Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with hypertension, positive p-ANCA. Evaluate for interstitial lung disease. LUNGS AND PLEURA: Subtle interstitial thickening is noted at the right base with mild bronchiectasis and associated subpleural cystic change. No evidence of groundglass opacity is seen. The left lung and the right upper lung are spared. Mild air trapping is evident on the expiration views. No suspicious nodules or masses. Calcified right lower lobe micronodule likely represents prior granulomatous disease. No pleural effusion. Volume loss on the right with distortion of the major fissure may reflect postoperative change versus a congenital variant. Correlation with surgical history is recommended.MEDIASTINUM AND HILA: Mildly prominent pretracheal and prevascular lymph nodes are seen. Calcified subcarinal and right hilar lymphoid tissue probably represents prior granulomatous disease.The cardiac size is normal. No pericardial effusion.CHEST WALL: Fusion of the right T4 and T5 ribs laterally, postsurgical versus congenital variant.UPPER ABDOMEN: 8 x 10 mm left adrenal nodule is too small to characterize but probably represents a benign adenoma.

Output: Interstitial changes at the right base probably represent post infectious sequelae given the lack of bilaterality. No definite evidence of interstitial lung disease is seen.


Instruction: Generate impression based on medical findings.

Input: Reason: asess for infection History: neutropenic fever Unremarkable cardiac and mediastinal silhouette. Catheter tip in the SVC.Large lung volumes suggest COPD.No sign of pneumonia.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Evaluate ET tube position. History: See above. ET tube tip 3 cm above carina. NG tube extends beyond the field-of-view of study. Venous catheters are unchanged.Small lung volumes with basilar interstitial opacities, unchanged.

Output: ET tube tip 3 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Fever Basilar suspected atelectasis without additional cardiopulmonary abnormality exam mildly limited with motion

Output: Basilar atelectasis


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: Eval for atelectasis effusion pneumothorax and stability of extrapleural hematoma History: S/P TECAB S/P CT removal Interval removal of a left-sided chest tube with a stable tiny left hydropneumothorax. Redemonstration of a loculated left pleural effusion and underlying atelectasis within the left lower lobe. There is right lower lobe subsegmental atelectasis. The heart size is stable.

Output: 1. Removal of a left sided chest tube with a stable tiny left hydropneumothorax.2. Stable loculated left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.History of hypoxemia. Support devices are unchanged. Bilateral interstitial opacities are unchanged from the prior examination. The cardiomediastinal silhouette is stable.

Output: Stable examination with bilateral pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress of the newborn. Emergent intubation.VIEW: Chest AP (one view) 1/27/15 at 1659 hrs. Left Main bronchus intubation. NG tube and left-sided chest tube again noted. Cardiac silhouette size is normal. Persistent multifocal streaky opacities on a background of diffuse lung haziness and right-sided pleural effusion.

Output: Left main bronchus intubation as described.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: r/o acs History: chest pain Cardiomediastinal silhouette is within normal limits.Streaky bibasilar and posterior basilar opacities compatible with subsegmental atelectasis/scarring.No pneumothorax or pleural effusion.

Output: Streaky basilar opacities compatible with subsegmental atelectasis with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Age: 28 yearsGender: FemaleReason for Study: Reason: assess lung anatomy History: s/p open lap by OG-GYN There is significantly decreased lung volumes.Cardiac size is normal.Mild widening of the mediastinum is nonspecific.Basilar opacities are compatible with atelectasis.No evidence of free peritoneal air.

Output: Nonspecific widening of the superior mediastinum. Basilar atelectasis, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: eval for focal infiltrate History: hypotension, fever Mild cardiomegaly.Basilar septal lines suggestive of interstitial edema.No specific evidence of infection.

Output: Cardiomegaly and mild interstitial edema, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: cough History: cough The heart is normal in size.Abnormal asymmetry of the right hilum, new from prior, could be positional although poorly characterized.Lung volumes are in the lower limits of normal. Right middle lobe calcified granulomas noted. No radiographic findings to suggest pneumonia.The pleural spaces are within normal limits.Limited assessment of the thoracic spine.

Output: No radiographic findings to suggest pneumonia.Limited assessment of both hila. Asymmetry of the right hilum is unchanged from recent studies, possibly artifactual. Correlate with patient's history. If there is smoking history, consider further assessment with chest CT in an nonemergent basis.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and atrial fibrillation Interval progression in size of the cardiac silhouette with a more globular shape suggesting a large pericardial effusion. Associated small pulmonary effusions with streaky patchy densities in both bases may represent early edema over atelectasis and aspiration. Early mild CHF cannot be excluded

Output: Enlarged cardiac silhouette and probable pericardial effusion with and mild CHF


Instruction: Generate impression based on medical findings.

Input: Breast cancer, dyspnea No cardiopulmonary abnormality. Bilateral breast implants and minimal bilateral axillary surgical clips

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 63 year old female with cough. Follow-up on right lower lobe nodule noted on 1/2007. LUNGS AND PLEURA: Previously noted right lower lobe pulmonary nodule measures approximately 6 mm - series 5, image 49 - (stable). Calcified right middle lobe nodule also unchanged.MEDIASTINUM AND HILA: No lymphadenopathy. Coronary calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Stable cholelithiasis.

Output: Right lower lobe pulmonary nodule remains stable since 4/23/2007, indicating benignity. Follow up is no longer necessary for this benign nodule.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: PNA and Improvement in fluid balance s/p lasix History: cough, SOB Stable cardiac enlargement.Diffuse peripheral chronic appearing interstitial opacities with decreased lung volume suggestive of fibrosis.Superimposed edema cannot be excluded.No large pleural effusions.No focal areas of consolidation.

Output: Unchanged appearance of diffuse predominantly peripheral interstitial opacities suggestive of pulmonary fibrosis. Concomitant pulmonary edema cannot be excluded. No new pulmonary opacities noted. CT of the chest would be of value.


Instruction: Generate impression based on medical findings.

Input: Altered mental status Mildly decreased lung volumes without additional cardiopulmonary abnormalityBilateral shoulder moderate osteophytic changes

Output: No acute disease given limitations


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: eval IABP placement History: subclavian IABP in place Dextrocardia with situs inversus.The lungs are unremarkable.Proximal marker IABP projects over the aortic arch.

Output: IABP unchanged in position. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: assess placement chest tube History: chest tube Iatrogenic devices are unchanged. Left basilar pleuroparenchymal opacity, not substantially changed. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Reason: eval shortness of breath History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: pleural effusions, acute pulmonary changes History: hypoxia, chronic dyspnea Small lung volumes, with possible subsegmental atelectasis but otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection or edema.

Output: Small lung volumes, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Worsening hypoxia assess for interval change. ETT 5.5 cm above the level of the carina. Nasogastric tube looped in the stomach.Bilateral airspace and interstitial opacities with interval progression since the prior examination.

Output: Worsening pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: 41F h/o peripheral T cell lymphoma s/p SCT, new onset chest pain, please evaluate History: see 1 Unremarkable cardiac and mediastinal silhouette.Venous catheter is extending to the SVC.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Multinodular goiter with choking sensation and shortness of breath. Enlargement of goiter. Is there airway obstruction? CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted. The airway is patent.CHEST WALL: The thyroid may be slightly larger than before. Reference made to a soft tissue neck CT obtained concurrently but reported separately which describes the thyroid in detail. UPPER ABDOMEN: Cholelithiasis.

Output: 1. No evidence of airway compromise.2. Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Device placement in EP lab Right dual-lead pacemaker device unchanged.Stable cardiomegaly and aortic tortuosity.No specific evidence of infection or edema.No pneumothorax.Degenerative changes of the thoracic spine with mild anterior wedging of multiple vertebral bodies.

Output: No acute cardiopulmonary abnormality. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea on exertion History: as above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with shortness of breath, elevated PA pressures. Evaluate for pulmonary hypertension and rule-out interstitial lung disease, rule-out pulmonary embolic disease. CHEST:PULMONARY VASCULATURE: No PE. Diagnostic quality study to the subsegmental level.Mild enlargement of the main pulmonary artery, compatible with pulmonary hypertension.LUNGS AND PLEURA: Mild basilar scarring/atelectasis bilaterally. Scattered micronodules bilaterally, many of which are clustered in the right lower lobe and including a calcified granuloma.No suspicious masses, or pleural effusion.Few simple intrapulmonary cysts.No evidence of significant air trapping on expiration views.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Marked degenerative changes of the lower thoracic spine with significant compression wedge deformity of T11 vertebral body of indeterminate age.UPPER ABDOMEN: Small amount of perihepatic ascites.

Output: 1. No PE.2. Scattered micronodules, probably inflammatory in etiology. If patient is of high-risk (for example, smoking history), follow-up CT at 12 months is recommended to confirm stability and/or resolution.3. Findings compatible of mild pulmonary hypertension with no evidence of interstitial lung disease.Findings were communicated to Dr. Beckert (pager: 3580) of the emergency department by the radiology resident on call.


Instruction: Generate impression based on medical findings.

Input: 59 years old Male. Reason: Evaluate for pulmonary edema History: Dyspnea. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal. The single lead ICD is noted.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: FemaleReason for Study: Reason: infiltration History: productive cough The cardiac mediastinal silhouette is unremarkable.Airspace opacity in the right middle lobe compatible with acute pneumonia.Remaining lungs are clear.No pleural effusion.

Output: Right middle lobe pneumonia. This was conveyed to the ED by phone at 12:55 PM


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p right thoracotomy History: NA Two right apically directed chest tubes are now in place.Streaky left mid zone and right upper lobe opacities. No significant pneumothorax is present. Subcutaneous emphysema over the right inferolateral chest wall. Multilevel degenerative changes of the spine.

Output: No significant pneumothorax in the setting of 2 right chest tubes.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: worsening shortness of breath, interval change History: as above Decreased lung volumes with elevation the right hemidiaphragm.Stable cardiomediastinal silhouette.Right basilar opacity is compatible with atelectasis and possible effusion.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance with right basilar opacity compatible with consolidation/atelectasis and possible pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Evaluate for ileus, follow-up, prior history of vomiting Evidence of colonic ileus with hepatic flexure more air-filled compared to earlier exam, no significant interval change otherwise. Findings discussed by oncall resident with Dr. Rebeiz via phone at 2:10 a.m. on 11/6/16. Percutaneous gastrostomy tube seen overlying mid abdomen.Please refer to same day chest radiography for additional findings.

Output: Evidence of colonic ileus with hepatic flexure more air-filled compared to earlier exam, no significant interval change otherwise.


Instruction: Generate impression based on medical findings.

Input: 64 years, Male. Reason: Confirm feeding tube placement. Pelvis excluded from field-of-view. Dobbhoff tube overlies antropyloric area. Multiple surgical drains ECMO catheter and postsurgical changes chest as well as left pleural effusion again seen. Please refer to chest x-ray for additional chest findings.

Output: Dobbhoff tube tip overlies antropyloric area.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.+PPD or positive Quantiferon evaluate for active TB. Normal heart size. Lungs are clear. No signs of active intrathoracic tuberculosis.

Output: Normal chest. No evidence of active intrathoracic tuberculosis.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: wheezing, lul collapse, lad History: see above Left central venous catheter unchanged.There is almost complete opacification of the left hemithorax compatible with increasing atelectasis most likely related to bronchial obstructionAgain identified is right paratracheal mass or lymphadenopathy.Right pleural effusion unchanged.

Output: Significant interval change with almost complete opacification of the left hemithorax compatible with increasing left bronchial obstruction.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: Pre kidney transplant evaluation/end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney transplant There is a fullness to the upper right hilar region without clear takeoff of the right upper lobe bronchus which in the absence of prior imaging warrants further imaging. The heart size is normal. There is no pneumothorax or pleural effusion.

Output: Right upper hilar fullness for which a possible mass cannot be excluded. Further evaluation with CT scan is recommended.These findings were relayed by telephone to Melissa Sands at 4:49 PM on 10/26/16.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: s/p left subclavian port removal. r/o retained material and PTX History: none Mild cardiomegaly.Unchanged right pleural effusion or pleural thickening.Left subclavian catheter removed.Right subclavian pacemaker unchanged.

Output: Persistent right effusion and cardiomegaly. Subclavian catheter removed. No pneumothorax or retained catheter fragment.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess for pneumonia History: cough, fever Evidence of prior granulomatous infection with calcified right hilar lymph nodes. No pneumonia or edema. The pleural spaces are clear. Heart size within limits of normal.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Shortness of breath, cough, missed dialysis x2. Evaluate for pneumonia and fluid overload. No pulmonary or pleural abnormalities. No evidence of pulmonary edema or pneumonia. Prominent pulmonary vasculature.Unchanged cardiomegaly.Right IJ central catheter with tip at cavoatrial junction.

Output: No acute cardiopulmonary abnormalities. No evidence of pneumonia or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Heart size upper normal.No specific evidence of infection or edema.No substantial pleural effusions.

Output: Heart size upper normal, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: ? CP History: ? PTX Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: MaleReason for Study: Reason: R/O Perforation History: Hx Toxic megacolon Markedly decreased lung volumes with stable cardiomediastinal silhouette.Basilar opacities compatible with atelectasis.Radiolucency underneath the right hemidiaphragm most likely representing bowel gas.No definite evidence of free peritoneal air.Air-filled dilated loops of bowel in the upper abdomen.

Output: Markedly decreased lung volumes with basilar atelectasis. Radiolucency underneath the right hemidiaphragm most likely representing bowel gas. No definite evidence of free peritoneal air.


Instruction: Generate impression based on medical findings.

Input: Male 62 years old Reason: short of breath, r/o effusion v. pneumo History: lung cancer stage 4 Decreased lung volumes. Cardiac silhouette size is top normal. Bibasilar atelectasis. No specific evidence of edema or infection. Right seventh lateral rib fracture. Small right pleural effusion.

Output: No specific evidence of infection. Right lateral rib fracture and small right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 62 year-old female status post recent CABG. Evaluate for pulmonary edema, infection or hydronephrosis CHEST:LUNGS AND PLEURA: Endotracheal tube is in place. Bilateral groundglass opacities which may be secondary to pulmonary edema. Left lower lobe consolidation suspicious for pneumonia. Bilateral pleural effusions, small.MEDIASTINUM AND HILA: Heart is enlarged.CHEST WALL: Postsurgical changes involving the sternum and anterior chest wall.ABDOMEN:LIVER, BILIARY TRACT: Vicarious excretion of the contrast into the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cardiomegaly with bilateral extensive groundglass opacities, most likely representing edema. Left lower lobe consolidation is suspicious for pneumonia. Bilateral small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Hypoxemia, VQ scan Improved aeration and presumed baseline was scattered granuloma. No distinct superimposed focal airspace process in light of prior studies. Cardiac silhouette and mediastinum are exaggerated due to scoliosis

Output: Scattered granuloma without evidence of superimposed new acute disease. Appearance suggests old granulomatous disease exposure


Instruction: Generate impression based on medical findings.

Input: Reason: daily ett, lung field eval History: ett ET tube 3 cm above the carina.Right jugular catheter unchanged.Bilateral pleural effusions with underlying atelectasis.

Output: Pleural effusions and atelectasis, slightly increased.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: on CPAP, trach dependent, eval lung fields History: on CPAP, trach dependent Tracheostomy tube remains in place. Parahilar opacities, not substantially different. Small left pleural effusion, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Unchanged mild perihilar opacities, likely representing edema.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: Chest pain/SOB History: SOB, CHF Cardiomegaly. Perihilar and basilar predominant interstitial and airspace opacities, compatible with pulmonary edema, Small pleural effusions. Unchanged calcified perihilar lymph nodes.

Output: Findings compatible with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: PNA History: intubated ET tube tip approximately 2 cm above the carina.Mild basilar opacity compatible with atelectasis and small effusions.No specific evidence of pneumonia.

Output: Mild basilar atelectasis and small effusions with no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: eval lung fields History: chest pain Normal heart size. Moderate right pleural effusion. Right upper lobe reexpansion with large underlying mass now visible. Left lung is well aerated.

Output: Moderate right pleural effusion and large right upper lobe mass.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: Shortness of breath Questionable mildly increasing small layered effusions which may partially be due to a more semiupright portable positioning. Persistent mild cardiomegaly with chronic appearing interstitial opacities and extensive scattered changes related to old granulomatous disease exposure. Specifically no discrete new superimposed focal air space process superimposed upon COPD changes. Of particular note is apical scarring with asymmetric greater on the left. Overall gross stability, however prior imaging at this institution is limited. Comparison with prior outside imaging if available would be helpful. Pager 3453 contactedCABG clips and midline sternotomy.

Output: Minimal increasing questionable CHF, however this change may be partially and/or entirely due to differences in positioning. Serial imaging will be helpful


Instruction: Generate impression based on medical findings.

Input: Male, 29 years old.Reason: s/p left thoracentesis. r/o pneumothorax History: pleural effusion Line position stable. Interval decrease in left pleural effusion. No other interval changes.

Output: Decreased left effusion, otherwise no interval change.


Instruction: Generate impression based on medical findings.

Input: Staging CT for cholangiocarcinoma status post resection CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality noted -- normal-appearing subcentimeter size small lymph nodes scattered.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes are seen in the left lobe of the liver status post resection. The bulk of the resection appears to be more inferiorly in the lateral left lobe in the region of the prior noted mass on MR. There is, however remaining lateral segment two parenchyma superiorly remaining.. This superior portion left lobe liver is nearly totally replaced with nonenhancing low attenuation near confluence zones with the largest of these measuring 2.5 x 3.1 cm. on the 10 minute delay image, much of the zones show delayed retention of contrast indicating they are not postoperative necrosis in liver, but most likely viable tumor with a fibrous matrix mixed with postoperative changes. This process extends medially and inferiorly towards the porta hepatis.As seen on prior scans common no visualization of the left portal vein.The right lobe of the liver shows no mass parenchymal lesions, however there is new right hepatic duct dilatation extending to the porta hepatis worrisome for early obstruction. The distal bile duct is not dilated past the porta hepatis into the head of the pancreas.Gallbladder is normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A mildly enlarged lymph node in the porta hepatis is seen just anterior to the main portal vein (series 12 on image 93) measuring 1.1 x 1.1 cm which appears new since the prior CT examination of 8/23/2011.An enlarged portacaval lymph node is seen (series 12, image 101) which measures 1.7 x 1.6 cm. This previously measured 1.0 x 0.8 cm.More inferiorly in the retroperitoneum does not show significant adenopathy.BOWEL, MESENTERY: Diffuse haziness is seen in the anterior omentum -- while this may be postoperative changes, there is nodularity to this (series 3, image 39) which is worrisome for omental disease spread of tumor.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: Small amount of peritoneal fluid in the dependent pelvis. No other abnormalities seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Apparent wedge resection of the inferior segment 3 left lobe liver mass with near replacement of the remaining lateral segment of the liver now with apparent tumor which cannot be separated from additional postoperative changes as well. The delay enhancement and large regions of this are not compatible with postoperative change in the majority of this is most likely tumor. 2. New dilatation of the right hepatic duct suggesting early obstruction at the hepatic duct confluence at the level of the confluence with common hepatic duct. 3. New enlarged porta hepatis lymph nodes as measured above. 4. Haziness and some nodular changes in the omentum worrisome for metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infiltrate History: AMS Normal heart size with severe coronary artery calcification.Skin folds over the right lung but no pneumothorax.No sign of pneumonia or other acute abnormalities.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Mantle cell lymphoma pre SCT evaluation Right subclavian chest port tip at the SVC/artery junction. Left humeral prosthesis.Right upper lobe bronchial wall thickening. This is seen to a lesser extent in the central airways of other lobes. Interval clearing of opacity previously seen in the right lower lobe.No pleural fluid or pneumothorax. No focal airspace opacities.

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


Instruction: Generate impression based on medical findings.

Input: Heart transplant, check status Motion degrades sensitivityETT and NG removed. Swan-Ganz again projects in right pulmonary outflow trackDecreased lung volumes with moderate cardiomegaly and basilar changes suggesting perihilar and basilar edema similar to prior study

Output: ETT and NGT removed


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: ETT History: ETT Unchanged pulmonary opacities and pleural effusions with moderate cardiomegaly.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.An NG tube extends below the lower margin of the image.

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


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: status post ETT adjustment History: ETT Endotracheal tube has been pulled back and now terminates approximately 4 cm from the carina. Other lines and tubes, unchanged.Diffuse pulmonary opacities again noted. Bilateral pleural effusions, left greater than right. No definite pneumothorax. Unchanged cardiomegaly.

Output: Endotracheal tube has pulled back and now terminates 4 cm from the carina. Otherwise, no substantial change.


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old.Reason: ETT, PNA History: ETT, PNA Left basilar atelectasis and small pleural effusion.ET tube advanced, the tip now 4 centimeters above the carina.A Dobbhoff tube extends below the lower margin of the image.

Output: ET tube repositioned. Stable left basilar opacities and small pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Reason: 50F h/o SOB and respiratory distress post-op History: SOB Interval development of right lung haziness which may represent infection and/or effusion. Follow-up recommended. Stable cardiomediastinal silhouette.Interval extubation and removal of NG tube.

Output: Interval development of right perihilar opacity is and likely effusion.


Instruction: Generate impression based on medical findings.

Input: 48 year-old female with 4-cm splenic lesion, left lower lobe infiltrate, recent sepsis. AML refractory to treatment. Flank pain, cough. CHEST:LUNGS AND PLEURA: Moderate emphysematous changes remain. Bilateral groundglass opacities have developed, greatest centrally.Infiltrate in the left base is most likely due to atelectasis, not significantly changed from 5/25/10. Right basilar atelectasis persists. Small bilateral pleural effusions remain, left greater than rightMEDIASTINUM AND HILA: Small mediastinal lymph nodes remain. Atrophic right lobe of the thyroid glandCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged. Numerous small hypodensities are identified in the right lobe of the liver, most located posteriorly. Some of these lesions are clustered.SPLEEN: Hypodense splenic lesion with a few septations has increased in size, measuring 7.6 x 5.0 cm, suggestive of abscess. It now demonstrates decreased densityPANCREAS: 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: Trace ascitesPELVIS:UTERUS, ADNEXA: Uterine lesion is compatible with a fibroidBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites

Output: Splenic lesion, increasing in size, likely representing abscess.Numerous small hypodensities developed in the right lobe of the liver, likely representing abscesses, though leukemic infiltrate is also possible.Development of groundglass opacities throughout both lungs, which may represent edema or drug reaction.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Left upper lobe lung cancer. 2 left-sided chest tubes; the more cranial tube tip is directed inferiorly projecting over the posterior pleural space but the lower tube which extends cranially projects over the soft tissues of the left chest wall and does not appear to be in the pleural space on the lateral film.Moderate loculated fluid in the mid left thorax slightly improved in volume. No significant sized pneumothorax. Decreasing hazy opacity in the right upper lobe. Right lung solid nodules likely unchanged.

Output: The more caudal of the 2 chest tubes projects over the soft tissues of the left posterior chest wall and appears to be external to the bony thorax, correlate with physical examination.


Instruction: Generate impression based on medical findings.

Input: 78-year-old male with history of colon carcinoma CHEST:LUNGS AND PLEURA: Right upper lobe calcified granuloma not significant change from previous study.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Subcentimeter lesion in the liver is unchanged.SPLEEN: 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: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with history of metastatic esophageal adenocarcinoma. Evaluate for progression of metastatic disease. CHEST:LUNGS AND PLEURA: A left upper lobe index lesion measures 1.7 x 1.4 cm on axial image 45/111 and is unchanged. Right lower lobe scar/atelectasis is unchanged. No new suspicious nodules or masses. Mild emphysematous changes are stable.MEDIASTINUM AND HILA: A reference left paratracheal/AP window lymph node measures 1.6 x 1.2 cm on axial image 38/225 and is smaller when compared to the prior exam where it measured 1.4 x 2.2 cm. Multiple para-aortic nodes are redemonstrated. A left para-aortic reference lesion demonstrates stable measurements of 2.2 x 1.7 cm on axial image 72/225; however, by visual inspection on the coronal images, these lymph nodes do appear slightly more prominent.Postoperative changes are redemonstrated at the mid to distal esophagus.CHEST WALL: Right chest wall port catheter in place.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Confluent retrocrural, retroperitoneal and porta hepatic lymphadenopathy is redemonstrated. A previously referenced conglomeration of retroperitoneal nodes measures 11 x 6 cm on axial image 117/225 which is equivocally larger when compared to the prior measurements of 10 x 6 centimeters. However, visual inspection of the coronal images again suggests that these lymph nodes are more prominent. This conglomeration of tissue encases the right renal artery, displaces the left renal vein superiorly, and severely attenuates the adjacent IVC, findings which are grossly unchanged.Atherosclerotic disease affects the abdominal aorta and its branches.BOWEL, MESENTERY: A broad based ventral abdominal wall hernia is again seen.BONES, SOFT TISSUES: Bony bridging is again evident between two posterior right-sided ribs.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval change in reference measurements as above.


Instruction: Generate impression based on medical findings.

Input: 70 year-old female with history of non-small cell lung cancer. Evaluate disease status. CHEST:LUNGS AND PLEURA: Extensive right paramediastinal fibrosis is unchanged compatible with radiation therapy. Right anterior scarlike opacities are grossly unchanged (axial image 40/91). Scattered nodular opacities seen on the prior examination have nearly completely resolved compatible with aspiration or an infectious etiology.No new nodules or masses. Moderate centrilobular emphysema unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Sclerosis of the right eighth and ninth ribs unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cystic lesion unchanged and probably benign.PANCREAS: 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 noted

Output: 1.Improvement in previously seen nodular opacities compatible with resolution of aspiration or infection.2.No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Age: 85 yearsGender: FemaleReason for Study: Reason: hx of DM, HTN, DVT p/w chest pain; eval for infiltrate, edema History: chest pain Stable cardiac enlargement with a large hiatal hernia redemonstrated.Right apical calcification unchanged.No new focal airspace opacities.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: 69 years old Female. Reason: r/o PE History: NP Cough; SOBOE. There is a large right pleural effusion and probable small left pleural effusion. Compression atelectasis are seen in the right lower lung.

Output: Large right effusion and probable small left pleural effusion with compression atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Squamous cell CA now with fever. Limited review of coronal lung images from CT dated 8/5/2015. Interval progression of left lower lobe atelectasis, now with complete opacification of the cardiophrenic angle. Bronchial wall thickening and mild associated atelectasis medially at the right lung base also slightly worse. Tracheostomy tube and left subclavian pacemaker unchanged in position.

Output: Worsening basal atelectasis, probably related to aspiration, unable to exclude development of pneumonia on the left.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: assess lines and tubes History: as above ETT tip 2.5 cm above the level of the carina. Right jugular catheter tip projects over the right atrium. Enteric tube sidehole beyond the GE junction.Dense consolidation left lower lobe about the same. Retrocardiac atelectasis. Right perihilar airspace process also similar.

Output: ETT tip 2.5 cm above the carina. No acute change in multifocal airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: intubated History: intubated Left pleural effusion and left lower lobe consolidation unchanged.Multiple chest tubes.Status post sternotomy for mitral valve repair, with cardiomegaly.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular Swan-Ganz catheter, tip in main pulmonary artery.The previously seen IABP catheter is no longer visible and may have been withdrawn.

Output: IABP catheter removal. Unchanged pulmonary opacities and left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval for pneumothorax History: R chest tube found disconnected Left apical chest tube remains in place. Small left-sided pneumothorax, as before. Unchanged bibasilar opacities. No new focal pleural parenchymal opacity. Unchanged heart size. Prominent loops of bowel again noted within the upper abdomen.

Output: Left apical chest tube remains in place. Small left-sided pneumothorax, as before. Unchanged bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: improvement in edema after lasix? History: hypoxia, history of COPD, possible infeciton and fluid over load The cardia mediastinal silhouette is unremarkable.Emphysema.Decreased lung volumes with extensive basilar predominant interstitial opacities most likely chronic in origin.No focal areas of consolidation.No large pleural effusions..

Output: Extensive basilar predominant interstitial opacities most likely chronic in origin. However, superimposed edema cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 66 years old Female. Reason: assess for pna, pleural effusion, other abnormality History: SOB, cough, hx breast cancer. The cardiac silhouette is normal. There is a questionable small right pleural effusion. There is no evidence for infiltrate in both lung or pneumothorax.

Output: Questionable right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female 39 years old Reason: fever, night sweats, costochondritis History: as above No focal consolidation, pleural effusion or pneumothorax. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 45 yearsGender: MaleReason for Study: Reason: eval lung fields History: cp The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: cough, sob Densely calcified granuloma at the left base and calcified hilar lymph nodes compatible with previous infection.No sign of pneumonia or CHF.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: SOB, weakness, new O2 requirement, fungal pneumonia History: new O2 requirement Tracheostomy tube is in place. Cervical spine hardware is partially imaged. Unchanged cardiomegaly. There is diffuse opacity in the left lung. There is no opacity visualized in the right lung. No pleural effusion.

Output: Diffuse left lung opacity is nonspecific and is consistent with infection given patient's fungal pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: ETT placement History: altered mental status, no gag reflex, intubated for airway protection Patchy interstitial and airspace opacities suggestive of aspiration or atypical edema.Heart size normal.ET tube tip approximately 3 cm above the carina.A Dobbhoff tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: Pre-chemo evaluation History: As above No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Right jugular catheter, tip in SVC.Cervical spine stabilization hardware noted.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: ? Pneumonia History: chest pain Nonspecific basilar opacities are unchanged, more likely aspiration than infectionHeart size normal.No significant change.

Output: Nonspecific basilar opacities more likely aspiration than infection.


Instruction: Generate impression based on medical findings.

Input: 68 years old Female. Reason: cardiopulm eval, hx of metastatic Breast ca s/p bilateral mastectomies, LN dissection History: as above. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. There is a questionable nodular density in the right upper lobe near the superior portion of the right lung hilum. Surgical clips are seen in the bilateral axillary regions.

Output: Questionable lung nodule in the right upper lung. Suggest further evaluation with CT if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Reason: dyspnea in asthmatic w cardiac risk factors History: dyspnea, chest pain Small lung volumes with motion artifact.Mild streaky opacity in both lower lobes most likely due to focal atelectasis due to mucous plugging or aspirated secretions.

Output: Mild basilar opacities most likely due to bronchial mucous plugging and atelectasis. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: check pulmonary status History: check pulmonary status Right IJ introducer in place.Interstitial and airspace opacities in both lungs are progressively increasing.Right upper lobe nodular opacity slightly increased from the prior exam.Bilateral pleural effusions and basilar atelectasis unchanged.

Output: Worsening interstitial/air space opacities in both lungs compatible with edema. Increasing nodular opacity in the right upper lobe concerning for infection.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Crackles and elevated JVD. Cardiomegaly with severe enlargement of the central pulmonary vasculature suggesting pulmonary hypertension. Interval development of perihilar opacities consistent with pulmonary edema. Basal/dependent atelectasis, right greater than left. Dobbhoff tube tip just beyond the GE junction. Valve prosthesis and sternal hardware unchanged allowing for patient rotation.

Output: Severe CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Cough with blood-tinged sputum and myalgias. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. Lung volumes are low normal.

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


Instruction: Generate impression based on medical findings.

Input: Status post left lower lobe thoracotomy, with result of synovial cell sarcoma, performed in 4/10, status post chemo. Acute shortness of breath, now resolved. LUNGS AND PLEURA: Status post left lower lobectomy with postsurgical changes and volume loss, unchanged. Right basilar atelectasis, slightly increased from previous. Scar-like linear opacities in the left lung base, unchanged.Previously described micronodule abutting the right major fissure ( image 40/series 5) appears more scar-like than previous.MEDIASTINUM AND HILA: Left upper extremity central line tip is in the SVC. Interval removal of right chest port catheter. Previously seen thrombus in the right jugular vein has decreased in size.CHEST WALL: No significant abnormality noted..UPPER ABDOMEN: No significant abnormality noted..

Output: 1. No new abnormalities in the chest. Post surgical changes in the left lung and right basilar atelectasis, without significant changes.2. Decrease in size of the right jugular vein thrombus.


Instruction: Generate impression based on medical findings.

Input: Age: 39 yearsGender: MaleReason for Study: Reason: Eval lines/tubes/devices History: Intubated Dobbhoff tube has been placed with its tip in the margin of the image.ET tube with its tip approximately 5 cm above the carina.Right IJ venous catheter with the tip in the SVC.Left-sided chest tubes and pleural drain unchanged.Increasing loculated left pleural effusion with opacity over the left upper lung zone over the last 2 days possibly representing a hematoma.Right pleural effusion unchanged.Interval improvement in the right upper lobe segmental atelectasis.No significant pneumothorax.

Output: Interval placement of a Dobbhoff tube. Bilateral pleural effusions with loculation on the left possibly representing an extrapleural hematoma.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p Open biopsy of the pleura History: post-op Moderate left pleural effusion with associated atelectasis, not significantly changed.Stable cardiomediastinal silhouette.The right lung is clear.Unchanged right chest port, tip in the SVC.

Output: Persistent left pleural effusion with associated atelectasis and volume loss.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: acute chest History: infection Stable global cardiomegaly.No signs of pulmonary edema or abnormal focal lung parenchymal opacities to suggest pneumonia.The pleural spaces are within normal limits.Mild diffuse osseous sclerosis. Deformity of the right humeral head secondary to prior avascular necrosis. Deformity of thoracic vertebral bodies, in keeping with history of sickle cell disease.

Output: No radiographic findings to suggest pneumonia or acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: To rule out any pneumonia History: Elevated WBC Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Cardiac loop recorder unchanged.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: Pre-surgical eval History: SOB Changes of a median sternotomy are noted. Surgical clips project over the mediastinum.The cardiomediastinal silhouette is normal. Calcified mediastinal lymph nodes are noted. No focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary disease.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: repeat History: repeat Interval development of predominantly interstitial perihilar and basilar opacities. The cardiomediastinal silhouette is within normal limits. Early pulmonary edema should be considered.There are no pleural effusions.No pneumothorax.

Output: Interval development of predominantly interstitial perihilar and basilar opacities. Early pulmonary edema should be considered


Instruction: Generate impression based on medical findings.

Input: Age: 61 yearsGender: MaleReason for Study: Reason: swan location? History: Patient has swan in Left IJ Swan-Ganz with its tip in the right upper lobe pulmonary artery.Left-sided ICD unchanged.Stable cardiac enlargement.Right pleural effusion and basilar opacities compatible with edema/atelectasis similar in appearance prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged with Swan-Ganz catheter tip in the proximal right upper lobe pulmonary artery. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: ETT placement, assess for volume overload after massive transfusion. ETT tip 6 cm above the level of the carina.Right jugular introducer projects over the right brachiocephalic vein.Moderate to severe interstitial and alveolar opacities consistent with edema, right greater than left.No pneumothorax.

Output: Moderate to severe interstitial and alveolar opacities consistent with edema. ETT tip 6 cm above the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Concern for pneumonia There is a small left pleural effusion. No pneumothorax.No abnormal focal lung parenchymal opacities.The cardiac and mediastinal contours are within normal limits.The right upper extremity PICC overlies the right axilla.

Output: Possible trace left pleural effusion. No radiographic findings to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: 64 year-old man with metastatic melanoma. Please evaluate current disease. CHEST:LUNGS AND PLEURA:Bilateral multiple pulmonary nodules are appreciated in the lungs. The largest lesion is located in the posterior aspect of the left superior lobe and measures 2.7 x 2.7 cm in size. Small right pleural effusion is noted.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy or pericardial effusion is appreciated.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and is without any intraparenchymal lesions. There is a calcified gallstone in the neck of the gallbladder. There is no wall thickening or fat stranding.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a simple cyst at the superior aspect of the right kidney. There is also a high attenuation cyst in the left kidney which requires a non-contrast study for further evaluation. No evidence of hydronephrosis.RETROPERITONEUM, 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: There is a right inguinal hernia without any evidence of bowel wall thickening or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Multiple bilateral metastatic pulmonary nodules.2. Indeterminate high attenuation cyst in the left kidney which requires a noncontrast study for further evaluation.3. Cholelithiasis.4. Right inguinal hernia.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: assess for aspiration PNA History: altered mental status Increased opacity in the left mid to lower lung zone could represent pneumonia or artifact of overlying soft tissue.Elsewhere, the lungs are unremarkable.Diffuse sclerotic skeletal metastases unchanged.

Output: Left mid and lower lung zone opacity, either infection or artifact. A lateral view might be helpful versus CT.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Reason: cough since 02/2016 History: chest discomfort - esp upon coughing Heart and mediastinal silhouette is normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of colon cancer CHEST:LUNGS AND PLEURA: Reference left lower lobe nodule measures 8 x 6 mm image number 61, series number 4, not significantly changed from previous study. Right-sided pleural effusion has resolved. Other bilateral nodules are also not significantly changed. Soft and demonstrate central cavitation.MEDIASTINUM AND HILA: The tip of the right port catheter is in the SVC and there is redundancy in the catheter.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Index segment 8 lesion measures 3 by 1.4 cm on image number 77, series number 3, not significantly changed from previous study. Other ill-defined hypodense lesions throughout the liver are also unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral simple appearing cysts unchanged.RETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node measures 4 x 1.2 cm on image number 95, series number 3. No significant change. IVC filter is in place.BOWEL, MESENTERY: Nonobstructing small bowel loops herniated through the ventral hernia are unchanged.BONES, SOFT TISSUES: Sclerotic lesion at the L3 vertebral body has slightly increased in size.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: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT other than slight increase in the size of the sclerotic lesion in the L3 vertebral body


Instruction: Generate impression based on medical findings.

Input: 55 years, Male. Reason: eval bowel loops History: s/p robotic prostatectomy s/p robotic takeback for bleeding. Now vomiting. ?ileus The cardiac silhouette and pulmonary vascular markings are within normal limits. A retrocardiac infiltrate is suspected. No definite pleural effusion or pneumothorax. The descending thoracic aorta is mildly tortuous.There are numerous loops of dilated small bowel with air-fluid levels and gaseous distention of the hepatic and splenic flexures of the colon. No evidence for pneumoperitoneum. Colonic interposition between the liver and right hemidiaphragm is noted. There is extensive subcutaneous emphysema in the bilateral flank and pelvic regions. A pelvic surgical drain is in place.

Output: 1. Dilated small bowel loops with air-fluid levels. Early bowel obstruction cannot be excluded. Extensive subcutaneous emphysema. No pneumoperitoneum.2. Suspected retrocardiac infiltrate.


Instruction: Generate impression based on medical findings.

Input: Reason: Postop bilateral VATS History: postop bilateral VATS Interval placement of bilateral chest tubes and resolution of loculated pneumothorax and subcutaneous air collections.Diffuse nonspecific opacity suggestive of edema with pleural effusions and atelectasis.Small loculated air collection in the left infrahilar area, unchanged.A more recent radiograph has been interpreted.

Output: New chest tubes and interval resolution of pneumothorax and subcutaneous air collections.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Hypoxemic with lung transplant evaluate for infiltrate/effusion. Fibrotic native left lung with slowly progressive groundglass opacity.Low normal lung volume on the right, similar to recent previous. Faint patchy opacities in the right lung, most pronounced in the right upper lobe, new from recent CT and suspicious for infection in the appropriate clinical context. In the absence of signs of infection this could be due to aspirated secretions.

Output: Patchy faint opacities in the right lung suspicious for infection in the appropriate clinical context. Slowly progressive groundglass opacities in the left lung could also reflect infection or, alternatively, acute exacerbation of ILD.


Instruction: Generate impression based on medical findings.

Input: Reason: hx of DM, HTN, recent cath p/w chest pain History: intermittent L-sided chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male 52 years old Reason: dialysis fem line placed History: as above Endotracheal tube tip terminates approximately 5 cm above the carina. Total artificial heart . Previously identified pneumopericardium has nearly completely resolved. Right internal jugular central venous catheter tip terminates in the SVC.Cardiomegaly with basilar predominant interstitial opacity similar to prior. Bilateral pleural effusions, loculated on the right, unchanged.

Output: Cardiomegaly, artificial heart, pleural effusions and basilar opacities similar to prior.


Instruction: Generate impression based on medical findings.

Input: 68 years, Male. Reason: r/o obstruction History: increasing abd distention, emesis, abd discomfort Bilateral pleural effusion and bibasilar atelectasis are again noted. The cardiomediastinal silhouette is within normal limits.Gaseous distention of small and large bowel, findings are compatible with ileus. No evidence of pneumoperitoneum.

Output: Gaseous distention of small and large bowel, findings are compatible with ileus.


Instruction: Generate impression based on medical findings.

Input: Right chest pain with history of bilateral spontaneous pneumothoraces status post bleb resection. Question recurrence of pneumothorax. Apical suture lines consistent with history of bleb resections. Lung volumes remain large. No conclusive pneumothorax. Normal heart size. No focal airspace opacities, pleural fluid or signs of pulmonary edema.

Output: No visible pneumothorax. Inspiration and expiration technique chest radiographs may be obtained if the patient remains symptomatic.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o active TB History: TB exposure Normal heart size with an aortic valve prosthesis in place.Mild scarring at the left base and no other significant pulmonary abnormalities.

Output: No sign of TB or other acute findings.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with previously seen hypoechoic focus on ultrasound the right kidney. Please evaluate. Patient also presenting with right flank pain CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of perinephric fat stranding, hydronephrosis, hydroureter, nephrolithiasis, ureteral calculus. Symmetric excretion on delayed phase imaging. No evidence of renal mass. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated loops of proximal small bowel with a definite transition point. Status post partial colectomy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 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: No other significant abnormality noted.

Output: Kidneys within normal limits.Mildly dilated loops of proximal small bowel. No CT findings to account for right flank pain.


Instruction: Generate impression based on medical findings.

Input: Reason: altered mental staus History: as above Unremarkable cardiac and mediastinal silhouette. Mild basilar interstitial opacity of uncertain chronicity, not significantly changed from previous.No sign of pneumonia.

Output: Basilar interstitial opacity most likely chronic though possibly related to interstitial edema. Further follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: SOB, chest pain and back pain. Chest pain when breathing. Known aortic dissection. Interval increase in left pleural fluid volume now occupying approximately one half of the left hemithorax. Small right pleural fluid collection is unchanged. Compressive atelectasis of the left lower lobe. Right jugular AD unchanged in position. Sternotomy hardware appears intact. Mediastinal widening unchanged.

Output: Enlarging left pleural fluid collection. Mediastinal widening not appreciably changed, please refer to subsequent CTA.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pneumonia in DKA History: see above Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: sob History: sob Low lung volumes with basilar opacities likely representing atelectasis. Aspirated secretions cannot be excluded. Follow-up recommended.Heart size within normal limits.No pleural effusion. No pneumothorax.

Output: Low lung volumes with basilar opacities likely atelectasis. Aspirated secretions cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male with vocal cord paralysis and subglottic stenosis now with cough and stridor.VIEW: Chest AP (one view); neck soft tissue AP and lateral 8/7/2016 Chest: The left upper extremity PICC and enteric tube have been removed.Normal cardiothymic silhouette size. No focal pulmonary opacity, pleural effusion or pneumothorax. Ingested contrast material is present within the transverse colon.Neck: There is prominence of the soft tissue contour at the C4-5 levels with narrowing of the subglottic airway compatible with history of subglottic stenosis. No abnormal thickening of the epiglottis or aryepiglottic folds.

Output: Normal chest radiograph. Narrowing of the subglottic airway is compatible with subglottic stenosis.


Instruction: Generate impression based on medical findings.

Input: Age: 66 yearsGender: MaleReason for Study: Reason: bivona location, also concern for infection History: vomiting, high peak airway pressures Support devices unchanged.Stable cardiomediastinal silhouette.Pulmonary opacities and pleural effusions similar to prior exam.No new pulmonary opacities identified.Large amount of free peritoneal air redemonstrated.

Output: Port devices unchanged. Stable cardiopulmonary appearance with distant large amount of free peritoneal air.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Swan status post PCI and Impella device. ETT tip 4 cm above the level of the carina.IABP marker 6.5 cm below the top of the aortic arch.Impella device in expected position.Enteric tube tip off the caudal margin of the film.Swan-Ganz catheter from an IVC approach terminates at the main pulmonary artery level.Persistent left costophrenic angle opacity nonspecific and could be the result of pleural fluid superimposed over a large pericardial fat pad.Hazy opacity bilaterally remains mild but is suspicious for edema and aspirated secretions.

Output: Swan-Ganz catheter tip at the main pulmonary artery level. Mild CHF.


Instruction: Generate impression based on medical findings.

Input: 75-year-old male with new left lower lobe mass immediately for cancer and metastatic focus. CHEST:LUNGS AND PLEURA: Patient's known soft tissue mass in the left lower lobe, centered on the left hilum with extension into the adjacent lung parenchyma and subcarinal spaces unchanged. Large left-sided pleural effusion is unchanged. Small right-sided pleural effusion, unchanged.Left lower lobe atelectasis.MEDIASTINUM AND HILA: Infiltrative mass invading the mediastinum is unchanged. Multiple mediastinal adenopathy is unchanged. Left main pulmonary artery and its major branches are invaded by the mass.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: Retroperitoneal likely metastatic adenopathy. The index node measures 4.5 x 1.7 cm on image number 126, series number 3.BOWEL, MESENTERY: Small amount of ascites in the abdomen.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: Large left hilar mass invading the mediastinum and left lung and left hilum. Mediastinal and retroperitoneal metastatic adenopathy. Large left, small right-sided pleural effusion small amount of ascites.


Instruction: Generate impression based on medical findings.

Input: 43 year old male s/p RLL mass resection. Interval removal of chest tubes. Persistent right pleural effusion not significantly changed. No focal airspace opacities. No pneumothorax. Cardiomediastinal silhouette is unremarkable.

Output: Persistent right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: s/p CT removal History: s/p CT removal Interval removal of mediastinal drain and chest tube with no evidence of pneumothorax.Interval removal of right central venous catheter.Stable cardiomegaly with vascular congestion.

Output: No complications related to line removal. Otherwise no change.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: IABP placement History: IABP placement Left lower lobe consolidation unchanged, with right basilar subsegmental atelectasis.IABP catheter distal tip 4 cm below the top of the aortic arch.ET tube tip approximately 4 cm above the carina.Right jugular Swan-Ganz catheter, tip in right pulmonary artery.An NG tube terminates in the stomach.

Output: Unchanged support devices. Stable pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: lung infiltrate History: cough Unremarkable cardiac and mediastinal silhouette. Streaky opacity at the right base of uncertain chronicity which may be due to subsegmental atelectasis or scarring. Depending on the clinical presentation this could be related to aspiration.No other specific evidence of pneumonia.

Output: Streaky right basilar opacity suggestive of scarring, but of uncertain chronicity. No other significant findings.


Instruction: Generate impression based on medical findings.

Input: Reason: infiltrate or consolidation, fluid overload History: abdominal pain, altered mental status Unremarkable cardiac and mediastinal silhouette. Catheter tip in the SVC.Mild basilar streaky opacities consistent with subsegmental atelectasis and scarring, possibly with small effusions, unchanged from previous.

Output: Possible small effusions and basilar atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: Eval for edema History: Wheezing Normal heart size and mediastinum.Bilateral lower zone coarse interstitial opacity, compatible with bronchiectasis and atelectasis, possibly with superimposed infection or aspiration, not significantly changed.No specific evidence of pulmonary edema.

Output: Coarse basilar interstitial opacities compatible with bronchiectasis and possibly infection but no sign of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: Daily CXR History: S/p AV replacement Median sternotomy with chest tubes, no pneumothorax but stable basilar opacities and pleural effusions.Probable IABP marker 6 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter tip in main pulmonary artery.A Dobbhoff tube extends below the lower margin of the image.Right subclavian ICD unchanged.

Output: Unchanged support devices and pulmonary opacities with pleural effusions. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: hx of bladder cancer, evaluate for metastatic disease History: see above No significant cardiopulmonary abnormality and no sign of metastases.Severe thoracic scoliosis.

Output: Severe thoracic scoliosis. No evidence of metastases or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: before initiating HD History: fatigue Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Shortness of breath Significant cardiomegaly with diffuse bilateral interstitial and airspace opacities have not significantly changed. No pneumothorax.

Output: Stable significant cardiomegaly and bilateral pulmonary opacities may reflect pulmonary edema or possibly infection.


Instruction: Generate impression based on medical findings.

Input: Reason: pt noted to have PE in prevoius imaging, please perform formal PE procotol to verify. History: AMS PULMONARY ARTERIES: Marked attenuation of the left pulmonary tree and its branches but no thrombus identified on the current scan.LUNGS AND PLEURA: Large left hilar mass encasing the pulmonary artery and extending into the bronchial lumen, increased in size on both axial and coronal dimension since the previous scan.The axial dimensions are approximately 30 3 x 56 mm (59/140) compared to 31 x 51mm a small nodule posterior lateral to the mass in the superior segment of the lower lobe measures 7 x 6 mm, also increased from previous. Moderately severe upper zone emphysema.MEDIASTINUM AND HILA: Bilateral thyroid cysts, unchanged.Left perihilar mass as previously described which extends into the AP window and probably involves contiguous lymph nodes.Small pericardial effusion, not significantly changed.Severe aortic atherosclerosis.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Evaluation is limited due to arterial phase of contrast material. Previously described small hypodensities in me liver are not well visualized but have not appreciably changed.Hypodense lesions in the upper left kidney, compatible with cysts.

Output: 1. Interval progression of left upper lobe mass and adjacent nodule.2.No evidence of pulmonary embolism on the current scan.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: pneumothorax History: pneumothorax Large right pleural effusion unchanged, with a right apical pneumothorax slightly improved.Right basilar consolidation unchanged.

Output: Improvement in small right apical pneumothorax with a moderate right effusion and right basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 27 years old.Reason: Eval for pneumonia/infection, other acute abnormality; on immunosuppressant meds, hx of severe cough x6 weeks, initially improved now worsened x1 week History: Pls see above No evidence of pneumonia.

Output: Stable chest radiograph with no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: ett History: ett ET tube, left IJ catheter, and enteric tube stable in position.Cardiomegaly is stable.Bilateral pulmonary opacities appear similar to the prior examination with dense pulmonary opacity in the right middle lobe. Loculated left pneumothorax appears similar to prior exams.Dense vertebral bodies compatible with renal osteodystrophy.

Output: ET tube tip 5-6 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: bleeding into lung History: oozing around catheter site Diffuse pulmonary opacities again noted. Unchanged cardiomegaly. Right IJ line, unchanged. No large pleural effusion or pneumothorax.

Output: No substantial change in diffuse pulmonary opacities which may represent pulmonary edema, multifocal infection, pulmonary hemorrhage, and/or diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: s/p ICD implantation History: s/p ICD implantation Cardiomegaly.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with shortness of breath and sarcoid. Evaluate lung nodule; evaluate for pneumonia. CHEST:LUNGS AND PLEURA: Interval decrease in size of spiculated nodule in the left lung apex (series 4, image 17; series 8024, coronal image 41). Nodular pleural thickening/effusions have decreased since prior study with near complete interval resolution of previously seen loculated component in the minor fissure.Stable calcified granulomata bilaterally. No new nodules or masses identified.Narrowing of the bilateral lower lung airways, greater on the right, is not significantly changed.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes from prior granulomatous disease as seen on prior studies. Mildly enlarged lymph nodes appear similar to prior study. Heart size normal without pericardial effusion.Mild decreased attenuation of the blood pool indicates anemia.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Interval decrease in size of left apical spiculated nodule.2. No evidence of active infection.3. Small residual nodular pleural thickening since prior study.


Instruction: Generate impression based on medical findings.

Input: Reason: Is there pulmonary edema or blood? History: Hemoptysis. Crackles. Dense airspace opacity in the right lung with associated pleural effusion not significantly changed.New focal opacity in the left mid lung suggestive of focal atelectasis and consolidation.Feeding tube tip in the stomach.

Output: Extensive nonspecific airspace opacity in the right lung and new focal opacity on the left, more suggestive of infection than edema. Some of the opacity may be related to aspirated blood.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: assess ETT position History: s/p intubation Cardiac lead has been pulled back and likely terminates within the more proximal aspect of the RV no motion artifact obscures clear visualization. Otherwise lines and tubes, unchanged. Mild pulmonary edema, increased from last study. Small pleural effusions. Unchanged heart size. No pneumothorax.

Output: Cardiac lead has been pulled back and likely terminates within the more proximal aspect of the RV no motion artifact obscures clear visualization. Consider repeat imaging for more definitive visualization. Mild pulmonary edema, increased from last study.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with history of carcinoid tumor CHEST:LUNGS AND PLEURA: Nonspecific micronodules are unchanged.MEDIASTINUM AND HILA: Precarinal lymph node is unchanged, measuring 1.2 x 1 .2 cm, image number 47, series number 5.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is unchanged. No focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Diffusely thickened is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Lobulated mesenteric soft tissue mass measures 3.2 by2.2-cm image number 131, series number 7. Other smaller lymph nodes are also stable. Surrounding thickwalled and dilated bowel loops are also unchanged. Trace amount of fluid is 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: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: 60 year-old male with metastatic renal cell cancer and history of nephrectomy and lung resection presenting with new shortness of breath CHEST:LUNGS AND PLEURA: Hazy, groundglass opacities in the right upper lobe. No nodules in the lung suspicious for metastatic disease.Postsurgical changes in the left lower lobe. Minimal pleural thickening in the left lower lobe.MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes. 16 x 15 mm soft tissue density in the left lower hilum on image number 47, series number 3. This may be postsurgical, however, possible to neoplasm cannot be excluded. Follow-up imaging is recommended for further evaluation. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland contains a nodule measuring 21 x 12 mm on image number 98, series number 3.KIDNEYS, URETERS: Benign appearing right renal cysts. The patient is status post left nephrectomy. Small amount of soft tissue adjacent to the metallic clips in the left nephrectomy bed measures 14 x 13 mm image number 109, series number 3. Follow-up imaging is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes involving the lumbar vertebral bodies.Left posterior sixth rib as an expansile sclerotic lesionlikely secondary to remote trauma. Follow-up imaging is recommended to exclude metastatic disease..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: No significant abnormality notedOTHER: No significant abnormality noted

Output: Small left adrenal nodule, nonspecific. Left rib lesion likely representing changes secondary to remote trauma.Left hilar and left para-aortic nonspecific soft tissue densities which can be postsurgical. Follow-up imaging is recommended to exclude neoplasm.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pacemaker History: s/p pacemaker New pacemaker device with generator in the left anterior chest wall and leads projected in the area of the right atrial appendage and right ventricular apex.Moderate cardiomegaly but no sign of pulmonary edema, pneumothorax or other acute disease.

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


Instruction: Generate impression based on medical findings.

Input: Reason: assess swan position History: swan Swan-Ganz catheter tip in the right main pulmonary artery.ICD leads unchanged.Moderate cardiomegaly with no sign of CHF.Interval clearing of mild left lower lobe opacity compatible with atelectasis.

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


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No acute cardiopulmonary abnormality. Moderate tortuosity of the aorta with atherosclerotic disease, contours are similar. Unchanged left subclavian 2-lead ICD.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: TE fistula and stent placement Unchanged esophageal stent traversing the mid esophagus with otherwise similar-appearing cardiopulmonary appearance. Specifically an elevated left hemidiaphragm with underlying atelectasis appears similar. The Dobbhoff tube has been removed.Single right jugular port has been placed, tip extends into the mid SVC. G-tube projects over left upper quadrantLeft mastectomy with left axillary surgical clips

Output: Right jugular port placed with Dobbhoff tube removed


Instruction: Generate impression based on medical findings.

Input: Reason: R/O PNA History: Leukopenic fever Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male. Metastatic colorectal cancer. Evaluate chemotherapy response. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Left venous access device in place with distal tip in the SVC.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse ill-define multiple bilobar hypoattenuating lesions representing metastatic disease are unchanged. A reference lesion in caudate lobe is unchanged measuring 9 x 8 mm on image number 91/224 of series 3. Cholelithiasis is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calculus is unchanged.RETROPERITONEUM, LYMPH NODES: There are numerous periaortic, aortocaval, pericaval and retrocaval retroperitoneal lymph nodes which are minimally increased in size since the prior examination. None of these exceed 1.4 cm in greatest dimension, but all appear slightly enlarged since the prior examination.BOWEL, MESENTERY: Left lower quadrant ileostomy at axial image 165/224 of series 3 is stable.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: Status post proctocolectomy with left lower quadrant colostomy unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis has resolved. Numerous scrotal phleboliths.

Output: Enlargement of multiple retroperitoneal lymph nodes, which now are borderline increased in size. See above.No other significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: 60-year-old male febrile at OSH. C/f aspiration pneumonia since recent chemotherapy for HN SCC, poor swallow with mucositis Right chest wall port catheter tip in SVC.Persistent patchy basilar opacities, left greater than right unchanged. No pleural effusion or pneumothorax.Cardiomediastinal silhouette is unremarkable.

Output: Unchanged patchy basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: confirm PICC line placement History: need for chemo Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Right PICC, tip in the SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: Micronodule in the rightminor fissure is smaller, measuring 2-mm image number 42, series number 4. Left-sided pleural effusion has resolved.MEDIASTINUM AND HILA: Duplicated IVC is unchanged. Reference anterior diaphragmatic lymph node is smaller, measuring 21 x 9 mm image number 65, series number 3. Left-sided preference lymph node is also smaller measuring 6 x 8 mm number 67, series number 3.Asymmetrically enlarged right thyroid lobe is unchanged.CHEST WALL: Stable left axillary lymph nodes.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: Reference left para-aortic lymph node measures 21 x 15 mm image number 87, series number 3, minimally decreased in size. Reference lymph node adjacent to the portal vein measures 29 x 24 mm image number 85, series number 3, not significantly changed.BOWEL, MESENTERY: Bowel containing ventral hernias are unchanged. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Reference is right iliac lymph node is smaller, measuring 24 x 12 mm, image number 150, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the diaphragmatic, pelvic adenopathy, right micronodule. Retroperitoneal lymph nodes are unchanged to slightly decreased is size.Interval resolution of the small left-sided pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 25 years old.Reason: eval for infiltrates History: post op The cardiomediastinal silhouette is within normal limits. No large pleural effusions. Mild volume loss of the right hemithorax. Patchy air space opacities in the right mid and lower lung fields may represent atelectasis versus developing infection.

Output: Atelectasis versus developing infection the right lower lung fields.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: s/p MVR History: pleural effusion Left hemithorax opacification unchanged.Right-sided edema pattern has improved on the right lung is better inflated.Left jugular catheter tip in SVC.

Output: Improved right sided inflation and edema. Stable left hemithorax opacification.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Nonproductive cough question pneumonia. Cardiomegaly with a tortuous and ectatic thoracic aorta, incompletely assessed, unable to exclude aneurysm on the basis of this single portable film.Paramediastinal opacities bilaterally may reflect compressive atelectasis or scarring, nonspecific. This is slightly greater on the right than on the left. Faint focal opacity in the left upper lobe at the level of the fifth rib posteriorly as it crosses the scapula.Dense linear opacity near the right apex.No visible pleural fluid or pneumothorax.

Output: 1. Faint 1.5 cm opacity left upper lobe is of indeterminate etiology. Follow-up PA and lateral chest radiographs recommended for further evaluation. Given patient's age, primary malignancy is a consideration. Infection is considered less likely.2. Ectatic thoracic aorta, unable to exclude possibility of an ascending aortic aneurysm.3. Nodular opacity right upper lobe too small to accurately characterize but is in a location which may indicate evidence related to the costochondral cartilage.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: balloon pump no longer augmenting History: balloon pump no longer augmenting The cardiomediastinal silhouette is unchanged. Swan-Ganz catheter tip is in the right main pulmonary artery. IABP marker is roughly 6 cm below the top of the aortic arch. Subcutaneous ICD in place. Bibasilar subsegmental atelectasis and small left pleural effusion. No pneumothorax.

Output: Bibasilar subsegmental atelectasis and small left pleural effusion. IABP marker is roughly 6 cm below the top of the aortic arch.


Instruction: Generate impression based on medical findings.

Input: Evaluate Dobhoff tube placement Enteric tube seen extending beyond expected confines of stomach and into distal duodenum. Catheter is either coiled on itself in third portion of duodenum, or traversing past ligament of Treitz with tip located in overlapping jejunum. Mild kinking of catheter noted approximately 17 cm from tip. Residual contrast seen throughout colon. Compared to prior exam there is now contrast seen in the descending colon. Nonobstructive bowel gas pattern. Chronic deformity of left hip/acetabulum seen. Heterogeneous appearance of right-sided ribs with overlapping or adjacent areas of relative lucency seen, nonspecific and poorly assessed on this nondedicated study. Multiple level spinal degenerative disease. Vascular calcifications.

Output: Enteric tube as above.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: swan catheter History: none Swan-Ganz catheter has its tip overlying the right interlobar pulmonary artery. A left chest wall ICD has its tip overlying the right ventricular apex.The cardiomediastinal silhouette is apparently magnified and may be enlarged. No focal pulmonary opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax.

Output: Swan-Ganz catheter tip overlying the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Reason: pna History: chest pain, cough w/ sputum Unremarkable cardiac and mediastinal silhouette.Mild linear scarring in the lower lung zones.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: MCTD now with intermittent shortness of breath. LUNGS AND PLEURA: The lungs are clear without evidence of discrete pulmonary nodule, pleural effusion, or pneumothorax. There are no specific findings of UIP/IPF. No evidence to suggest airtrapping.MEDIASTINUM AND HILA: Bilateral axillary lymph nodes, however none are considered pathologic in size. No abnormal mediastinal or hilar lymph nodes.The cardiac and pericardium are normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted given the limitations of a non-infused study.

Output: No specific findings to suggest interstitial lung disease. No change


Instruction: Generate impression based on medical findings.

Input: Male, 28 years old.Reason: infxn History: infxn Small lung volumes with right pleural thickening and basilar scarring.Median sternotomy.No specific evidence of infection or edema.

Output: Basilar scarring and pleural thickening, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Follow-up ICU x-ray. Exam limited by motion artifact. Severe cardiomegaly again noted. Two left-sided chest drainage catheters are seen with a probable small left pleural effusion. Right jugular Swan-Ganz catheter tip not well visualized given the artifact. No pneumothorax detected. Lungs otherwise clear. ET tube 2 -- 3 cm above the carina. No significant interval change.

Output: Small left pleural effusion and severe cardiomegaly, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: Chest pain, SOB, eval for CHF/PNA History: Chest pain, SOB, eval for CHF/PNA Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.Motion artifact on the lateral view and suboptimal image quality related to morbid obesity.

Output: No significant cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 22 years old.Respiratory failure. Altered mental status rule out infection. Interval replacement of tracheostomy tube with endotracheal tube, which is positioned approximately 4 cm above the carina. The cardiac silhouette is within normal limits in size. Moderate pulmonary vessel congestion. There is a pulmonary edema versus developing airspace disease noted in both lungs. Relative increased lucency of right lung at the left lung may be attributable to positioning the patient's breasts.

Output: Moderate pulmonary vessel congestion with pulmonary edema. Patchy opacities scattered throughout both lungs could represent developing pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female 55 years old Reason: ? PTX History: h/o PTX and chest pain No focal consolidation, pleural effusion or pneumothorax. Healing/healed left seventh rib fracture. Large lung volumes compatible with COPD. The heart and mediastinal contours are within normal limits for size.

Output: Healing/healed left seventh rib fracture, no 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, 57 years old.Reason: 57yoM here w/ neutropenic fever, look for PNA History: neutropenic fever Right upper extremity PICC has tip at the superior cavoatrial junction.Low lung volumes. The cardiomediastinal silhouette is normal. No focal pulmonary opacity suggestive of pneumonia. No large pleural effusion. No pneumothorax. Left basilar linear opacities likely scarring and present on prior radiograph.

Output: Low lung volumes without definite acute cardiopulmonary disease. Of note, chest radiography is not sensitive for the detection of opportunistic infections in immunocompromised patients. Consider chest CT for further evaluation if clinically warranted.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p L VATS, pleurX catheter History: pleurX catheter Nodular pleural thickening noted within the left hemithorax. Moderate-sized loculated pneumothorax noted along the lateral aspect of the left hemithorax. Left basilar Pleurx catheter is noted. Moderate degree of left-sided subcutaneous emphysema. Mild rightward mediastinal shift. Right lung is grossly unremarkable.

Output: Moderate loculated left pneumothorax. Left Pleurx catheter is in place. Nodular left-sided pleural thickening consistent with pleural malignancy.