISSUES: No significant abnormality noted. Stable spinal hemangiomas in L1 and L2 vertebral bodies.

Output: 1.Pneumomediastinum adjacent to esophageal stent that has increased on comparison to prior study. A small esophageal leak is a consideration that would be better evaluated with an oral contrast-enhanced study.2.Interval decrease in previously noted intrathoracic fluid collections.3.Fluid-filled gastric pull-up with pooling of contrast in its most dependent portion, suggesting ineffective emptying. Small amount of barium noted in the distal bowel, suggesting some passage of contrast.4.Displaced right seventh rib fracture; new finding since CT study from 2/9/2009.Findings were communicated to Christopher Holbrook of the general surgery team at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: GOH History: GOH ET tube tip approximately 3 cm above the carina.NG tube coiled in the stomach.No visible pulmonary abnormalities, though a CT scan shows mild airspace opacity at the right base.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Precordial chest pain (left and central extending to shoulder), shortness of breath. Mitral prosthesis. Unchanged right anterior chest wall wire, presumably an epicardial pacing lead which terminates to the right of midline at the level of the fifth anterior rib. Plate and screw device overlying the right fourth rib.Moderate to severe cardiomegaly, unchanged. Tortuous course of the thoracic aorta exaggerated by thoracic scoliosis, unchanged.Scarring at the right lung base and elevation of the right hemidiaphragm present previously. No pneumothorax or pleural fluid.

Output: Unchanged moderate cardiomegaly but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Coughing and dyspnea Mild asymmetry in lung volumes without discrete distinct explanation. Although likely artifact, if concern remains high, repeat imaging may be indicated. Specifically no discrete focal airspace process.Borderline cardiomegaly persist unchanged. Mediastinal contours are within normal limits

Output: No distinct acute cardiopulmonary abnormality, see discussion provided


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: assess for pulm edema or PNA History: tachypnea, AMS Small pleural effusions, left lower lobe consolidation and cardiomegaly, the heart possibly larger than on the prior study.Left jugular catheter, tip in SVC.A Dobbhoff tube extends below the lower margin of the image.Status post extubation.

Output: Pleural effusions and left lower lobe consolidation unchanged, the heart possibly larger versus different magnification artifact.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: has afib w rvr- look for lung abnormality History: afib w rvr Unfavorable progression with complete opacification of the right hemithorax.Left lung remains clear.No change in heart size.No pneumothorax.

Output: Complete opacification of right hemithorax.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: PA catheter in place The tip of the pulmonary artery catheter has been advanced and projects over the right main pulmonary artery.Left internal jugular catheter tip in the proximal SVC.Stable cardiomegaly.Stable left basilar atelectasis/consolidation and small left pleural effusion or pleural thickening. The right lung is clear.No pneumothorax.

Output: Tip of the pulmonary artery catheter projects over the right main pulmonary artery. Stable left basilar atelectasis/consolidation and pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: crohns flare on tysabri and IV steroids with cough and elevated wbc. please eval for infection. History: cough and elevated wbc No new opacity to suggest pneumonia.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Table fell on child. Loss of consciousness. Abdominal tenderness. CHEST:LUNG BASES: 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. No evidence of malrotation is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small collections of subdiaphragmatic and perihepatic air are noted as well as scattered pockets throughout the abdomen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Significant amount of free fluid is noted in the pelvis.

Output: 1.Scattered collections of intraperitoneal air as described above.2.Significant amount of free fluid in the pelvis.3.No discrete solid organ injury is identified.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Balloon pump placement. Interval removal of right jugular introducer without pneumothorax. A peripherally inserted catheter from the right terminates at the SVC level. IABP marker projects over the descending thoracic aorta approximately 3.5-4 cm below the expected top of the aortic arch.Lung volumes slightly improved, moderate pleural effusions, edema and basal atelectasis persist, though the volume of pleural fluid on the right appears to be improving. Retrocardiac atelectasis.

Output: IABP marker approximately 3.5-4 cm below the top of the aortic arch. Moderate CHF. Basal atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Reason: pulmonary edema? History: chest pain, dyspnea with exertion No specific evidence of edema or infection. Blunting of the posterior costophrenic angles most compatible with scarring. The heart size is normal.

Output: No evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Chronic cough question sarcoidosis. No specific evidence of sarcoidosis or other acute pulmonary pathology by plain films.Cardiomegaly.Enlargement of the central pulmonary vasculature suggestive of pulmonary hypertension.Spinal osteophyte formation.

Output: No acute pulmonary abnormality. Specifically no signs of sarcoidosis by plain film. Cardiomegaly with signs of pulmonary hypertension are present.


Instruction: Generate impression based on medical findings.

Input: 53 years old Male. Reason: 53 y/o M with IABP, ? Placement History: 53 y/o M with IABP, ? Placement. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The tubes and lines are stable in position.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: eval for ptx History: shortness of breath Interval reduction in the multifocal mid to lower zone opacities noted in the prior examination. There is an ill-defined opacity noted at the right base. Given the patient's clinical history as noted by prior imaging, this may represent a new focus of infection. No associated edema or pleural effusion. The cardiomediastinal silhouette is unremarkable. No pneumothorax.

Output: No pneumothorax, as clinically questioned. There is a right basilar opacity that may represent a focus of infection, markedly improved from February 2015.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of renal and liver transplant admitted for fever, leukocytosis and abdominal pain. Please evaluate pleural effusion, abdominal abscess, biliary abnormality. CHEST:LUNGS AND PLEURA: Small right lower lobe micronodule is unchanged (series 5, image 57). Minimal right pleural thickening with some calcifications is also unchanged and likely from prior asbestos exposure. No suspicious nodules or masses. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Left chest wall pacemaker. ABDOMEN:LIVER, BILIARY TRACT: Expected pneumobilia from hepaticojejunostomy. No discrete liver lesions.SPLEEN: Splenic varices (series 3, image 110) which may be of little clinical significance.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously noted right perinephric collection persists (series 3, image 127) but is decreased in size on comparison to prior study. It extends along the right psoas muscle, measuring 7.3 x 5 cm in the axial plane. It previously measured 9.1 x 5.6 cm. No evidence of hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Scattered, small retroperitoneal nodes, a nonspecific finding.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Transplant kidney in left iliac fossa without evidence of hydronephrosis or perinephric fluid collections.

Output: Right perinephric collection extending along right psoas muscle persists but is smaller on comparison to prior study from 12/27/2008.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: post chest tube removal History: post chest tube removal Stable left pneumothorax and left chest wall soft tissue emphysema.Unchanged basilar opacities.Left jugular catheter removed.

Output: Stable left pneumothorax. Left jugular catheter removed.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: fever History: fever No significant cardiopulmonary abnormality.

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


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Evaluate for infection, effusion History: Seizure, altered mental status Low lung volumes.Nonspecific basilar opacity most compatible with atelectasis or aspirate.

Output: Atelectasis versus aspirate at the right lung base.


Instruction: Generate impression based on medical findings.

Input: Reason: please eval tube History: desating with tube ET tube tip approximately 3 cm above the carina.Right jugular catheter tip in right atrium.Severe cardiomegaly with bilateral airspace opacity suggestive of edema and atelectasis, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: r/o pna History: chest pain Lungs hypoinflated with minimal subsegmental atelectasis at bases but no evidence of pneumonia.

Output: Lungs hypoinflated with minimal subsegmental atelectasis at bases but no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with shortness of breath. No focal airspace opacity to suggest infection, no pleural effusion.Cardiomediastinal silhouette is unchanged.Embolization coils are seen in the left upper quadrant.

Output: There is no specific evidence of infection or edema. 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: 43 years old Female. Reason: sob History: dialysis, sob. Unchanged cardiomegaly and pulmonary vascular redistribution.Slightly improved basilar predominant interstitial opacities.

Output: Persistent, but improved, pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: ETT placement, infiltrate History: as above Cardiomegaly and mild right basilar atelectasis unchanged.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.

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


Instruction: Generate impression based on medical findings.

Input: Age: 54 yearsGender: FemaleReason for Study: Reason: s/p ICD History: S/P ICD Left-sided ICD is been placed with its lead wires within the right atrial appendage, right ventricle, and coronary sinus.Right IJ venous catheter with its tip in the SVC.Stable cardiac enlargement.The lungs are clear.No pleural effusions.No evidence of a pneumothorax.

Output: Interval placement of an ICD without complication.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: evaluate lungs History: pneumothorax, COPD Limited portable examination with rotation and significant kyphosis. Left apical chest tube position unchanged. Right chest wall Port-A-Cath tip terminates at the cavoatrial junction. Left lower lobe atelectasis slightly increased. Moderate layering left pleural effusion suspected, unchanged. Patchy and streaky right basilar opacity slightly increased from the prior. No definite pneumothorax.Moderate gaseous distention of several loops of upper abdominal bowel.

Output: 1.Limited study with no definite pneumothorax.2.Slightly increased left basilar atelectasis and associated pleural effusion with question left bronchus cutoff.3.Increased right basilar opacity suggestive of atelectasis.


Instruction: Generate impression based on medical findings.

Input: 50 year-old female with colon cancer. CHEST:LUNGS AND PLEURA: Reference right lower lobe nodule has increased in size now measures 12 x 14 mm image number 36, series number 4. No new nodules identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The two reference lesions in the liver are unchanged and most likely represents hemangioma rather than metastatic disease. No new lesions.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: Multiple fibroids in the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval increase in the size of the right lower lobe nodule.Liver lesions are unchanged. They most likely represent hemangiomas rather than metastatic disease. MRI can be obtained for confirmation.


Instruction: Generate impression based on medical findings.

Input: Reason: IABP History: IABP Balloon catheter marker at the level of the aortic arch and ICD leads unchanged. PICC line tip in the right axilla.No significant pulmonary abnormalities.

Output: Balloon catheter marker at the level of the aortic arch, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: 76 y/o lady w/ fever History: 76 y/o lady w/ fever Unremarkable cardiac and mediastinal silhouette. Calcified granuloma at the left base consistent with previous infection.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: 80yo F w/ hx of CHF now with SOB History: SOB Small lung volumes with stable basilar atelectasis and pleural effusions.Moderate cardiomegaly unchanged.

Output: Unchanged basilar opacities and pleural effusions with cardiomegaly. Findings could all be the result of CHF.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on exertion check for CHF Persistent decreased lung volumes with mild basilar suspect is scarring. No superimposed new acute cardiopulmonary maladyBorderline cardiomegaly persists with moderate tortuosity aorta. Mediastinal contours are otherwise similar.Left subclavian ICD unchanged

Output: Mild basilar scarring without superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: r/o infectious etiology History: fever, wbc Mild cardiomegaly. Left base scarring.Apical scarlike nodules are unchanged as far back as a 6/19/2013 chest CT.Healed left rib fractures.No specific evidence of infection or edema.

Output: Mild cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 80 years old.Reason: assess for PNA, parasternal/left sided CP this AM History: acute chest pain Left AICD with leads in stable position. Multiple coronary stents again seen.Stable enlargement of the cardiac silhouette. Right pleural effusion and pleural scarring as seen on recent CT.

Output: Stable right pleural effusion and pleural scarring without radiographic findings to account for patient's pain.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out worsening CHF History: tachypnea Severe cardiomegaly with vascular redistribution.Moderate right pleural effusion with underlying atelectasis, similar to the previous radiograph, consistent with CHF.Intact sternal fixation devices, with an isolated screw projected over the left side of the manubrium.

Output: CHF and moderate right pleural effusion with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.History of shortness of breath. There are moderate right and small left pleural effusions with adjacent consolidation. The cardiac silhouette is enlarged but stable.

Output: Bilateral pleural effusions with adjacent atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Pre-op transplant assessment. Stable mild cardiac enlargement. No focal airspace opacity or large pneumothorax. Improved left effusion.

Output: Stable mild cardiomegaly with slightly improved left pleural effusion. No focal airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 36 yearsGender: FemaleReason for Study: Reason: Pt admitted with central venous catheter in place; please assess position History: On TPN Central venous catheter with its tip in the SVC.The cardiomediastinal silhouette is unremarkable.Minimal basilar atelectasis without focal areas of consolidation.No pleural effusions.No pneumothorax.Surgical clips in the right upper abdomen most likely related to a cholecystectomy

Output: Mild basilar atelectasis. No acute cardiopulmonary abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Liver transplant. Check for signs of rejection. Cough No cardiopulmonary abnormality. Borderline cardiac silhouette unchanged

Output: Borderline cardiomegaly without acute abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Intubated History: None Small lung volumes with mild left base subsegmental atelectasis, unchanged.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube terminates in the stomach.Left jugular catheter, tip in SVC. Right jugular dialysis catheter removed.

Output: Removal of right jugular catheter, with stable left base subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: EmpyemaVIEWS: Chest AP and lateral Right-sided chest tube in place. There is a small right pleural effusion not significantly changed. There is improved aeration at the right lung base. Minimal subcutaneous emphysema in the right lateral chest wall. Cardiothymic silhouette normal.

Output: Right lung opacity has improved with small right pleural effusion not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Tachycardia Motion degrade sensitivity.Mild to moderate mixed interstitial and patchy opacities most pronounced in the left lower lung with a large layered effusion are similar. Borderline cardiomegalyLeft PICC line and inferior Swan-Ganz extending into the right pulmonary outflow track are both unchanged

Output: Left lower lobe focal consolidation, remains nonspecific


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old. Reason: assess for pna History: productive cough, rhonci on exam Cardiomediastinal silhouette is unremarkable.No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: right upper lobe resection History: same Interval removal of right-sided chest tube. No pneumothorax visualized. Patchy opacity in the right lung consistent with postoperative contusion, atelectasis and pleural effusion. No other new findings.

Output: Interval removal of right-sided chest tube no significant pneumothorax. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: assess ET tube position History: new ET tube Interval intubation with the endotracheal tube terminating 1 cm within the right mainstem bronchus. This has been repositioned but does remain low and subsequent radiographs. Right IJ central catheter now terminates at the superior right atrium. Interval placement of nasogastric tube with the sidehole position in the distal esophagus. Advancement is recommended.Persistent low lung volumes with basilar opacities of subsegmental atelectasis. Aspirated secretions are also suspected. No pneumothorax. The bowel gas pattern is obstructive.

Output: Endotracheal tube positioned within the ostium of the right mainstem bronchus. This has been repositioned but remains low on subsequent radiographs. Advancement of nasogastric tube recommended. Obstructive bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Metastatic cholangiocarcinoma. CHEST:LUNGS AND PLEURA: Previously described bilateral lung nodules have increased in size. Previously measured right upper lobe node now measures 10 x 12 mm image number 44.MEDIASTINUM AND HILA: No evidence of enlarged mediastinal or hilar lymph nodes. Previously measured right hilar lymph node is no longer visualized.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Biliary stents, unchanged with associated pneumobilia. Intrahepatic biliary dilatation, more prominent in the right posterior segment persists. Gallbladder is also distended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Previously described retroperitoneal mass invading the celiac trunk portal vein at the level of the confluence, SMA and SMV has increased in size. The mass now measures 6.9 by 8-cm. The mass extends into the bilateral para-aortic regions.Bilateral retroperitoneal adenopathy has also increased in size. Previously measured reference retroperitoneal lymph node is now contiguous with the mass has increased in size measuring 5.3 x 3 cm in image number 118.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: Small amount of fluid in the pelvis.

Output: Interval progression of the disease with increase in the size of the lung nodules, retroperitoneal mass and retroperitoneal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old.Reason: Assess for pneumonia; Worsened chronic cough, COPD History: cough, phlegm Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Median sternotomy with metal clamps.

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


Instruction: Generate impression based on medical findings.

Input: Age: 77 yearsGender: FemaleReason for Study: Reason: evaluate for pneumonia History: weakness, anorexia x1 week Stable heart and mediastinal silhouette.Lungs are clear.Calcified hilar mediastinal lymph nodes compatible with prior granulomatous disease.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male 65 years old with history of pleural effusion s/p thoracotomy yesterday, assess interval change Improved aeration of right lung base. Foci of air in the left hemithorax compatible with subpulmonic hydropneumothorax. Large left lower lobe mass and pleural thickening similar to prior exam and better characterized on recent CT dated 2/5/2016. Left chest wall subcutaneous emphysema.

Output: Left lower lobe mass, pleural thickening, and subpulmonic hydropneumothorax, which appear similar to prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Sepsis. Assessment of the cardia mediastinum is limited by rotation.The lung volumes and bilateral basilar subsegmental atelectasis or scarring again noted. No new abnormal lung parenchymal opacities.Limited assessment for pleural effusions. No supine evidence of pneumothorax.A new right IJ port catheter overlies the superior cavoatrial junction.New stent overlying the right upper quadrant of the abdomen is noted.

Output: Limited assessment of the cardiomediastinum, lungs secondary to technique. Within these limitations, no radiographic evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 87 years old.Reason: et placement History: intubated Median sternotomy for aortic valve replacement, with persistent retrocardiac atelectasis, small pleural effusions but no infection or edema.ET tube tip at the level of the thoracic inlet.Right jugular catheter, tip in SVC.An NG tube terminates in the stomach.Right subclavian single lead pacemaker comment tip unchanged in the RV apex region.

Output: No change in cardiomegaly and left basilar atelectasis. The ET tube has been partially withdrawn, and is high in location.


Instruction: Generate impression based on medical findings.

Input: Reevaluate liver disease. Provide tumor measurements. CHEST:LUNGS AND PLEURA: Ill-defined ground glass opacity in the right lower lobe measuring 7 x 6 mm unchanged from previous CT. This lesion is also unchanged from CT dated 8/9/06. No new lung lesions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic lesions are again seen. The reference to these and is unchanged measuring 4.4 x 2.2 cm in image number 86/213. No significant change in the size and number of the lesions.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: Small amount of free fluid.

Output: Stable exam


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: eval for pna History: infectious r/o Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: please assess lung fields History: GI bleed, LVAD, hemodynamic instability Support devices are unchanged in position.Scarlike opacity at the right mid lung is new since 11/4/2015, likely subsegmental atelectasis. No interval pneumothorax or edema. Heart size upper limits normal. Skinfold is noted at the thoracic inlet.

Output: Scarlike opacity on the right likely subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Wheezing and chest pain No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: Shortness of breath History: Cardiac arrest. Shortness of breath. The endotracheal tube terminates approximately 3 cm from the carina. Catheter overlies the right inferior aspect of the mediastinum. Mild cardiomegaly. Low lung volumes. Dense left lower lobe opacity. No pneumothorax.

Output: Endotracheal tube terminates 3 cm from the carina. Left lower lobe opacity consistent with atelectasis and/or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: FemaleReason for Study: Reason: r/o pneumonia History: post-op fever The cardiomediastinal silhouette is unremarkable.There are decreased lung volumes with patchy areas of atelectasis.No definite areas of consolidation.No pleural effusions.Mildly dilated air-filled loops of bowel in the upper abdomen.

Output: Multifocal areas of subsegmental atelectasis without specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: infiltrates History: ards Support devices unchanged. Minimal improvement in bilateral pulmonary opacities. No pneumothorax.

Output: Minimal improvement in bilateral pulmonary opacities. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: r/o infectious process vs acute chest History: cough, shortness of breath, sickle cell disease Interval decreased lung volumes. New peripheral airspace opacity at the right base. Previous right apical opacity is incompletely resolved. Central bronchial wall thickening. Consolation of findings suspicious for infection. No significant pleural effusion or pneumothorax. The heart size remains normal. Vertebral body abnormalities reflected of sickle cell disease.

Output: Airspace opacities, new right peripheral lower zone, incompletely resolved right apex with bronchial wall thickening suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: Status post Left chest tube removal Interval removal of left-sided chest tube. Right chest tube in a similar position overlying the mid right lung.Enteric tube tip in the distal third of the esophagus.Stable perimediastinal silhouette. Right apical pneumothorax persists without significant interval change. Small locules of air at the left lung base likely represent residual pleural air. No large pneumothorax. No focal consolidation.Skin staples project over the left upper neck.

Output: No significant residual left sided pneumothorax. Persistent right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old. Desaturation. Evaluate lung fields. Interval removal of right chest tube with a small unchanged pneumothorax.Low lung volumes with basilar atelectasis, not significantly changed.Right chest wall subcutaneous emphysema.

Output: Interval removal of right chest tube. Small right pneumothorax, unchanged.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with a chronic cough after which an extensile transplant for CLL, rule out pneumonia LUNGS AND PLEURA: Been almost complete clearing of the small focal area of groundglass opacity in the right upper lobe. No new pulmonary abnormalities, nodules, or groundglass opacities can be identifiedMEDIASTINUM AND HILA: Central venous catheter with its tip in the RA/SVC. No hilar or mediastinal lymphadenopathy. Mild coronary and aortic calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Stable hepatic hypodensity in the left lobe

Output: No evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Chest pain rule out infiltrate. Unchanged cardiomegaly and tortuosity of the thoracic aorta for age. Central pulmonary vasculature appears prominent, cannot exclude pulmonary hypertension. No focal pulmonary opacities, pleural fluid or pneumothorax.

Output: Cardiomegaly and tortuosity of the thoracic aorta for age unchanged. No acute pulmonary abnormality. Prominence of the central pulmonary vasculature is suspicious for pulmonary hypertension. Further evaluation recommended given patient's age. Please note that vascular pathology cannot be excluded by plain film technique.Dr. David Beiser (2013) notified via text page regarding the finding and recommendation at 9:45 AM at 4/15/2016.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: pneumonia, cardiomegaly, effusion History: generalized weakness, confusion x 2 days Rightward tracheal deviation compatible with goiter. Calcified pulmonary nodules compatible prior granulomatous infection. No focal consolidation, pleural effusion or pneumothorax is evident. The cardiac and mediastinal contours are within normal limits for size, and unchanged from the prior prior exam.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Bilateral likely loculated pleural effusions, right greater than left, which appears slightly improved when compared to previous radiograph.Persistent basilar opacities likely reflect compressive atelectasis.Stable postsurgical changes related to lung transplant.Calcified hilar and mediastinal nodes compatible with healed granulomatous disease.No significant pneumothorax.

Output: Bilateral effusions and basilar compressive atelectasis, slightly improved from prior. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male who presents with fever after intubation. Cardiomediastinal silhouette is unchanged.The lungs are hyperinflated, suggestive of COPD. No pneumothorax or pleural effusion.Endotracheal tube with tip roughly 7 cm above the carina.Left-sided 3-lead ICD is unchanged. LVAD is again noted in place. Median sternotomy wires and fixation devices in place.

Output: No acute cardiopulmonary abnormality. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Enteric tube placement Dobbhoff tube located at gastroesophageal junction and further advancing recommended. Persistent ileus pattern. IVC filter seen. Intrauterine device seen. Multiple pelvic phleboliths.

Output: Further advancing of enteric tube recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: shortness of breath History: shortness of breath Left chest wall port catheter tip in the right atrium.Large hiatal hernia.No new focal pulmonary opacity, pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: Large hiatal hernia, but no specific findings to account for shortness of breath.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Chest pain. Dyspnea. Multiple right-sided rib fractures appear more likely chronic. Cardiac silhouette is slightly more rightward than typical but likely anatomic variant. Heart size is normal. The lungs are clear.

Output: Multiple chronic appearing right-sided rib fractures. Otherwise no significant cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate for ventilator associated pneumonia History: copious ett secretions ET tube tip approximately 5 cm above the carina.Bilateral lower lobe airspace opacity, greater on the right, not significantly changed from the previous day but increased in the right lower lobe over the past 2 days, compatible with pneumonia.

Output: Bilateral lower lobe pneumonia, increased over the past 2 days.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old. Reason: chest tubes History: chest tubes Lines and tubes are unchanged. Again, the enteric tube is likely within the gastric pull-up. Lower lung volumes. Probable increased atelectasis, right greater than left. Small pleural effusions. No large pneumothorax. Unchanged heart size.

Output: Expected postoperative appearance without evidence of significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old, with history of renal mass with bone metastases. Evaluate for lung metastases or primary. LUNGS AND PLEURA: Mild centrilobular emphysema. Scattered nonspecific pulmonary micronodules, some calcified and likely representing prior granulomatous disease. No suspicious nodules or masses. No pleural fluid.MEDIASTINUM AND HILA: Marked cardiomegaly, particularly the left atrium, and a prosthetic mitral valve is present. A single pacer lead is evident in the right ventricle. Mediastinal surgical clips and/or coronary stents. Aortic and coronary atherosclerotic calcification. No pericardial fluid.A prominent precarinal lymph node is not pathologically enlarged by CT criteria. No evidence of enlarged hilar lymph nodes.CHEST WALL: Left chest wall pacer generator.UPPER ABDOMEN: A left upper pole renal lesion is incompletely evaluated on this study. Slightly enlarged left para-aortic lymph nodes are evident.

Output: 1.No evidence of lung primary or metastatic disease.2.Mild emphysema.3.Marked cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with end-stage renal disease status post renal transplant presented with PE from outside hospital, distended abdomen, increased LFTs and acute renal failure. Please evaluate for intra-abdominal and chest pathology. The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Small left-sided pleural effusion. Nonspecific central bilateral groundglass opacities which may be secondary to pulmonary edema. Atelectasis involving the left lower lobe. A superimposed pneumonia cannot be excluded.MEDIASTINUM AND HILA: Heart is enlarged with a moderate sized paracardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Moderate amount of ascites. Enlarged liver with nodular contour is a hypertrophied left lobe suggestive of chronic liver disease. An ill-defined hypodense area in the left lobe measures 5.3 x 2.3 cm. This lesion cannot be optimally characterized due to lack of IV contrast. The hypodensity may also extend laterally in the left lobe. Ill-defined hypodense areas are also noted in the inferior aspect of the right lobe of the liver.Hazy, high density material is present within the ascites. The highest density in the ascites is seen inferior to the left lobe of the liver with loculations. Other intraperitoneal high density material is noted on image number 81, series number 3 posterior and superior to the fundus of the stomach and in the bilateral paracolic gutters.Tiny air droplet in the right paracolic gutter image number 132, series number 3 may represent extraluminal air.Cholelithiasis without evidence of biliary dilatation.SPLEEN: Spleen is not visualized.PANCREAS: No significant abnormality notedADRENAL GLANDS: Small left adrenal nodule is unchanged.KIDNEYS, URETERS: Small atrophic native kidneys. Small hypodensity in the right kidney is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate amount of ascites with foci of hazy increased density. Distention of the proximal bowel loops measuring up to 2.6 cm in the right upper quadrant. Distal small bowel loops are decompressed. This maybe secondary to mild ileus versus mild partial small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Thickened bone trabecula and likely secondary to patient's known history of chronic renal disease and sickle cell disease.OTHER: Moderate amount of heterogeneous density ascites. Left common femoral vein catheter extending into the IVC .

Output: Moderate amount of heterogeneous density ascites with loculations. Due to the high density of the material in the ascites the most likely diagnoses extravasated oral contrast likely representing a perforation. Other less likely etiology for high density in the ascites can be intraperitoneal hemorrhage or peritoneal tumor spread. Partial proximal small bowel obstruction. Lack of IV contrast due limits optimal evaluation of the abdomen and pelvis.Ill-defined hypodense lesions in the liver, new from previous CT.Cardiomegaly, pericardial effusion and small left-sided pleural effusion.Bilateral central groundglass opacities are suspicious for pulmonary edema.Cholelithiasis without evidence of cholecystitis.These findings were discussed with Dr. Megan at 12:30 p.m. on 10/6/2008.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: r/o infectious etiology History: altered mental status Mild bibasilar subsegmental atelectasis or scarring. Question of small pleural effusions. Heart size normal. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: assess pneumothorax History: pneumothorax, pneumomediastinum Left sided chest tube has been slightly superiorly repositioned. Small left apical pneumothorax, not substantially changed. Moderate degree of pneumomediastinum, as before. Low lung volumes makes detailed cardiopulmonary assessment difficult. No substantial change in diffuse pulmonary opacities given differences in inspiration. Unchanged cardiomegaly.

Output: Left sided chest tube has been slightly superiorly repositioned. Small left apical pneumothorax, not substantially changed. Moderate degree of pneumomediastinum, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: assess for acute lung changes - daily icu film History: icu Right jugular Swan-Ganz catheter has been pulled back with remaining sheath. No pneumothorax. Cardiomegaly with basilar opacities, stable.

Output: Swan-Ganz catheter pulled back with remaining sheath. Stable bibasilar opacities. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: swan in place History: swan in place Unchanged moderate cardiomegaly.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.Right PICC, tip at cavoatrial junction.Right jugular Swan-Ganz catheter, obscured by motion beyond the tricuspid level.

Output: Right jugular Swan-Ganz catheter is obscured by motion be on the tricuspid level. Otherwise unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 40 years old.Reason: s/p Haplo/Cord Stem Cell Transplant with SOB and chest pain. History: SOB and Chest pain Venous catheter unchanged. No new opacity to suggest pneumonia or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: central line tip location History: RIJ Cardiomegaly without edema or pneumonia.Left subclavian ICD, leads unchanged in position.Right jugular catheter tip at SVC/RA junction level.

Output: Stable tubes and devices. Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 85 years old.Reason: infiltrate vs volume overload History: confusion Mild basilar interstitial opacities appear more chronic than acute, but there is no sign of infection.Heart size normal.

Output: Increased basilar interstitial opacities most likely slowly evolving fibrosis relative than edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: s/p redosternotomy and CABG History: SOB Median sternotomy. Interval removal of Swan-Ganz catheter and chest tubes.Bilateral pleural effusions with basilar interstitial and airspace opacities.Mild cardiomegaly.No pneumothorax.

Output: Worsening pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old. Reason: hypoxia and SOB, evaluate for aspiration; s/p chemoradiation for head and neck cancer History: SOB Tracheostomy and gastrostomy tubes in place. Right chest port, tip in the right atrium.Cardiomediastinal silhouette is unchanged.Persistent elevation of the left hemidiaphragm, with associated mild basilar atelectasis. Previously described interstitial and airspace opacities throughout the right lung are slightly improved. No significant pleural effusions. No pneumothorax.

Output: Persistent elevation of the left hemidiaphragm. Underlying left basilar airspace disease is not excluded. Otherwise no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA History: see above Large right upper lobe mass contiguous with the pleural surface measuring approximately 12 cm in maximum diameter consistent with known primary lung carcinoma.Mild interstitial opacity with several septal lines, suggestive of edema.No specific evidence of pneumonia.

Output: Large right upper lobe mass with no sign of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: r/o HF History: edema No new focal lung consolidation. New small pleural effusions. Moderate cardiomegaly, unchanged. No pneumothorax. Large patient body habitus, as before.

Output: New small pleural effusions. Moderate cardiomegaly, unchanged. No evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.End stage renal disease pre-kidney transplant. No specific signs of edema. Normal heart size. Atherosclerotic calcification of the thoracic aorta.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Pneumothorax, status post chest tube. Interval enlargement of right pneumothorax, now measuring up to 3 cm. Right chest wall pigtail pleural drain intact, though possibly within the extrapleural fat.Unchanged bilateral diffuse coarse interstitial opacities. Unchanged small loculated right pleural effusion.

Output: Interval enlargement of right pneumothorax. Right chest wall pigtail pleural drain intact, though possibly malpositioned within the extrapleural fat. Correlate with function. Consider repositioning.Notification: Findings discussed with primary service/Dr. Jun on 9/21/2016 at 11:50 AM.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: Line Placement, Initial Check History: POST-OP Transplant Lungs hypoinflated. Multiple peripheral vascular stents are seen. A central venous catheter is not visible

Output: A central venous catheter is not visible


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: line placement, infiltrate History: cardiogenic shock, known pneumoperitoneum and recent laparotomy. Unchanged cardiomegaly. There is a large left pleural fluid collection. Perihilar edema and atelectasis bilaterally appears slightly worse. No pneumothorax. Large volume of pneumoperitoneum.Swan-Ganz catheter appears similar to previous exam. Enteric tube tip is not visualized.

Output: Left pleural fluid collection with worsening bilateral atelectasis and interstitial edema. Large pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: patient removed PICC. evaluate for any remaining PICC portions History: above Motion and rotation limit sensitivity.Stable cardiac enlargement.Basilar opacities are compatible with atelectasis and possible pleural effusions.Interval removal of right PICC line.No residual catheter remnant can be identified.

Output: Basilar atelectasis and possible effusions similar to the prior exam. No evidence of a retained catheter.


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: R/o pneumonic process History: SOB Heart status post sternotomy.Status post aortic valve replacement.Mild interstitial opacities consistent with edema.Right right jugular catheter removed.

Output: Cardiomegaly with mild edema.


Instruction: Generate impression based on medical findings.

Input: Reason: fluid balance History: fluid overload Unremarkable cardiac and mediastinal silhouette. PICC catheter tip in the right axilla.Linear subsegmental atelectasis or scarring in the perihilar regions bilaterally, unchanged.No evidence of pulmonary edema or effusion.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: s/p LUL wedge History: s/p LUL wedge Left apical chest tube noted. Port catheter terminates in the cavoatrial junction. Probable postoperative change noted in the upper aspect of the left lung. Subsegmental atelectasis or scarring again noted at the lung bases. Heart size at the upper limit of normal. No large pneumothorax or large pleural effusion.

Output: Status post left upper lobe wedge resection, with expected imaging appearance.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p aortic dissection repair now with poor oxygenation History: poor oxygenation, chest tube, ETT Unchanged pulmonary opacities.Stable right chest tube with no significant pneumothorax.ET tube tip 5 cm above the carina.Right jugular Swan-Ganz catheter tip at the pulmonary outflow track.NG and Dobbhoff as far as it leaves the proximal stomach.

Output: No change in pulmonary opacities, tubes or devices.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. ET tube is been placed with its tip 3 cm above the carina.NG tube with its tip in the stomach.Left central venous catheter with its tip in the SVC.Stable cardiomediastinal silhouette.Persistent airspace/ interstitial opacities bilaterally with left retrocardiac consolidation/atelectasis.

Output: Interval intubation with ET tube in satisfactory position. Stable cardiopulmonary appearance with left retrocardiac consolidation/atelectasis and diffuse pulmonary opacities .


Instruction: Generate impression based on medical findings.

Input: Female, 101 years old.Reason: assess for PNA History: tachypnea Cardiomegaly with mild interstitial abnormality suggestive of edema, unchanged.No specific evidence of infection.

Output: Cardiomegaly with edema but no reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: S/P LVAD. S/P TLC insertion. Eval for line placement History: TLC placement Cardiomegaly with mild edema and left lower lobe consolidation unchanged.Multiple support devices are stable in position.New right jugular catheter tip in SVC.

Output: New right jugular catheter tip in SVC. No other change.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: s/p TEVAR History: s/p TEVAR New aortic stent is noted. Diffuse left hemithorax pleural-parenchymal opacities. Mild right basilar atelectasis. Heart size, difficult to assess.

Output: New aortic stent is noted. Diffuse left hemithorax pleural-parenchymal opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: pneumonia History: productive cough Heart size within normal limits.Lungs clear.No pleural effusion. No pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 79-year-old man with shortness of breath. History of pancreatic cancer. Moderately large bilateral pleural effusions with underlying atelectasis, increased from the prior exam. Interval increase in size and number of the bilateral pulmonary nodules. No pneumothorax. No cardiomegaly. The right chest wall central venous catheter terminates in the cava-atrial junction.

Output: 1. Moderately large bilateral pleural effusions likely related to the known abdominal malignancy.2. Interval progression of the pulmonary nodules in both lungs, compatible with metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 87 year-old female weight loss, increased ESR, increased CRP. Urinary incontinence. Rule out mass. CHEST:LUNGS AND PLEURA: Atherosclerotic changes aorta. Calcified asymmetric aneurysmal bulge off the arch of the aorta correlate with surgical history. Estimated diameter on series 4 image 28, 16 .2 mm. Coronary artery calcifications.MEDIASTINUM AND HILA: Hypoattenuating nodule abutting the inferior lobe of left thyroid gland measuring 15.2 x 11.2 mm is seen on coronal image 51/77.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations are madeLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small hypoattenuating focus left kidney likely cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm. No lymphadenopathy.BOWEL, MESENTERY: Diverticulosis. Otherwise normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Slightly atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis. No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of malignancy. Atherosclerotic changes. Calcified aneurysm aortic arch. Thyroid nodule. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Metastatic sarcoma. New left thigh numbness and right thoracic pain. Noncontrast study. CHEST: The following observations are made given limitations of an unenhanced study.LUNGS AND PLEURA: Increasing number of innumerable bilateral pulmonary nodules. Reference left lower lobe peripheral nodule (image 60; series 4) is stable and measures 1.1 x 1.2 cm.MEDIASTINUM AND HILA: Reference subcarinal lymph node, (image 41; series 3) measures 2.0 x 1.7 cm. Right internal jugular vein central venous catheter terminates in the right atrium.CHEST WALL: New right (approximately T8) thoracic rib fracture (image 60; series 3).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: New bony metastases in the spinal column.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval decrease in size of lobulated right ischiorectal fossa mass lesion, (image 208; series 3) which now measures 9.7 x 8.2 cm. New bony metastases throughout the pelvis. There is new destruction of the inferior aspect of the left sacrum (image 190; series 3). Correlate with clinical symptoms. Additionally, the left portion of the mid sacrum is been destroyed by tumor. This could be better evaluated using MRI exam as clinically indicated. Multiple flat bone metastases also noted.OTHER: No significant abnormality noted

Output: With regard to the clinical query:1. New right (approximate T8) lateral rib fracture.2. Innumerable bony metastases throughout the vertebral bodies and pelvis. In particular, there are destructive lesions of the mid and inferior left sacrum.Other findings and measurements as above.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with left rib pain, chest pain. Evaluate for fracture as cause of left rib pain. 4 metallic markers were placed overlying the left lower chest wall corresponding to the patient's site of pain. No rib fractures are identified bilaterally. The lungs are clear.

Output: No rib fractures or other radiographic findings to account for the patient's left rib/chest pain.


Instruction: Generate impression based on medical findings.

Input: 32-year-old male with leukemia with retroperitoneal and skin involvement. CHEST:LUNGS AND PLEURA: Nodular subpleural opacities and a few small air space opacities in the anterior upper lobes are unchanged.MEDIASTINUM AND HILA: Small AP window low attenuation rounded lesion may represent a small lymph node, unchanged. No pathologically enlarged lymph nodes.CHEST WALL: Right-sided central line terminates at the atriocaval junction.Right anterior chest wall lesion (series 3; image 26), unchanged. Focal left anterior chest wall skin thickening (series 3; image 36), also unchanged.Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right hydronephrosis is identified, secondary to soft tissue encasing the aorta and compressing the right ureter, unchanged.RETROPERITONEUM, LYMPH NODES: Enlarged peripancreatic lymph node is unchanged.Soft tissue encasement of the aorta is grossly unchanged.BOWEL, MESENTERY: Thickening of the first through third portion of the duodenum is seen (series 80236; images 43-45) unchanged.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: Grossly unchanged disease.Small focal skin lesions, pulmonary opacities, duodenal thickening and peripancreatic adenopathy remain.Soft tissue surrounding the aorta can be due to leukemic infiltration or retroperitoneal fibrosis. Mild right hydronephrosis secondary to soft tissue surrounding the aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: Fever, evaluate for infection History: As above Right IJ central venous catheter with tip in the SVC.Stable moderate cardiomegaly.Interval improvement in the right basilar opacity.Bibasilar effusion and atelectasis are unchanged.Unchanged osseous abnormality of left upper thorax. Left upper quadrant surgical clips are redemonstrated.

Output: Interval improvement in the right basilar opacity. Bilateral pleural effusions and atelectasis remain stable. No other new acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Chills. Evaluate for pneumonia. Minimal bibasilar atelectasis, without focal pulmonary opacities to suggest infection. No pleural effusions or pneumothorax.Cardiac silhouette within normal limits. Tortuous aorta.Left IJ central venous catheter with tip in the SVC.

Output: Minimal bibasilar atelectasis. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 57 years old Female. Reason: icu History: shortness of breath. Bilateral chest tubes in place. Feeding tube tip in the stomach. Left subclavian line tip in the brachiocephalic vein. Patient is status post sternotomy. Surgical clips and skin sutures overlie the mediastinum and upper abdomen.Stable cardiomediastinal silhouette. Small right pleural effusion. Bilateral small pneumothoraces. Stable appearing right subcutaneous emphysema. Mild interstitial opacities suggestive of edema.

Output: Small right pleural effusion and bilateral small pneumothoraces unchanged. Mild interstitial opacity suggestive of edema, unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old. Reason: r/o PTX History: chest pain with inspiration Cardiomediastinal silhouette is unremarkable.No focal opacity, pleural effusion, or pneumothorax.Mild scoliosis is again noted.

Output: No acute cardiopulmonary abnormality, specifically no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 86 years old.Crackles and volume overload, evaluate for edema. Unchanged cardiomegaly. Postoperative volume loss on the right with elevation of the right hemidiaphragm. Calcified granulomas and right hilar lymph nodes. Coarse peripheral and basal interstitial abnormality consistent with fibrosis appears slightly worse suggesting mild superimposed edema.

Output: Probable mild pulmonary edema superimposed upon chronic interstitial changes consistent with pulmonary fibrosis.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval ETT, lung fields History: s/p MVR Status post interval median sternotomy and mitral valve surgery. Right IJ Swan-Ganz catheter tip now overlies the right pulmonary artery. Two new mediastinal chest tubes are in place. Endotracheal tube is grossly unchanged. Interval removal of left IJ central venous catheterStable cardiomediastinal silhouette in size and configuration.Patchy bilateral airspace disease with more confluent retrocardiac opacity remain grossly unchanged. Small left pleural effusion suspected.

Output: Postsurgical changes as above with no significant change in bilateral lung aeration.


Instruction: Generate impression based on medical findings.

Input: Reason: pleural effusion History: wheezing SOB Large bilateral pleural effusions, greater on the right, with underlying atelectasis.PICC line tip in the area of the left subclavian vein.

Output: Large pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old. Productive cough for 6 days. Unremarkable cardiac and mediastinal silhouette.No evidence of infection or edema.Multilevel mild degenerative changes of the thoracic spine with upper to mid thoracic mild vertebral body compression deformities and resultant kyphosis.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: S/P LEFT thoracentesis History: Dyspnea Partially obscured cardiac silhouette is unchanged.Slight decrease in left basilar loculated hydropneumothorax with decrease in the number of multiple small pockets of gas and redemonstration of pleural thickening and subpleural scarring. Right lung patchy airspace disease is grossly unchanged.

Output: Redemonstration of left basilar loculated hydropneumothorax with decrease in the number of small pockets of gas.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of lymphoma CHEST:LUNGS AND PLEURA: Scattered pulmonary nodules are unchanged.MEDIASTINUM AND HILA: Reference prevascular lymph node is stable measuring 12 x 10 mm image number 32, series number 3.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 change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 39 years old.Reason: R pleural effusion post appendectomy History: pleural effusion Persistent right pleural effusion. No new findings.

Output: Persistent right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Reason: endotracheal intubation History: endotracheal intubation ET tube tip approximately 3 cm above the carina.Mild streaky basilar opacities compatible with atelectasis and aspirated secretions.Enteric tube extending below the radiograph with its tip in the abdomen.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: pneumonia Cannulae and chest tubes unchanged.Small lung volumes with bilateral opacity compatible with pleural effusions and atelectasis.No specific evidence of pneumonia or other acute change.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Dyspnea. Small to moderate pleural effusions. Airspace opacities in the posterior lung fields, right greater than left, about the same. Pulmonary vascular redistribution, but no specific signs of edema. Hardware and devices unchanged in position. Unchanged cardiomegaly.

Output: Posterior lung opacity suspicious for pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: possible pre-op History: BLE edema Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Mild thoracic scoliosis.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: z11.1 History: Positive TB skin test. No significant cardiopulmonary abnormality.No active TB.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: 44 yo female with stem cell transplant today, febrile neutropenia History: febrile neutropenia No significant cardiopulmonary abnormality.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Sepsis evaluate for pneumonia and further distinguish findings on portable chest x-ray. Persistent nodular opacity in the right lower lobe suspicious for infection.Mild thickening of the adjacent fissure.Normal heart size.Tortuous thoracic aorta.Inferolateral right rib deformity is nonspecific and may be correlated with WBC scan if there is clinical concern for osteomyelitis. This is more likely to represent a prominent tumor related to hyperparathyroidism.

Output: Right lower lobe nodular opacity suspicious for infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT, lung fields History: s/p AVR, MVR, TVR ET tube tip approximately 4 cm above the carina.Swan-Ganz catheter tip in the right main pulmonary artery.Venous catheters extending to the SVC.New small right apical pneumothorax with the apex of the lung about 1 cm from the chest wall.Bilateral nonspecific nodular and interstitial pulmonary opacity, not significantly changed. The differential diagnosis includes septic emboli and ARDS.

Output: New small right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: assess for acute process - shortness of breath History: assess for acute process - shortness of breath Stable cardiomegaly.Mild perihilar vascular congestion but no frank edema. Minimal right basilar opacity likely atelectasis. Trace basilar pleural effusions versus pleural thickening. No pneumothorax.

Output: Cardiomegaly with mild perihilar vascular congestion but no frank edema. Trace basilar pleural effusions versus pleural thickening.


Instruction: Generate impression based on medical findings.

Input: Female 20 years old Reason: eval for ptx Support tubes and lines unchanged.Small right pneumothorax, not significantly changed.Diffuse bilateral interstitial opacities compatible with provided history of ARDS.No large pleural effusions identified.The cardiomediastinal silhouette is unremarkable.

Output: 1.Diffuse bilateral interstitial opacities compatible with reported history of ARDS.2.Bilateral chest tubes, with an associated small right pneumothorax.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, 51 years old.Reason: acutely hemodynamically unstable s/p liver transplant History: normal respirations, HR 140, BP 73/44, normal mentation Unchanged pleural effusions and basilar opacities.Right jugular introducer removed, and the patient extubated.Left jugular and left subclavian catheters are unchanged.

Output: No change in pleural effusions and basilar opacities status post extubation.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Empyema is one day status post left lung wedge resection. Left pleural effusion and basilar consolidation appears similar compared to previous. Left chest tube unchanged without measurable pneumothorax. Small right effusion stable.

Output: Stable exam. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Post mediastinal biopsy evaluate for pneumothorax. Unchanged scarlike abnormality left lower lobe, described as an infarct on CT. Faint paramediastinal opacity near the left apex similar to recent CT. Heart size is at least upper normal. No pneumothorax. No large amount of pneumomediastinum. Known anterior mediastinal mass not visible by this technique.

Output: No pneumothorax or large pneumomediastinum.