Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Chest pain. Coronary pleural effusions. Acute myocardial infarction. Low lung volumes. Small pleural effusions and/or thickening. Amorphous right suprahilar and infrahilar opacities. Heart size is difficult to assess on given low lung volumes and the AP projection. No acute bony abnormality.

Output: Low lung volumes.Small pleural effusions and/or thickening.Amorphous right suprahilar and infrahilar opacities which could represent aspiration or pneumonia but is indeterminate. Consider correlation with chest CT for further assessment or chest radiographic follow-up in 8 weeks after treatment.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: eval ett placement History: see above Unfavorable progression of perihilar and basilar opacities including increasing bilateral pleural effusions.The endotracheal tube is been advanced, with tip approximately 4 cm above the carina. No other change in line position.No evidence of pneumothorax.

Output: Unfavorable progression of perihilar and basilar opacities with development of pleural effusions.Advancement of endotracheal tube.


Instruction: Generate impression based on medical findings.

Input: Age: 43 yearsGender: FemaleReason for Study: Reason: chest tube History: chest tube Right sided chest tube and mediastinal tube have been removed.Esophageal stent, enteric tube, right PICC line, and left sided chest tube unchanged.Left apical pneumothorax increased from the prior exam.Elevation of the left hemidiaphragm with basilar atelectasis small pleural effusion similar to the prior exam.

Output: Removal of right-sided and mediastinal chest tubes. Increasing left apical pneumothorax in the presence of a left basilar chest tube..


Instruction: Generate impression based on medical findings.

Input: 60 year-old female with restrictive lung disease. Rule out ILD. LUNGS AND PLEURA: Bilateral pleural effusions with adjacent consolidation and atelectasis left greater than right. Left pleural effusion appears loculated on the left. Centrilobular and paraseptal emphysema particularly affects the upper lobes bilaterally.MEDIASTINUM AND HILA: The thyroid gland appears enlarged with multiple areas of heterogeneity and calcification most prominent at the isthmus extending to a retrosternal location. Heart size appears within normal limits. There are multiple mediastinal/hilar lymph nodes. Evaluation of these nodes are limited due to lack of contrast enhancement.CHEST WALL: Asymmetric breast tissue is incompletely evaluated on this examination however retroareolar tissue appears prominent and adjacent skin appears thickened.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Bilateral pleural effusions, partially loculated on the left, with adjacent consolidation and atelectasis.2. Centrilobular and paraseptal emphysema.3. Enlarged heterogeneous thyroid may represent a goiter however evaluation with ultrasound is recommended for further characterization.4. Asymmetric breast tissue noted prominent retroareolar tissue and possible adjacent skin thickening may be evaluated further with mammography.5. Mediastinal and possible perihilar lymphadenopathy of uncertain etiology.


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: any change to mediastinum, lungs, tubes History: esophageal tear s/p esophagectomy A large mediastinal air collection is still present though slightly decreased from previous.ET tube and right chest tubes unchanged with interval removal of the left chest tube.Nonspecific basilar opacity consistent with atelectasis, consolidation and effusions.No significant pneumothorax.

Output: The mediastinal air collection appears to have decreased somewhat however this may be technique related. No other interval changes are demonstrated.


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Reason: r/o infection, fever Right IJ line terminates near the cavoatrial junction. No pneumothorax. Scarlike opacities at the lung bases. Mild cardiomegaly. No large pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 48 years old.Reason: 48 yo F w/ ards, eval lung fields History: ards Unchanged pulmonary opacities and pleural effusions.Left chest tube stable in position with no pneumothorax.Tracheostomy tube tip approximately 3 cm above the carina.Left PICC, tip in the SVC.

Output: Unchanged pulmonary opacities and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: cp History: see above The cardiomediastinal silhouette is unremarkable. There are mildly decreased lung volumes with basilar subsegmental atelectasis.No focal areas of consolidation.No pleural effusions.Degenerative changes in the thoracic spine.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Anal carcinoma, known liver metastases. Evaluate response to chemotherapy. CHEST:LUNGS AND PLEURA: Previously measured left upper lobe nodule has almost completely resolved. A 5-mm groundglass opacity associated with linear atelectasis is noted in the place of the lesion on image number 20, series number 3. Reference right lower lobe nodule has also significantly decreased in size and measures 3 millimeter on image number 65MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Borderline enlarged right axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Patient's known liver metastases is significantly smaller and appears necrotic compared to previous CT measuring 6.2 x 5.3 cm image number 92, series number 3SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant interval decrease in the size of the hepatic and lung metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval mediastinum History: cp, elevated bp, blurry vision Sternotomy hardware intact. Multiple clips project over the mediastinum. There is no focal consolidation, pleural effusion or pneumothorax. The cardiac and mediastinal contours are within normal limits for size. The bones and upper abdomen are unremarkable.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality given portable technique

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with history of palatine adenoid cancer status post resection. Please for interval change. LUNGS AND PLEURA: Previously described micronodules (images 65 and 71, series 5) are stable in size and appearance compared to previous exams. No evidence of metastatic nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 71-year-old male with presumed prostate cancer. Need CT for staging. The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Several, bilateral scattered nodules along the fissures, likely representing intrapulmonary lymph nodes. 12 x 10 mm ill-defined opacity in the right upper lobe on image number 36. Left-sided pleural-based nodular densities and dependent atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST 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: Bilateral significant hydronephrosis and dilated ureters to the level of the pelvis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ill-defined soft tissue densities throughout the peritoneum, likely represents peritoneal carcinomatosis, although unopacified bowel cannot be entirely excluded.BONES, SOFT TISSUES: Diffuse blastic metastases throughout the spine, ribs, sternum and left scapula.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: Bladder wall is diffusely thickened. A Foley catheter is present in the wall of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse blastic metastases throughout the pelvic bonesOTHER: Infiltrative soft tissue density around bilateral distal ureters encases the ureters. The soft tissue density extends into the more proximal aspects of the distal ureter on the right.

Output: Infiltrative soft tissue density encasing the distal ureters, and causing significant bilateral hydronephrosis and hydroureter. This may be arising from prostate cancer. Extensive diffuse blastic metastases likely from the prostate cancer.Possible peritoneal carcinomatosis.Multiple nodular densities in both lungs, predominantly around the fissures. Although they may represent metastatic disease. They may also represent intrapulmonary lymph nodes. Further follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.PICC placement Left PICC tip at the SVC/RA junction. Nasogastric tube can be followed to the left upper quadrant but the tip is off the caudal margin of the film. Lung volumes remain low. Probable pleural effusions. Improving atelectasis and edema.

Output: Left PICC tip at the SVC/RA junction.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male history of non-Hodgkin lymphoma. CHEST:LUNGS AND PLEURA: Stable left lung base subcentimeter nodules. Stable punctate nodule in the right middle lobe.MEDIASTINUM AND HILA: Scattered nonenlarged mediastinal nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant abnormality noted


Instruction: Generate impression based on medical findings.

Input: Multiple myeloma No distinct superimposed osseous or acute cardiopulmonary abnormality. Mild COPD changes. Old healed rib fracture involving the left seventh posterior lateral eighth rib Right subclavian port extends into the mid SVC.

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: 63 -year-old male with history of OHT, DM, CRI, orthostatic hypotension/syncope, depression, compression fracture (T12, T9). Chest x-ray with atypical pneumonia. LUNGS AND PLEURA: Biapical scarring and severe centrilobular emphysema unchanged.Bilateral lower lobe scarlike opacities, more prominent on the right come unchanged. Suture line along the right major fissure. New multifocal regions of ground glass and nodules may represent atypical infection. Consolidation/atelectasis involving the lingula.MEDIASTINUM AND HILA: Stable postsurgical changes including Surgical clips in the mediastinum from heart transplant and mild pericardial thickening. Heart size within normal limits. Atherosclerotic calcifications throughout the aortic arch. No pericardial effusion.Subcarinal lymph node appears larger when compared to previous examination measuring 1.3 x 0.9 cm, (image 46, series 5).Small paraesophageal hernia.CHEST WALL: Status post median sternotomy.Unchanged collapse and sclerosis of the T9 vertebral body when compared to the previous study. New collapse of T12 may be pathologic.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. New, multifocal regions of ground glass and nodularity likely represents atypical infection.2. Stable collapse and sclerosis of T9 vertebral body with new collapse of T12.3. Severe centrilobular emphysema and bibasilar scarring unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: AMS with Hypoxia; Aspiration PNA? History: Hypoxia Cardiomegaly with lower lung zone edema and pleural effusions unchanged.ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.

Output: Unchanged pulmonary opacities and pleural effusions. New intubation.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: eval for cause of hypoxia, respiratory distress Tracheostomy with cannula in place, the cuff of which appear somewhat hyperinflated. The NG tube tip terminates in the body of the stomach.Extensive diffuse interstitial opacities are unchanged, with stable basilar airspace opacities. Reticulated appearance of the lung is consistent with underlying emphysema. Stable bilateral pleural effusions. There is no pneumothorax.Moderate cardiomegaly persist. There is moderate gaseous distention of upper abdominal bowel loops.

Output: 1.Stable pulmonary edema pattern with associated pleural effusions and atelectasis.2.Hyperinflation of the tracheostomy cannula cuff.


Instruction: Generate impression based on medical findings.

Input: 34-year-old male with shortness of breath and wheezing. Evaluate for pneumonia. Cardiac silhouette is within normal limits.Mild peribronchial thickening.Compressive atelectasis abutting the diaphragm.No focal airspace opacities.No pneumothorax or pleural effusion.

Output: Mild peribronchial thickening suggestive of bronchitis or reactive airway disease. No signs of pneumonia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: CHEST: Examination limited by field of view and range of coverage.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extracardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: No significant abnormality noted in the extracardiovascular portions of the examination.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: chest pain History: chest pain Heart size near upper normal with a very tortuous aorta for age suggestive of systemic hypertension.Linear scar left lower lobe lung zone, but no evidence of edema or pneumonia.

Output: Heart size upper normal with a very tortuous aorta suggest systemic hypertension.


Instruction: Generate impression based on medical findings.

Input: Male 53 years old Reason: s/p renal transplant Vascular stents noted in the left axilla, right axilla and right upper extremity.Unchanged nonspecific right basilar interstitial opacity may reflect chronic aspiration or edema.Moderate cardiomegaly unchanged.No pleural effusion or pneumothorax.

Output: Nonspecific right basilar interstitial opacity . Unchanged from 2/19/2014.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: desaturation History: desaturation Mild cardiomegaly. No specific evidence of infection or edema.

Output: Mild cardiomegaly, without other acute findings.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: Pulmonary edema History: sob Stable mild cardiomegaly. Small pleural effusions. Improved edema. No focal pulmonary opacity. G-tube in place.

Output: Persistent small pleural effusions with improved edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: 45 yo M with etoh cirrhosis presenting with R hepatohydrothorax now with worsening respiratory distress following 2 units FFP History: respiratory distress Near complete opacification of the right hemithorax, reflecting large effusion seen on CT.Left lung clear.Cardiomediastinal silhouette is not well assessed.

Output: Large pleural effusion with near-complete collapse of the right lung.


Instruction: Generate impression based on medical findings.

Input: 72 year old female with history of non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: Few subcentimeter nodules in the lungs bilaterally, unchanged.MEDIASTINUM AND HILA: Postoperative changes of median sternotomy again noted. Cardiac size is mildly enlarged, but stable. Few retroaortic lymph nodes are slightly more prominent, the largest (series 3 image 63) measures 1.6 x 1 cm.CHEST WALL: Bilateral shoulder prostheses are incompletely visualized.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Ill-defined left periaortic soft tissue mass (series 3, image 111) measures 3.2 x 1.5 cm, unchanged in size.BOWEL, MESENTERY: Index mesentery lymph node (series 3, image 109) now measures 7 x 6 mm (previously 8 x 9 mm)BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prosthetic enlargement, similar to prior.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left gluteus minimus lipoma, unchanged.OTHER: No significant abnormality noted

Output: Subtle increase in few retroaortic lymph nodes in the chest. Stable small para-aortic mass in abdomen. No new lesions identified.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Empyema without mention of fistula, CT follow-up. Sepsis. Right hydropneumothorax about the same; the majority of the air collection is medial.severe edema-like interstitial and air space opacities bilaterally have increased. Volume of pleural fluid bilaterally has also increased, now moderate to large.

Output: Worsening edema-like opacities and pleural fluid. No significant change in the moderate right pneumothorax component.


Instruction: Generate impression based on medical findings.

Input: Evaluate for bowel obstruction patient with extensive surgical history Suture material and scattered surgical clips in right abdomen and lower pelvis. Nonobstructive bowel gas pattern. No free air seen on upright view.

Output: Nonobstructive bowel gas pattern.No free air.


Instruction: Generate impression based on medical findings.

Input: Age: 51 yearsGender: MaleReason for Study: Reason: s/p TECAB History: NA Interval improvement in the left pleural effusion and left basilar atelectasis.Cardiac mediastinal silhouette is unremarkable.The right lung is clear.No new pulmonary opacities identified.

Output: Significant interval improvement in small left pleural effusion and left basilar atelectasis. No acute cardiopulmonary abdomen identified.


Instruction: Generate impression based on medical findings.

Input: Reason: Will receive RAI. Needs a post-therapy scan about a week later. History: thyroid cancer There is residual functioning thyroid tissue in the thyroid bed, consistent with thyroid remnant and/or tumor. There is no evidence of extrathyroidal metastatic disease. There is somewhat focally prominent but benign gastric activity in the left upper quadrant.

Output: Residual functioning thyroid tissue in the thyroid bed. No evidence of extrathyroidal metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: CTICU patient History: Nontraumatic mitral valve insufficiency. ET tube tip approximately 3 cm above the carina.Swan-Ganz catheter tip in the main pulmonary artery or right ventricular outflow tract.Bilateral opacities compatible with atelectasis and effusions, not significantly changed.No pneumothorax or other acute change.

Output: ET tube in acceptable position. Atelectasis and pleural effusions with no significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old. Reason: shortness of breath History: short of breath, chest pain, s/p cocaine Cardiomediastinal silhouette is within normal limits.No focal airspace consolidation. No pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Reason: post-op from lobectomy History: same Right apical pneumothorax remains. Line position stable.Right perihilar mass unchanged.Left lung remains clear.

Output: No significant change in the right apical pneumothorax and other pulmonary findings.


Instruction: Generate impression based on medical findings.

Input: Reason: right pneumothorax, evaluation History: chest pain Moderate right pneumothorax, slightly increased compared to previous.Multiple right lung nodules and partial atelectasis in the right lower lobe.Unremarkable cardiac and mediastinal silhouette.

Output: Slightly increased right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Personal history of tobacco use, desaturation on room air. Assess for fluid/pneumonia/pneumothorax. Low lung volumes with elevation of the hemidiaphragm.Perihilar opacity suggestive of edema. Basal atelectasis. Probable small left pleural fluid collection. A surgical drain projects over the left neck. Left humeral prosthesis incompletely visualized. No pneumothorax.

Output: Perihilar opacities most consistent with edema, but no specific signs of bacterial pneumonia. If patient is immunocompromised, pneumocystis may be considered. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: progression of pneumonia History: shortness of breath Worsening right basilar consolidation and right pleural effusion.New atelectasis left lower lobe.New lower lung zone edema.

Output: Worsening pneumonia with developing CHF and edema.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with history of altered mental status. There has been interval placement of a right-sided pacemaker with leads in expected location. Cholecystotomy clips are present. Stable cardiomediastinal silhouette. No focal air space opacities, pleural effusions, or pneumothorax. Tortuous aorta.

Output: Interval placement of right-sided pacemaker, however no acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for tube placement; evidence of pneumonia or edema History: sob, rhonchi, sz disorder; intubated ET tube tip at the level of C7-T1 with the cuff above the vocal cords and overinflated. Markedly elevated left hemidiaphragm with overlying subsegmental atelectasis.Enteric tube traversing the esophagus.

Output: High position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: sickle cell pain w h/o acute chest History: typical pain Right Port-A-Cath with its tip in the SVC.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 or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.ARDS, sepsis and intubated. Endotracheal tube 3.5-cm above the level of the carina. NGT off the caudal margin of the film. Air space opacities, left greater than right, not significantly changed.

Output: No acute change in ARDS-like opacities.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out PNA History: slight fevers, cough Unremarkable cardiac and mediastinal silhouette, except for mild scoliosis. Streaky opacity at the left base consistent with scarring and/or subsegmental atelectasis. Catheter tip in the SVC.No specific evidence of pneumonia.

Output: Left basilar atelectasis or scarring but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Chest pain. Question pneumonia or pneumothorax. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: r/o cardiopulm History: chest pain The lungs and pleural spaces are clear. Heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: 63F with legionella PNA. Fevers and worsening cough despite appropriate abx coverage. Eval for worsening PNA or new lobar PNA History: fever, cough Unchanged right upper lobe airspace opacity.Elsewhere, the lungs are unremarkable and the heart size is normal.

Output: Unchanged right upper lobe airspace opacity consistent with infection.


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: r/o pneumonia History: generalized weakness Left basilar opacity could represent infection or aspiration.Basilar septal lines consistent with edema or fibrosis.Moderate cardiomegaly and a tortuous aorta are present.

Output: Findings suggestive of edema and possible left lower lobe infection or aspiration.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with nearly diagnosed metastatic melanoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Nonspecific, 12 x 13 mm, low-density nodule in the anterior chest on image number 67, series number 3. The etiology and significance of this lesion is unknown.CHEST WALL: Bilateral small, nonenlarged axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hyperdense lesion in the anterior left lobe on image number 111, series number 3 likely representing a benign lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal soft tissue nodules. An index lesion adjacent to the descending colon, lateral to the left psoas muscle measures 15 x 15 mm image number 169, series number 3. Other smaller nodules are present around the both kidneys.BOWEL, MESENTERY: Small peritoneal soft tissue nodules, suspicious for metastatic disease. An index nodule measures 6-mm on image number 141, series number 3.BONES, SOFT TISSUES: Multiple soft tissue nodules. An index nodule measures 2.6 x 2 cm in the right gluteal region on image number 180, series number 3.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Please see the discussion aboveOTHER: No significant abnormality noted

Output: Metastatic retroperitoneal, peritoneal, and pelvic soft tissue lesions.Indeterminate low density lesion in the anterior mediastinum.


Instruction: Generate impression based on medical findings.

Input: Reason: atelectasis History: sob Cardiomegaly and aortic aneurysm as previously characterized by CT scan, not appreciably changed.Moderately large bilateral pleural effusions with underlying basilar atelectasis.Extensive left lung atelectasis has largely resolved since the previous day however.

Output: Partial resolution of left lung atelectasis with residual pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: worsening pneumonia History: hypotension, sepsis New right basilar pleural-parenchymal opacities. Diffuse opacities in left lung with more focal left basilar opacity and probable left pleural effusion again noted. Mild to moderate cardiomegaly, unchanged. Unchanged right IJ line terminating near the cavoatrial junction. Spinal curvature, unchanged.

Output: New right pleural parenchymal opacity which certainly could represent aspiration or pneumonia versus pleural effusion with associated atelectasis. Diffuse opacities in left lung, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: pna? History: weakness The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 46 years old Male. Reason: OG tube placement History: new OG tube. The tip of the endotracheal tube is about 2.5 cm above the carina. The feeding tube is stable in position. Apparent opacities in both lung fields and chest wall likely artifactual.

Output: Endotracheal tube is about 2.5 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Reason: coarse breath sounds History: as above Unremarkable cardiac and mediastinal silhouette. Slightly decreased volume in the right lower lobe with mild opacity medially that may be due to infection or aspiration.Healed rib fractures bilaterally.

Output: Mild volume loss and opacity in the right lower lobe that may be due to aspiration and/or infection. Further follow-up is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: et tube History: intubated Left lower lobe atelectasis or scarring, unchanged.No specific evidence of infection or edema.ET tube tip approximately 2 cm above the carina.An NG tube terminates in the stomach.

Output: Left basilar scarring or subsegmental atelectasis, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Reason: broken bones History: tender over chest wall and right clavicle Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 70 years old Female. Reason: sob History: sob. There is a patchy opacity in the right middle lung field, which can be due to soft tissue attenuation from the breast tissue or infiltrate. The cardiac silhouette is normal.

Output: Questionable infiltrative change in the right middle lung field. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: 75 years old Female. Reason: ET tube reposition, Swan reposition History: as above. The tip of the Swan-Ganz catheter projects over the left upper lobe pulmonary artery. The cardiomediastinal silhouette is unchanged. The ET tube, the mediastinal drain, surgical sponge markers, intra-articular pleural pump tip and chest tubes are stable in position. There is no apparent pneumothorax. Large area of increased density in the left breast is stable.

Output: The tip of the Swan catheter projecting over the left upper lobe pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: rule out pneumonia History: chest pain, SOB Moderate cardiomegaly.No significant pulmonary or pleural abnormality.

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


Instruction: Generate impression based on medical findings.

Input: 47-year-old male with history of colorectal cancer CHEST:LUNGS AND PLEURA: No significant abnormality noted mild right apical scarring is unchanged. Calcified nodule in the lingula is unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild wall thickening of the rectosigmoid colon, nonspecific.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Grossly stable examination.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: pna? History: fever The cardiomediastinal silhouette is normal.There are no focal pulmonary opacities or large pleural effusions.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: assess for changes in opacities and ETT position History: ETT in place, cardiogenic shock Markedly enlarged central pulmonary arteries again noted. Mild bibasilar atelectasis has improved since previous study. Unchanged mild cardiomegaly. No pneumothorax. Lines and tubes are unchanged. NG tube again terminates in the proximal aspect of stomach and could be advanced if clinically indicated

Output: Improvement in bibasilar atelectasis. NG tube again terminates in the proximal aspect of stomach and could be advanced if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Abdominal pain, endocarditis on pulmonary valve. Venous anatomy for possible CT surgery (valve repair/replacement); pancreatitis flair changes. Multiple DVTs in IVC filter in 2001. Right IJ thrombectomy in 2008. CHEST:LUNGS AND PLEURA: In the left apex, an irregular opacity measuring 22 x 20 x 29-mm with cavitation and air bronchogram is noted, which is new since 3/2009. This lesion may represent septic embolus, fungal or mycobacterial infection cannot be excluded.Previously (3/2009) seen patchy groundglass and air space opacities in the left lobe are not present. Bibasilar scarring/atelectasis likely due to prior infection, unchanged.MEDIASTINUM AND HILA: No pathologically enlarged hilar or mediastinal lymph nodes. Normal cardiac size. No free pericardial effusion.Left IJ line tip in the right atrium. Right IJ and right brachiocephalic veins are not opacified. Right subclavian vein is poorly opacified. Left subclavian vein is poorly opacified, which could be due to contrast injection from the left IJ catheter. SVC reconstitutes with inflow from a dilated azygos and left brachiocephalic vein. Dilated hemiazygos vein flows to the left brachiocephalic vein. Numerous collateral vessels are evident within the chest wall as seen on the prior study in 3/2009.CHEST WALL: Status post medium sternotomy. Port in the left chest wall.ABDOMEN:LIVER, BILIARY TRACT: Patient status post cholecystectomy. No focal liver lesions identified. Air bubble in the intra and extra hepatic biliary tract. No intra-or extrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No new findings suggestive of pancreatitis. No pseudocyst or free fluid collections. Postsurgical changes consistent with Whipple surgery, unchanged. Multiple calcifications are noted in the residual pancreatic head, compatible with known history of chronic pancreatitis, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.VASCULATURE: IVC filter is again noted. BOWEL, MESENTERY: NG tube tip in the stomach. Surgical changes consistent with Whipple procedure. No intraperitoneal fluid collection.SOFT TISSUES: No significant abnormality noted.

Output: 1. A new irregular opacity with cavitation in the left apex, which may represent septic embolus, fungal or mycobacterial infection cannot be excluded.2. No change in thrombosis or stenosis of the right internal jugular vein and right brachiocephalic vein.3. Status post Whipple procedure. No evidence of acute pancreatitis.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: trach replaced, confirm placement History: as above Severe stable pulmonary opacities consistent with ARDS.Tracheostomy tube, the tip at the level of the thoracic inlet.Other tubes and devices are stable.

Output: Tracheostomy tube, the tip at the level of the thoracic inlet. Unchanged severe pulmonary opacities consistent with ARDS.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: fracture History: pain to L ribs after hitting a truck while bike riding No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Scattered calcified granulomas.Unremarkable cardiomediastinal silhouette.No obvious displaced rib fracture.

Output: No evidence of acute cardiopulmonary abnormality. Please note that chest radiographs are insensitive for rib fractures.


Instruction: Generate impression based on medical findings.

Input: Chest tube check Right chest tube remains unchanged, tip projects towards the inferior midline. Tracheostomy tube and Dobbhoff are also similar in position, however Dobbhoff has been minimally retracted, tip currently projects 3 to 4 cm beyond the GE junction onlyCardiopulmonary appearance otherwise unchanged with large pleural effusions with apical suspected loculated components

Output: Mild retraction of Dobbhoff tube


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Reason: SOB History: as above Right upper and left lower lobe opacities suggestive of multifocal pneumonia.No significant sized pleural effusions.Unremarkable mediastinal contours and cardiac silhouette.

Output: Multifocal pneumonia, which should be followed to complete resolution. If the patient does not appear infected, a CT could be obtained.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: sob ET tube tip approximately 3 cm above the carina. Left jugular catheter unchanged.Small lung volumes with diffuse nonspecific interstitial and airspace opacity, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 64 year old female with small cell lung cancer status post chemo and chest RT. Please compare to the study and evaluate disease status. CHEST:LUNGS AND PLEURA: Left paramediastinal parenchymal fibrosis and bronchiectasis is compatible with evolving sequela of radiation therapy. Few small nodules are seen in the left upper lobe peripherally (series 5, images 47-50) and are new since prior study. While they may be postinflammatory in etiology, continued surveillance is recommended.Reference left lower lobe mass is relatively unchanged in size accounting for differences in technique. It again measures 25 x 15 mm (series 5, image 52). Stable small left pleural effusion.Fibrotic changes at the medial aspect of the right lower lobe are decreased on comparison to prior study.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Moderate calcifications affect the right coronary, left circumflex, and LAD arteries. Aortic valve calcifications also seen.Right thyroid nodule appearing similar to prior study.CHEST WALL: Right chest wall Port-A-Cath with tip near the SVC/RA junction.Median sternotomy wires.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: Atherosclerotic disease of the aorta with partial visualization of endovascular stents in the iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Stable reference left lower lobe nodule and left pleural effusion. 2. Evolving sequela of radiation treatment in the left upper lobe. 3. Few small nodules are seen in the left upper lobe peripherally as well; while they may be postinflammatory in etiology, continued surveillance is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pre op History: pre op The heart is normal in size.Increased lung volumes and signs of upper lobe predominant emphysema. Coarse reticular opacities and signs of scarring in the right upper lobe are noted.There is a nodular opacity in the left upper lobe, which measures approximately 12 mm. No prior images available.The pleural spaces and visualized bones are within normal limits.

Output: Increased lung volumes and signs of emphysema.Indeterminate left upper lobe nodular opacity, concerning for a pulmonary nodule. Characterization with nonemergent chest CT is recommended.


Instruction: Generate impression based on medical findings.

Input: Male, 89 years old.Reason: eval lung fields History: s/p cabg Left IJ catheter tip is again obscured by overlying wires but is visualized within the brachiocephalic vein. Previously described enteric tube has been removed.Otherwise, cardiopulmonary monitoring and support devices are unchanged.Stable enlargement of the cardiomediastinal silhouette.Slightly decreased size of left apical extrapleural mass, suspicious for hematoma.Stable left pleural fluid collection and left basilar atelectasis.Patchy airspace opacities in the right lower lung zone may represent atelectasis/aspiration.

Output: Slightly decreased left apical mass suspicious for hematoma. Otherwise, no significant interval change.


Instruction: Generate impression based on medical findings.

Input: Reason: intraaortic baloon pump placement History: IABP placement A balloon catheter marker 2 cm below the top of the aortic arch and ICD leads unchanged. No sign of CHF or other acute change.

Output: Balloon catheter in the proximal descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Shortness of breath. The cardiomediastinal silhouette is within normal limits. The hila and pulmonary vasculature are also within normal limits. Elevation of the right hemidiaphragm. No air space opacity, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Age: 20 yearsGender: FemaleReason for Study: Reason: is there an infiltrate History: sob The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Reason: Pneumonia, assess severity History: Cough and fever Right upper lobe focal opacity consistent with pneumonia.Heart size normal.

Output: Left upper lobe pneumonia. This should be followed to resolution.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Chest pressure evaluate for pneumothorax, pneumonia or pulmonary edema. No pneumothorax or pleural fluid. Chronic blunting of the costophrenic angles noted.Normal heart size. Atherosclerotic calcification of the thoracic aorta.Moderate air-filled hiatal hernia.No focal pulmonary opacities.Right upper quadrant surgical clips.

Output: Moderate air filled hiatal hernia, correlate for site of the chest pressure. No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: 38-year-old male with new right subclavian triple-lumen catheter.Male, 38 years old. Interval placement of right subclavian CVC with tip at the cavoatrial junction. No pneumothorax.Cardiopulmonary monitoring and support devices, unchanged.Bilateral pulmonary opacity compatible with edema and nonspecific consolidation, similar to prior study

Output: Interval placement of right subclavian CVC with tip at the cavoatrial junction. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: r/o pulmonary disease History: cough, left sided CP Calcified granuloma at the right costophrenic angle. No evidence of displaced rib fracture. Heart size is normal. Multilevel degenerative changes of the thoracic spine. No evidence of pneumonia.

Output: No evidence of infection or displaced rib fracture.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old. Reason: arrival w ith PICC, confirming placement History: PICC line PICC terminates near the cavoatrial junction. Enteric tube terminates within the proximal aspect of stomach and could be advanced if clinically indicated. Elevation of the right hemidiaphragm versus large right hemidiaphragmatic eventration. Mild cardiomegaly. Small left pleural effusion versus pleural thickening. Prominent loops of bowel within the upper abdomen.

Output: Mild cardiomegaly. Small left pleural effusion versus pleural thickening. Prominent loops of bowel within the upper abdomen.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Reason: eval RIJ line placement History: RIJ line placement Moderate cardiomegaly with slightly worse patchy opacities suggestive of aspiration with underlying edema.IABP catheter tip higher than before, the tip projected just below the top of the aortic arch.An NG tube terminates in the stomach.ET tube tip approximately 4 cm above the carina.Right jugular catheter, tip in the right atrium.Unchanged circulatory assist catheters.

Output: Right jugular catheter placed, tip in the right atrium. Slight increase in patchy opacities.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Moderate nonspecific cardiomegaly with minimal basilar atelectasis, however no definite superimposed acute cardiopulmonary canal at any given semiupright portable technique. Consider serial dedicated imaging to confirm.

Output: Nonspecific cardiomegaly without definite additional superimposed findings


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: wbc work up History: fever work up No significant cardiopulmonary abnormality.No specific evidence of infection or edema.Surgical artifacts are projected over the chest.Left subclavian catheter, tip in SVC.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: r/o acute infxn or pneumothorax History: SOB, h/o metastatic lung CA, on home hospice Large left upper lobe mass unchanged.New diffuse interstitial opacities suggestive of edema with small lung volumes.Marked left hemidiaphragm elevation.Right lung metastases.

Output: Known metastatic lung cancer, now with diffuse interstitial opacities suggestive of edema versus underinflation artifact. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old. Venous catheter and aortic balloon catheter unchanged.No significant cardiopulmonary abnormalities.

Output: Venous catheter and aortic catheter in appropriate location with no significant change.


Instruction: Generate impression based on medical findings.

Input: 39-year-old male with history of metastatic sarcoma CHEST:LUNGS AND PLEURA: Reference right upper lobe nodule is increased in size and now measures 9 x 9 mm image number 44, series number 4. Postsurgical changes in the right lung are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Postsurgical changes, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodensity in the right dome is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Ill-defined hypodense lesion in the posterior aspect of the right kidney is ill-defined and difficult to measure and differentiate from the surrounding normal kidney but appears to have slightly increased in size and now measures 18 x 23-mm on image number 98, series number 3. Again noted thrombus in the right renal vein.Thrombus also extends to the IVC. A linear hypodensity in the right common iliac vein may represent linear thrombus versus mixing artifact. 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: Reference right external iliac lymph node is unchanged measuring 8 x 7 mm image number 162, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval increase in the size of the right upper lobe nodule and right adrenal mass. Right renal vein thrombus extending to IVC is unchanged. The


Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: Evaluate ET tube position History: intubated Increasing airspace opacity in the right upper lobe consistent with infection or aspiration.An edema pattern seen elsewhere has diminished.Moderate cardiomegaly.ET tube tip approximately 1 cm above the carina.Left subclavian pacemaker, leads unchanged in position.

Output: 1. Low ET tube.2. Worsening right upper lobe pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 32 years old.Reason: S/p IABP plcmt - assess position. Evidence of emphysema?? FYI dextrocardia History: S/p IABP plcmt. Dextrocardia with situs inversus, with mild to moderate cardiomegaly.No specific evidence of infection or edema.IABP catheter tip a few centimeters below the top of the aortic arch, at the level of the carina.IVC Swan-Ganz catheter extends into a proximal right lower lung zone lobar artery.Nodular opacity over the right lung base likely a nipple shadow.

Output: IABP catheter, tip several centimeters below the top of the aortic arch, at the level of the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Immunocompromise patient with productive cough evaluate for pneumonia. Lateral radiograph degraded by motion artifact.No pneumothorax. Minimal pleural fluid or thickening on the left unchanged since at least 7/2015.Mild left ventricular cardiomegaly, also unchanged.Valve prostheses and sternal hardware unchanged in position. Azygos arch is chronically distended which may indicate hypervolemia, but there is no evidence of pulmonary edema.Scarring left lower lobe, present previously. No new nodules or specific evidence of infection.

Output: Chronic mild left pleural thickening and basal scarring but no specific evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 73-year-old male with history of bladder cancer status post chemotherapy The study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Subcentimeter lung nodule in the right upper lobe best seen on image number 33, series number 4 is unchanged.MEDIASTINUM AND HILA: Calcified hilar lymph nodes are unchanged.CHEST WALL: Subcutaneous nodule at the level of the left mid scapula is unchanged.ABDOMEN: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 and again has lobular contours. A focal lesion cannot be excluded due to lack of IV contrast.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: Status post prostatectomy.BLADDER: Status post cystectomy. Right lower quadrant ileostomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic right iliac wing lesion is unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous CT.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: preop TECAB History: angina The cardiomediastinal silhouette is within normal limits. No focal consolidation, significant pleural effusion or pneumothorax.

Output: No acute cardiopulmonary process is identified.


Instruction: Generate impression based on medical findings.

Input: Esophageal tracheal fistula Persistent bilateral basilar fibrotic changes, probable partial atelectasis and scarring with probable residual small effusions greater on the right with an elevated right hemidiaphragm. Specifically no superimposed air space abnormalities.Cardiac and mediastinal contours remain within limits

Output: Underlying chronic scarring and fibrotic changes without distinct superimposed acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: 57 y/o F self- discontinued PICC line, tip not intact, please evaluate for retained fragment History: as above Improved left basilar atelectasis, increased on the right however.NG tube and left PICC removed.Left upper quadrant drainage catheter unchanged.

Output: Increased right base atelectasis but moderate improvement in the right lower lobe consolidation.


Instruction: Generate impression based on medical findings.

Input: Female, 50 years old.Shortness of breath, evaluate for pulmonary edema. Normal cardiomediastinal silhouette. Large lung volumes. Left subclavian ICD leads are unchanged in position. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality or significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 75 years old.Reason: et tube History: et tube Endotracheal tube has been pulled back and now terminating approximately 4.5 cm from the carina. Left greater than right pleural parenchymal opacities, unchanged. Unchanged presumably. No pneumothorax.

Output: Endotracheal tube has been pulled back and now terminating approximately 4.5 cm from the carina. Left greater than right pleural parenchymal opacities, unchanged.


Instruction: Generate impression based on medical findings.

Input: Respiratory distress Moderate COPD changes with probable minimal atelectasis and/or scarring. No superimposed new acute abnormalities. See subsequent report

Output: COPD without superimposed new abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 84 years old. ETT and fluid overload status post-Lasix. ETT tip 4 to 5 cm above the carina.Left subclavian catheter tip in SVC.Small lung volumes with left basilar atelectasis, unchanged.No new findings.

Output: Left basilar atelectasis without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Resolution of right empyema. The right chest tube projects into the apex of the right lung without significant change in position. No evidence of pneumothorax. There is improved aeration at the right lung base. Mild pleural thickening

Output: Right chest tube is unchanged without evidence of pneumothorax. There is improved aeration at the right lung base.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: na History: na ET tube and right IJ Swan-Ganz unchanged.Stable cardiomediastinal silhouette.Basilar opacities are compatible with atelectasis and probable small effusions.No new pulmonary opacities identified.

Output: Support devices unchanged. Stable cardiopulmonary appearance with bilateral basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: MaleReason for Study: Reason: ams, pna History: ams Left central venous catheter with its tip in the SVC.Decreased lung volumes with stable cardiomediastinal silhouette.Scattered areas of subsegmental atelectasis.No new focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Reason: line change, triple lumen L IJ, trialysis catheter R IJ History: n/a New left jugular catheter extending to the area of the left innominate vein with no pneumothorax or other complications.Large pleural effusions with underlying atelectasis, unchanged.A more recent radiograph has been interpreted.

Output: New catheter with no complications.


Instruction: Generate impression based on medical findings.

Input: 65 year old female. Metastatic GIST, status post 2 cycles of sorafenib. Disease status evaluation. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple metastatic lesions in both lobes of the liver. A reference metastatic lesion measures 4.4 x 6.9 cm on image number 112/217. A simple cyst is present in the left lobe.SPLEEN: Spleen is not visualized. Enhancing soft tissue density lesions in the left subdiaphragmatic space likely represent splenules.. In addition, several hypodense focal lesions in the left subdiaphragmatic space are also present. There reference hypodense lesion measures 14 by 26 mm on image number 75/217. These are suspicious for metastatic disease. PANCREAS: Pancreatic head and body are unremarkable. Pancreatic tail is not well visualized and patient may be status post distal pancreatectomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral multiple parapelvic cysts. Punctate stones in the right kidney.RETROPERITONEUM, LYMPH NODES: Hepatic gastric, peripancreatic adenopathy. A reference lymph node anterior to the pancreas measures 2.6 x 2 cm at image number 97/217. Adenopathy is also present in the left adrenal gland and stomach.BOWEL, MESENTERY: Multiple peritoneal deposits throughout the abdomen. The anterior reference lesion measures 2.8 x 4.4 cm at image number 100/217.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: There reference peritoneal metastatic deposit measures 2.9 x 2.5 cm on image number 177/217. Multiple other peritoneal deposits are also present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Increase size of diffuse peritoneal and hepatic metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 61-year-old female with history of breast cancer. Evaluate disease extent. CHEST:LUNGS AND PLEURA: Numerous pulmonary nodules bilaterally appearing grossly unchanged in size and number since prior study. Reference right upper lobe nodule (series 4, image 28) measures 12 x 9 mm (please note that while the report for comparison study states a measurement of 10 x 9 mm, previous measurement is in fact 12 x 9 mm.)New PEs bilaterally are seen at the segmental level (series 3, image 47; image 38).MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes have slightly increased in size since prior study. Reference precarinal lymph node (series 3, image 36) measures 19 x 18 mm; previously measuring 17 x 16 mm. Heart size normal without pericardial effusion. Coronary and aortic calcifications.CHEST WALL: Subcutaneous metastatic deposit (series 3, image 14) seen posteriorly has also slightly increased in size since prior study, measuring 23 mm; previously measuring approximately 20 mm.ABDOMEN: LIVER, BILIARY TRACT: Reference lesion in hepatic dome (series 3, image 71) measures 11 x 10 mm; previously measuring 14 x 14 mm. This change in size may be due to differences in phase of contrast as it appears similar in size to multiple prior studies.Hyperattenuating focus also in the caudate lobe is unchanged (series 3, image 73).Lesion in the caudate lobe (series 3, image 89) measures 14 x 13 mm; please note while it was previously measured as 16 x 12 mm, it has not changed in size but merely reflects differences in technique.New ill-defined hypoattenuating lesion in right hepatic lobe (series 3, image 104).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule (series 3, image 90) measures 13 x 12 mm, which is unchanged when accounting for differences in technique.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged upper abdominal lymph nodes adjacent to the celiac axis appear unchanged compared to prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T12 metastatic lesion, involving posterior elements, unchanged.Subcutaneous nodule posteriorly measures 9 mm diameter (series 3, image 111); previously 7mm.

Output: 1. New PEs bilaterally. 2. Pulmonary metastases without significant change in size or number.3. Multiple hepatic masses, unchanged in size with a new ill-defined lesion in right hepatic lobe. However, the study is not protocoled for evaluation of the liver. If further characterization is clinically warranted, consider a dedicated liver protocol CT or an MRI.4. Two subcutaneous metastatic deposits posteriorly have slightly increased in size.5. Left adrenal nodule, unchanged.6. Mesenteric adenopathy adjacent to celiac axis, unchanged.Findings were communicated to pager 2089 (covered by pager 5433) at the time of dictation via telephone.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: eval lung fields History: s/p ex lap, extubated Basilar opacities left greater than right progressed since the prior study and consistent with infection or aspirated secretions. Dobbhoff and NG tube both extend below the lower margin of the image.Right jugular catheter, tip in SVC.Left jugular catheter tip at right atrial level. ET tube tip approximately 2 cm above the carina.Right upper quadrant surgical drains.A lead looped over the thoracic inlet is presumably outside the patient.

Output: Increasing basilar opacities, aspiration or infection the differential diagnosis.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: bilateral lung transplant History: bilateral lung transplant Right chest tube unchanged with no pneumothorax but a persistent right pleural effusion as well is a left.Left chest tube removed with no pneumothorax.Stable basilar atelectasis.Other tubes and catheters are unchanged.

Output: No significant pneumothorax. Stable basilar opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: advanced Swan this AM after rounding History: advanced Swan this AM after rounding Swan-Ganz catheter tip in the distal main right pulmonary artery. Endotracheal tube tip 6 cm from the carina.IABP marker 2 cm from the top of the aortic arch, unchanged.Cardiomegaly, edema, effusions stable.

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


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Shortness of breath Aortic atherosclerotic calcifications. Otherwise unremarkable cardiomediastinal silhouette.No specific evidence of infection or edema.Cervical spinal fusion hardware, partially imaged

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: Evaluate size of post procedure ptx History: Apical ptx seen post procedure, SOB, cough There is a mid esophageal stent that is unchanged when compared to prior.Persistent moderate right hydropneumothorax with groundglass opacity over the right mid zone at site of prior nodule biopsy. Left lung is fully inflated. Left infrahilar opacities of atelectasis. Retention enteric contrast in the transverse colon.

Output: Stable position of mid esophageal stent. Persistent moderate right hydropneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lungs History: eval lungs Tracheostomy tube and venous catheters unchanged.Patchy airspace opacity on the right suggestive of infection or aspiration and bibasilar atelectasis, unchanged from previous.No new findings.

Output: Bilateral pulmonary airspace opacities and atelectasis without significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 71 years old.Reason: check pulmonary status History: check pulmonary status Improving right basilar opacities and decrease in size of the right pleural effusion.Unchanged left basilar atelectasis.Left common tip in axillary region.Upper abdominal surgical drain.

Output: Improving right basilar opacity and decrease in size of the right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Chest tube status post lung transplant Partially loculated right pleural fluid collection similar in volume. Unchanged elevation of the left hemidiaphragm.Left pneumothorax with maximal pleural separation of the chest wall of 7-mm, new from previous. No visible pneumothorax on the right.

Output: 7-mm left pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: SOB post valve surgery History: SOB Small pleural effusions. Probable bibasilar subsegmental atelectasis or scarring. No new focal lung consolidation. Unchanged cardiomegaly. Unchanged cardiac leads. No pneumothorax.

Output: Small pleural effusions. Probable bibasilar subsegmental atelectasis or scarring. No new focal lung consolidation.


Instruction: Generate impression based on medical findings.

Input: Male, 38 years old.Reason: IABP History: IABP Swan-Ganz catheter tip in right pulmonary artery. Other support hardware is stable with IABP in proximal descending thoracic aorta. Stable cardiomegaly. No significant pulmonary edema.

Output: IABP in proximal descending thoracic aorta


Instruction: Generate impression based on medical findings.

Input: Female, 60 years old.Reason: infection? History: AMS Right basilar scarring, without evidence of edema or pneumonia.Heart size normal, the aorta tortuous.No specific evidence of infection or edema.

Output: Right basilar scarring. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 77 y/o male with Hx of malignant epithelioid mesothelioma s/p right middle and lower lobe decortication, thoracotomy, pleurectomy and in diaphragmatic repair with mesh s/p chest tube removal, evaluate for right lung expansion Interval removal of right mid lung chest tube. Right apical chest tube unchanged in position.No pneumothorax visualized. Cardiomediastinal silhouette stable in appearance. Right greater than left hazy basilar opacities and effusions not significantly changed from prior exam. No new pulmonary opacities identified.

Output: Interval removal of right mid-lung chest tube. Stable bibasilar atelectasis and/or effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: Pre-Kidney Transplant Moderate cardiomegaly with pulmonary vascular redistribution consistent with increased circulating blood volume.No evidence of pulmonary edema or pneumonia.

Output: Cardiomegaly with no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Increased dyspnea on exertion and cough. Evaluate for pneumonia or fluid overload. Right central venous catheter tip at the SVC/RA junction. Left subclavian ICD leads are unchanged in position.The cardiomediastinal silhouette with severe cardiomegaly is unchanged.There is trace pleural scarring and/or effusion but no reliable evidence of infection or interstitial edema.

Output: No reliable evidence of infection or interstitial edema.


Instruction: Generate impression based on medical findings.

Input: Male, 24 years old.Reason: daily am cxr History: daily am cxr History of lung transplant Improved left pneumothorax. Right pleural effusion unchanged. Improved aeration of right lung.Tracheostomy tube, venous catheters, chest tubes are unchanged.

Output: Improved left pneumothorax. Right pleural effusion unchanged. Improved aeration of right lung.


Instruction: Generate impression based on medical findings.

Input: Male, 42 years old.Reason: pneumonia, pulmonary edema History: intubated for altered mental status, seizures, febrile ET tube overlying the mid trachea. Enteric tube coursing below the diaphragm. The left IJ central venous catheter overlies the proximal right atrium.Limited assessment of the cardiac mediastinum.Very low lung volumes. Left retrocardiac consolidation may represent atelectasis and pleural fluid, although characterization is very limited. Improved aeration of the left apex.No supine evidence of pneumothorax.

Output: Very limited assessment of the lungs and mediastinum. Suggestion of persistent interstitial pulmonary edema.Moderate left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: s/p pericardiectomy, pleurectomy. CT in place History: asx Left chest tube unchanged in position, the right removed, with no pneumothorax.Left chest wall and bilateral neck soft tissue emphysema is present. Unchanged basilar opacities.

Output: No pneumothorax following right chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: pneumonia History: cardiac arrest Limited examination due to chest wall deformity and patient rotation with thoracic spine fusion hardware in place. Endotracheal tube tip projects 5 cm superior to the carina. Moderate cardiomegaly.Pulmonary vascular redistribution with increased interstitial markings likely represent pulmonary congestion and interstitial edema. Diffuse haziness of the right hemithorax suggesting layering pleural fluid. Right basilar calcified granuloma.

Output: 1.Cardiomegaly with worsening pulmonary edema pattern.2.Increased haziness of the right hemithorax suggesting layering pleural fluid.


Instruction: Generate impression based on medical findings.

Input: Male, 23 years old.Reason: s/p extubation History: shortness of breath Patient has been extubated. Left apical chest tube has also been removed. Other lines and tubes, unchanged. Bibasilar opacities and pleural effusions again noted. Miniscule left apical pneumothorax noted. Unchanged appearance of the mediastinum.

Output: Interval removal of a left apical chest tube and endotracheal tube. Persistent bibasilar opacities with pleural effusions. Miniscule left apical pneumothorax, not unexpected after removal of a chest tube.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: pneumonia History: fever, wheezing, cough Mild patchy left basilar opacity, unchanged. Improvement in patchy right basilar opacity. Unchanged moderate cardiomegaly. Aortic and coronary atherosclerosis again noted. Mild peribronchial cuffing. No pneumothorax.

Output: Improvement in patchy right basilar opacity with stable patchy left basilar atelectasis or consolidation.Bronchial thickening consistent with bronchitis or asthma.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: eval ett placement Endotracheal tube tip is 6 cm above the carina. Remaining support devices including ECMO cannulae, Swan-Ganz catheter, IABP marker, and left chest tube are unchanged.Improved aeration in the right lung with persistent near complete atelectasis of the right upper lobe. Worsening left pulmonary edema. Cardiomediastinal silhouette is unchanged. Bilateral pleural effusions.

Output: Endotracheal tube tip is 6 cm above the carina. Improved aeration in the right lung with persistent near complete atelectasis of the right upper lobe. Worsening left pulmonary edema. Bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male 1 day old Reason: please assess line placement History: pulled back UVC another 1cmVIEW: Chest and abdomen AP (2 views) 8/24/2016 at 1554 hours. ET tube tip is at the thoracic inlet. NG tube terminates at the stomach. Multiple bilateral chest tubes and UAC unchanged. UVC tip is at the right atrium.Cardiac silhouette size is normal. Crescent shape lucency of the right paraspinal region from T5 to T9 is unchanged.Persistent bilateral pneumothoraces and pattern of PIE of the right lung. No new focal lung opacities or effusions.Paucity of abdominal gas.

Output: Persistent bilateral pneumothoraces with right-sided pulmonary interstitial emphysema.Paucity of abdominal gas.


Instruction: Generate impression based on medical findings.

Input: Status post thoracentesis No immediate postprocedural complication. Overall moderate to large right pleural effusion with more moderate left effusion otherwise persistUnderlying nonspecific streaky patchy densities in both lungs greater on the right are again observed and nonspecific.

Output: Persistent bilateral pleural effusions greater on the right


Instruction: Generate impression based on medical findings.

Input: Hypoxemia Persistent diffuse moderate interstitial opacities with septal lines at. Suggesting mild edema superimposed upon chronic changes. Basilar atelectasis. Cardiac silhouette is borderline in size and within limits. Mediastinal contours are unremarkable.

Output: Persistent mild edema superimposed upon chronic interstitial changes.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old.Reason: r/o infectious etiology History: DKA Cardiomediastinal silhouette is normal. No large pleural effusion or pneumothorax. No focal pulmonary opacity. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Fever. Evaluate for pneumonia. Low lung volumes. Left basilar subsegmental atelectasis. No focal consolidation, pleural effusion or pneumothorax. The heart size is at the upper limits of normal, with contour abnormality in the AP window region.

Output: Left basilar subsegmental atelectasis. Contour abnormality in the AP window region, cannot exclude pulmonary artery enlargement. Recommend PA and lateral radiographs.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with appendiceal carcinoma. Status post chemotherapy. Evaluate disease status. CHEST:LUNGS AND PLEURA: Stable emphysema and right lung base. MEDIASTINUM AND HILA: Pulmonary arteries are enlarged, suggestive of prominent arterial hypertension. Posterior mediastinal adenopathy has resolved, now measuring 7 mm in diameter on the left lower chest, anterior to the descending aorta is unchanged. Reference left retrocrural adenopathy has decreased in size, now measuring 11 x 14 mm on image number 92, series number 4. Right retrocrural adenopathy is also decreased. Mitral annulus and aortic root calcifications. Cardiomegaly. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Minimal irregularity of the peritoneum surrounding the liver is unchanged. No focal liver lesions. Mild intrahepatic biliary dilatation is unchanged. Hepatomegaly. The liver measures more than 20 cm. Status post cholecystectomy. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable benign renal cysts.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes have decreased in size. Reference retroperitoneal lymph nodes have significantly enlarged within the internal. For comparison, aortocaval lymph node now measures 1.2 x 1.5 cm, image number 99.BOWEL, MESENTERY: Small mesenteric nodules are unchanged.BONES, SOFT TISSUES: Mild stranding in the anterior abdominal wall has decreased, significance is unknown.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: UnremarkableLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in the retroperitoneal adenopathy.No new lesions were found.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Reason: change in opacities and atelectasis? History: tachycardia Lines and tubes are unchanged. Bibasilar opacities and pleural effusions, not substantially different. Unchanged heart size. No pneumothorax.

Output: Bibasilar opacities and pleural effusions, not substantially different.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: seziure Single lead ICD device with its tip projected over the area of the right ventricle but possibly located in the coronary sinus, which could be clarified by a lateral view of the chest.Mild cardiomegaly with aortic valve prosthesis.No evidence of pulmonary edema or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: 43 year old female with known metastatic breast cancer CHEST:LUNGS AND PLEURA: Micronodular in the right upper lobe and right lower lobe or unchanged. No new nodules.MEDIASTINUM AND HILA: Residual thymus and borderline enlarged right hilar lymph nodes are stable.CHEST WALL: Enhancing right chest wall nodule is larger compared to previous study. It measures 1.8 x 1.2 cm on image number 20, series number 3. Previously, it was measuring 1.5 x 0.7 cm on image number 23, series number 6.Status post right mastectomy.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: Interval increase in the size of the right chest wall enhancing nodule suspicious for recurrent disease. Borderline enlarged right hilar lymph node is stable.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.SOB. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax. High normal lung volumes.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Weight loss 20 pounds in 2 months evaluate for mass. Pulmonary nodules described on prior CT are not visible by this technique. No pleural fluid. Normal heart size. Tortuous thoracic aorta. The main pulmonary artery appears prominent, suspicious for pulmonary hypertension.

Output: Signs of pulmonary hypertension but no visible pulmonary nodules or masses by plain film technique. Please note that pulmonary nodules were reported on a CT dated 11/10/2015 and a follow-up CT was recommended (due 5/10/16).


Instruction: Generate impression based on medical findings.

Input: Male, 30 years old.SOB, hypoxia, missed dialysis. Cardiomegaly with distention of the superior vena cava consistent with hypervolemia. Enlargement of central pulmonary vasculature compatible with pulmonary hypertension.Left upper lobe peribronchial distribution airspace opacities are again seen. New basilar interstitial and airspace opacities bilaterally along with significant atelectasis.Chronic bilateral upper lobe volume loss with areas of hypovascularity, correlate for possibility of chronic thromboembolic disease.

Output: Worsening pulmonary opacities may reflect atypical edema and atelectasis in the absence of clinical signs of infection. Cardiomegaly and signs of pulmonary hypertension.


Instruction: Generate impression based on medical findings.

Input: 50 year-old male with history of non-Hodgkin's lymphoma, status post stem cell transplantation, re-evaluate the disease The skull base, cavernous sinuses, and limited view of the brain parenchyma is negative for metastatic lesion.Views of soft tissue neck is negative for discrete mass. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The visualized portion of the lungs are clear. Please refer to the dedicated chest CT for more comments. The cervical vertebral bodies in general are intact with evidence of mild degenerative change.

Output: There is no pathologic lymphadenopathy in the neck soft tissue.


Instruction: Generate impression based on medical findings.

Input: This renal cell carcinoma status post resection and chemotherapy. CHEST:LUNGS AND PLEURA: 6-mm nodule in the left apex on image number 15/233.Calcified granulomas in the left upper lobe.Subsegmental atelectasis in the left lower lobe.MEDIASTINUM AND HILA: 2.9 x 2 . 7-cm round soft tissue mass abutting the anterior chest wall in the anterior/superior mediastinum.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland is unremarkable.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of recurrence in the right nephrectomy bed.RETROPERITONEUM, LYMPH NODES: Multiple nonenlarged retroperitoneal lymph nodes.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: Left apical parenchymal nodule and soft tissue mass in the anterior/superior mediastinum suspicious for metastatic disease or less likely primary bronchogenic neoplasm. This mass is amenable to percutaneous biopsy.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: FemaleReason for Study: Reason: ASPIRATION History: SEIZURES The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.History of PE, now with left-sided chest pain. The cardiomediastinal silhouette is normal.No focal pulmonary opacity or pleural effusion.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: eval chest tube placement History: sob, ptx Interval placement of right chest tube, with tip in the right apex. Marked interval decrease in size of right pneumothorax.Cardiomediastinal silhouette is unremarkable. Left upper lobe nodule is again noted. Probable small bilateral pleural effusions.

Output: Interval placement of right apical chest tube with marked interval decrease in size of right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: ET tube placement. Status post burn.VIEW: Chest AP (one view) 11/15/2016 at 0437 hours. Feeding tube terminates at the second portion of the duodenum. Multiple surgical staples are again noted. Soft tissue thickening of the left-sided chest wall has decreased. ET tube tip is below thoracic inlet.Cardiac silhouette size is normal. Persistent multifocal opacities of the right upper, right middle lobe and both lung bases.

Output: Persistent multifocal airspace opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: central line placement History: central line placement Left-sided subclavian catheter tip extends into the left internal jugular vein with tip not visualized. Enteric tube terminates within the stomach. Endotracheal tube, unchanged. Mild pulmonary edema. No definite pneumothorax.

Output: Left subclavian catheter tip extends into left internal jugular vein with tip not visualized. This has been subsequently repositioned. Probable pulmonary edema, as before.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: h/o PE, p/w palpitations, compliant on Xarelto. Cardiomediastinal silhouette is unremarkable. Low lung volumes are noted. No focal airspace opacities, pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 38 years old.Chest pain Cardiomediastinal silhouette is unremarkable. No pleural effusions or pneumothorax. No focal pulmonary opacity.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: shortness of breath, eval for volume overload History: above Pleural effusions have improved in the interval. Pulmonary edema has improved. No new opacity.

Output: Interval improvement in pulmonary edema and pleural effusions


Instruction: Generate impression based on medical findings.

Input: Patient with history of sickle cell disease, cough and fever Retrocardiac opacity suggestive of pneumonia or acute chest syndrome. No large pleural effusions or pneumothorax. Cardiothymic silhouette is within normal limits.

Output: Retrocardiac opacity suggestive of pneumonia or acute chest syndrome.


Instruction: Generate impression based on medical findings.

Input: 69-year-old male with metastatic melanoma. Status post DTIC chemotherapy. Evaluate for response disease. CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules are again seen. The reference right lower lobe lesion has increased in size and measures 1.7 cm x 2.3 cm (image 70/220, series 3), compared to 1.9 cm x 1.3 cm on the previous exam. The left upper lobe reference lesion is stable and measures 0.5 cm x 0.9 cm (image 41/220, series 3) compared to 0.5 cm x 1.1 cm on the previous exam.MEDIASTINUM AND HILA: Stable subcentimeter mediastinal and hilar lymphadenopathy. Mild cardiomegaly with a stable pericardial effusion. A moderate-sized hiatal hernia is again seenCHEST WALL: Postoperative changes from median sternotomy. ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hypodense lesions are seen in the liver and appear stable when compared to the prior exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Small prostatic calcifications are again seen.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. Equivocal enlargement of the right lower lobe pulmonary nodule; Multiple other pulmonary nodules are too small to measure but appear to be unchanged in size, when compared to the prior exam.2. Mild cardiomegaly with stable, small pericardial effusion


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Malignant neoplasm of anterior wall of bladder. Vascular stents in the left paratracheal position. Atherosclerotic calcification of the thoracic aorta. Normal heart size. Chronic apical scarring, right greater than left, unchanged. No pleural fluid or focal airspace opacities. No suspicious nodules or masses within the limitations of plain film technique.

Output: No visible signs of pulmonary metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o infection History: seizure Unremarkable cardiac and mediastinal contours.Multiple skin folds on the right but no pneumothorax.Nipple shadow projected over the left lower lung.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 43 years old.Reason: Pre-Kidney evaluation, end stage renal disease. Rule out cardiomegaly. Rule out infiltrates. History: baseline eval pre kidney transplant Focal opacity right lower lung zone could be artifact although a follow-up study is recommended.Heart size normal.Right jugular catheter, tip at SVC/artery junction level.

Output: Focal opacity right lower lung zone could be an artifact although a repeat examination is recommended for verification.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: r/o infection History: concern for DKA 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, 26 years old.Reason: ro acute chest History: chest pain, SCC Mild/moderate cardiomegaly is unchanged.Right hemithorax volume loss and basilar scarring is stable.No reliable evidence of infection or infarction.

Output: Cardiomegaly with stable right pleural thickening and basilar scarring.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Kidney cancer surveillance History: As above Status post median sternotomy with a known repaired aortic dissection, not significantly different than on prior studies although the last CT was performed 8/12/2014.No significant pulmonary or pleural abnormality.No sign of metastases.

Output: Repair of aortic aneurysm. No evidence of metastases or other acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old.Patient is status post right internal jugular catheter placement. There is a new right internal jugular catheter with tip in the SVC. Endotracheal tube tip is approximately 6 cm above the carina. Enteric tube tip is beyond the field of view. Catheter projecting over the left inferior thorax is unchanged in position.The cardiac silhouette is enlarged but stable.Bilateral interstitial opacities again noted with patchy bibasilar atelectasis and small pleural effusions. No pneumothorax.

Output: 1.Interval placement of right internal jugular catheter with tip in the SVC and no pneumothorax.2.Cardiomegaly with pulmonary edema and small effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: rule out infection History: cough The lungs and pleural spaces are clear. The heart size is normal.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: volume status, pna History: sob The intra-aortic balloon pump marker remains in stable position, in the proximal descending thoracic aorta.Dense bilateral airspace and interstitial opacities not significantly changed. Cardiac contour is obscured but does remain enlarged. Calcification in the left mediastinum in the setting of known tricuspid and pulmonic valve atresia with previous Fontan and Glenn shunts.

Output: Cardiac enlargement with severe bilateral airspace and interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.With a history of LVAD and syncope/pulmonary edema. LVAD appears unchanged in position. No pleural effusion or pneumothorax. Streaky bilateral opacities are consistent with prior exam. Sternotomy hardware in place. No specific evidence of edema.

Output: LVAD appears unchanged in position. No specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: PNA History: as above Line position stable. No change in basilar opacities.

Output: Persistent airspace opacities are unchanged.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Left hilar mass appears similar to prior study without evidence of new pulmonary associated abnormalities. Cardiac silhouette is also unchanged. Mediastinal lymphadenopathyNG tube extends beyond the inferior edge of the image.

Output: Left hilar mass and lymphadenopathy again observed and grossly unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 74 years old.Reason: Pneumonia History: Cough, fevers No focal lung consolidation or evidence of overt left-sided heart failure. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Port catheter, unchanged.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: s/p R chest tube removal, ensure no worsening PTX History: see above Removal of right-sided chest tube. No significant pneumothorax. Basilar atelectasis or scarring again noted. Unchanged heart size. No large pleural effusion or pneumothorax.

Output: Removal of right-sided chest tube. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: surveillance chest tube History: dyspnea on exertion Stable right chest tube with no pneumothorax.Slight improvement in right sided opacities and pleural fluid.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 41 years old.Reason: central CP, assess for PNA History: central chest pain Lungs and pleural spaces are clear. The heart size is within limits of normal.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: pneumonia? History: fever, leukocytosis Current mediastinal silhouette is unchanged. No focal pulmonary opacity. No specific evidence of infection or edema. No large pleural effusion or pneumothorax.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: 64 year female with history of head and neck cancer with lung metastases. LUNGS AND PLEURA: Multiple pulmonary nodules are stable in size. Reference right upper lobe nodule measures 11 x 13 mm (axial image 33/113), stable from 11 x 10 mm on the prior exam. No new nodules are evident. No focal consolidation, edema or pleural effusion. Mild emphysema unchanged.MEDIASTINUM AND HILA: Left hilar lymphoid tissue is smaller measuring 10 x 9 mm on axial image 38/113 which is decreased from 13 x 12 mm. Additional pretracheal and prevascular lymph nodes are stable.Cardiac size is normal with no pericardial effusion. Significant coronary and aortic calcifications noted with an atheroma evident in the ascending aorta, unchanged. The ascending aorta measures approximately 4.5 cm in diameter which is unchanged from prior.CHEST WALL: No evidence of osseous metastases.UPPER ABDOMEN: Small cystlike lesion in the dome of the liver is unchanged. Multiple hypoattenuating lesions within both kidneys are stable. Continued follow-up recommended. Otherwise, no significant interval change. A G-tube is present in the stomach.

Output: Stable pulmonary nodules and lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: 55-year-old male with history of ESRD s/p PEA arrest Stable cardiomegaly.No focal airspace opacities. Streaky left retrocardiac opacities again noted, most consistent with subsegmental atelectasis.No significant pleural effusions.

Output: Stable cardiomegaly with no specific evidence of pulmonary edema or infection.


Instruction: Generate impression based on medical findings.

Input: Female, 81 years old.Reason: Evaluate PNA History: fever, weakness There is a right lower lobe opacity consistent with consolidation secondary to pneumonia. No pleural effusion or pneumothorax. The heart size is at the upper limit of normal.

Output: Right lower lobe consolidation consistent with pneumonia.