Instruction: Generate impression based on medical findings.

Input: 70 year-old female with metastatic renal cancer. Evaluate for progression. CHEST:LUNGS AND PLEURA: No significant change in the right upper lobe extensive fibrotic markings. Mild scarring in the left upper lobe as well. Scarring and atelectasis also extends to the right middle lobe. No nodules to suggest metastatic disease.MEDIASTINUM AND HILA: Again noted enlargement of the thyroid gland with extension into the superior mediastinum. Small mediastinal nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral hypodense lesions which cannot be optimally characterized due to lack of IV contrast. Some of these lesions contain faint calcifications in the lesion in the right lower pole may have a soft tissue component. Lack of IV contrast severely limits optimal characterization of these lesions.RETROPERITONEUM, LYMPH NODES: Stable extensive retroperitoneal metastases disease. Reference left para-aortic lymph node measures 3.5 x 2 cm in image number 102/200.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral external iliac and obturator adenopathy. Reference right obturator lymph node measures 4.6 x 2.3 cm image number 162/200. Reference left obturator lymph node measuresBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable left sclerotic iliac wing, right femur and L5 vertebral body.OTHER: No significant abnormality noted.

Output: Stable metastatic retroperitoneal and pelvic adenopathy.Bilateral hypodense renal lesions, unchanged. Due to lack of IV contrast optimal characterization of these lesions is not possible and solid component in some of these lesions cannot be excluded.Enlarged thyroid gland.Stables fibrotic changes in the lungs.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: lung cancer History: s/p RLL superior segmentectomy for NSCLC Right lower lobe segmentectomy.No evidence of tumor recurrence.Unremarkable mediastinal contours and cardiac silhouette.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Bladder cancer Scattered calcified granulomata without additional new superimposed airspace abnormalities. Moderate COPD changes.Additional superimposed dense annular calcifications. The cardiac and mediastinal contours otherwise significant for moderate atherosclerotic changes

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male 41 years old Reason: Evaluate for infection History: stroke Severe cardiomegaly is unchanged. Bibasilar interstitial opacities likely representing edema. No specific evidence of pneumonia. No pneumothorax.

Output: Severe cardiomegaly and probable basilar edema. No specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: s/p left chest tube placement History: s/p left chest tube placement Interval placement of a left apical chest tube. Right IJ central venous catheter remains unchanged.Partially obscured cardiomediastinal silhouette is unchanged.Continued decrease in volume of left-sided hemothorax with no pneumothorax. Other findings remain unchanged.

Output: Left apical chest tube now in place with continued decrease in left-sided hemothorax and no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: assess for ETT position, changes in pulm opacities History: s/p intubation, PNA Unchanged left pleural effusion and left basilar consolidation.Right lung unremarkable.Heart size normal.ET tube tip approximately 6 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.Skeletal metastases unchanged.

Output: Unchanged left pleural effusion and left basilar consolidation. ET tube tip approximately 6 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: chest tube in place History: chest tube Right subpulmonic chest tube with a slightly larger right pleural effusion and overlying atelectasis.Minimal left lower lung zone edema.Unchanged hepatic and right jugular catheter.

Output: Unchanged right chest tube with no pneumothorax but persistent pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: pneumothorax; post-device placement in EP Lab History: s/p device placement in EP lab Mild/moderate cardiomegaly.Mild interstitial opacities are suggestive of edema. Left subclavian dual-chamber pacemaker, leads in appropriate position.

Output: Pacemaker placement with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: cause of hypoxia History: hypoxia, intubated Small right pneumothorax with a right pleural vent.Nonspecific basilar atelectasis left greater than right and small pleural effusions noted.ET tube tip approximately 2 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip in SVC.

Output: Small pneumothorax with a thoracic vent.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: tobacco history, dyspnea History: see above Increased lung volumes compatible COPD.The cardiomediastinal silhouette is unremarkable.Faint opacity in the region of the right first costochondral junction.No pleural effusions.

Output: Ill-defined nodular opacity in the region of the right first costochondral junction. CT of the chest is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: new dx of cervical cancer, now w/ hemoptysis vs hematemesis, evaluate for lung mets History: hematemesis vs. hemoptysis Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: 23YO male sickle cell disease and ACS History: 23YO male sickle cell disease and ACS Progression of basilar opacities representing some degree of atelectasis however as previously described, pneumonia/aspiration is likely.Stable cardiac silhouette.No pneumothorax.

Output: Progression of basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Chest discomfort after ablation Bibasilar atelectasis.No pneumothorax.Cardiac mediastinal silhouette is normal.

Output: Bibasilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: please evaluate for a pneumothorax History: please evaluate for a pneumothorax No significant cardiopulmonary abnormality.No pneumothorax after recent biventricular ICD placement, leads in appropriate position although the recapture lead does not extend very far past the coronary sinus.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Infection, aspiration. The distal tip of the feeding tube again projects beyond the film. The cardia measles silhouette is within normal limits. Bibasilar airspace disease may represent infection or atelectasis. Small pleural effusions cannot be excluded.

Output: Interval development of right basilar airspace disease and/or small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Reason: Rule out pneumonia History: SOB Cardiomediastinal silhouette is normal in size.No focal airspace opacity, pneumothorax or large pleural effusion.Healed left posterior rib fracture.

Output: No acute cardiopulmonary findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Presenting with shortness of breath. Please evaluate for effusion and edema. Bilateral left greater than right pleural effusions with adjacent atelectasis. Interval increase in heart size is compatible with CT scan demonstrating moderate pericardial effusion. Redemonstration of multiple pulmonary nodules that are better defined on same day CT scan. Redemonstration of right Port-A-Cath with tip in the SVC. Interval elevation of the left hemidiaphragm. Worsening of left superior rib destruction most notably at ribs 3 and 4.

Output: Bilateral left greater than right pleural effusions with adjacent atelectasis. Interval increase in heart size is compatible with moderate pericardial effusion. These findings are better demonstrated on same day CT scan.


Instruction: Generate impression based on medical findings.

Input: Female, 32 years old.Reason: fever, high WBC History: fever, high WBC Heart size upper normal.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.History of lung CA status post RT, evaluate RT pneumonitis. Cough. Right upper lobe hazy opacity increased, presumably the result of radiation reaction. Right upper lobe nodular opacity appears more pronounced but is most likely the result of radiation reaction or post-therapeutic organizing pneumonia.Bilateral groundglass opacities seen on recent CT are improving. Lymphadenopathy about the same.

Output: Improving groundglass opacities most consistent with resolving acute phase radiation pneumonitis. Subacute appearing radiation pneumonitis in the right upper lobe similar to recent CT.


Instruction: Generate impression based on medical findings.

Input: 47-year-old woman breast cancer. Staging. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral nonenlarged 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: Multiple fluid density, round lesions in the region of the left collecting system. Due to the early phase of imaging, it is not clear whether these represent parapelvic cysts, dilated collecting system or both. Left ureter is normal in size. Right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Enlarged heterogeneous uterus. Endometrium cannot be well seen. This heterogeneity may be secondary to fibroids however endometrial thickening and a possible carcinoma cannot be excluded.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: Heterogeneous uterus. Fibroids versus thickened endometrium. Pelvic ultrasound is recommended for further evaluation.Left parapelvic cysts versus dilatation of the collecting system with a normal ureter.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: Lines/drains/devices in place History: Lines/drains/devices Left basilar chest tube remains in place. Interval removal of subxiphoid mediastinal drains.Persistent low lung volumes with basilar edema, atelectasis and small effusions. No interval pneumothorax.

Output: No pneumothorax following mediastinal drain removal.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: FemaleReason for Study: Reason: h/o heart transplant, leukocytosis, eval for infiltrate History: see above Decreased lung volumes with stable mild cardiac enlargement.The lungs are clear.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Enterocutaneous fistula Bibasilar atelectasis.Percutaneous drain distal end superimposed over the superior sacrum. No bowel obstruction or free air.

Output: Bibasilar atelectasis.Percutaneous drain distal end superimposed over the superior sacrum. No bowel obstruction or free air.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Status post trach. No tracheostomy tube is identified. The left apex is obscured on both films due to the patient's overlying mandible and associated soft tissues. No visible pneumothorax or pneumomediastinum.Moderate pleural effusions, slightly increased in volume. Basal compressive atelectasis. Patchy groundglass opacities about the same.Retrievable IVC filter projects over the upper abdomen; this has been present since the patient's initial abdominal CT dated 5/1/2015.

Output: Moderate pleural effusions with basal atelectasis. No pneumothorax or pneumomediastinum.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: eval swan ganz, pna History: swan ganz Right jugular Swan-Ganz catheter tip at the right main pulmonary artery. Left subclavian ICD unchanged.Unchanged cardiomegaly.The lungs are clear. No pneumothorax.

Output: Right jugular Swan-Ganz catheter tip at the right main pulmonary artery level.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Right pleural progress History: decrease lung sound r lung Right greater than left pleural effusions again noted. Bibasilar opacities, unchanged. No pneumothorax. Unchanged heart size.

Output: No substantial difference in right greater than left pleural effusions and bibasilar atelectasis or consolidated lung.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Abnormal lung sounds, cough, on TPN. Evaluate for pneumonia. Streaky opacities in the left lung likely representing lower lobe atelectasis. Right basilar atelectasis.Cardiac silhouette is within normal limits.Right IJ catheter with tip in the SVC.Significant diffuse bowel gas, better seen on the abdominal radiograph from the same day.

Output: Bibasilar atelectasis. Early infection cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 22 yearsGender: FemaleReason for Study: Reason: r/o pneumothorax History: chest pain The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.No evidence of a pneumothorax.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: PNA History: cough Heart size normal.Lungs clear.No pneumothorax. No pleural effusion.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Productive cough and nasal congestion. History of AML status post stem cell transplant and donor lymphocyte infusion. Please evaluate for pneumonia. Left lateral chest wall generator and presternal lead are unchanged.The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Interval resolution of the small left pneumothorax without additional underlying cardiopulmonary change. Borderline cardiomegaly similar to prior

Output: Interval resolution of left pneumothorax


Instruction: Generate impression based on medical findings.

Input: 39 years, Male. Reason: eval Dobbhoff History: Dobbhoff placed Dobbhoff tube tip in the distribution of the second portion of the duodenum. Mild gaseous distention of the bowel loops, which may represent developing ileus. Please see same day chest radiograph report for thoracic findings.

Output: Dobbhoff tube tip in the distribution of the second portion of the duodenum. Mild gaseous distention of the bowel loops, which may represent developing ileus.


Instruction: Generate impression based on medical findings.

Input: Female, 46 years old.Reason: desaturation, tachycardia postop History: desaturation, tachycardia postop Basilar atelectasis, left greater than right, suggestive of mucous plugging or aspirated secretions.No specific evidence of infection or edema.Heart size normal.Right jugular catheter, tip at cavoatrial junction.Cholecystectomy clips noted.

Output: Basilar atelectasis, possibly from aspirated secretions or mucous plugging although pulmonary embolism is in the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p lead extraction History: s/p robotic lead extraction. PICC line tip in the SVC.Partial clearing of left lower lobe atelectasis.Right chest tube and orphaned cardiac electrode, unchanged.

Output: Pleural effusions and atelectasis with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Intubated, bilateral SDH. Evaluate ETT position. Endotracheal tube 4 cm above the level of the carina. Other devices unchanged in position. Retrocardiac opacity suggesting atelectasis and pleural fluid about the same. Mild opacity at the right base may reflect aspirated secretions.

Output: ETT 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Age: 79 yearsGender: MaleReason for Study: Reason: evaluation of SOB, DOE History: DOE Stable cardiac mediastinal silhouette.Right pleural thickening/effusion new from the prior exam.The left lung is clear.

Output: Right pleural effusion/thickening new from the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: eval lung fields History: s/p MVR, CABG Open sternotomy with surgical sponge material projected over the mediastinum.Cardiomegaly with patchy atelectasis and edema are unchanged.One surgical drain may been removed. Chest tubes remain in place with no pneumothorax.Unchanged ECMO cannula.Right jugular Swan-Ganz catheter tip in left descending pulmonary artery or lingular branch.ET tube tip approximately 3 cm above the carina.Right jugular introducer.

Output: No significant pneumothorax. Unchanged support devices except for possible withdrawal of one drainage catheter.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: MaleReason for Study: Reason: Evaluate for pneumothorax, effusion. History: lung cancer. status post left PleurX drain placement Interval placement of left pleural drain with decrease in left pleural effusion.No significant pneumothorax.Stable cardiac enlargement.Multiple pulmonary nodules redemonstrated.

Output: Interval placement of a left pleural drain with mild decrease in left pleural effusion. No significant pneumothorax identified.


Instruction: Generate impression based on medical findings.

Input: 42 year-old female status post right modified radical mastectomy for IDC grade 3 with lymph node involvement. CT scan for metastatic workup. CHEST:LUNGS AND PLEURA: Few subpleural micronodules bilaterally and a punctate calcified granuloma in the right lower lobe. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.CHEST WALL: Left chest port catheter with catheter tip in distal SVC. Right axillary surgical clips. Right chest wall drain.ABDOMEN: LIVER, BILIARY TRACT: Punctate hepatic hypodensities too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Circumaortic left renal vein, normal anatomic variant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate sclerotic focus in the left humeral head (series 3, image 8) and as well as a 5 mm sclerotic focus in the right glenoid are compatible with benign bone islands.Punctate sclerotic focus in the left transverse process of the T9 vertebral body (series 3, image 65) is also favored to be a benign bone island.Minimal degenerative changes of the spine.

Output: No definitive evidence of distant metastases. Few probable benign bone islands as above.


Instruction: Generate impression based on medical findings.

Input: Male 66 years old Reason: eval quinton placement History: line placed Right IJ catheter tip in the SVC.Mild cardiomegaly.Right basilar atelectasis and or scarring.No other focal airspace opacities.No significant pleural effusions or pneumothorax.

Output: Right IJ catheter tip in the SVC.Findings discussed with Dr. Mckee on 8/10/15 at 1325.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: 59M hx T1 high grade bladder cancer. Evaluate for metastasis History: As above The cardiomediastinal silhouette is within normal limits.No pulmonary opacities or pleural effusions.No pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Female, 88 years old.Reason: SOB History: above Increase cardiomegaly. Pulmonary vascular distribution is again noted and unchanged. There is blunting of the costophrenic angles likely representing small effusions.No specific evidence of infection or edema. No pneumothorax.

Output: Increase in cardiomegaly with very small pleural effusions. No evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Line placement. ETT tip 4 cm above the level of the carina.New left jugular catheter tip at the confluence of brachiocephalic veins with the SVC. Right jugular catheter and visualized portion of the enteric tube unchanged in position.Small lung volumes with diffuse interstitial and airspace opacities bilaterally without acute change.No pneumothorax.

Output: Left jugular catheter tip at the confluence of the brachiocephalic veins with the SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: eval lung fields History: palpitations Cardiomediastinal silhouette is normal. Lungs clear of airspace and interstitial opacities. No pneumothorax or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: 56F with COPD and cough, eval for e/o infiltrates to suggest PNA History: SOB Status post right mastectomy.Normal cardiomediastinal silhouette. Mild bibasilar atelectasis and bronchial wall thickening, left greater than right. No pneumonia. No pleural effusions or pneumothorax.Surgical clips noted in the right axilla.

Output: No acute cardiopulmonary abnormality. Specifically no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male, follow up CT for previous lung nodules LUNGS AND PLEURA: Stable scattered micronodules. Previous reference nodule in the right upper lobe is not identified in this exam. Presumably, this was inflammatory in origin. Underlying paraseptal and centrilobular emphysema. No pleural effusion is present.MEDIASTINUM AND HILA: Right paratracheal, prevascular, and subcarinal, and hilar lymphadenopathy unchanged with a reference measurement (image 38, series 3) measuring 13.4 mm x 14.4 mm, previously, measuring 13.6 mm x 14 mm.Atherosclerotic changes of aortic calcification coronary arteries, unchanged. Mild enlargement of the main pulmonary artery.Cardiac size is normal without evidence of pericardial effusionCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Prominent periaortic, gastrohepatic, and porta hepatus lymph nodes are stable.

Output: 1. Stable micronodules without evidence of new pulmonary nodules.2. Moderate to severe centrilobular and paraseptal emphysema with evidence of pulmonary arterial hypertension.3. Mediastinal, hilar, and upper abdominal lymphadenopathy without interval change may be inflammatory in origin.


Instruction: Generate impression based on medical findings.

Input: Reason: removal of chest tubes History: ct removal Interval removal of chest tubes.No significant pneumothorax.Moderate right pleural effusion and bilateral subsegmental atelectasis, largely unchanged.

Output: Removal of chest tubes with no pneumothorax or other acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: s/p bronchoscopy with BAL of RLL and biopsies of RLL and RUL. Rule out PTX History: SOB Patchy bilateral dense airspace opacity involving both upper lobes and the right lower lobe. Apparent increase in opacities may be related to BAL fluid. No significant pneumothorax or pleural effusion. Cardiomediastinal silhouette is within normal limits.

Output: No evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old. Reason: Eval lung fields History: Intubated ET tube tip approximately 4 cm above the carina.Dobbhoff tube tip in the transverse portion of the duodenum.Enteric tube tip in the stomach.Left subclavian catheter courses superiorly into the left jugular vein, unchanged.Worsening pulmonary opacity suggestive of edema with increasing left pleural effusion.

Output: 1. Worsening pulmonary opacity suggestive of edema with increasing left pleural effusion.2. Left subclavian catheter continues to course superiorly into the left jugular vein.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: effusion, infection History: s/p malignancy Left hemidiaphragm elevation with a left effusion and overlying atelectasis. Right lung unremarkable.Mild bronchial wall thickening.Heart size probably normal partially obscured.Right jugular catheter tip at cavoatrial junction.

Output: Left pleural effusion with overlying atelectasis, but no reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 72 years old Male. Reason: s/p R chest tube insertion for hemothorax History: postop hemothorax. Right loculated pleural effusion or hemothorax with associated atelectasis, unchanged as compared with prior study. The evaluation of the cardiac silhouette is limited due to right pleural effusion.

Output: Loculated right pleural effusion or hemothorax with associated atelectasis, unchanged as compared with prior study.


Instruction: Generate impression based on medical findings.

Input: 53 year old female with endometrial cancer. Please evaluate pre-therapy. CHEST:LUNGS AND PLEURA: Calcified granuloma in the left lower lobe. No evidence of pleural effusion.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy or pericardial effusion. Small hypodense thyroid lesion is seen in the right lobe of thyroid.CHEST WALL: Left-sided chest port with the tip of the catheter in the SVC-RA junction.ABDOMEN:LIVER, BILIARY TRACT: Small hypodense lesion too small to characterize in segment 6, portal venous phase, of the liver that is isodense with the liver parenchyma on delayed images. Otherwise, homogenous enhancement of the liver. The gallbladder is normal in appearance without any calcified stones. No evidence of intrahepatic or extrahepatic ductal dilatationSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is equal and homogenous uptake of contrast in both kidneys. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Enlarged lymph nodes are seen in the retrocrural region of the abdomen with reference node measuring 1.8 x 1.1 cm seen on image 87/206 of series 4. There are also multiple enlarged para-aortic lymph node with a conglomerate mass of lymph nodes measuring 3.9 x 2.6 cm as seen on image 103/206 of series 4. Multiple surgical clips are also seen in the region of the bifurcation of the aorta. Small external iliac nodes are also appreciated.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a lytic lesion at the level of T5-T6 which involves part of the vertebral body, pedicle, and transverse process. The lesion is not expansile and there is no interruption of cortex likely indicating a benign process.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Periaortic and retrocrural lymphadenopathy.2. Likely benign lytic bony lesion at T5/T6.3. Hypodense lesion in segment 6 of the liver which is too small to characterize.


Instruction: Generate impression based on medical findings.

Input: Neck, lower back and knee pain Chest: No cardiopulmonary abnormality. Mild scoliosisC-spine: Mild degenerative changes largely involving the mid cervical spine without evidence of alignment, vertebral body or disc space abnormality. Changes include large osteophytes. Neural foramina widely patent bilaterallyL-spine: Mild osteoarthritic changes including narrowing, sclerosis and small osteophytes without alignment abnormality. Vertebral body heights and posterior elements are preserved.Knees: Moderate right over left of tricompartmental osteoarthritis. Narrowing, sclerosis and osteophytes are observed. No effusions

Output: Scattered mild to moderate degenerative changes as described


Instruction: Generate impression based on medical findings.

Input: Metastatic prostate cancer CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged.MEDIASTINUM AND HILA: Index right hilar lymph node is slightly enlarged measuring 1.1 x 1.4 cm in image number 42, series number 3.CHEST WALL: Metastatic left scapular and sternal lesions are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index aortocaval reference node is unchanged measuring 7 by 5 mm on image number 120, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in the size and density of some of the sclerotic bone metastases involving the pelvic bones and lumbar vertebral bodies.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval increase in the size and density of some of the sclerotic bone metastases involving the pelvic bones and lumbar vertebral bodies.OTHER: No significant abnormality noted

Output: Interval increase in the size and density of some of the sclerotic bone metastases involving the pelvic bones and lumbar vertebral bodies.Minimal interval increase in the size of the right hilar lymph node


Instruction: Generate impression based on medical findings.

Input: Reason: hx of bladder cancer, evaluate for metastatic disease 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: Female, 55 years old.Reason: eval for acute cardiopulm abnormality History: sob, wheezing No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: MaleReason for Study: Reason: h/o CHF, eval fluid status, evidence of pneumonia History: DOE Decreased lung volumes with stable cardiomediastinal silhouette.Bilateral basilar atelectasis.No focal areas of consolidation.No large pleural effusions.Scoliosis of the thoracolumbar spine.

Output: Basilar atelectasis without specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Reason: repositioned ett History: see above Interval adjustment of ET tube with the tip within 1 cm of the carina.Diffuse interstitial opacity without significant change.NG tube tip in the gastric antrum.

Output: Low position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: swan, impella History: swan, impella, sepsis Moderate cardiomegaly without edema or pleural effusions.Impella unchanged.Left subclavian ICD, leads unchanged in position.IVC Swan-Ganz catheter tip in main pulmonary artery, slightly redundant in the right atrium.

Output: No change in support devices.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with acute lymphoid leukemia CHEST:LUNGS AND PLEURA: Stable bilateral micronodules.MEDIASTINUM AND HILA: Prevascular lymph node is smaller and has a very low density and difficult to measure and appears to be a conglomerate of smaller lymph nodes, rather than a single large lymph node. Given these limitations it measures 12 x 9 mm on image number 26, series number 3. Other mediastinal lymph nodes are also smaller.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node is also smaller measuring 13 by 5 noted on image number 97, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerosis involving the left iliac wing.OTHER: No significant abnormality noted.

Output: Interval decrease in the size of the mediastinal and retroperitoneal lymph node


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: 47yo female with metastatic ovarian cancer, assess for chest disease History: none Left lower lobe consolidation and left pleural effusion similar to the recent CT.Right lung unremarkable.Heart size normal.

Output: Left pleural effusion and left lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: 67M hx bladder cancer s/p cystectomy, neobladder in 2/2016. Surveillance imaging for metastasis. History: as above Left base scar like opacity.The lungs are otherwise unremarkable as is the mediastinum.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: r/o Pneumothorax ; shortness of breath History: shortness of breath Elevation right hemidiaphragm with postsurgical volume loss in the right lower lobe.Increasing right basilar opacities compatible with atelectasis which may be secondary to aspiration.Stable cardiomediastinal silhouette.Mild scarring/discoid atelectasis in the left lung base.No evidence of a pneumothorax.Small right pleural effusion.

Output: Increasing right basilar opacities suggestive of atelectasis, possibly secondary to aspiration/infection and small right pleural effusion. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Acute stroke Mildly decreased lung volumes likely due to portable semiupright technique. No discrete distinct superimposed focal additional abnormality

Output: Decreased lung volumes


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval lung fields History: intubated Enlarging pleural effusions and increasing basilar opacities suggestive of edema with atelectasis.Cardiomegaly.ET tube tip approximately 2 cm above the carina.Gastrostomy tube.

Output: Worsening CHF with increased pulmonary edema, pleural effusions and basilar consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: eval lung fields History: eval lung fields Support devices are unchanged in position.Multifocal, right greater than left, pulmonary opacities in the edema-like pattern, unchanged. Small pleural effusions. Cardiomegaly. No pneumothorax. A bioprosthetic valve occupies the aortic position.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old. New right IJ venous catheter with its tip at the SVC/RA junction.Stable and mediastinal silhouette.Mild interstitial opacities suggestive of bronchial wall thickening, unchanged.No focal areas of consolidation.No pleural effusions.No pneumothorax.

Output: Interval placement of a right IJ venous catheter without complication.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Status post trach, evaluate lung fields. Interval placement of tracheostomy tube tip still the level of the clavicular heads. Other tubes, lines and devices are similar in position. No visible pneumothorax. Moderate volume of pleural fluid bilaterally, right greater than left, with associated atelectasis.

Output: Interval placement of tracheostomy tube. Persistent moderate pleural fluid collections with associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: 67-year-old man squamous cell carcinoma urethra status post chemotherapy. Evaluate disease. Creatinine is increased therefore scan is done without IV contrast. CHEST:LUNGS AND PLEURA: Some areas atelectasis is seen in the posterior aspects of the lung however two areas are taking on a somewhat nodular character one a posterior aspect of the right lung series 5 image 39 measuring 9 x 8 mm and just above it on image 35 measuring 1.2 x 1.1 cm. These should be followed. No effusions.MEDIASTINUM AND HILA: Small mediastinal nodes, unchanged from prior exam. Coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN: Exam is not sensitive for solid organs due to lack of IV contrast. Given that limitation following observations are made.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 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: Surgically absent.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Stoma right lower quadrant nonobstructive parastomal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Omentum and left inguinal hernia versus lipoma spermatic cord.

Output: No definite interval change although there is a somewhat nodular character to two areas within the atelectasis in the right lung. These should be followed. All of the other findings are stable.


Instruction: Generate impression based on medical findings.

Input: Reason: eval infection, edema, effusion History: Left sided cp 2.4 cm poorly defined nodule in the superior segment of the left lower lobe, confirmed on the subsequent CT scan and suspicious for primary carcinoma.A small subsolid nodule in the right upper lobe, also confirmed on a subsequent CT scan is not clearly visible on the radiograph.Unremarkable cardiac and mediastinal silhouette. No sign of infection, edema or pleural effusions.

Output: Left lower lobe nodule, increased from previous, highly suspicious for primary carcinoma.A CT scan has been performed and provides more detailed evaluation.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Interstitial fibrosis. SOB. Cardiomegaly with underinflated lungs with moderate foraminal interstitial opacities are stable. Small pleural effusions also unchanged. No pneumothorax. Left PICC tip over the SVC.

Output: No significant change in bilateral pulmonary opacities and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: eval for CP, SOB Moderate cardiomegaly, stable. No focal airspace opacity or pneumothorax. Likely small right pleural effusion. Degenerative changes of the shoulders and spine.

Output: Stable cardiomegaly. Right pleural effusion and/or scarring. No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: eval multifocal nodules seen on prior CT abd/pelvis History: multifoca pna Stable mild cardiac enlargement.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalites identified without interval change. No specific evidence of infection. CT of the chest is recommended to evaluate groundglass nodules identified on recent abdominal/pelvic CT.


Instruction: Generate impression based on medical findings.

Input: Female 40 years old Reason: eval for pathology History: low grade fever No focal consolidation, pleural effusion or pneumothorax. Mild right basilar bronchial wall thickening suggest bronchitis. The heart and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: Mild right basilar bronchial wall thickening suggests bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: Eval for infiltrate, edema History: sob Right pleural effusion with increasing right-sided interstitial opacities, possibly localized edema from central lymphatic and venous obstruction.Mild interstitial opacities left lower lung zone with left lower and mid lung periphery nodular opacities.Right jugular catheter, tip at the cavoatrial junction.

Output: Right pleural effusion with increasing opacities on the right suggestive of localized edema from central lymphatic or venous obstruction. No reliable evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with history of metastatic axillary gland tumor with metastases to the lung. Now with fever, cough and sputum. Evaluate for infection/post obstructive the PNA/abscess. Also, evaluate disease status. CHEST:LUNGS AND PLEURA: Biapical scarring redemonstrated. Interval increase in size of air and fluid containing lesion inferior to the right main bronchus, displacing the right lower bronchus medially. The mass now measures 5.9 x 5.8 cm (image 51, series 5), contains air-fluid level, with thick irregular heterogeneous wall and thick fluid layering along the dependent portion, most favor an abscess in appropriate clinical setting or a necrotic mass. Distal air space opacities noted involving the apical and posterior segment of right lower lobe, extending to the periphery with pleural thickening. Interval increase in size of right lower lobe pulmonary nodule, image 67, series 5, now measures 7 mm. Few subpleural nodules noted in bilateral lower lobes. No new nodules identified.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy noted in the subcarinal, precarinal, pretracheal, and right hilar region. Stable reference subcarinal lymph node measures 16 x 11 mm on image number 43, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy clipSPLEEN: Stable low-attenuation splenic lesion identified, measuring up to 17 Hounsfield units.PANCREAS: No significant abnormality notedADRENAL GLANDS: Interval increase in size of left adrenal mass, now measures 3.4 x 2.4 cm (image hundred, series 3). Right adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. Minimal fluid tracking along the right paracolic gutter is seen on image 171, series 3. Minimal haziness also noted within the mesentery as seen on image 156, series 3. The fluid is identified adjacent to opacified ileal loop, however, no obvious filling defect or abnormality or change in caliber identified of the small bowel.Few diverticula noted in the sigmoid colon without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As described in the abdomen finding.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Interval increase in size of right lower lobe lung nodule. Interval increase in size of right lower lobe lung mass containing air-fluid level as described above, favor a lung abscess over necrotic mass with distal inflammatory changes. 2. Interval increase in size of left adrenal mass suspicious for metastatic disease.3. Interval development of minimal fluid tracking along the right paracolic gutter. No obvious underlying bowel abnormality identified.


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: ? Infection History: lethargy, AMS Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Mild spinal curvature, as before.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o pleural effusions, intra-pulm path History: dyspnea, tachypnea Left-sided PICC has been pulled back slightly and terminates in the superior aspect of the SVC. Lower lung volumes. Increased patchy. Basilar opacities. No large pleural effusion or pneumothorax. Unchanged heart size. Bilateral calcified breast implants again noted.

Output: Bibasilar opacities consistent with atelectasis, aspiration, or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o esophageal cancer History: n/a Air-filled gastric interposition consistent with previous esophagectomy.Mild scarring at the left base and no acute findings.

Output: Gastric interposition with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusions History: increased seizure frequency Unremarkable cardiac and mediastinal silhouette. Small lung volumes with no significant pulmonary or pleural abnormalities.No visible pleural effusions.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: 70M s/p PPM, ?pneumothorax History: 70M s/p PPM, ?pneumothorax New right subclavian AICD.No pneumothorax.No focal pulmonary opacity or significant pleural effusion.Tortuous thoracic aorta.Stable cardiac silhouette size.Dilated loops of small and large bowel may reflect ileus.

Output: No pneumothorax.Dilated loops of bowel may reflect ileus and can be further evaluated with abdominal radiographs if indicated.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, 69 years old.Reason: rule out chest metastasis History: hx of renal cell carcinoma, prostate cancer Cardiomediastinal silhouette is within normal limits. No pulmonary opacity, pleural effusions or pneumothorax.

Output: No evidence of metastatic disease, or other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: s/p pleurectomy History: - 2 left-sided chest tubes unchanged.No significant pneumothorax.Stable cardiomediastinal silhouette.Left pleural thickening nonspecific basilar opacity similar in appearance the prior exam.No new pulmonary opacities identified.

Output: Stable cardiopulmonary appearance. No evidence of a pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Evaluat for effusion History: Optic neuritis, possible MS flare, congestion No acute cardiopulmonary abnormality.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: SOB History: SOB The cardiomediastinal silhouette is mildly enlarged, unchanged. Vascular indistinctness and inter lobular septal thickening are suggestive of mild pulmonary edema. Small bilateral pleural effusions. No focal pulmonary opacity suggestive of pneumonia. No pneumothorax.

Output: Constellation of findings consistent with clinical diagnosis of CHF; interval worsening since prior radiograph.


Instruction: Generate impression based on medical findings.

Input: 14-year-old male postopVIEWS: Lumbrosacral spine AP (1 view) 9/14/2015 The exam is markedly limited by pads overlying the right and left chest, right and left lower abdomen as well as orthopedic hardware. Right chest tube is present. There is subcutaneous air along the right lateral chest wall.Posterior spinal stabilization hardware is noted without radiographic evidence of hardware complication in the visualized portion.There is a paucity of bowel gas present.

Output: Postoperative changes as described above.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath and hypoxemia Essentially unchanged extensive pulmonary opacities in all 4 quadrants with associated layered large effusions. Underlying cardiomegaly difficult to discern but grossly similar.Midline sternotomy

Output: Nonspecific extensive pulmonary opacities and pleural effusions


Instruction: Generate impression based on medical findings.

Input: Male 85 years old Reason: infiltrate History: hypoxia. Diffuse nonspecific airspace and interstitial opacities consistent with chronic interstitial disease as seen on prior CT scan, possibly with superimposed edema or infection.No significant interval change compared to prior examination.

Output: Severe chronic interstitial disease with possible superimposed acute infection/edema, but no recent significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT. Cerebral palsy. History: same ET tube tip approximately 3 cm above the carina.Catheter from the right extending to the right subclavian vein.NG tube tip in the stomach.Small lung volumes with nonspecific bilateral airspace opacity, slightly improved compared to previous.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: ? pneumo History: open cardiac surgery Patient status post sternotomy and cardiac surgery. Previous lines and tubes, unchanged. Low lung volumes. Bibasilar opacities. Moderate cardiomegaly. No large pleural effusion or pneumothorax.

Output: Expected postoperative appearance status post cardiac surgery.


Instruction: Generate impression based on medical findings.

Input: Reason: 81yo M w/ dysphagia s/p dobhoff, evaluate for placement History: as above Dobbhoff tube tip in the stomach.Mild streaky basilar opacities consistent with aspiration as documented on recent CT scan.A suspicious right upper lobe nodule seen on the recent CT scan is not clearly visible on the radiograph.

Output: Dobbhoff tube tip in the gastric fundus.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Reason: Evaluate for aspiration History: as above Leftward tracheal deviation in the setting of goiter at this location. Nasogastric tube remains in place. Improved aeration left lower lobe with residual basilar atelectasis. No significant pneumothorax. Possible trace left pleural effusion.

Output: Improved aeration left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: dyspnea History: dyspnea The lungs and pleural spaces are clear. The heart size is normal.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with dyspnea. Follow-up pleural effusion. Left upper lobe cavity unchanged. Chronic elevation of the left hemidiaphragm. Near-complete resolution of left sided pleural effusion compared to prior CT. No new focal airspace opacities. No pneumothorax.

Output: Near complete resolution of left-sided pleural effusion. Left upper lobe cavity and other chronic findings unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: h/o R sided infected pleural effusion, eval interval change History: see above Right jugular to RA stent is unchanged in position. Right chest tube is unchanged.No significant change in pleural effusion and adjacent atelectasis allowing for differences in technique and positioning. Right upper lobe opacity is similar to the prior exam. No pneumothorax.Mild cardiomegaly.

Output: No significant interval changes.


Instruction: Generate impression based on medical findings.

Input: 57-year-old female with squamous cell cancer of the tongue. LUNGS AND PLEURA: Radiation fibrosis in the apices unchanged. Dependent patchy airspace opacities compatible with aspiration. Mild bronchiectasis and bronchial wall thickening. No pleural effusion.MEDIASTINUM AND HILA: Tracheostomy in place. Small pretracheal lymph nodes are unchanged. Cardiac size normal with no pericardial effusion.CHEST WALL: Right-sided Port-A-Cath in place with its distal tip in the SVC. Surgical clips within the right neck.UPPER ABDOMEN: No significant abnormality noted.

Output: Patchy airspace disease compatible with aspiration. No other significant interval change.


Instruction: Generate impression based on medical findings.

Input: 51 year-old female history of cough. Evaluate for pneumonia. The cardiomediastinal silhouette is unremarkable. Bibasilar opacities suggesting atelectasis/aspiration. No specific evidence of infection.

Output: Bibasilar opacities suggesting atelectasis/aspiration with no specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ETT placement History: ETT in place, routine check ET tube tip approximately 2 cm above the carina.Other devices unchanged.Bilateral mainly perihilar airspace opacities suggestive of aspiration.No new findings.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: eval for cardiomegaly History: chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: check pulmonary status History: check pulmonary status Surgical drains overlie the mediastinum with no pneumothorax.Right-sided mediastinal widening is present, perhaps slightly increased since the immediate postoperative examination yesterday, suggestive of hematoma formation.Patchy left basilar opacity and bilateral pleural effusions are present.Low ET tube, within 1 cm of the carina.

Output: Increasing mediastinal right paratracheal soft tissue possibly postoperative hematoma. Low ETT.


Instruction: Generate impression based on medical findings.

Input: 26-day-old female reported 28 weeks status post cardiac catheterization.VIEWS: Chest and abdomen AP (2 views) 12/20/2015, 1511 ET tube tip at the level of the carina. Left upper extremity PICC tip at the SVC.The cardiothymic silhouette is mild to moderately enlarged. Diffuse bilateral lung haziness.Overly tubular and mildly dilated loops of bowel in a disorganized pattern. No pneumoperitoneum, pneumatosis, portal venous gas.

Output: Enlargement of the cardiac silhouette, hazy lung opacities, and disorganized bowel gas pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: eval lung fields History: hx of CF, s/p ecmo, drop in flows Support devices stable.Stable appearance of extensive bilateral pulmonary opacities.

Output: Extensive bilateral pulmonary opacities with no interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Reason: eval for pulm edema History: see above Enteric tube extends below the lower margin of the image.Swan-Ganz catheter has been removedUnchanged cardiomegaly.Bilateral pleural effusions and basilar opacities are unchanged from prior.No pneumothorax.

Output: Stable bilateral pleural effusions and basilar opacities with no evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: r/o infiltrate History: SOB Small lung volumes with bibasilar subsegmental atelectasis/scarring but with no new pulmonary opacity to suggest pneumonia. Cardiomediastinal silhouette is within normal limits. No large pleural effusions or pneumothorax. Osseous changes related to sickle cell disease.

Output: No acute cardiopulmonary abnormality, without interval change. Specifically, no evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male history of HNPCC metastatic RCC lung CA. History of nephrectomy. Check response to chemotherapy. CHEST:LUNGS AND PLEURA: No new sites of disease. Lesions visually stable measurements as follows. Left upper lobe lesion series 5 image 20 measures 1.9 x 1.4 cm. Consolidation right left perihilar unchanged.Right middle lobe nodule series 5 image 46 1.6 x 1.2 cm and poorly marginated lesion in the dorsal aspect of the right middle lobe on the same cut measures 1.4 x 1 cm.Emphysematous changes. Basilar fibrosis.MEDIASTINUM AND HILA: Small mediastinal nodes unchanged. Coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation the following observations are made.LIVER, BILIARY TRACT: 8mm nonspecific, hypodense lesion lateral segment left lobe series 4 image 85, unchanged. No new lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of local Cronson the left nephrectomy bed. Contour the right kidney is normal.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: Submucosal fat rectum sigmoid colon redemonstrated. No evidence of active inflammation. No bowel wall thickening or dilatation. No ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: NGT placement, post-extubation History: NGT previously coiled in esophagus Left basilar atelectasis likely from aspirated secretions, unchanged.Small lung volumes.An NG tube terminates in the stomach.Upper abdominal drain terminating in the left upper quadrant.Right jugular catheter, tip at right atrial level.Status post extubation.

Output: NG tube placement, the tip now in the stomach. Unchanged left basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: sickle cell with pulm HTN, multiple episodes acute chest, now with chest pain, self-reported fever No new focal pleural parenchymal opacity. Patchy areas of scarring again noted. No large pleural effusion or pneumothorax. Unchanged cardiomegaly. Bony changes consistent with sickle cell disease.

Output: No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: s/p 5/26 Minimally-invasive esophagectomy History: none Status post gastric pull-up.Persistent small pleural effusions, otherwise resolution of prior lung base opacities.Heart size normal.Right jugular catheter, tip in SVC.

Output: Persistent left pleural small effusions, otherwise unremarkable following gastric pull-up.


Instruction: Generate impression based on medical findings.

Input: Reason: linton tube placement s/p deflation History: UGIB Esophageal tube extending to the upper body of the stomach.ET tube tip approximately 3 cm above the carina.Basilar opacities compatible with atelectasis and small effusions.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Right-sided pleuritic chest pain, SOB, sore throat. Low lung volumes. Cardiothoracic ratio appears similar to prior. Interval removal of left PICC.Small focal opacities along the diaphragm at the lung bases bilaterally, nonspecific.

Output: Patchy basilar opacities bilaterally are nonspecific and could be artifact of underinflation. Consider erect PA and lateral chest radiographs at full inspiratory effort to exclude artifact. Differential considerations include aspiration, atelectasis or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: r/o PNA, eval pulm edema History: SOB, increased WOB Small lung volumes with an interstitial abnormality suggestive of edema.Heart size upper normal.Right jugular catheter, tip in SVC.Multiple surgical clips in the upper abdomen with residual contrast material in large bowel.

Output: Pulmonary opacities suggestive of edema with a heart size upper normal. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 86 years old Female. Reason: serial eval History: hypoxia. Right subclavian ICD lead and generator in place. Left IJ catheter tip in the brachiocephalic vein. Stable appearing TAVR in the aortic position. Mitral annulus calcification.Bilateral moderate pleural effusions with associated atelectasis and edema, unchanged. Diffuse pulmonary opacities and possible bronchiectasis appear chronic and unchanged. Increased lung volumes suggestive of COPD, unchanged

Output: Unchanged support devices. Stable appearing pleural effusions and edema.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: intubated History: intubated Support devices unchanged in position. Basilar atelectasis, unchanged.

Output: ET tube tip 5 cm above carina.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: eval for pna or evidence of viral infection History: syncope, tachcyardia Heterogeneous and bandlike opacities in the anterior segment of the left upper lobe may represent bronchopneumonia and appropriate clinical setting; no comparison images available to determine chronicity of these opacities. Correlate with physical exam.No pleural effusion or pneumothorax.The heart is normal in size.

Output: Findings suggestive of left upper lobe bronchopneumonia in the setting of infectious ventricle presentation. Correlate with physical exam. Recommend radiographic follow-up after treatment to ensure complete resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Left upper lobectomy. Postoperative volume loss consistent with left upper lobe resection.Left-sided chest tubes terminate at the lung apex. No significant sized pneumothorax. Mild basal atelectasis on the right, probably due to aspirated secretions.

Output: Mild atelectasis, most likely the result of aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: ET tube History: ET tube Lines and tubes are unchanged. Diffuse pulmonary opacities again noted. Small pleural effusions. Unchanged heart size. No pneumothorax

Output: Diffuse pulmonary opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for opacities or effusions History: s/p tracheostomy, s/p LVAD Persistent left lower lobe atelectasis and opacity elsewhere compatible with atelectasis and possibly edema.Probable small pleural effusions.Small amount of residual free intraperitoneal air, decreased from previous.

Output: Persistent left lower lobe atelectasis, likely secondary to aspirated secretions, with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: sob wtih hx of pulm edema and effusions History: sob wtih hx of pulm edema and effusions Normal heart size and mediastinum.Catheter tip in the SVC.Diffuse interstitial and airspace opacity with moderate pleural effusions, consistent with CHF, with underlying emphysema.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: respiratory failure s/p trach History: s/p trach Small lung volumes with cardiomegaly and patchy pulmonary opacities, not significantly changed.Stable small pleural effusions.Support devices are stable in position.

Output: No change in support devices, cardiomegaly or pulmonary opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Evaluate for aspiration. Altered mental status. Interval removal of the enteric tube.Stable cardiac mediastinal silhouette.Increased pleural effusions with slightly increased bibasilar atelectasis.Linear opacities projecting over both lungs are likely external.

Output: Increased bibasilar atelectasis and pleural effusions, which may reflect aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: pneumonia? History: Cough for two weeks with fever Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Pectus excavatum deformity, normal variant.

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


Instruction: Generate impression based on medical findings.

Input: 53-year-old woman colon cancer status post chemo with complete response. Evaluate EVD, compare to previous. CHEST:LUNGS AND PLEURA: Small left posterior pleural plaque or lipoma seized image 45, unchanged from 10/14 2006. No lung nodules or effusions.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation, the following observations are made:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Atherosclerotic changes redemonstrated.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Central line rectum. No evidence of recurrence. Remainder visualized are also normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No measurable disease. Stable left pleural plaques probably lipoma or fibrolipoma.


Instruction: Generate impression based on medical findings.

Input: 54-year-old female with LLQ tube cancer CHEST:LUNGS AND PLEURA: Linear atelectasis at lung bases. Multiple subcentimeter calcified micronodules unchanged. There is a new 5 mm nodule in the right middle lobe on image number 37, series number 5.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple new hepatic hypodense lesions consistent with metastatic disease. Some of them are intrahepatic and some extends from the surrounding peritoneum into the liver. A reference intrahepatic lesion the left lobe measures 9 by 8mm image number 90, series number 3. A reference peritoneal metastatic disease extending into liver near the dome measures 16 x 15 mm image number 81, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant interval increase in the peritoneal carcinomatosis. Extensive peritoneal nodules throughout the entire abdomen. Previously measured soft tissue anterior to the opacified bowel in the left pelvis now measures 4.9 x 2.2 cm in image number 147, series number 3.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized. Left adnexal soft tissue density consistent with peritoneal metastatic disease. This lesion measures 3.3 x 1.9 cm in image number 166 on series number 3.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval progression of disease with new hepatic metastases and significant increase in the peritoneal carcinomatosis. A new , right, subcentimeter lung middle lobe nodule,nonspecific. However given the progression of disease metastatic disease is likely.


Instruction: Generate impression based on medical findings.

Input: Reason: cough, prolonged URI 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: Female, 28 years old.Reason: acute chest syndrome History: h/o sickle cell anemia in VOC with shortness of breath Moderate cardiomegaly.No specific evidence of infection or edema.No evidence of acute infection or infarction.Right jugular catheter tip at cavoatrial junction.

Output: Moderate cardiomegaly, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: Pneumothorax; Post device placement in EP Lab History: Post device placement in EP Lab Single lead ICD device with its tip projected in the area of the apex of the right ventricle.No pneumothorax or other complications. Nipple shadows projected over the lower lungs.

Output: New ICD device in expected location with no complications.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for PNA/pneumonitis, please r/o mediastinal free air History: s/p endoscopy, likely aspiration pna/pneumonitis Extensive airspace opacities throughout the left lung, compatible with pneumonia.Moderately large bilateral pleural effusions. Catheter tip in the SVC.Right apical scarring compatible with scarring.

Output: Extensive left lung opacities compatible with pneumonia, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: 49-year-old female metastatic melanoma. Please measurable lesions in two dimensions particularly right axillary lymph node right subcutaneous chest wall nodule, left dorsal subcutaneous chest wall nodule left anterior chest wall nodule possible. Compared to prior scans 1/4/2008. CHEST:LUNGS AND PLEURA: Punctate nodules in the right upper lobe is stable in size and number.There are new small bilateral pleural effusions.MEDIASTINUM AND HILA: Clusters of nodes in the prevascular space are stable. No evidence of hilar nodes.CHEST WALL: High right axillary node image 24/250 and measures 1.3 x 0.8 cm.Caudal to it is another measured axillary node on image 32/250 and measures 1.3 x 1 cm.The left axilla is normal.Clusters of right cardiophrenic nodes are slightly increased. Previously measured node seen on image 72/215 and measures 1.1 x 0.9-cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is new massive ascites and extensive solid carcinomatosis in the distribution of the omentum. This pattern is unusual for melanoma correlate clinically as to the possibility of an ovarian neoplasm.The small bowel is intrinsically normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: There is some soft tissue prominence in the distribution of the left adnexa. It is questionable whether this could represent some implants inseparable from the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: Previously measured index node in the right common iliac artery distribution as seen in image 150/215 and measures 1.5 x 1.3 cm. No new nodes are seen.BOWEL, MESENTERY: Massive generalized ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Progression of disease based on findings of massive generalized ascites and carcinomatosis. Pattern would be somewhat unusual for metastatic melanoma.The lymph nodes are generally stable with measurements as above.


Instruction: Generate impression based on medical findings.

Input: Stem cell transplant evaluation multiple myeloma Lower thoracic spine fixation without apparent complication and similar appearance to dedicated imaging, however mottled appearance of multiple osseous structures correlate with patient's known myeloma. Please refer to dedicated imaging given greater sensitivityLungs are clear. Cardiac and mediastinal contours are within limits. Left subclavian single port terminates in the mid SVC

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.Reason: infiltrate History: SOB Median sternotomy and mitral annuloplasty, heart size at least upper normal.Mild left basilar opacity partially artifact of under inflation, with a small left effusion.

Output: Heart size upper normal with left basilar opacity possibly aspiration or edema, more likely artifactual.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old. Reason: Thyroid nodule. No change clinically. Please assess for change. History: As above RIGHT LOBE MEASUREMENTS: 5.4 x 2.1 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous thyroid parenchyma. Isoechoic interpolar nodule is not significantly changed in appearance and measures 1.5 x 0.8 x 1.1 cm, previously 1.3 x 0.8 x 1.1 cm.LEFT LOBE: Heterogeneous thyroid parenchyma. Reference superior pole hypoechoic nodule measures 0.9 x 0.4 x 0.7 cm, previously 0.8 x 0.4 x 0.8 cm. Left lower pole nodule is unchanged and measures 0.7 x 0.4 x 0.7 cm, previously 0.8 x 0.4 x 0.8 cm.ISTHMUS: Isoechoic right isthmus nodule is unchanged in appearance and measures 2.3 x 1.5 x 1.5 cm, previously 2.0 x 1.4 x 1.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 3 lymph node measures 2.0 x 0.2 x 0.7 cm. Benign-appearing left level 2 lymph node measures 1.7 x 0.3 x 0.6 cm.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid gland with multiple stable solid nodules.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: r/o cholecystitis, evaluate ascites/liver History: abnormal CT scan LIVER: Liver measures 16.2 cm in length. The parenchyma is mildly coarse and echogenic with a micronodular contour which may reflect cirrhosis.Main portal vein is patent with hepatopetal flowBILIARY TRACT: The dependent portion of the gallbladder lumen is a large gallstone measuring approximately 4 cm, unchanged from last time. The gallbladder is contracted around this stone limiting evaluation. There is a small amount of pericholecystic fluid, unchanged from prior exam. Negative sonographic Murphy's sign. No intrahepatic ductal dilatation. There is mild prominence of the common bile duct measuring up to 0.7 cm, which is nonspecific.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 11.8 cm. At the inferior pole of the right kidney is a predominantly anechoic lesion measuring 2.7 x 2.4 x 1.9 cm and previously measured 2.8 x 2.5 x 2.4 cm, overall unchanged from prior exam. Previously seen thin septation is not as well visualized on this examination and there is no definite associated solid component. No shadowing renal calculus or hydronephrosis.The left kidney measures 12.1 cm. No shadowing renal calculus or hydronephrosis.SPLEEN: The spleen measures 10.6 cm. in length. OTHER: No significant abnormality noted.

Output: 1.Gallbladder is contracted around cholelithiasis seen on the prior exam, limiting evaluation. No secondary signs of acute cholecystitis, however there may be a component of chronic cholecystitis.2.Indeterminate right renal inferior pole lesion, unchanged from the prior exam. If further evaluation is clinically warranted, cross-sectional imaging such as CT or MR is recommended.3.Mildly coarsened echogenic liver with a micronodular contour which may reflect cirrhosis. Correlation with patient's clinical history is recommended.


Instruction: Generate impression based on medical findings.

Input: Reason: Nodules seen on CT> Patient scheduled to have as outpatient. Will perform while inpatient. History: Asx RIGHT LOBE MEASUREMENTS: 1.8 x 2.3 x 4.3 cmLEFT LOBE MEASUREMENTS: 2.0 x 1.6 x 4.1 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous gland with multiple thyroid nodules. Largest nodule in the mid posterior right lobe is predominantly cystic and measures 1.9 x 1.4 x 1.6 cm.LEFT LOBE: Heterogeneous gland with multiple thyroid nodules. Largest in the superior pole appears spongy formed and measures 1.1 x 0.7 x 0.7 cm.ISTHMUS: Hypoechoic nodule measuring 0.5 x 0.4 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 lymph node measuring 0.5 x 0.2 x 0.6 cm. Left level 2 lymph node noted measuring 0.6 x 0.3 x 1.0 cm.OTHER: No significant abnormality noted.

Output: Predominantly cystic right thyroid nodule corresponding to lesion seen on CT, favor benign etiology. Multiple small spongiform nodules as above, also favor benign etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old. Reason: obstruction, hydronephrosis. History: decreasing urine output Suboptimal exam due to body habitus and positioning.RIGHT KIDNEY: Right kidney measures 12 cm in length with normal cortical echogenicity. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Suboptimal evaluation of the left kidney due to the above limitations. Left kidney measures 9.9 cm in length. No severe hydronephrosis is noted.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Suboptimal examination as above. No right hydronephrosis or severe left hydronephrosis (left kidney not optimally assessed).


Instruction: Generate impression based on medical findings.

Input: Female 66 years old; Reason: acute renal failure History: altered mental status RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12.3 cm in length. The cortex is mildly echogenic. No shadowing calculi or hydronephrosis is present. URINARY BLADDER: The bladder is decompressed with a Foley catheter.OTHER: No significant abnormalities noted.

Output: No hydronephrosis, stone, or focal renal parenchymal lesion. Echogenic renal parenchyma compatible with medical renal disease.


Instruction: Generate impression based on medical findings.

Input: 43-year-old female with history of multiple sclerosis and transaminitis. LIVER: The hepatic parenchyma shows heterogeneous increased echogenicity. No focal hepatic lesion or mass. The liver measures 15.1 cm in length. The main portal vein is patent with normal hepatopedal flow and velocity of 18 cm/s.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts. The common bile duct measures 0.6 cm in diameter. No choledocholithiasis.PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.2 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.SPLEEN: The spleen is normal in echogenicity and measures 10.1 cm in length. OTHER: There is no free or loculated fluid.

Output: Moderately increased echogenicity and coarse echotexture of the hepatic parenchyma, consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation.


Instruction: Generate impression based on medical findings.

Input: Left upper extremity fistula now swollen and red Diffuse subcutaneous edema. 1.7 x 1.1 x 1.3 cm complex hypoechoic focus adjacent to the AV graft may represent a loculated complex fluid collection.

Output: Diffuse subcutaneous edema. 1.7 x 1.1 x 1.3 cm complex hypoechoic focus adjacent to the AV graft may represent a loculated complex fluid collection; a focal abscess cannot be excluded..


Instruction: Generate impression based on medical findings.

Input: 49-year-old female presents with left upper quadrant pain, evaluate for splenomegaly. LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 16 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 22 cm/s. GALLBLADDER/BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 13 mm in diameter, likely due to post cholecystectomy state. No choledocholithiasis. No intrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. The right kidney measures 10 cm and has normal vascular flow. The left kidney measures 11 cm and has normal vascular flow. OTHER: No significant abnormality noted.

Output: 1. Unremarkable sonographic evaluation of the spleen.2. Increase in hepatic parenchymal echogenicity with coarsened echotexture compatible with fatty liver/hepatic parenchymal dysfunction.3. Dilatation of the common bile duct without intrahepatic biliary ductal dilatation. Likely due to post cholecystectomy state.


Instruction: Generate impression based on medical findings.

Input: Female 57 years old Reason: f/u liver abscess History: none LIMITED ABDOMENLIVER: The liver has a smooth contour. The parenchyma is midlly coarse and echogenic. The previously seen predominantly hypoechoic lesion with mild internal echogenicity and posterior acoustic enhancement in the right lobe of the liver now measures 2.2 x 1.8 1.8 cm, decreased from the prior examination.BILIARY TRACT: The gallbladder is grossly unremarkable without wall thickening or gallstones.KIDNEYS: The kidneys are grossly unremarkable.SPLEEN: Partially visualized spleen is unremarkable.OTHER: No significant abnormalities noted.

Output: Decrease in size of complex cystic right hepatic lesion compatible with resolving abscess.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with a history of alcohol abuse. Reason: Question cirrhosis. LIVER: The liver measures 17.1 cm in length. Coarse echogenic liver echotexture without worrisome mass or ductal dilatation. Peripherally located focus of mixed echogenicity in the right lobe measuring 1.5 x 1.5 x 1.1 cm likely represents known hemangioma as seen on prior CT in segment 7 of the right lobe. Portal vein is patent.GALLBLADDER, BILIARY TRACT: No gallstones, pericholecystic fluid, gallbladder wall thickening or ductal dilatation.PANCREAS: The visualized pancreas is without significant abnormalities.RIGHT KIDNEY: The right kidney measures 11 cm. The cortex is of normal echogenicity. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm. The cortex is of normal echogenicity. No mass, stone or hydronephrosis.SPLEEN: The spleen measures 7.4 cm.OTHER: No ascites.

Output: 1. Coarse echogenic liver echotexture compatible with fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation.2. Peripherally located focus of mixed echogenicity in the right hepatic lobe likely represents known hemangioma as seen on prior CT.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: R/O HCC History: HCV, cirrhosis LIMITED ABDOMENLIVER: The liver has a smooth contour. Liver measures 21.0 cm in length. The parenchyma is normal in echotexture. Portal flow is normal.BILIARY TRACT: The gallbladder has an anechoic lumen. Wall measures 3 mm in thickness. Common duct measures 4 mm.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.9 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.The left kidney measures 10.3 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 14.8 cm. in length.OTHER: No significant abnormalities noted.

Output: 1.No ultrasonographic evidence of hepatic cirrhosis or mass.


Instruction: Generate impression based on medical findings.

Input: Female 63 years old Reason: baseline exam to evaluate heart transplant candidacy History: none LIVER: The liver has a smooth contour. Liver measures 16.9 cm in length. The parenchyma is normal in echotexture. Right hepatic cystic focus with posterior acoustic enhancement it measures 1.7 cm. A smaller second right hepatic cystic focus measures 1 cm.BILIARY TRACT: The gallbladder has echogenic calculi with posterior acoustic shadowing. Wall measures 2 mm in thickness. Common duct measures 5 mm. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 10.5 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.0 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 7.9 cm. in length. OTHER: No ascitesABDOMINAL AORTA: Proximal: 1.7 x 1.8 cmMid: 1.8 x 1.9 cmDistal: 1.7 x 1.3 cmRight common iliac artery: Obscured by bowel gasLeft common iliac artery: Obscured by bowel gas INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis.2.Probable hepatic cysts.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old. Reason: evaluate right neck fullness History: pain x 3 days, h/o neck surgery in china 20 years ago RIGHT LOBE MEASUREMENTS: 7.2 x 2.0 x 1.3 cm.LEFT LOBE MEASUREMENTS: Status post left thyroidectomyISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Homogeneous echotexture without focal nodule. No increased vascularity or microcalcifications.LEFT LOBE: Status post left thyroidectomy.ISTHMUS: Homogeneous echotexture without focal nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 3 neck lymph node measures 1.3 x 0.8 x 0.3 cm.OTHER: No obvious abnormality deep to the site of the patient's palpable concern.

Output: 1. Status post left thyroid lobectomy with unremarkable right thyroid lobe.2. No obvious abnormality deep to the site of the patient's palpable concern.


Instruction: Generate impression based on medical findings.

Input: Male 70 years old Reason: eval for resolution of hydronephrosis History: as above RIGHT KIDNEY: The right kidney measures 8.9 cm. Mild fullness of renal collecting system. No shadowing calculi present. Upper pole cyst measuring 2.2 x 2.1 x 2 cm. Increased renal cortical echogenicity.LEFT KIDNEY: The left kidney measures 10 cm. Moderate left-sided hydronephrosis. No shadowing calculi is present. Left-sided renal cyst measuring 1.8 x 1.6 x 1.6 cm. Increased renal cortical echogenicity.BLADDER: Suboptimal evaluation with Foley catheter present, echogenic foci with 'dirty'-appearing posterior acoustic shadowing seen in nondependent aspect of bladder, likely gas related to catheter-placement.OTHER: No significant abnormalities noted. Pleural areas not well assessed.

Output: Moderate left-sided hydronephrosis and fullness of right renal collecting system.Echogenic kidneys, consistent with medical renal disease. Bilateral simple renal cysts. Postprocedural sequela involving bladder as above.


Instruction: Generate impression based on medical findings.

Input: 17-year-old male with history of neurogenic bladder and incontinence. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 10 cm Left: 9.8 cm   Mean for age: 10 cm  Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: None.

Output: Normal examination.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469


Instruction: Generate impression based on medical findings.

Input: Pain. Guyon canal mass or hook of the hamate fracture? I see no mass within Guyon's canal. The ventral margin of the hook of the hamate is unremarkable, but I cannot exclude a fracture on the basis of ultrasonography. The ventral margin of the pisiform likewise appears normal. The fascicles of the ulnar nerve subjectively appear slightly prominent, but I see no site of compression. The bifurcation of the nerve into the superficial sensory branch and deep motor branch appears normal. The ulnar artery appears normal without evidence of dilatation. The muscles in the vicinity of the canal appear normal.

Output: No specific findings to account for the patient's pain and ulnar nerve symptoms.


Instruction: Generate impression based on medical findings.

Input: Female 67 years old Reason: 67 y/o lady w/ elevated creatinine RIGHT KIDNEY: The right kidney measures 8.5 cm. Increased renal cortical echogenicity. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. LEFT KIDNEY: The left kidney measures 10.8 cm. Increased renal cortical echogenicity. Left-sided renal cyst measuring 2.1 x 1.8 x 1.4 cm. No shadowing calculi or hydronephrosis is present. No perinephric free fluid. BLADDER: Visualized portions unremarkable.OTHER: No significant abnormalities noted.

Output: No hydronephrosis. Echogenic kidneys, compatible with medical renal disease.Again seen left renal cyst.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with metastatic thyroid cancer. Reason: Lymph node mapping. RIGHT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cm in the AP dimensionRIGHT LOBE: There is a spongiform-appearing nodule in the inferior pole, measuring 0.6 x 0.4 x 0.4 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: There is a hypoechoic nodule associated with moderate vascularity, measuring 1.2 x 0.4 x 1 x 1 cm. There are multiple punctate echogenic foci within the nodule, likely representing microcalcifications.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are numerous round-appearing lymph nodes without fatty hilum throughout the neck as listed below, concerning for metastatic disease.Right level 2, #1: 0.5 x 0.4 x 1.1 cmRight level 2, #2: 0.7 x 0.5 x 0.9 cmRight level 2, #3: 0.7 x 0.5 x 1.7 cmRight level 4: 0.7 x 0.6 x 1.4 cmLeft level 2, #1: 0.7 x 0.5 x 0.9 cmLeft level 2, #2: 0.4 x 0.3 x 0.8 cmLeft level 4, #1: 0.7 x 0.6 x 0.6 cmLeft level 4, #2: 0.3 x 0.3 x 0.4 cmOTHER: No significant abnormality noted.

Output: 1. Numerous suspicious appearing cervical lymph nodes, concerning for metastatic disease.2. Hypoechoic isthmus nodule associated with moderate vascularity. This nodule is amenable to fine-needle aspiration if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Please evaluate for thyroid nodules, central and lateral lymph nodes; isthmus nodule with pathology consistent with papillary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 1.5 x 2.0 x 4.7 cm. LEFT LOBE MEASUREMENTS: 0.9 x 1.6 x 4.6 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: Hypoechoic nodule measuring 0.6 x 0.3 x 0.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Rates level 1B lymph node measuring 2.1 x 0.5 x 2.8 cm. Right level 2 lymph node measuring 0.9 x 0.3 x 1.2 cm. Right level 3 lymph node measuring 1.2 x 0.5 x 1.3 cm. These nodes nodes are normal in morphology.Left level 3 lymph node measuring 0.5 x 0.2 x 0.7 cm. Left level 4 lymph node measuring 0.4 x 0.3 x 0.6 cm. Left level 5 lymph node measuring 0.7 x 0.2 x 1.3 cm. These lymph nodes are normal in morphology.OTHER: No significant abnormality noted.

Output: Redemonstration of isthmus nodule. Bilateral cervical lymph nodes as above without definite evidence of metastasis.


Instruction: Generate impression based on medical findings.

Input: History nephrolithiasis now with pain RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 14.2 cm in length.COLLECTING SYSTEM/URETER: New mild to moderate hydronephrosis. 0.5 x 0.6 x 0.3 cm left renal stone again noted.URINARY BLADDER: Enlarged prostate again notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Patent vasculature without evidence for inflow or outflow compromiseOTHER: No significant abnormality noted

Output: New mild to moderate hydronephrosis. Subcentimeter left renal stone again noted. Patent vasculature without evidence for inflow or outflow compromise.


Instruction: Generate impression based on medical findings.

Input: Male 60 years old; Reason: GFR 10, dense ATN History: oliguria, fluid retention, gross electrolyte abnormalities, ATN RIGHT KIDNEY: The right kidney measures 13 cm in length. The cortex is echogenic. No definite shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm in length. The cortex is echogenic. Stable single small shadowing calculi with no hydronephrosis. OTHER: Visualized portions of the urinary bladder are unremarkable.

Output: 1.Echogenic kidneys can be seen in nonspecific medical renal disease. Stable nonobstructing stone in the left kidney.


Instruction: Generate impression based on medical findings.

Input: Rising liver enzymes and bilirubin. Evaluate for biliary obstruction. LIVER: The liver is enlarged measuring 21.9 cm in length. The hepatic parenchyma is diffusely increased echotexture compatible with hepatic steatosis. No focal lesions identified. The portal vein is patent with hepatopedal flow, but the velocities are elevated measuring 42.4 cm/s. This is of uncertain clinical significance.BILIARY TRACT: Multiple shadowing stones are noted within the gallbladder. The gallbladder wall is normal in thickness. The gallbladder is not distended. No pericholecystic fluid.No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is normal in size measuring 11.3 cm in length. There is normal homogeneous parenchymal echotexture.RIGHT KIDNEY: The right kidney is normal in size measuring 14.8 cm in length. There is normal corticomedullary differentiation. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: The left kidney is normal in size measuring 15.3 cm in length. There is normal corticomedullary differentiation. No hydronephrosis or nephrolithiasis. OTHER: No significant abnormalities noted.

Output: 1. Hepatomegaly and hepatic steatosis. 2. Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.