Instruction: Generate impression based on medical findings.

Input: Female, 83 years old.Reason: eval acute process History: elev trop Cardiomediastinal silhouette is unremarkable. No focal airspace opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: chest pain History: as above Cardiomediastinal silhouette is unchanged.Mild interstitial basilar opacities likely atelectasis with mild associated vascular congestion and edema.No significant effusions. No pneumothorax.

Output: Interstitial basilar opacities likely atelectasis. In addition there may be mild associated vascular congestion and edema. Follow-up recommended.


Instruction: Generate impression based on medical findings.

Input: Evaluate for perforation, history of abdominal pain and duodenal ulcer, status post PEG tube placement No free air seen on submitted left lateral decubitus images. Percutaneous gastrostomy tube visualized. Moderate amount of residual enteric contrast, seen to level of rectum. Dilated bowel seen in pelvis measuring up to 4.5 cm. Findings suggestive of ileus. Right costophrenic angle blunting.

Output: No free air seen.Findings suggestive of ileus, follow-up should be pursued as clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: r/o cardiopulmonary process History: cough and chest pain Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Age: 55 yearsGender: FemaleReason for Study: Reason: pneumonia, effusion History: productive cough x 1 month. The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.Bilateral nephrostomy tubes identified.

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


Instruction: Generate impression based on medical findings.

Input: 90 years, Female. Reason: SBO History: SBO Again seen are multiple dilated loops of small bowel and enteric contrast in the transverse colon, compatible with high-grade small bowel obstruction. No pneumoperitoneum. Interval removal of enteric feeding tube.

Output: Small bowel obstruction without pneumoperitoneum.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: pna History: infectious workup, fever s/p stem cell transplant Right Port-A-Cath with its tip in the SVC.Left central venous catheter is been removed.The cardiomediastinal silhouette is unremarkable.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: 56-year-old male with gastric cancer status post chemotherapy. Evaluate disease status. CHEST:LUNGS AND PLEURA: The cystic lesion in the left lower lobe has decreased in size, now measuring 2 x 1.2 cm in image number 45, series number 4. This is compatible with a resolving abscess.Bilateral small parenchymal nodules are smaller. Index lesion on image number which previously measured 5-mm in diameter cannot be located.MEDIASTINUM AND HILA: Right hilar borderline enlarged lymph node is unchanged.CHEST WALL: Right venous access device is in the expected position.ABDOMEN:LIVER, BILIARY TRACT: Multiple bilobar metastases lesions. Index segment 3 lesion now measures 5 x 4 cm image number 103, series number 3, not significant changed from previous study. A segment 4 index lesion measures 5.5 x 5.5-cm image number 88, series number 3. Index segment 7 lesion measures 4.8 x 4.4-cm image number 114, series number 3. These lesions are stable compared to previous study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrolithiasis unchanged.RETROPERITONEUM, LYMPH NODES: A small infrarenal abdominal aortic aneurysm measuring 3 cm unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Resolution of left lower lobe lung abscess with decreased nodule size.Otherwise stable lung nodules and liver lesions.


Instruction: Generate impression based on medical findings.

Input: Preoperative mitral valve replacement Mildly elevated right hemidiaphragm with large lung volumes. Early COPD changes cannot be excluded given patient age.Lungs are otherwise clear. Cardiac and mediastinal contours are within limits given scoliosis

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Interval development of groundglass opacity in the left upper lobe best seen on image number 36, series number 5 is nonspecific and may represent early pneumonia versus drug reaction. No new nodules.MEDIASTINUM AND HILA: Multiple borderline enlarged in the spinal lymph nodes unchanged.CHEST WALL: Lytic lesions in bilateral rips with associated pathologic fracture and surrounding soft tissue component have not significantly changed compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postsurgical changes involving the right kidney are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous sclerotic foci involving the vertebral bodyOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral total hip arthroplasty. Numerous sclerotic foci involving the pelvic bones representing metastatic disease are unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: ARDS? and NG tube History: see above Support devices are unchanged in position.Coarse bilateral interstitial and airspace opacities of ARDS, unchanged. No significant pneumothorax is visualized. Retrocardiac atelectasis increased, consider retained secretions or mucous plugging.

Output: Diffuse pulmonary opacities of ARDS unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old. Status post LVAD. Cardiopulmonary monitoring and support devices, unchanged.Stable cardiomegaly.Large left pleural effusion with underlying atelectasis, not significantly changed.Right lower lung zone opacity consistent with edema, atelectasis, and a pleural effusion, unchanged.

Output: Pleural effusions and atelectasis/edema without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 95 years old.Reason: evaluate for pneumonia History: confusion, reported hypotension The heart size is within normal limits. Tortuous calcified aorta is unchanged compared to the prior exam. Chronic elevation the left hemidiaphragm. No specific evidence of infection or edema.

Output: Chronic elevation of the left hemidiaphragm without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Swan position, SOB History: As above. Cardiomegaly with mild interstitial edema unchanged. Right jugular Swan-Ganz catheter, tip in main pulmonary artery.Left subclavian ICD, leads unchanged in position.Right PICC, tip in axillary region.

Output: Right jugular Swan-Ganz catheter, tip in main pulmonary artery. Mild edema.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: swan History: as above Swan-Ganz catheter tip in truncus anterior. Left jugular catheter has been removed. Other findings stable.

Output: Swan-Ganz catheter tip in truncus anterior.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Shortness of breath rule out pneumonia. Malignant neoplasm of prostate. Right chest port tip at the SVC level. Normal heart size. Anterior mediastinal opacity could reflect mediastinal fat deposition as seen on a CT dated 6/30/2015, but is nonspecific by plain film. Mild scarring at the lung bases. Azygos pseudolobe, normal variant anatomy. Degenerative changes of the spine. Right seventh rib sclerotic lesion, other known skeletal metastases not readily visible by this technique.

Output: No evidence of pneumonia. Anterior mediastinal opacity most likely reflects mediastinal lipomatosis and can be followed at the time of the patient's next scheduled CT scan.


Instruction: Generate impression based on medical findings.

Input: 82-year-old male with metastatic rectal cancer. Left multicystic kidney lesion slightly increased on the last scan. Reimage due to concern for metastasis versus RCC. CHEST:LUNGS AND PLEURA: A new, 4-mm right apical nodule is evident on axial image 21/102 which is suspicious for metastatic disease. Previously noted right upper and right lower lobe nodules as well scattered micronodules are unchanged. Right middle lobe and right lower lobe atelectasis/scarring is unchanged. No pleural fluid.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Port catheter in the right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating segment 6 lesion measures 1.8 x 1.5 cm on axial image 102/203 and has increased in size from the prior exam where it measured 1.1 x 1.0 cm. Scattered punctate hypoattenuating lesions, too small to characterize, are unchanged. No new liver lesions.SPLEEN: Punctate hypoattenuating lesions are evident in the spleen, some of which may have been present on the prior exam. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Low attenuation lesion off the upper pole of the right kidney most likely represents a benign cyst and is unchanged.A multilocular, cystic lesion arising from the left kidney measures 5.8 x 7.0 on axial image 125/203 and 6.0 x 7.0 cm on coronal image 37/87. These measurements are slightly increased when compared to equivalent measurements made on the prior exam of 5.2 x 7.1 cm on axial image 128/196 and 5.5 x 6.7 cm on coronal image 39/84. However, there is no significant enhancement within this lesion on either the portal venous or delayed phases.RETROPERITONEUM, LYMPH NODES: An enhancing soft tissue nodule adjacent to the distal colon on axial image 128/203 was not clearly evident on the prior exam and probably represents a new mesenteric lymph node suspicious for metastatic disease. Scattered additional small mesenteric lymph nodes are unchanged.BOWEL, MESENTERY: Postoperative changes status post resection of the rectosigmoid colon with a left lower quadrant colostomy. Multiple loops of small bowel within the pelvis demonstrate wall thickening and infiltration of the adjacent mesentery, grossly unchanged from the prior exam. This finding is nonspecific and could represent radiation change, inflammation, or tumor infiltration.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Surgical clips are evident within the prostatic bed.BLADDER: No significant abnormality notedLYMPH NODES: A previously referenced left inguinal soft tissue mass measures 3.4 x 2.9 cm on axial image 178/203 and is slightly smaller when compared to the prior exam where it measured 3.6 x 3.3 cm.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.New right apical nodule, increase in size of a liver lesion, and new mesenteric lymph node suspicious for progression of metastatic disease.2.Slight interval increase in the size of a multiloculated, cystic left renal lesion.3.Stable nonspecific small bowel wall thickening and mesenteric infiltration.4.Stable postoperative changes as described above.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female with history of larynx cancer. Status post CRT 2003. Laryngectomy. Left radical neck dissection in October 2008 with more postoperative chemo RT. Please evaluate for recurrence. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.Mild bronchial wall thickening bilaterally with few areas of occlusion in the lower lobes, likely from aspiration. Groundglass and nodular opacities in the left lower lobe are likely aspiration-related. Additionally, scarring at the bases is grossly unchanged and likely reflects sequela of chronic aspiration as well.Left apical scarring, unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Mild coronary and aortic calcifications.Tracheostomy tube in expected location with postsurgical changes again seen in the visualized neck.CHEST WALL: Asymmetric degenerative changes at the right sternoclavicular joint are unchanged and may be posttraumatic in etiology.Degenerative changes of the spine. UPPER ABDOMEN: Gastrostomy tube in expected location. Nonobstructing renal stones bilaterally.

Output: No evidence of metastases.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female evaluate for staging, upper urothelial cancer, status post left nephrectomy CHEST:8mm nodule in the apical segment of the right lower lobe on image number 38, series number 5. Left apical scarring.No evidence of mediastinal adenopathy.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Focal mild intrahepatic ductal dilatation the hepatic dome is unchanged. No focal lesions.SPLEEN: New payor fro enhancing fluid collection around the spleen. It measures 2.9 x 1.6 cm image number 19, series number 5. A small amount of free fluid around the spleen.PANCREAS: UnremarkableADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Collection in the left nephrectomy bed extending to the perisplenic area as described in the spleen section.Small right renal lesions.RETROPERITONEUM, LYMPH NODES: Postsurgical changes along the left para-aortic space and left psoas muscle. Previously described lymph nodes cannot be visualized due to these postsurgical changes and may have been excised.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Artifacts from the left hip prosthesis limits ultimately evaluation of the pelvis.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval left nephrectomy. Fluid collection in the left nephrectomy bed extending superiorly around the spleen. Peripheral enhancement of this collection suggests an abscess.Right lower lobe nodule. Metastatic lesion cannot be excluded.Dr. O'Donnell was notified at the time of dictation.


Instruction: Generate impression based on medical findings.

Input: Male, 88 years old.Reason: SOB History: SOB Bilateral pleural effusions, right greater than left with associated edema and atelectasis. Heart size is normal. No pneumothorax.

Output: Pulmonary opacities and pleural effusions unchanged.


Instruction: Generate impression based on medical findings.

Input: Age: 44 yearsGender: FemaleReason for Study: Reason: pls eval for pneumothorax History: chest tube fell out Right-sided chest tube has been replaced with new right-sided chest tube with its tip directed superiorly in the mid thorax.Right-sided pneumothorax has decreased in size since the prior exam.Again noted are right-sided endobronchial valves.Stable cardiomediastinal silhouette.Diffuse interstitial opacities unchanged.

Output: New right-sided chest tube with interval decrease in right apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 82 years old.Dyspnea, follow-up bilateral pleural effusion Bilateral pleural effusions, increasing on the left. Right-sided pleural catheter is unchanged. Right midlung pulmonary nodules with incomplete borders likely correlate to pleural-based nodules on CT scan. The cardiac and mediastinal silhouette is unchanged.

Output: Increasing left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 81 years old Reason: CT position History: ct position Swan-Ganz catheter unchanged position with tip in the right main pulmonary artery.Chest tube stable in position without pneumothorax.Nonspecific basilar opacity consistent with atelectasis, consolidation, and effusions.

Output: Small effusions and atelectasis without significant change. Stable tubes and devices.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: assess ET tube History: see above ET tube tip 3 cm above carina. NG tube tip in stomach.Lungs hypoinflated with chronic basilar predominant interstitial abnormality likely due to scarring or atelectasis.

Output: ET tube tip 3 cm above carina.


Instruction: Generate impression based on medical findings.

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

Output: Stable exam


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Dyspnea on exertion, Pulmonary edema vs pneumonia Stable cardiomegaly. No large pleural effusions or pneumothorax. Bilateral basilar streaky opacities compatible with subsegmental atelectasis.

Output: Bilateral basilar streaky opacities compatible with subsegmental atelectasis. No specific evidence of edema or infection.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: eval for pneumonia History: HIV +; fever The lungs and pleural spaces are clear. The cardia mediastinal silhouette is unremarkable.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.History of shortness of breath with known pleural effusion. The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities. Small bilateral pleural effusions persist.

Output: Query very small pleural effusions without additional cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: rule out RFO (required due to 2 surgical teams and BMI 62), unable to get entire abdomen on intraop x-ray History: s/p panniculectomy, total abdominal hysterectomy/bso Mild cardiomegaly with basilar atelectasis and possible edema.No radiodense foreign object identified.Rightward deviation of the trachea at the thoracic inlet level suggestive of a goiter.

Output: Cardiomegaly and possible edema with atelectasis. No radiodense foreign object. Findings were communicated by telephone at 5:44 PM to pager 98762 previously relayed findings to Dr. Tenney at 2:00 PM 5/5/2016, by the radiology resident on call.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: eval for acute process History: prod cough/sob Cardiomediastinal silhouette is unremarkable.Lungs are clear with no focal opacities. No pleural effusions.No pneumothorax.

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


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Hypertension rule out infection or atelectasis. Low lung volumes, about the same. Retrocardiac atelectasis. Patchy nodular opacities in the right lower lung with superimposed bronchiolitis and atelectasis. Tracheostomy tube unchanged in position.

Output: Atelectasis is present. Hazy opacities suspicious for bronchiolitis with pneumonia on the right. Given the presence of a tracheostomy tube, this is most likely the result of aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: s/p right middle lobe lobectomy History: see above Line position stable. No change in pulmonary opacities. No pneumothorax.

Output: No change in pulmonary opacities


Instruction: Generate impression based on medical findings.

Input: Reason: please assess for edema, aspiration History: new hypoxia, worsening respiratory status Moderate cardiomegaly, unchanged.Perihilar and lower zone airspace opacity, similar to the previous day but increased since 8/5/2016, compatible with aspiration or less likely pulmonary edema.Enteric tube traversing the esophagus and extending below the inferior margin of the radiograph.

Output: Pulmonary opacities compatible with aspiration or possibly pulmonary edema, new since 8/5/2016


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: chest pain History: pain Small bilateral pleural effusions are improved and there is no longer evidence of pulmonary edema. Heart size stable.

Output: Small bilateral pleural effusions are improved and there is no longer evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: 71F with CHF and new afib. History: afib, altered mental status Mild to moderate cardiomegaly.Mild basilar edema.No specific evidence of infection.Right jugular catheter tip at right atrial level.

Output: Cardiomegaly with mild edema suggestive of CHF. No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infil, effusion, or PTX. History: CP for one week Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: OSH with sepsis; acute on chronic GVHD; coarse breath sounds History: see above No focal lung consolidation. No evidence of overt left-sided heart failure. Calcified mediastinal and hilar lymph nodes again noted. Normal heart size. Question of old left eighth posterior rib fracture.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: post op, eval lung fields History: s/p AV canal repair, MVR, TVR Improvement in left basilar atelectasis.Perihilar opacities could be edema or aspiration.Stable right chest tube with no pneumothorax.ET tube tip approximately 3 cm above the carina.Right jugular catheter, tip in SVC.

Output: Improving left lower lobe atelectasis, with perihilar edema today.


Instruction: Generate impression based on medical findings.

Input: Reason: PICC line placement History: s/p PICC line repositioning PICC line tip in the SVC with no visible complications.Focal atelectasis or scarring at the left base and no acute findings.

Output: Catheter tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Chest pain radiating to back -- rule-out aortic dissection. CHEST:LUNGS AND PLEURA: Several subcentimeter lung nodules of uncertain significance noted. Left upper lobe ( series 4, image 20) nodule measures 6 mm in diameter and right middle lobe laterally (series 4, image 47) measures 6.5 mm. No pleural effusions are seen. Marked elevation left hemidiaphragm is seen without etiology evident..MEDIASTINUM AND HILA: Aorta is normal in appearance with no evidence of dissection, aneurysm or periaortic abnormalities. Large multinodular changes in the thyroid with marked enlargement of both lobes extending into the anterior/superior mediastinum and displacing trachea to the left and posterior. Mildly enlarged subcarinal lymph node is seen measuring 2.1 x 1.3 cm. No other areas of adenopathy or other mediastinal abnormality seen.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Normal arterial supply to the liver. Arterial phase imaging is difficult to evaluate liver parenchyma -- there is a question of two hypoattenuating lesions in segment 3 (series 9, image 99 and 104). These measure slightly greater than a centimeter in size and are nonspecific. If concern exists over potential for malignancy in the liver, standard liver evaluation would be recommended. No other abnormalities are seen in the liver or biliary tract..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 -- scattered normal sized lymph nodes are seen in the periaortic location without significant enlargement..BOWEL, MESENTERY: Descending colon shows circumferential submucosal low attenuation most consistent with fat deposition from prior colitis. No signs of active inflammation are seen. No abnormal fluid collections..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Anterior ventral abdominal wall hernia containing only mesenteric fat without complication bowel..PELVIS:UTERUS, ADNEXAE: Small uterus with hypo-attenuating regions most consistent with fibroid tumor..BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Rectosigmoid colon shows submucosal low attenuation most consistent with fat deposition from an old colitis. No signs of active inflammation are noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No evidence of aortic dissection or other aortic abnormality. 2. Markedly elevated left hemidiaphragm of uncertain etiology. 3. Markedly enlarged nodular thyroid with extension into the anterior mediastinum as described above 4. Nonspecific subcentimeter lung nodules of uncertain significance and etiology 5. Question of nonspecific hypoattenuating liver lesions in segment 3 -- see above.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: monitor IABP History: iabp The tip of the intra-aortic balloon pump is angulated to the left, possibly within the distal transverse arch or in the proximal left subclavian artery. Repositioning is recommended. The left univentricular AICD and right PICC are unchanged.Cardiomegaly with left ventricular enlargement is unchanged. Progressive left lower lobe atelectasis with leftward shift of the mediastinum. Subcarinal and right infrahilar calcified lymph nodes unchanged. No significant edema or evidence of infection.

Output: The tip of the intra-aortic balloon pump is angulated to the left at the upper level of the distal transverse arch. Repositioning is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: rule out pneumonia History: Congestion Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: evaluate for pleural effusion History: rule out pleural effusion No significant cardiopulmonary abnormality.Left jugular catheter, tip at cavoatrial junction, and a right jugular catheter terminating in the SVC.

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


Instruction: Generate impression based on medical findings.

Input: Pain in a sickle cell patient. Normal heart size. No focal airspace opacities to suggest pneumonia. No pleural fluid or pneumothorax. Subtle sclerosis involving the posterior vertebral elements at about the T11 level could be the result of acute or chronic skeletal infarct.

Output: Possible skeletal infarct at about the T11 level of unclear chronicity, but no acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 86-year-old female with history of renal cell cancer and lymphoma. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: 6 x 5 millimeters subpleural nodule in the right lower lobe (series 81289; image 31), not significantly changed).Mild bilateral paramediastinal fibrotic changes are noted in the apicesMEDIASTINUM AND HILA: Mild stable ectasia of the proximal descending thoracic aorta. Coronary artery calcifications are seen.CHEST WALL: Extensive glenohumeral degenerative changesABDOMEN: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: The lesion in the lower pole of the right kidney status post cryoablation does not demonstrate enhancement and is decreased in size, measure approximately 3.0 x 2.6 cm (measuring approximately 3.3 x 2.7 cm when remeasured on prior MRI). The renal veins are patent.1.3 x 1.3 cm lesion in the anterior aspect of the midpole the right kidney (series 81048; image 44) appears to exhibit mild enhancement. On CT 10/5/06, it measured approximately 8 x 7 mm.Bilateral renal sinus cysts. Some subcentimeter hypodensities on the left are too small to definitively characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Small periumbilical hernia.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: Severe diverticular changes affect the sigmoid colon with scattered diverticula elsewhere.BONES, SOFT TISSUES: Healed lumbar spinous process fracture, unchangedOTHER: Mild atherosclerotic disease.

Output: No evidence of enhancement of the lesion in the lower pole of the right kidney, status post cryoablation.Small enhancing lesion (approximately 1.3 x 1.2 cm) in the anterior aspect of the midpole the right kidney, gradually increasing in size since over 3 years. This lesion is suspicious for renal cell carcinoma.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.SOB, known history of lung cancer evaluate for CHF or effusion. Bilateral scarring unchanged. Low lung volumes with scarring at the right apex. Bronchial wall thickening and volume loss left lung about the same. Eventration of the right hemidiaphragm. Enlargement of the central pulmonary vasculature unchanged. Atherosclerotic calcification of the aortic arch.

Output: No signs of CHF, pleural fluid or acute abnormality. Chronic abnormalities about the same.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: fever, cough History: fever, cough Stable cardiomediastinal silhouette, including tortuous and calcified aorta. No focal consolidation, significant pleural effusion or pneumothorax. Left PICC line terminates in the proximal SVC.

Output: No specific evidence of infection or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: r/o pna vs edema History: sob, copd, chest pain There are decreased lung volumes with stable marked elevation of the left hemidiaphragm.Mild left basilar atelectasis.No focal areas of consolidation.No pleural effusions.Stable cardiomediastinal silhouette with tortuosity of the aorta.

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


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: chest pain History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: SOB, fever Resolution of pulmonary edema and pleural effusions. No acute cardiopulmonary process on radiography. Moderate cardiomegaly again noted. Aortic atherosclerosis, as before. No pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: eval for pna History: seizure No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Unremarkable cardiomediastinal silhouette.Slight elevation of the right hemidiaphragm.

Output: No specific evidence of infection or effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: 44M s/p picc placement s/p pullback History: assess placement Left PICC, tip in the SVC.Unchanged basilar opacities suggestive of aspirated secretions or mucous plugging.Persistent pneumoperitoneum.

Output: Right PICC, tip in the SVC.


Instruction: Generate impression based on medical findings.

Input: Unexplained weight loss CHEST:LUNGS AND PLEURA: Emphysema and bilateral bulla, more prominent in the apicesMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: CholelithiasisSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.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: Emphysema.Unremarkable CT of abdomen and pelvis


Instruction: Generate impression based on medical findings.

Input: Reason: interval change s/p chest tube History: interval change Moderately large bilateral pneumothoraces, slightly decreased on the right following chest tube insertion, but increased on the left compared to previous. Right chest tube directed medially at the lung base.The margins of the upper lobes are about 25 mm from the chest wall.Diffuse cystic interstitial lung disease, upper zone predominant, unchanged.

Output: Slightly decreased right pneumothorax following chest tube insertion and increased left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Status post left decortication pleurectomy, evaluate chest tube position. Inferior most left chest tube has been removed. Two left-sided chest tubes remain with tips near left apex, unchanged. No significant pneumothorax.Unchanged cardiomegaly.Diffuse airspace and interstitial opacities in left lung similar to prior. Right lung remains clear.Left chest wall subcutaneous emphysema.

Output: Interval removal of one of the left-sided chest tubes without significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Heart failure Moderate cardiomegaly without superimposed pulmonary abnormalities. Swan-Ganz continues to extend and right pulmonary outflow tract. ICD unchanged

Output: No superimposed new acute abnormality


Instruction: Generate impression based on medical findings.

Input: Cough and hemoptysis. Pneumonia, evaluate for change in right pleural effusion. History of CLL, SLE, aspergillus. LUNGS AND PLEURA: Right pleural effusion is slightly increased in comparison to the previous. Small left pleural effusion, unchanged.Consolidation with air bronchograms and surrounding groundglass opacity, involving the medial basilar segment of right lower lobe, without significant changes.MEDIASTINUM AND HILA: Mild increase in the pericardial effusion. Central venous catheter tip in the SVC. Hypoattenuated blood pool compatible with anemia.Innumerable mildly enlarged/enlarged mediastinal lymph nodes, not significantly changed compared to the previous. Left anterior mediastinal defined mass (image 50, series 3) has increased in size, currently measuring 14 mm x 40 mm (previously this measured 25 mm x 29 mm).CHEST WALL: Decrease in size of multiple left axillary lymph nodes with the largest deep lymph node measuring 16 x 12 mm. Soft tissue stranding surrounding these lymph nodes are less prominent than previous. An enlarged right axillary lymph node measuring 19 x 12 mm, unchanged in size.No interval change in the left third costochondral junction destructive lesion.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Increased right pleural effusion compared to the previous. Persistent small left pleural effusion.2. Consolidation with air bronchograms and surrounding groundglass opacity, suggestive of hemorrhage, in the medial basilar segment of the right lobe, consistent with bacterial or fungal infection.3. Increase in size of anterior mediastinal soft tissue mass. Mild interval increase in pericardial effusion. Decrease in size of left axillary adenopathy.


Instruction: Generate impression based on medical findings.

Input: Aortic and mitral valve replacement ETT projects 6 cm above the carina, unchanged. Mediastinal and bilateral basilar chest tubes, Swan-Ganz in the main pulmonary outflow as well as radiopaque Raytek sponges or packing projected over the cardiac silhouette are all unchanged.Improving pulmonary aeration minimally, however more focal opacities in the right upper and left lower lung persist. Suspected improving superimposed edema with nonspecific right upper and left lower lobe opacities

Output: Unchanged hardware including radiopaque packing and/or Raytek expanded is overlying the midline


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: why short of breath History: sob Endotracheal tube tip approximately 7 cm from the carina. Clamshell sternotomy.Low lung volumes.Extensive upper lobe predominant airspace and interstitial opacities, increased from prior radiograph.Stable cardiomediastinal silhouette.

Output: Extensive upper lobe predominant opacities, increased from prior radiograph. Endotracheal tube tip approximately 7 cm from the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: infection, aspiration History: cough Focal air space opacity seen to suggest infection. Ectatic aorta. Cardiac size normal.Curvilinear high density projecting over the right mediastinum is of uncertain significance. If indicated, repeat PA lateral views suggested.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: s/p Thoracoscopy History: "SIB", history of diffuse large cell lymphoma Patchy opacification of right lung, most notable at the base, similar in appearance to previous study and consistent with known pleural-based tumors. Enlarged right hilar silhouette likely due to known paratracheal lymphadenopathy and mediastinal tumor. Blunting of right costophrenic angle with fluid collection in superior part of minor fissure consistent with small right pleural effusion. Right lobulated pleural thickening again noted, but no significant pneumothorax.Stable right Pleurx drain. Left subclavian catheter tip in SVC.

Output: Nodular opacities and small right pleural effusion similar to previous studies and consistent with known history of large B cell lymphoma. No evidence of superimposed acute process.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with metastatic and neck cancer status post chemotherapy. Please reevaluate disease and compare prior exam. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: A prevascular lymph node (series 3, image 36) measures 12 x 8 mm and has been subtly increasing in size since prior study from 3/29/2011. Heart size normal without pericardial effusion. Coronary calcifications.CHEST WALL: Numerous osseous metastases in the thoracic spine, ribs, and sternum as seen previously. No pathologic fractures identified.ABDOMEN: LIVER, BILIARY TRACT: Hypoattenuating subcapsular lesion in the left hepatic lobe (series 3, image 98) measures 21 x 15 mm; previously measuring 12 x 7 mm. No other hepatic lesions identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous osseous metastases throughout the axial skeleton and partially visualized pelvis. No pathologic fractures identified.

Output: 1. Interval increase in the size of left hepatic lobe lesion. While this difference may be due to varying phase of contrast from prior study, metastasis or other lesion remains a possibility. An MRI is suggested for further characterization.2. Stable widespread osseous metastases. No pathologic fractures identified.3. Subtle increase in a prevascular lymph node, suspicious for nodal metastasis.


Instruction: Generate impression based on medical findings.

Input: 53-year-old female with history of breast cancer CHEST:LUNGS AND PLEURA: Abdomen two changes, stable. One was in the right lung, stable. Stable bilateral multifocal nodules with irregular shape some with fibrotic stranding suggesting treated metastases. Scarring left apex. No new lesions.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hemangiomas in the liver are stable.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall are stable.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: Small sclerotic lesions in the bones are stable.OTHER: No significant abnormality noted.

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female 68 years old Reason: Lung Transplant Evaluation History: Increasing oxygen needs, shortness of breath. The comparison chest radiograph performed on 5/29 demonstrates interstitial lung disease, with no focal pulmonary opacities or pleural fluid. The ventilation images show right upper and right lower lung with decreased ventilation.The perfusion images show a heterogenous pattern, matched to ventilation images, likely due to interstitial lung disease. Quantitation of relative single breath ventilation (using the posterior image):Left lung: 62.8% (upper lung 12.6%; lower lung 21.9%)Right lung: 37.2% (upper lung 8.3%; lower lung 11.4%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 55.2% (upper lung 16.8%; lower lung 14.4%)Right lung: 44.8% (upper lung 12.2%; lower lung 10.1%)

Output: Ventilation and perfusion images as quantified above.


Instruction: Generate impression based on medical findings.

Input: Balloon dilatation of esophagus Interval decreased perihilar opacities with mostly minimal changes persisting along with scarring and/or atelectasis along the minor fissure. Small lung volumes persist. Midline sternotomy.

Output: Interval near improvement in previously described perihilar edema-like pattern.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old, with history of thyroid cancer with metastases status post resection, brain radiation, chemotherapy. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary nodules compatible with metastatic disease are stable in size and number. The reference right lower lobe nodule measures 1.7 x 1.1 cm on axial image 38/97, unchanged.Right middle lobe atelectasis unchanged. Small bilateral pleural effusions, slightly improved on the right.MEDIASTINUM AND HILA: Tracheostomy tube in place. Right chest port catheter, tip at the junction of the SVC and RA.Reference superior mediastinal mass on the right measures 2.8 x 1.9 cm on axial image 24/150, unchanged when remeasured on the prior exam. This mass continues to obstruct the right brachiocephalic vein and narrow the left brachiocephalic vein, similar to the prior exam. Additional prevascular, paratracheal and subcarinal lymphadenopathy is grossly unchanged. A large right hilar mass is likewise unchanged, encasing and obstructing the right middle lobe bronchi. Narrowing of the right lower lobe bronchi is evident as well.The cardiac size is normal. No pericardial fluid. CHEST WALL: Numerous sclerotic foci throughout the thoracic vertebral bodies compatible with metastatic disease unchanged. A sclerotic focus within the lateral aspect of the right fifth rib is new (coronal image 26 left 117).ABDOMEN:LIVER, BILIARY TRACT: Reference lesion in the dome of the liver measures 4.3 x 3.1 cm on axial image 74/150, increased from 2.1 x 3.4 cm. Additional smaller hypoattenuating foci within the liver are unchanged.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypoattenuating lesions in the kidneys are unchanged.PANCREAS: Hypodense lesion within the body of the pancreas (axial image 102/150) is unchanged. Subtle soft tissue density in the region of the head of the pancreas measures 4.9 x 3.3 cm on axial image 110/150 and is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A G-tube is in place. Multiple small bowel intussusceptions are observed (axial images 139 and 127/150).BONES, SOFT TISSUES: See above.

Output: Stable disease in the lungs and mediastinum with evidence of progression in the liver and bones.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: Evaluation for cardiopulmonary abnormalities History: Kidney Donor Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: eval et tube position History: advanced Interval advancement of endotracheal tube, with tube tip now approximately 4 cm above the carina. Right central venous catheter terminates in the superior vena cava. Basal scarring/atelectasis is unchanged. Probable small pleural effusions. No focal airspace opacities.

Output: Interval advancement of endotracheal tube, with tip now approximately 4 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with history of ILD, COPD; here with shortness of breath. CHEST:LUNGS AND PLEURA: Mild chronic interstitial opacities bilaterally on background of diffuse emphysema. Small pleural effusions with marked compressive atelectasis of the left lower lobe along with small nodular opacities at both lung bases. Mild bronchiectasis in the lower lobes, likely from chronic infection.No significant air trapping. Scattered micronodules, unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size severely enlarged small pericardial fluid. Enlargement of the main pulmonary artery is compatible with pulmonary hypertension.CHEST WALL: Superior endplate depression of T12 vertebral body, unchanged.UPPER ABDOMEN: Small ascites. Anasarca.

Output: Mild chronic, nonspecific interstitial abnormalities compatible with sequela of pulmonary hypertension, chronic CHF, and emphysema. Severe cardiomegaly with small pericardial effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old. Reason: ETT placement, eval lung fields for pleural effusions/edema History: post op ET tube approximately 2 cm above the carina. NG tube with distal side port above the level of the GE junction. This has been adjusted on follow-up imaging. Right IJ central venous catheter, tip near the cavoatrial junction. Additional catheter tubing overlying the right hemidiaphragm likely reflects a surgical drain. Surgical clips and staples overlie the upper abdomen and left chest.Low lung volumes and increasing basilar opacities, likely reflecting effusions and atelectasis.

Output: Increasing basilar opacities, likely reflecting effusions and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain Nonobstructive bowel gas pattern. Cholelithiasis.

Output: No bowel obstruction. Cholelithiasis.Please refer to same day chest radiography and CT body imaging for additional findings.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.History of cardiogenic shock, evaluate Swan position Cardiac defibrillator lead unchanged in position. Swan-Ganz catheter with a loop in the right atrium but tip advanced to the level of the main pulmonary artery.Stable cardiomegaly.Indistinctness of the pulmonary vasculature is noted. No focal pulmonary opacities or large pleural effusions.

Output: 1.Swan-Ganz catheter looped in the right atrium with tip advanced to the level of the main pulmonary artery.2.Mild pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 24 years old.Reason: asthma vs infection History: sob Unchanged mild/moderate cardiomegaly.No specific evidence of infection or edema.Right upper lobe scarring unchanged.Congenital fusion of the right fifth and sixth ribs noted.

Output: Cardiomegaly, without acute edema or pneumonia. No complication of asthma identified.


Instruction: Generate impression based on medical findings.

Input: Reason: 59 y/o man w/ a hx of CHF w/ dyspnea History: dyspnea Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: pneumothorax? History: s/p right chest tube pull. Interval removal of right chest tube. No significant right pneumothorax. Left basilar chest tube in unchanged position. Small left pneumothorax is stable to slightly decreased from the prior exam.ET tube terminates one to 2 cm above the carina. A nasogastric tube terminates in the stomach. A Dobbhoff tube extends below the inferior margin of the image. Changes of bilateral lung transplant.Stable cardiomediastinal silhouette.Basilar atelectasis and small effusions, unchanged.

Output: No significant right pneumothorax. Small residual left pneumothorax with left chest tube in place. Unchanged basilar atelectasis and effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.Reason: SOB History: SOB No significant cardiopulmonary abnormality.Healed granulomatous disease.No specific evidence of infection or edema.

Output: No significant abnormality. Calcified left upper lobe granuloma.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: MaleReason for Study: Reason: PNA? History: SOB and weak Right IJ venous catheter with its tip in the SVC.Esophageal and aortic stents unchanged.Volume loss left lung with pleural thickening and chronic pulmonary opacities similar in appearance to the prior exam.Mild right basilar interstitial opacities are suggestive of edema.No new pulmonary opacities identified.Extensive left chest wall reconstructive surgery redemonstrated.

Output: Stable postsurgical and chronic appearing abnormalities in left hemithorax. No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: ETT, IABP, swan ganz position History: ETT, IABP, swan ganz position Support devices unchanged with Swan-Ganz catheter tip in the right descending pulmonary artery and IABP marker in the proximal descending aorta.Stable cardiac enlargement.Bilateral pleural effusions and underlying atelectasis similar to the prior exam.

Output: Support devices unchanged with Swan-Ganz catheter tip in the right descending pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: preop eval to r/o pulmonary disorders History: SOB Enlarging left pleural effusion with marked distortion of the left lung and focal perihilar consolidation.Unremarkable right lung.

Output: Enlarging left pleural effusion, with marked left hemithorax volume loss.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: MaleReason for Study: Reason: r/o infection History: HIV, cough, fevers The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are 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: 52-year-old female being, question sarcoidosis, p/w hypercalcemia and tender superficial right lower quadrant abdominal mass. Rule out abscess. The exam is not sensitive for detecting lesions in the solid organs due to lack of IV contrast. Given that limitation, the following observations are made.CHEST:LUNGS BASES: Small right pleural effusion. Cardiomegaly. Pacer wires.ABDOMEN:LIVER, BILIARY TRACT: Liver length 18.5-cm coronal image 57. Smooth liver surface. No obvious biliary dilatation. Gravel versus calcification wall gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Diffuse small nodes. Some may be pathologic by size criteria, but no individual node is large enough for percutaneous biopsy.BOWEL, MESENTERY: Moderate to severe amount of generalized ascites with nodularity to the omentum suggestive of carcinomatosis. Small diffuse nodes in the mesenteric root.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Calcified uterine masses consistent with fibroids.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The large midline hernias (see sagittal image 73/146) containing ascites and omentum. Focal air in the subcutaneous fat may be due to subcutaneous injection see series 2 image 109. Small vessel calcification. No obvious aneurysm.

Output: Ascites and nodularity to the omentum suggestive of carcinomatosis with numerous small nodes in the mesentery and retroperitoneum. Gravel in the gallbladder versus gallbladder wall calcification. Small right pleural effusion. Ventral hernias. Uterine fibroids. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male. History prostate cancer status post resection. Left renal mass solid probably renal CA. No surgery. Recent cough. CHEST:LUNGS AND PLEURA: Micronodule right middle lobe series 5 image 61 probably unchanged from series 7 image 58 and also from older scans such as December 2007 series 5 image 65. No effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality noted

Output: Slight increase size of left renal mass, consistent with renal cell carcinoma. Other findings as above unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: eval for acute cardiopulmonary abnormality History: intermittent cp No significant cardiopulmonary abnormality.Right jugular catheter, tip at SVC/RA junction level.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: 66yoM w/ SOB, hx ofCHF History: SOB There is no significant interval change in the large right pleural effusion tracking laterally and compressing the right lung. Left basilar opacity is again seen. No obvious change in degree of cardiomegaly and vascular congestion.

Output: No significant change in the large right pleural effusion and basilar opacity. Additional findings stable as well.


Instruction: Generate impression based on medical findings.

Input: 79-year-old male with lung cancer -- please evaluate for disease prior to starting a new chemotherapy. CHEST:LUNGS AND PLEURA: Left lung shows some minimal patchy nonspecific groundglass infiltrate in left apex (series 5, image 17). No other significant abnormality in the parenchyma or effusions.Right lung shows a large right hilar and suprahilar mass measuring 6.6 x 4.1 cm (series 3 Conners 25) with associated medial, apical and posterior atelectasis.large loculated right hydropneumothorax is seen. Bibasilar pleural thickening is seen along the loculated pleural effusion (series 3 carriage 86).MEDIASTINUM AND HILA: Mediastinal lymph node enlargement is seen, some of which are calcified represent prior granulomatous disease. Noncalcified enlarged lymph nodes are seen with the largest in the subcarinal space (series 3, image 39) measuring 2.0 x 1.4 cm.CHEST WALL: Enlarged right anterior cardiophrenic angle lymph node mass is seen (series 3, image 71) measuring 3.0 x 2.0-cmABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign renal cysts -- no other significant abnormalities.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: No significant abnormality notedBONES, SOFT TISSUES: Left hip prosthesis. Diffuse degenerative changes throughout the lumbar spine and pelvis.OTHER: No significant abnormality noted

Output: 1. Large right hilar/suprahilar mass with associated atelectasis as above. 2. Large right loculated hydropneumothorax with associated pleural thickening at the base. 3. Mildly enlarged mediastinal lymph nodes, some of which are calcified and some are not as delay needed above. 4. Large right anterior cardiophrenic angle lymph node mass.


Instruction: Generate impression based on medical findings.

Input: Female, 95 years old.Reason: effusion History: effusion Patchy pulmonary opacities and pleural effusions.Cardiomegaly, status post transcatheter aortic valve repair.

Output: Cardiomegaly with patchy pulmonary opacities suggestive of atypical edema or aspiration. Right predominant pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Multiple sclerosis. Pneumonia. Lung volumes remain low. Cardiothoracic ratio similar to previous. No pneumothorax. No focal air space opacities. Dependent atelectasis.

Output: Low lung volumes with underinflation artifact and dependent atelectasis. If there is continued clinical concern for pneumonia, short-term follow-up erect PA and lateral chest radiographs may be of use.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: check ett History: intubated Nasogastric tube has been removed. Feeding tube terminates within the body of the stomach. Other lines and tubes, unchanged. Improvement in lung volumes and pulmonary edema. Right greater than left pleural-parenchymal opacities again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Nasogastric tube has been removed. Feeding tube terminates within the body of the stomach. Other lines and tubes, unchanged. Improvement in lung volumes and pulmonary edema. Right greater than left pleural-parenchymal opacities again noted.


Instruction: Generate impression based on medical findings.

Input: Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST: Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.LUNGS AND PLEURA: Severe centrilobular emphysema. Part solid subpleural nodule in the left upper lobe measuring 12 mm in diameter with a solid component measuring 6 mm. This is new since the previous scan of 3/21/2014, and based on this relatively rapid development for this type of nodule it is more likely an inflammatory than neoplastic, but further follow-up is recommended.9 x 10 mm sharply marginated solid nodule in the left upper lobe, slightly increased from previous, with internal fat density consistent with a hamartoma.New air space groundglass opacity in the right lower lobe may be due to focal edema or mild aspiration.Diffuse bronchial thickening compatible with bronchitis with increased interlobular septal thickening of the lung bases consistent with mild interstitial edema.MEDIASTINUM AND HILA: Paratracheal lymphadenopathy with conglomerate matted nodes measuring up to 14 mm, with loss of fat planes in the mediastinum suggestive of edema.CHEST WALL: A previously described nodule in the left breast is not included in field of view.Degenerative disease in the spine.UPPER ABDOMEN: Very limited evaluation with no gross abnormalities.

Output: 1. New left upper lobe part solid nodule which is indeterminate but new since the previous scan. A follow-up CT scan is recommended in approximately 3-6 months to determine resolution or stability.2. New basilar interstitial opacity with ground glass and air space components in the right lower lobe, and increased mediastinal soft tissue opacity, suggestive of edema, possibly secondary to rapid hydration prior to the scan.3. Left upper lobe hamartoma with mild interval growth.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic bladder cancer status post cystectomy CHEST:LUNGS AND PLEURA: Mild emphysematous changes are unchanged.Subcentimeter nodule along the right major fissure is unchanged.MEDIASTINUM AND HILA: Left hilar lymph node is unchanged measuring 19 x 11 mm image number 42, series number 4. Other mediastinal lymph nodes are also unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney is unchanged. Mild bilateral dilated ureters are unchanged.RETROPERITONEUM, LYMPH NODES: Index left para-aortic lymph node is unchanged measuring 10 x 9 minutes on image number 114, series number 4. A second index left aortic lymph node is also unchanged measuring 14 x 10 minutes on image number 130, series number 4.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post processes second.BLADDER: Status post cholecystectomy. Postsurgical changes in the right lower quadrant ileostomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic changes of the right pubis is stable.OTHER: No significant abnormality noted

Output: Stable borderline enlarged lymph nodes in the abdomen and left hilum.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: evaluate for wheezing History: wheezing Low lung volumes makes detailed pulmonary evaluation difficult. No new focal pleural parenchymal opacity. Unchanged heart size. Unchanged cardiac leads. Tortuous and atherosclerotic aorta again noted. No large pleural effusion or pneumothorax.

Output: Low lung volumes makes detailed pulmonary evaluation difficult. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Reason: Infiltrates History: fever Severe mediastinal and hilar lymphadenopathy.Increased diffuse bilateral interstitial and airspace opacities suggestive of edema with a moderately large right pleural effusion.No specific evidence of pneumonia though diffuse infection could produce a similar appearance.

Output: Extensive mediastinal metastatic disease with new diffuse pulmonary opacities suggestive of edema and possibly progression of pulmonary metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with colon cancer to lung, follow-up. Flank pain. CHEST:LUNGS AND PLEURA: The vast majority of the previously identified pulmonary nodules have increased in size and several new nodules are also now present. Reference left posterior upper lobe nodule has increased in size, measuring 10 x 9 mm (series 4; image 45).MEDIASTINUM AND HILA: Prevascular adenopathy has not significantly changedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Moderately severe bilateral hydroureteronephrosis, increased from the prior study. Simple cyst in the right kidney. Tiny hypodensities in left kidney are stable and most likely represent simple cysts as well.Circumaortic left renal vein with a larger retroaortic component.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are are seen, overall not significantly changedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged and indents the base of the bladderBLADDER: The urinary bladder is greatly distended and demonstrates a thickened wall, not significantly changed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Progression of pulmonary metastases.Moderately severe bilateral and hydroureteronephrosis, mild increased, likely secondary to bladder outlet obstruction. Correlation with PSA is suggested.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Assess right pleural effusion and pulmonary edema. Right pneumothorax measures 5 mm laterally but may be larger medially.Low lung volumes, about the same. Moderate to large right pleural fluid collection similar to previous. Left basal atelectasis unchanged. The left colon appears mildly dilated with air which may be correlated with abdominal radiographs if required.

Output: Newly visible small right pneumothorax, this was identified on a recent chest CT on 4/19/2016 but not visible by plain film until today's date which suggests interval enlargement.


Instruction: Generate impression based on medical findings.

Input: Age: 65 yearsGender: MaleReason for Study: Reason: eval airspaces, s/p LVAD History: asx Support devices unchanged.Bilateral air space opacities, pleural effusions, and basilar atelectasis similar in appearance to the prior exam.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with extensive pulmonary opacities, pleural effusions, and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: shortness of breath History: shortness of breath Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: pneumonia History: fever, chest pain, SOB, tachy 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, 70 years old.Reason: s/p minimally invasive esophagectomy History: s/p minimally invasive esophagectomy Two right chest tubes unchanged with no pneumothorax postop.Postoperative basilar atelectasis and small pleural effusions are noted as well as cardiomegaly.An NG tube traverses a gastric pull-up.

Output: Basilar atelectasis and small pleural effusions. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: 50 of female with history of pulmonary fibrosis LUNGS AND PLEURA: No interval change in the fine peripheral honeycombing in the upper lobes with a peri-fissural distribution. Again noted are scattered upper lobe since. No specific pulmonary nodules identified. No evidence of air trapping.MEDIASTINUM AND HILA: Persistent left vertical vein, consistent with duplication of the superior vena cava.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. No interval change in the fine peripheral upper lobe fibrosis. Evaluate for underlying collagen vascular disease.2. Scattered cysts within the upper lobes without interval change..


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval for SOB History: SOB, flank pain and some chest pain. H/o sarcoidosis and COPD Slight interval increase in nonspecific basilar opacities likely edema or atelectasis superimposed on chronic interstitial abnormality.

Output: Slight interval increase in nonspecific basilar opacities likely edema or atelectasis superimposed on chronic interstitial abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.History: Known left lower lobe nodule with planned resection, follow-up on opacities from 6/19/2015 radiograph Large hiatal hernia unchanged in appearance.Interval improvement of the basilar opacities..No new focal pulmonary opacity. No pleural effusions or pneumothorax.

Output: Interval improvement in the basilar opacities. No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: Infiltrates History: fever Right upper lobe airspace opacity, extending a bit into the lower lung zone as well, and a questionable small right pleural effusion.Left lung unremarkable.Heart size upper normal.ET tube tip approximately 6 cm above the carina.An NG tube terminates in the stomach.Left jugular catheter, tip in SVC.

Output: Right upper lobe opacity, more extensive than on the prior examination, and possibly recurrent infection or aspiration. However, consideration must be given to an indolent mucinous adenocarcinoma. This should be followed to complete resolution or a CT obtained at this time.


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Reason: r/o pna History: fever, leukocytosis The cardiomediastinal silhouette and vasculature are normal. The lungs are clear of airspace and interstitial opacities. There are no pleural effusions. No pneumothorax.

Output: No acute cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: 54 year old female with right breast cancer and stage I clear cell uterine cancer, status post right mastectomy and TAH/BSO. IVC filter due to history of DVT/PE. Question of enlarged right inguinal lymph node. Evaluate disease status. CHEST:LUNGS AND PLEURA: Right scarring and pleural thickening, especially in the right upper lobe. Right lung nodule measuring 6-mm image number 48, series number 5. Linear atelectasis and scar in the right upper lobe.MEDIASTINUM AND HILA: No evidence of enlarged mediastinal lymph nodes.CHEST WALL: Left axillary adenopathy. Most of the lymph nodes have fatty hila suggestive of a benign etiology. Status post right mastectomy and right axillary node dissection. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, the liver measures 19 cm craniocaudally. Probable fatty infiltration. No focal lesions. SPLEEN: Faint small hypodensities in central spleen. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter is in place.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Mesenteric lymph node seen on the prior exam is not identified. There are many subcentimeter nodes in the central mesentery and pelvis, and no larger nodes were found.Bilateral inguinal and external iliac adenopathy. The reference right inguinal lymph node measures 2.6 X 1.4 cm on image number 164, series number 4.Many small inguinal lymph nodes are present bilaterally, unchanged from the prior exam. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Ill-defined increased density in pelvis area best seen on axial image number 154, series 3, on the left but not on the right. This density is stable since the prior exam and may represent recurrence vs. post-op change. Follow imaging is recommended.

Output: Nonspecific right lung nodule is stable. Small right-sided pleural effusion has resolved and there is stable scarring / pleural thickening involving the upper lobes.No significant interval change.Nonspecific enlarged pelvic lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Male, 20 years old.Reason: intubated MG crisis History: MG crisis intubated Basilar atelectasis and pleural effusions are unchanged.Mild to moderate cardiomegaly is present.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular catheter, tip at SVC/RA junction level.

Output: Unchanged basilar consolidation and pleural effusions, likely atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: r/o PNA History: Greenish sputum when coughing Cardiomediastinal silhouette is not significantly changed from 2007 comparison study, with tortuous aorta again noted. Streaky opacities at the right cardiophrenic angle may reflect atelectasis, possibly with superimposed infection. There are no pleural effusions. There is no evidence of pneumothorax. A calcific density projecting over the right upper lobe has increased in size compared to the 2007 prior.

Output: 1. Atelectasis at the right lung base, possibly with superimposed pneumonia.2. Interval increase in a calcified lesion which projects over the right upper lobe. This lesion may be located within the posterior right fourth rib. Chest CT is recommended for further evaluation of this finding.


Instruction: Generate impression based on medical findings.

Input: Status post 10 cycles of Taxol. Ovarian cancer. Debulking. Ca1 25 remains elevated. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Previously described mediastinal subcarinal lymph node is no longer measurable, measuring less than 5 mm in diameter.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cysts are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previous described left hydronephrosis has improved.RETROPERITONEUM, LYMPH NODES: There is an enlarging retroperitoneal soft tissue nodule (image 153; series 3) which measures 2.8 x 2.8 cm. In retrospect, this was present previously but difficult to appreciate due to lack of intravenous contrast and being virtually indistinguishable from closely apposed bowel loops. It previously measured 1.8 x 1.6 cm (image 146; series 3; 8/29/2008 study). Reference iliac bifurcation lymph node a measures 7 x 6 mm (image 143; series 3)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Uterus absent.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: Enlarging retroperitoneal soft tissue nodule compatible with tumor recurrence as described above. Findings discussed with clinical service (pager 8148) at the time of this dictation.


Instruction: Generate impression based on medical findings.

Input: Reason: post-op cardiac surgery History: post-op cardiac surgery ET tube and right jugular catheter unchanged. Right-sided aortic arch.Valve prosthesis and other surgical artifacts unchanged.Mild basilar atelectasis, and small effusions.A more recent radiograph has been interpreted.

Output: Basilar atelectasis and no acute change.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with a history of weight loss CHEST:LUNGS AND PLEURA: Calcified granuloma in the right upper lobe. Nonspecific subcentimeter subpleural nodule in the right upper no in image number 24, series number 4.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable CT of chest abdomen and pelvis.


Instruction: Generate impression based on medical findings.

Input: Reason: lung eval History: lung eval Interval extubation. Right jugular catheter unchanged.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.No significant pneumothorax.

Output: Interval extubation and no other acute change.


Instruction: Generate impression based on medical findings.

Input: 20 year-old male with testicular cancer status post chemotherapy. Evaluate for staging. CHEST:LUNGS AND PLEURA: Moderate right pleural effusion and large left pleural effusion with compression atelectasis of the left base, improved from outside exam.Nonspecific subcentimeter subpleural nodule in the left apex (series 5 image 18) was not apparent on outside exam.MEDIASTINUM AND HILA: Predominate low-attenuating, septated and confluent mediastinal mass measures 11.3 x 8.3 cm in maximal axial dimensions (series 3, image 35) and is similar in size to outside exam. There is moderate compression of the trachea. This mass extends superiorly into the supraclavicular fossa bilaterally, (right greater than left) and is incompletely visualized, but measures at least 9.1 x 4.4 cm in the right supraclavicular fossa (series 3, image 1). CHEST WALL: Left-sided Port-A-Cath traverses a narrowed left innominate vein to terminate with tip at the superior cavo-atrial junction. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular hypodensities at the left adrenal gland (series 3 image 115), is nonspecific but concerning metastatic disease.KIDNEYS, URETERS: Subcentimeter hypodensity and in the superior pole of the left kidney is too small to characterize. No significant renal vasculature narrowing caused by tumor encasement.RETROPERITONEUM, LYMPH NODES: There is a massive confluent, predominatly hypoattenuating, septated mass extending from the retrocrural lymph nodes superiorly to the inguinal nodes inferiorly with encasement of the retroperitoneal vasculature. Maximal axial dimension is 13.9 x 6.6 cm (series 3 image 128) at the L2 vertebral body level. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Retroperitoneal mass described above extends inferiorly to encase the left external iliac artery (series 3, image 182), measuring 6.2 x 3.1 cm and involves the right internal iliac lymph node chain, measuring 5.8 x 4.2 cm at the same level. More cephalically, there is compression of the left common iliac vein with upstream dilatation of the left common iliac and left femoral vein.

Output: 1) Massive confluent lymphadenopathy extends from supraclavicular fossa, mediastinum, retroperitoneum, and into the pelvis, compatible with history of testicular cancer. 2) Moderate right pleural effusion and a large left pleural effusion with slight interval improvement from outside study.3) Moderate compression of the trachea by mass effect.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: ho pulm htn History: desaturation No change in marked cardiomegaly and pulmonary findings. Support devices are unchanged.No pneumothorax.

Output: Stable cardiac and pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: 31-year-old female with shortness of breath/lower Germany edema. Status post cesarean delivery 7 days ago. CHEST:PULMONARY VASCULATURE: No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries.LUNGS AND PLEURA: Small left pleural effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal with small pericardial effusion.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: No significant abnormality noted.LOWER EXTREMITIES: No DVT identified.

Output: No PE. Study is diagnostic to the level of the subsegmental pulmonary arteries. No DVT.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with thyroid cancer, status post 14 cycles of therapy. Evaluate disease status. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Stable 9 x 8 mm anterior mediastinal lymph node (series 3, image 33).Postsurgical changes in the thyroid bed.The esophagus is dilated with an air fluid level, correlate for achalasia.CHEST WALL: Gynecomastia. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of pericholecystic fluid or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Fatty infiltration of the pancreas. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small left, fat-containing inguinal hernia.BONES, SOFT TISSUES: The large lytic lesion affecting the right iliac bone measures 9.6 x 2.7 cm. Sacral neuroforaminal extension is identified on the right (series 3, image 173). Extension of the right iliac lytic bone lesion into the adjacent sacral neural foramen, unchanged from 10/4/07. The predominantly lytic lesion affecting the L2 vertebral body is stable.OTHER: No significant abnormality noted

Output: Stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: evaluate ETT History: see above Lines and tubes are unchanged. Stable mild pulmonary edema and patchy bibasilar opacities. Unchanged heart size. No pneumothorax.

Output: Stable mild pulmonary edema and patchy bibasilar opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: 63M low grade fever, also with PICC and NGT History: fever ] PICC line with its tip in the SVC.NG tube with its tip in the stomach.The cardiomediastinal silhouette is unremarkable.The lungs are clear.No large pleural effusions.

Output: No specific evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 41-year-old male with heart failure. Evaluate interval change. Right Swan-Ganz catheter tip projects over the right interlobar pulmonary artery.Right central venous catheter terminates at the SVC. Mitral valve prosthesis and ICD are noted, unchanged. LVAD incompletely visualized. Status post median sternotomy with intact sternal fixation devices.Cardiomegaly, unchanged.Low lung volumes. Persistent patchy atelectasis of the lung bases.

Output: Persistent patchy atelectasis of the lung bases.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: concern for URI/PNA History: fever, + RVP Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

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


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: history of testicular ca History: same The cardiomediastinal silhouette is normal. No pulmonary opacity, no pleural effusion, no pneumothorax. No evidence of metastatic disease.

Output: No acute cardiopulmonary disease. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: assess et tube History: sp intubation. Endotracheal tube tip 5 cm from the carina. Right IJ catheter tip in the mid SVC. Enteric tube tip in the stomach.Persistent left pleural effusion. Left basilar atelectasis. No new focal pulmonary opacity. Stable mild to moderate cardiomegaly.

Output: Persistent left pleural effusion. No new focal pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: 28 years old Female. Reason: IABP placement History: IABP placement. Cardiomegaly. There is no evidence of acute infiltrate, pleural effusion or pneumothorax. The Swan-Ganz catheter, the cardiac pacemaker/defibrillator electrodes are stable in position.

Output: Cardiomegaly, unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: aortic dissection History: chest pain Cardiomediastinal silhouette at upper limits normal. Basilar streaky opacities representing subsegmental atelectasis.No pleural effusion or pneumothorax.Support devices stable.

Output: Cardiac mediastinal silhouette at upper limits normal. Basilar subsegmental atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: pneumonia, endotracheal tube position History: s/p cardiac arrest Unchanged basilar opacities suggestive of edema, with small pleural effusions.Mild cardiomegaly.ET tube tip approximately 3 cm above the carina.Right jugular catheter tip at cavoatrial junction level.An NG tube extends below the lower margin of the image.Tubing projected over the left clavicle may be external to the patient.

Output: ET tube tip approximately 3 cm above the carina. Unchanged edema like opacities with pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 36 years old.Reason: Chest pain Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 68-year-old female presents for evaluation of a PICC placement. There is been interval placement of the right-sided PICC with its tip in the right atrium. Stable diffuse pulmonary opacities with relative sparing of the mid aspect of the right lung. Pleural effusions again noted. Bibasilar opacities likely represent atelectasis or aspiration. Unchanged heart size.

Output: 1.PICC tip in the right atrium.2.Other pulmonary abnormalities appear stable since chest radiograph a few hours prior.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: assess for infiltrate History: CP, SOB Left-sided PICC terminates near the cavoatrial junction, as before. Diffuse opacities in the left lung again noted. Increasing left pleural effusion particularly at the apex. No pneumothorax. Unchanged cardiomegaly.

Output: Worsening left pleural effusion, particularly at the left apex.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: ecmo History: ecmo Lines and tubes are unchanged. Mild pulmonary edema again noted. Improvement in patchy right basilar opacity. Dense left lower lobe opacity again noted. Unchanged cardiomegaly. No pneumothorax.

Output: Improvement in patchy right basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: intubated History: intubated The endotracheal tube terminates approximately 2 cm from the carina. Focal nodular opacity at the left apex with adjacent suture material is more apparent on the previous radiograph. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 27 years old.Sickle cell disease and history of acute chest syndrome. Presents with chest pain. Evaluate for pneumonia/acute chest. Unchanged right lower lobe hazy opacity, probably atelectasis. Chronic blunting of the right costophrenic angle. No new focal consolidation. The cardiomediastinal silhouette is mildly enlarged, unchanged. Osseous changes compatible with sickle cell disease.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: s/p chest compressions for cardiac arrest, eval for pneumothorax History: cardiac arrest The study is limited due to technique. The tip of the ET tube is about 5 cm above the carina. The tip of the NG tube projects over the fundus of stomach. The tip of the left IJ catheter project over the SVC. There is no major infiltrate, pleural effusion or pneumothorax.

Output: No definite evidence of pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: ETT in place History: see above ET tube tip approximately 3 cm above the carina.Diffuse bilateral opacity suggestive of edema with a moderately large right pleural effusion.Underlying nodular opacities are most likely secondary to infection or patchy edema.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 65 years old Male. Reason: R/o pericarditis vs pericardial effusions vs pulmonary edema History: Known CAD w/ exertional CP /SOB. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax.. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female 47 years old Reason: eval for infiltrate History: s/p kidney transplant with cough x 1 week There is no focal consolidation, pleural effusion or pneumothorax.The cardiomediastinal contours are within normal limits for size.The imaged skeleton and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.History of LVAD placement. Basilar subsegmental atelectasis, improved.Cardiomediastinal silhouette unchanged in size.Support devices including left chest tube unchanged.

Output: Basilar subsegmental atelectasis, improved, without acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with metastatic RCC and history of breast cancer CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again seen, unchanged in size. Reference lesion in the right lung base measures 4 by 3.3 cm, minimally enlarged compared to previous study. Other nodules are also minimally enlarged to unchanged in size. No new nodules.MEDIASTINUM AND HILA: Small hypoattenuating thyroid nodules are unchanged. Small pretracheal lymph node measures 10 x 10 mm image number 33, series number 5. Another node in the anterior mediastinum measures 18 x 21 mm image number 29, series number 5, new from previous CT.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous benign cysts in the liver, not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney has been removed. Enlarge post cystic right kidney with innumerable cysts of various size and density are again noted. No obvious enhancement. Previously described hyperdense cysts is unchanged measuring 2.9 x 2.6 cm on image number 106, series number 5.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small amount of fluid and around the left hip joint.OTHER: No significant abnormality noted.

Output: Minimal interval increase in the size of to some of the lung nodules. New anterior mediastinal adenopathy.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Neutropenic hypotension and tachycardia rule out infection. Right jugular catheter tip near the SVC. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: cardiopulm abnormality? History: SOB , metastatic brest cancer Unremarkable cardiac and mediastinal silhouette. Small bilateral pleural effusions with some underlying basilar atelectasis.Dense abdomen suggestive of ascites which may be contributing to dyspnea.

Output: Small bilateral pleural effusions, basilar atelectasis and probable ascites.


Instruction: Generate impression based on medical findings.

Input: Female, 68 years old.Reason: evaluation left chest History: evaluation of left chest Stable cardiomediastinal silhouette.Increased lucency in the left apex may reflect interval enlargement of a left apical cavitary mass versus improved aeration in this region.Stable appearance of bilateral airspace opacities in the mid and upper lung zones.Stable elevation of left hemidiaphragm.Chest wall hardware unchanged in position and appearance.Unchanged right chest port catheter tip in the SVC.

Output: Increased lucency in the left apex may reflect interval enlargement of a left apical cavitary mass versus improved aeration in this region. Stable appearance of bilateral air space opacities. Findings are concerning for disease recurrence. Recommend contrast-enhanced thoracic CT for further characterization.The ordering provider, Dr. Sincer Jacob, was notified of findings/recommendations via text page on 1/2/15 at 12:38.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: intubated with persistent comatose status monitor ETT position History: intubated Lines and tubes are unchanged. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography