Instruction: Generate impression based on medical findings.

Input: Female, 84 years old.Reason: assess for free air, cholangiocarcinoma s/p stent yesterday History: increased abdominal pain, tachy Unchanged basilar opacities and pleural effusions likely from aspirated secretions or mucous plugging.Moderate cardiomegaly.No evidence of free air.Right upper quadrant stent.

Output: No free air. Unchanged basilar opacities and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 51 year-old female with HIV. History of metastatic breast cancer. No with brain lesions. Evaluate for metastatic lesions. CHEST:LUNGS AND PLEURA: There are extensive focal fibrotic interstitial changes seen segmentally in the right apex right upper lobe and lingula. Some of these have the appearance however chronic fibrosis likely related to radiation changes. Additionally, there are a few small scattered discrete nodules consistent with metastases. These are seen both in the right lung for example image 65/92 the right base and at the left base for example image 70/92. There are no pleural effusions.MEDIASTINUM AND HILA: Clusters of small nodes in the right axilla suspicious for metastatic disease the largest measuring 1.2 x 1.1 cm image 21/213. Pretracheal adenopathy estimated at 1.6 x 1.2 cm on image 30/213. Clusters of nodes also seen in the right hilum on image 42 and 54. Also fullness in the subcarinal area and left hilum.There are no retrocrural diaphragmatic nodes.CHEST WALL: Postsurgical changes left chest wall.ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous and ill-defined hypodense lesion in segment 8 measuring 3.0 x 2.7 cm as seen in image 86 .Poorly defined lesions are seen elsewhere for example in image 111 in segment 6. Few punctate hypodensities are ill-defined and seen elsewhere in the right lobe.SPLEEN: Multifocal hypodensities are seen throughout the entire spleen. These could represent metastatic lesions from the patient's breast cancer however given the history of HIV these could also represent sequela of other infections such as pneumocystis or mycobacterium.KIDNEYS, URETERS: A wedge shaped hypodensity along the lateral aspect of the right lower pole of the kidney likely representing an area of infarction with some cortical loss associated. No other lesions seen in the kidneys.ADRENAL GLANDS: No significant abnormality noted.PANCREAS: 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: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postsurgical and radiation changes left chest wall left lung. Scattered lung nodules suspicious for metastatic disease. Clusters of mediastinal nodes and small right axillary nodes suspicious for metastatic disease. Liver lesions likely metastases. Spleen lesions differential diagnosis includes metastases versus infection which may be acute or chronic in nature.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: s/p trach History: eval for pneumonia No significant change in left basilar opacity. Low lung volumes with basilar atelectasis again noted. No other interval change.

Output: No significant interval change


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.ET tube placement. Unchanged diffuse interstitial opacities, right hilar mass, small lung volumes, small left pleural effusion.Cardiomediastinal silhouette is within normal limits.ETT tip approximately 4 cm above the carina.

Output: ETT tip approximately 4 cm above the carina.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, 80 years old.Reason: hypoxia, dyspnea History: dyspnea Cardiomegaly.No reliable evidence of edema although there may be minimal basilar fibrosis.No significant size plural effusions.No specific evidence of infection.

Output: Cardiomegaly, without acute edema or pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: swan, pulm edema, IABP History: swan, IABP placement Median sternotomy, with mild cardiomegaly status post valve repair.Mild right basilar edema, unchanged.Right jugular Swan-Ganz catheter tip in right interlobar pulmonary artery. IABP catheter tip 4 cm below the top of the aortic arch.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Ancient mild right basilar edema and support devices.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: sarcoid flare History: as above Small lung volumes.Heart size upper normal.No specific evidence of infection or edema.

Output: Heart size upper normal, otherwise unremarkable and unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: chest pain, sob, bnp up. pulm edema History: above Right basilar pleural-parenchymal scarring again noted. No new focal pleural parenchymal opacity. No pneumothorax. Unchanged cardiomegaly.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Reason: chest pain History: chest pain Pectus excavatum deformity resulting in obscuration of the right heart border.Normal heart size and no significant pulmonary abnormalities.No other significant findings.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: CHF w/ pulmonary edema History: as above Dual-lead ICD with tips unchanged in position.The cardiomediastinal silhouette is stable. Atherosclerotic calcifications of the aorta noted. Calcification of the trachea noted. Near interval resolution of left-sided pulmonary opacity, however minimal increase in bilateral interstitial opacities suggestive of persistent pulmonary edema. Small bilateral pleural effusions. Streaky bibasilar opacities suggestive of atelectasis and/or scarring. No pneumothorax.

Output: Persistent mild pulmonary edema. Near interval resolution of left-sided pulmonary opacity.


Instruction: Generate impression based on medical findings.

Input: Atrial fibrillation Limited exam secondary to mild motion. Mild cardiomegaly with bilateral moderate pleural effusions and basilar atelectasis greater on the left. Partial consolidation left lower lobe cannot be excluded. In addition, postsurgical changes are observed in the right upper hemithorax, with volume loss and suspected partial or complete right upper lobe resection. Associated rib deformity.A 2-lead left subclavian ICD is observed with lead tips in the expected location. Please see subsequent report

Output: Nonspecific pulmonary changes including effusions, suspected atelectasis and possible partial consolidation of the left lower lobe


Instruction: Generate impression based on medical findings.

Input: Male 84 years old with history of persistent right pleural effusion, evaluate after dialysis Slight interval decrease in moderate/large right pleural effusion with associated compressive atelectasis. Streaky left basilar opacities without focal consolidation within the aerated portions of the lungs.

Output: Slight interval decrease in moderate/large right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.History: Asthma, worsening productive cough. Query pneumonia. Unremarkable cardiomediastinal silhouette. Bibasilar atelectasis/scarring, stable. No focal opacity.

Output: No cardiopulmonary abnormality


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: fever and history of cough History: cough 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, 47 years old.Reason: MVA - neck and back pain History: MVA - neck and back pain Cardiac silhouette is normal. There is no evidence of acute infiltrate, pleural effusion or pneumothorax. No evidence of displaced rib fracture.

Output: Unremarkable examination. Fracture can be further evaluated with rib radiographs if clinically indicated.


Instruction: Generate impression based on medical findings.

Input: Age: 75 yearsGender: FemaleReason for Study: Reason: s/p chest tube palcement History: cough, frank empyema Right-sided chest tube has been placed with its tip directed superiorly at the right lung base.Considerable subcutaneous emphysema noted along the right lateral chest wall.No pneumothorax identified.Right pleural thickening/effusion markedly decreased from the prior exam.Underlying airspace and interstitial opacities in the right lung compatible with edema.The left lung is clear.

Output: 1.Right-sided chest tube is been placed and looped at the right base with its tip directed superiorly.2.Interval reduction in the loculated right pleural effusion with residual pleural thickening/effusion noted.3.Extensive subcutaneous emphysema along the right lateral chest wall without evidence of a pneumothorax..


Instruction: Generate impression based on medical findings.

Input: Male, 85 years old.Reason: ro worsening pneumonia History: oxygen requirement Unremarkable cardiac and mediastinal silhouette. Diffuse bilateral mainly interstitial opacity of uncertain chronicity. There may be a component of resolving pneumonia but there may also be underlying chronic interstitial disease and emphysema.Small pleural effusions in the posterior costophrenic angles.

Output: No significant change in diffuse interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.History: Cystic fibrosis, status post bilateral lung transplant (5/28/2015), on immunosuppressive therapy Interval resolution of left pneumothorax.Left central venous catheter with tip in the right atrium.Stable cardiomediastinal silhouette.Resolving focal right lower lobe opacity, consistent with atelectasis versus infection.Small bilateral pleural effusions, left greater than right.

Output: Interval resolution of small left pneumothorax. Interval decrease in focal right lower lobe opacity, consistent with atelectasis versus infection.Small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: post op, eval lung fields History: s/p AVR Interval extubation.Swan catheter doubled back in the area of the main pulmonary artery.Basilar opacities compatible with subsegmental atelectasis and small pleural effusions.

Output: Interval extubation and no other acute change.


Instruction: Generate impression based on medical findings.

Input: Reason: shunt malfunction? Malpositioned? Hardware issue? History: headache, pain at shunt site SHUNT DEVICE: There is a spinal shunt with its tip at the level of T5. The catheter tubing courses down the spinal canal exiting at the level of L3. The catheter then courses along the left flank entering the abdomen and terminating in the left lower quadrant. Portions of the shunt device overlying the left flank are relatively radiolucent and hence difficult to evaluate. The notch on the pressure valve is positioned posteriorly and inferiorly. Overall, we see no complications.SKULL: No shunt tubing is identified within the skull. There is no acute abnormality.CERVICAL SPINE: No shunt tubing is identified within the cervical spine. The posterior arch of C1 appears incomplete.CHEST: There are no focal pulmonary opacities. The cardiomediastinal silhouette is normal. ABDOMEN: Nonobstructive bowel gas pattern.

Output: Spinal peritoneal shunt device as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 78 years old.Chest pain. There is mild left ventricular enlargement. Mild tortuosity of the thoracic aorta.Lung volumes are normal.Left lower lobe calcified granulomas are noted.No pleural effusion or pneumothorax.Age-indeterminate wedge deformity of L1 vertebral body.

Output: Sequela of prior granulomatous infection. No abnormal radiographic findings to explain patient's symptoms.Age-indeterminate wedge deformity of L1 vertebral body.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: concern for PNA History: crackles and rhonchi on lung exam No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: 5/19/15 Left thoracotomy and partial pulmonary decortication History: none 1 of the 3 left chest tubes has been removed.Increasing left hydropneumothorax with atelectasis of the left lung. Left osseous post surgical abnormalities again noted. Trace right pleural effusion. The heart size is within limits of normal.

Output: Increasing left hydropneumothorax in the setting of 2 chest tubes.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pleural effusion, fluid overload, infection History: shortness of breath, usually during HD Normal heart size with an aortic valve prosthesis and pacemaker leads in place, unchanged.Filter device in the IVC.Small lung volumes with no gross abnormalities and no visible pleural effusions.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: post op, eval ETT, lung fields History: s/p LVAD Basilar atelectasis with bilateral chest tubes and a minimal left apical pneumothorax, unchanged.ET tube tip 5 cm above the carina.Right jugular Swan-Ganz catheter tip in right main pulmonary artery.New LVAD.Multiple pacemaker leads unchanged.

Output: No significant complication following LVAD placement.


Instruction: Generate impression based on medical findings.

Input: Elevated white count Tracheostomy tube remains 6 cm above the carina. Dobbhoff tube extends into the proximal stomach. Cardiac silhouette is normal with a tortuous and calcified aorta similar to prior studies. The small left pleural effusion with left basilar retrocardiac opacities suggesting probable atelectasis again observed.

Output: Unchanged appearance with a left lower lobe opacity representing probable atelectasis yet aspiration or even infection cannot be excluded. Serial imaging demonstrating clearance is needed.


Instruction: Generate impression based on medical findings.

Input: Reason: h/o hemoptysis, r/o infection and fluid overload, dialysis pt History: hemoptysis Cardiomegaly with distention of mediastinal veins.Diffuse symmetrical interstitial and airspace opacity suggestive of edema though the differential diagnosis includes pulmonary hemorrhage especially in the setting of hemoptysis.No visible pleural effusions.Diffuse skeletal sclerosis consistent with renal osteodystrophy.

Output: Diffuse pulmonary edema versus hemorrhage, similar to the previous radiograph.


Instruction: Generate impression based on medical findings.

Input: Age: 78 yearsGender: MaleReason for Study: Reason: interval change History: interval change Right-sided chest tubes and right IJ venous catheter unchanged.Decreased lung lines with stable cardiomediastinal silhouette.Loculated right pleural effusion with basilar atelectasis similar to the prior exam.No evidence of pneumothorax.

Output: . Right pleural effusion and basilar atelectasis similar to the prior exam.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: chf History: chf Lordotic patient orientation. Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size. Atherosclerosis of aorta.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Female, 77 years old.Reason: post chest tube, pleurodesis right History: pain Unchanged right chest tube with no pneumothorax.Unchanged right Pleurx catheter.Stable pleural effusions.Increased basilar opacity particularly on the right.

Output: No significant pneumothorax. Stable pleural effusions but increased basilar opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Prekidney transplant evaluation. Rule out cardiomegaly. The cardiomediastinal silhouette is within normal limits. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 37 years old.Reason: eval ETT placement History: ETT placed Interval development of complete left lung atelectasis, most likely related to mucous plugging. Abrupt cut off of the left mainstem bronchus. Endotracheal tube terminates approximately 2 cm from the carina. Feeding tube extends inferiorly off the field of view. Left nephrostomy tube is in place. Likely unchanged heart size. Improvement in right basilar opacity and pleural effusion.

Output: Interval development of complete left lung atelectasis, most likely related to mucous plugging.


Instruction: Generate impression based on medical findings.

Input: Reason: shortness of breath History: shortness of breath Normal heart size and mediastinal contours. Moderately large left pleural effusion, slightly decreased over the past 5 days and small right pleural effusion. Fixation devices in the thoracolumbar spine and surgical staples projected over the upper midline.

Output: Bilateral pleural effusions, decreased on the left over the past 5 days.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Shortness of breath. Cardiopulmonary monitoring and support devices similar in position. Blunting of the right costophrenic angle unchanged. New opacity at the right lung base, otherwise pulmonary edema is unchanged.

Output: New opacity at the right lung base which may reflect atelectasis or aspirate secretions, otherwise CHF is unchanged.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: Eval for cardiopulmonary disease. History: Chest pain Stably enlarged cardiac silhouette.Interval improvement in bibasilar aeration with no evidence of focal consolidation or pneumothorax. Trace bilateral pleural effusions versus pleural thickening.No acute osseous abnormalities.

Output: Essentially stable appearance of the chest with cardiomegaly and no acute findings.


Instruction: Generate impression based on medical findings.

Input: Female 28 years old Reason: pna? History: hyperglycemia, CP Stable cardiopulmonary silhouette.No focal airspace opacities.No significant pleural effusions or pneumothorax.

Output: No acute cardiopulmonary abnormalities. No specific evidence of infection.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, 31 years old.Reason: 31 yo w/ hypoxemic respiratory failure, c/f diffuse alveolar hemorrhage vs drug reaction vs infection, eval for interval change History: see above Improvement in mid and lower lung pulmonary opacities and small pleural effusions. Unchanged heart size. No pneumothorax. Left-sided PICC has been removed.

Output: Improvement in basilar opacities and pleural effusions. Rapid improvement suggests pulmonary edema or bland aspiration.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: eval for active TB History: hx +tb skin test or +QFT 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: Male, 52 years old.Cough and shortness breath. The cardiomediastinal silhouette is within normal limits. Low lung volumes with basilar atelectasis. No focal airspace opacity, significant pleural effusion, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: evaluate for fluid overload or pneumonia History: crackles on exam - Right hemidiaphragm elevation in part chronic, with overlying atelectasis.Perihilar bronchial wall thickening is present but nose other evidence of edema, no sign of infection.No large pleural effusions.Moderate cardiomegaly.

Output: Chronic right hemidiaphragm elevation and bronchial wall thickening, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: 57 years old Male. Reason: eval for expanding pleural effusion, infiltrate History: neutropenic fever. Stable patchy opacities in the right upper perihilar region. The cardiac silhouette is normal. Basilar linear opacities, consistent with the atelectasis are noted. The Port-A-Cath has been removed. The tip of the left PICC line projects over the left axilla.

Output: Stable right upper perihilar opacity, which can be due to infection. Suggest follow-up.


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old. Right IJ venous catheter placed with its tip in the RA.No evidence of pneumothorax.Decreased lung lines with stable cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis.

Output: Right IJ venous catheter placed without complication. Stable cardiopulmonary appearance with cardiomegaly and basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate L pleural effusion History: prior effusion Markedly decreased left pleural effusion with moderate residual.Status post median sternotomy with intact fixation devices.

Output: Marked interval decrease in a left pleural effusion with reexpansion of the left lung.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Gastric distention. Rule out aspiration. Slight advancement of endotracheal tube, with tip approximately 3 cm above the carina. Remainder of cardiopulmonary monitoring and support devices, unchanged.Cardiomegaly and lower zone opacities consistent with atelectasis and possibly edema or infection, unchanged from previous.

Output: No new cardiopulmonary findings. ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 59-year-old male status post esophagectomy. CHEST:LUNGS AND PLEURA: Small left-sided pleural effusion.MEDIASTINUM AND HILA: Changes secondary to esophagectomy and gastric pull-through. Multiple small, nonenlarged lymph node in the upper mediastinum unchanged from previous CT.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Punctate hypodense, nonspecific lesions in the liver are unchanged. 1 cm enhancing lesion in the inferior aspect of the posterior segment of the right lobe, likely benign hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy.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: Prostate gland is enlarged.BLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous CT. No evidence of metastatic disease in chest abdomen or pelvis. Left-sided pleural effusion is unchanged. Diffuse wall thickening of the bladder. Nonspecific most likely benign lesions in liver.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Reason: confirm placement of new intra aortic balloon pump History: CHF, waiting for heart transplant Mild cardiomegaly status post sternotomy.No specific evidence of infection or edema.IABP catheter proximal marker 3 cm below the top of the aortic arch.Left PICC, tip in left subclavian.

Output: IABP catheter, proximal marker 3 cm below the top of the aortic arch. No acute abnormality.


Instruction: Generate impression based on medical findings.

Input: 36-year-old male who is intubated and sedated on ventilator. Evaluate endotracheal tube placement. Endotracheal tube tip approximately 5 cm above the carina. Right chest port with catheter tip in the right atrium. Additional right central venous catheter with tip in the right atrium. Enteric tube tip in the gastric body. Cholecystectomy clips. Residual contrast within the gastric body is noted.Persistent large bilateral pleural effusions with probable underlying atelectasis.

Output: 1.Enteric tube tip 5 cm above the carina. 2.Persistent large bilateral pleural effusions with underlying atelectasis are unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: PA catheter placement? History: see above Lines and tubes are unchanged. Diffuse pulmonary opacities with more confluent left basilar opacity again noted. Small pleural effusions, as before. Unchanged cardiomegaly. No pneumothorax.

Output: Stable pulmonary edema with confluent left basilar atelectasis and/or consolidated lung. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Reason: eval picc placement History: eval picc placement Cardiomegaly with basilar opacities suggestive of edema.Left subclavian ICD, leads unchanged in position.Right PICC repositioned, the tip now in the right innominate vein.

Output: PICC repositioned. Basilar edema-like opacities with cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 49 years old Male. Reason: evidence of PNA History: acute drop in BP. There is no significant change as compared with prior study. The paramediastinal opacities and calcified lymph nodes in the mediastinal and hilar regions are again identified. The tip of port catheter projects over the right atrium. Stable right small pleural effusion.

Output: Left-sided central line stable in position. No evidence of acute pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Reason: increased o2 requirement, known r ptx with pleurx placement History: increased O2 requirement Stable right pneumothorax as well as large pneumoperitoneum.No change in diffuse pulmonary opacities.Stable position of support devices.

Output: No interval change in pneumothorax, pulmonary opacities and large pneumoperitoneum


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: intubated History: as above Unchanged pulmonary opacities.ET tube tip approximately 3 cm above the carina.An NG tube terminates in the stomach.Left jugular catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with new diagnosis of acute cancer. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Biapical scarring.MEDIASTINUM AND HILA: Precarinal mediastinal borderline enlarged lymph node measuring 17 x 12 mm on image number 43, series number 5.CHEST WALL: Borderline enlarged, nonspecific axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate left upper pole stone without evidence of hydronephrosis. 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: Enlarged, Leiomyomatous uterus with multiple fibroids, some of which demonstrating calcifications.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: Enlarged leiomyomatous uterus. Patient's known endometrial carcinoma could not be well seen in this enlarged uterus.Nonspecific borderline enlarged mediastinal lymph nodes and axillary lymph nodes.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: PNA History: smoker with sob Cardiac silhouette is normal. Diffuse mild interstitial changes are noted in both lungs. No evidence of focal infiltrate, pleural effusion or pneumothorax.

Output: Diffuse mild interstitial changes in both lungs, which is a nonspecific.


Instruction: Generate impression based on medical findings.

Input: Age: 70 yearsGender: FemaleReason for Study: Reason: assess for hemothorax History: perforation post pci Decreased lung volumes with stable cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis.No large pleural effusions.New pulmonary opacities noted.Median sternotomy is intact with evidence of prior aortic and mitral valve replacements.

Output: No acute cardiopulmonary abnormalites identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 26 years old. Cystic fibrosis status post ThoraQuick placement. Pleural effusion. Large left and small to moderate right pleural fluid collections. On the left, pleural fluid collection appears dense and produces mass effect. Multi-loculated air collection in the left hemithorax increased in volume.The aerated portions of the lung show increased peribronchial air space opacities and bronchial wall thickening suggesting a worsening bronchopneumonia.

Output: Worsening bronchopneumonia. Enlarging multi-loculated air and fluid collection in the left hemithorax; though the air could be iatrogenic, infection within the pleural space cannot be excluded.


Instruction: Generate impression based on medical findings.

Input: Age: 25 yearsGender: FemaleReason for Study: Reason: PNA, acute chest syndrome History: chest pain, shortness of breath 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.


Instruction: Generate impression based on medical findings.

Input: Reason: intubated History: intubated ET tube tip approximately 3 cm above the carina.Left jugular catheter directed inferiorly over the left side of the mediastinum, most likely in a persistent left SVC.Cardiomegaly with small pleural effusions and basilar atelectasis, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 51 years old.Reason: Pt is a 51 yo male w/ hx of NHL; pre-auto sct evaluation History: Evaluate Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.Left subclavian catheter, tip in SVC.

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


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: Infiltrates History: fever s/p bilateral lung transplant Right port is accessed. Sternotomy hardware remains intact. Percutaneous gastrostomy balloon now projects over the left upper abdomen. Left PICC remains in stable position.Predominantly interstitial pattern in the mid to lower zones has increased, compatible with edema. Small pleural effusions, partially loculated. Heart size remains normal.

Output: Mild increased interstitial opacities compatible with edema. Small pleural effusions which are partially loculated.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: patient OSH transfer, suspected pneumonia, want to evaluate History: SOB Right subpulmonic effusion, less likely hemidiaphragm elevation, with overlying consolidation.Small but clear left lung. Heart size normal.

Output: Large right subpulmonic effusion with overlying consolidation, less likely right hemidiaphragm elevation.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: r/o pneumonia History: cough Median sternotomy, heart size normal.No significant pulmonary or pleural abnormality.Remnants of a left subclavian ICD remain in in place following heart transplant.

Output: Status post median sternotomy for heart transplant, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Dyspnea on exertion, edema history and shortness of breath Focal opacity projects over right lung base correlating with a masslike opacity in the right middle lobe as best appreciated in the lateral projection. Mildly flattened hemidiaphragms with an associated additional opacity projected in the posterior right lung base. Borderline cardiomegaly.

Output: Nonspecific multifocal opacities in both lung bases which in light of the patient's history may represent infection warranting serial follow-up imaging. In addition, however if further characterization and confirmation is needed, CT evaluation is appropriate. The somewhat well-defined opacities, specifically the finding observed in the anterior right lung base, may represent a congenital and pericardial abnormality.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, 44 years old.Reason: Evaluate central line placement History: Central line placement Severe cardiomegaly.Mild basilar opacities are suggestive of edema, unchanged.Left jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: Cardiomegaly with mild pulmonary edema. Left jugular catheter, tip in SVC.


Instruction: Generate impression based on medical findings.

Input: 44-day-old female with upper GI study earlier. Evaluate contrast progression.VIEW: Abdomen AP (one view) 11/22/2016, 17:18 Gastrostomy tube is present. There is a tiny amount of contrast which has passed into the distal bowel. Almost no bowel gas is seen. Hazy opacities are present in the lung bases. Silastic tube is identified around the TE fistula and mediastinal surgical clips are noted.

Output: 1. Very tiny amount of contrast distal to the stomach.2. Increase in lung base haziness.


Instruction: Generate impression based on medical findings.

Input: Reason: 33F with new onset productive cough, yellow-green blood-tinged sputum History: productive cough Small lung volumes. Retrocardiac opacity on the left is new. Bibasilar interstitial and airspace opacities and diffuse mild bronchial wall thickening. No large pleural effusions or pneumothorax.

Output: Retrocardiac opacity on the left, suspicious for pneumonia or aspiration.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: evaluate for infection, effusion History: dyspnea, confusion Widespread pulmonary metastases with no new opacity to suggest pneumonia. Port unchanged.

Output: Widespread pulmonary metastases with no new opacity to suggest pneumonia.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Reason: pulm edema/ARDS; hypoxia Feeding tube extends inferiorly off the field-of-view. No substantial change in diffuse pulmonary opacities given differences in inspiration. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No substantial change in diffuse pulmonary opacities given differences in inspiration consistent with pulmonary edema/diffuse alveolar damage.


Instruction: Generate impression based on medical findings.

Input: 21-year-old female with history of sickle cell disease p/w fever and chest pain. Mild stable cardiomegaly.No focal pulmonary opacities.No blunting of costophrenic angles.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Cough, evaluate for infection. Lytic, expansile lesion involving the posterior lateral right ninth rib, with underlying fracture and abundant callus formation.Normal heart size.Scarring in the right lower lobe and mild atelectasis at the left base.

Output: Subacute appearing posterior lateral right ninth rib lesion may reflect osteomyelitis at site of prior fracture given history of diabetes however a pathologic fracture from metastatic or other lesion cannot be excluded. Recommend bone-technique rib films for further evaluation. If there is clinical concern for osteomyelitis, a tagged WBC scan may be considered. No signs of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 77-year-old male with shortness of breath. Hypoxia. Evaluate for PE. Also better evaluation of bilateral opacity seen on chest x-ray and possible cavitary lesion. CHEST:PULMONARY VASCULATURE: Pulmonary embolus in a left lower lobe segmental pulmonary artery (series 5, image 157).LUNGS AND PLEURA: Diffuse centrilobular and paraseptal emphysema. Upper lobe areas of consolidation bilaterally. Possible cavitary focus seen in the left lung (series 80424, coronal, image 85); however, this may represent an infected bulla.Right lower lobe nodule (series 7, image 47).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion.Debris seen in the trachea and right mainstem bronchus (series 7, images 30 and 66).CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Hypoattenuating foci in the liver, largest of which is in the left hepatic lobe.

Output: 1. Pulmonary embolus in a left lower lobe segmental pulmonary artery.2. Upper lobe areas of consolidation bilaterally with background severe emphysema. Possible focus of cavitation in the left lung. Findings are compatible with infection or aspiration. Debris is also seen in the trachea.


Instruction: Generate impression based on medical findings.

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

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 64 years old.Reason: r/o pna History: increasing WOB Low lung volumes with increasing left diffuse interstitial and airspace opacities. No large pleural effusion.

Output: Increasing left interstitial and airspace opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: ett advancement History: ett pushed in ET tube has been advanced and is now 2.5 cm above the carina. Underinflated lungs with moderate interstitial edema pattern, stable. No pneumothorax. Other devices are unchanged.

Output: ET tube advanced now 2.5 cm above the carina. Moderate edema pattern stable.


Instruction: Generate impression based on medical findings.

Input: Female, 97 years old.Reason: aspiration History: SOB Basilar opacities with pleural effusions are not significantly changed.Unchanged cardiomegaly.No pneumothorax.Dilated air-filled esophagus.Interval placement of defibrillator pads.

Output: Unchanged pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Age: 26 yearsGender: FemaleReason for Study: Reason: SOB History: SOB The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for pleural effusion History: sob ET tube tip approximately 3 cm above the carina.Jugular catheter tip in the area of the right brachiocephalic vein. Small lung volumes with mild basilar opacities compatible with atelectasis and aspirated secretions.No visible pleural effusions.

Output: Mild basilar opacities compatible with atelectasis and aspirated secretions.


Instruction: Generate impression based on medical findings.

Input: Female, 47 years old.Reason: acute hypotension, sob History: sob No interval change in the loculated right pleural effusion and right basilar subsegmental atelectasis.Cardiomediastinal silhouette unremarkable.No pneumothorax.

Output: Stable exam with no interval change in the right pleural effusion and accompanying basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: LVAD check Swan-Ganz catheter again projects in the pulmonary outflow tract at the bifurcation. ICD and LVAD unchangedCardiopulmonary appearance are otherwise similar with moderate nonspecific cardiomegaly and minimal basilar atelectasis and pulmonary vascular redistribution at least partially due to semiupright technique.

Output: Swan-Ganz unchanged


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with history of metastatic rectal cancer CHEST:LUNGS AND PLEURA: Reference noncalcified nodule in the right middle lobe measures 3-mm in diameter on image number 45, series number 5. Other scattered pulmonary micronodules are also unchanged. Scarring and atelectasis at the lung bases associated with mild bronchiectasis, unchanged.MEDIASTINUM AND HILA: Multiple borderline enlarged mediastinal lymph nodes are grossly unchanged.CHEST WALL: Reference left axillary lymph node is unchanged measuring 18 x 10 mm on image number 14, series number 3.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small cysts are unchanged.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: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: Index lymph node in the right obturator area measures 20 by 10 mm, on image number 155, series number 3. This is unchanged from previous CT.BOWEL, MESENTERY: Postsurgical changes involving the rectum.BONES, SOFT TISSUES: Postsurgical changes involving the left femur, unchanged.OTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Female, 90 years old.Reason: assess for aspiration History: altered mental status, fever Low lung volumes. No focal lung consolidation or evidence of overt left-sided heart failure. Moderate cardiomegaly again noted. Aortic atherosclerosis, as before. Patient status post sternotomy and probable CABG. Status post cholecystectomy. No large pleural effusion or pneumothorax.

Output: Low lung volumes. No focal lung consolidation or evidence of overt left-sided heart failure.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: r/o ptx, lung mets History: new brca diagnosis, cp/sob Lungs and pleural spaces are clear. Heart size is normal. No pneumothorax.

Output: No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Mild hypoxemia on room air. Weakness and falls. Evaluate for infiltrate/edema. Soft tissue summation artifact and scarring at the lung bases.Increased opacity in the right middle lobe minimally more prominent compared to prior exams and may reflect atelectasis or developing infection. Bronchial wall thickening is seen in the lung bases. Retrocardiac compressive atelectasis. No pneumothorax. Normal heart size. No pleural fluid.

Output: Increased opacity in the right middle lobe largely the result of overlying soft tissue summation and chronic scarring, but does appear more pronounced compared to prior studies. This is suspicious for superimposed aspiration or developing infection. Suggest short-term plain film follow-up to assess for clearance.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Evaluate for etiology of shortness of breath History: Shortness of breath Low lung volumes. Basilar interstitial opacities appear similar to the prior, perhaps reflecting chronic interstitial pulmonary edema. No large pleural effusion is evident. There is no pneumothorax. Mild cardiomegaly persists. Scoliosis of the thoracolumbar spine again noted.

Output: Unchanged basilar interstitial opacities, which may reflect pulmonary edema, possibly chronic.


Instruction: Generate impression based on medical findings.

Input: 28 years old Female. Reason: SOB with cough productive green sputum History: as above. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. The cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old.Reason: cough, h/o breast CA and radiation eval for infiltrates History: cough Mild cardiomegaly with redistribution of the pulmonary blood flow.No specific evidence of infection or edema.

Output: Mild cardiomegaly, but no pulmonary abnormality and no sign of metastases.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Acute respiratory failure. Hypoxia. Moderate diffuse somewhat coarsened interstitial abnormalities which may reflect edema superimposed on interstitial fibrosis or possibly ARDS, stable. Tracheostomy tube again noted. Right jugular catheter tip over the right atrium. Small left pleural effusion or thickening also unchanged. No pneumothorax.

Output: No acute change in diffuse interstitial opacities.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Reason: s/p cardiac surgery r/o effusions and pneumo History: as above Lines and tubes are unchanged. Patchy bibasilar opacities again noted. Small pleural effusions. No pneumothorax. Unchanged heart size.

Output: Patchy bibasilar opacities again noted. Small pleural effusions. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Renal cell carcinoma No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with lung cancer, pneumonectomy 1999. Cirrhosis. CHEST:LUNGS AND PLEURA: Status post right pneumonectomy with small amount of fluid in the right pneumonectomy space, unchanged. The left lung demonstrates hyperinflation, unchanged. Several calcified granulomata are again identified.Mild emphysema.MEDIASTINUM AND HILA: Rightward shift of the mediastinum is again noted with the heart in the right hemithorax. No bronchial obstruction is identifiedCHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is mildly nodular in contour.Small ill -defined arterially enhancing focus in segment VIII of the liver (series 11; image 45) is isodense on subsequent phases, compatible with a transient hepatic attenuation differenceCholelithiasis.SPLEEN: The spleen is at the upper limit of normal in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: 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.

Output: Status post right pneumonectomy.Cirrhosis with no suspicious hepatic lesions.Cholelithiasis.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: SLE hemoptysis History: HX DAH Stable cardiomediastinal silhouette.Lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities are identified.


Instruction: Generate impression based on medical findings.

Input: Female, 23 years old.Reason: evaluating for chest wall abnormality, any cardiopulmonary abnormality History: pt with atypical left sided chest pain x 1 wk, localized to left chest wall, below breast, +point ttp. PE is also in ddx, d-dimer pending, pt On OCP w/ recent plane travel to/from Seattle. VSS, normal oxygenation. Clinical exam is otherwise unremarkable. Cardiomediastinal silhouette is normal. No focal air space opacities, pleural effusion, or pneumothorax identified. No displaced rib fractures.

Output: No acute cardiopulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 14 months old. Reason: Follow up previous X-ray. History: Intubated, HFOV.VIEW: Chest AP (one view) 4/12/2016, 0332. ET tube tip is below the thoracic inlet and above the carina. NG tube and feeding tube are unchanged. Lower extremity PICC with tip in the right atrium. Right internal jugular central venous catheter with tip in the SVC, unchanged. Two chest tubes on the right and one chest tube on the left which appear unchanged in position. Small bilateral subpulmonic pneumothoraces are unchanged. Cardiothymic silhouette is normal.

Output: Small bilateral pneumothoraces not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Male, 70 years old.Reason: eval apical mass History: right arm weakness No evidence of mass or acute cardiopulmonary abnormality.

Output: No evidence of mass.


Instruction: Generate impression based on medical findings.

Input: 20 year-old female with chest pain, hypoxia. Follow pneumothorax and pneumomediastinum. CHEST:LUNGS AND PLEURA: Increasing lower lobe atelectasis bilaterally with associated increase in costophrenic component of the right pneumothorax possibly secondary to increased parenchymal volume loss. No left pneumothorax.MEDIASTINUM AND HILA: Stable extensive pneumomediastinum without mediastinal shift. Trachea, mainstem bronchi, and large airway branches are patent.Heart size normal without pericardial effusion.No abnormally extravasated enteric contrast noted from prior esophagram examination.CHEST WALL: Right pleural drain enters from the lateral chest wall. UPPER ABDOMEN: Enteric contrast from previous esophagrams as well as vicarious excretion of contrast into the gallbladder.

Output: Increasing lower lobe atelectasis bilaterally. Extensive pneumomediastinum and a right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.SOB and chest pain. COPD exacerbation versus pneumonia. Cardiomegaly, about the same. Left subclavian ICD leads are unchanged in position. A portion of the left upper lobe is obscured by the pulse generator and cannot be assessed.Trace pleural fluid. Mild thickening of the fissures. Moderate basal interstitial abnormality. Asymmetric pleural thickening on the right with associated subpleural interstitial abnormality, present previously.

Output: Signs of moderate CHF. Pleural thickening and subpleural interstitial opacity in the periphery of the right upper lobe raises question of a superimposed chronic process such as interstitial lung disease. Suggest follow-up PA and lateral chest radiographs after management of the patient's fluid status to assess for clearance. If this abnormality persists, correlation with pulmonary function tests and/or ILD protocol CT may be considered if clinically warranted. No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. 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 pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 65 years old.Reason: Central line placed, please confirm position History: Central line placed for apheresis procedure emergently Left jugular catheter, tip projected over the top of the aortic arch, probably in the left brachiocephalic vein.No other significant abnormality.Left upper quadrant surgical clips.

Output: Left jugular catheter, although the tip is projected over the aortic arch, most likely terminates in the left brachiocephalic vein.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: 52F newly diagnosed renal mass. Evaluate for metastasis. History: as above Cardia mediastinal silhouette is normal. No suspicious pulmonary opacities. Possible small left pleural effusion. No specific evidence of infection or edema.

Output: Possible small left pleural effusion. No definite evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: eval infection, edema, effusion History: productive cough Cardiomediastinal silhouette is unchanged.No focal airspace opacity.Possible trace effusions.No pneumothorax.

Output: No specific evidence of infection or edema at this time.


Instruction: Generate impression based on medical findings.

Input: Reason: evaluate ETT placement History: intubated ET tube about 7 cm above the carina.Left lower lobe atelectasis with probable small bilateral effusions.A more recent radiograph has been interpreted.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: Interval changes to lung fields s/p esophagectomy History: daily assessment Bilateral chest tubes with no significant pneumothorax.Basilar atelectasis and pleural effusions are unchanged.An NG tube traverses a gastric pull-up, unchanged in position. Right jugular catheter, tip in SVC.

Output: No pneumothorax. Stable pulmonary opacities and support devices.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate SWAN position and interval change History: Heart failure Swan-Ganz catheter tip in the right descending pulmonary artery.Cardiomegaly with bilateral pleural effusions, interstitial edema and atelectasis.ICD leads unchanged.

Output: CHF with no significant change.


Instruction: Generate impression based on medical findings.

Input: End-stage renal disease. Check for cardiomegaly No cardiopulmonary abnormality

Output: Normal


Instruction: Generate impression based on medical findings.

Input: Male 51 years old Reason: Patient w/ AMS, cirrhosis, eval for infiltrate History: alteration in mental status Cardiomediastinal silhouette is unremarkable.Low lung volumes.No focal lung opacity or large pleural effusion.

Output: Persistent low lung volumes without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: r/o infection/edemaj History: chest pain The cardiomediastinal silhouette is within normal limits. No specific evidence of infection or edema.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Steven Johnson syndrome, intubation ETT, bilateral jugular catheters are unchanged. Motion degrades sensitivity. Diffuse moderate 4 quadrant pulmonary opacities again consistent with aspiration and/or edema greater in the left lower lobe in a retrocardiac probable atelectasis, all appear similar

Output: ETT unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 54 years old.Reason: SOB History: SOB Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Heart size is upper limit of normal.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 33 years old.Reason: evaluate PICC placement History: as above Interval placement of a nasogastric tube with the side hole inferior to the GE junction. Interval removal right central catheter. Left port is now accessed and in stable position. Surgical staples now occupy the right axilla; skin staples have been removed. Multiple staples again visualized in the right upper abdomen.Right upper lobe nodule obscured by overlying wires. Small right pleural effusion and basilar opacities of atelectasis. No pneumothorax.

Output: PICC is not visualized. No pneumothorax following central catheter removal. Right upper lobe nodule obscured.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with left-sided abdominal pain and lung nodule CHEST:LUNGS AND PLEURA: Bilateral emphysema with bilateral large blebs.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. A subcentimeter focal hyperdense lesion near the dome, image number 16, series number 3. Additional multiple hypodense lesions in the liver, measuring fluid density like representing cysts. Some of these lesions are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter right renal cyst.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: Prostate gland is enlarged. BLADDER: Bladder wall is diffuses thickened, consistent with cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of pulmonary nodules. The suspected nodule in lumber MR likely represents a hepatic cyst. No CT finding to explain patient's left-sided abdominal pain.Fatty infiltration of the liver. Multiple cysts in the liver. There is as small hyperdense focus near the dome of the liver. The etiology is unknown. This represent an area of focal sparing. MR of the liver may be helpful for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Age: 63 yearsGender: MaleReason for Study: Reason: eval lung fields History: heart failure Calcified granuloma right upper lobe.Right pleural effusion/thickening similar to the prior exam.No new pulmonary opacities identified.Stable cardiomediastinal silhouette.Median sternotomy and evidence of prior CABG.

Output: Right pleural effusion/thickening unchanged. No acute abnormalities identified. No specific evidence of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: et tube placement History: seizures ET tube tip is between the thoracic inlet and the carina.Enteric tube tip overlies the gastric fundus.Stable cardiomediastinal silhouette.Previously noted nodular opacity at the right lung base may be obscured by overlying lung markings.No pneumothorax or pleural effusion.

Output: ET tube tip between the thoracic inlet and the carina.


Instruction: Generate impression based on medical findings.

Input: 42-year-old male with right heart failure. Question pulmonary edema and fluid status. Left jugular catheter remains near the confluence of the brachiocephalic veins.Stable cardiomediastinal silhouette with moderate cardiomegaly and enlarged pulmonary artery.Persistent perihilar predominant opacities suggestive of edema.

Output: Persistent perihilar predominant opacities suggestive of edema.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Productive cough and thoracic pain; r/o pneumonia History: Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection or edema, or other findings to account for the patient's reported thoracic pain.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: interval exam History: Cardiomyopathy. Cardiopulmonary monitoring and support devices, unchanged.Small lung volumes with no sign of CHF or infection.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: hypoxia History: hypoxia No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: Check Pulmonary Status History: Check Pulmonary Status ET tube tip approximately 2 cm above the carina.Left jugular catheter tip in the right atrium.Small lung volumes with perihilar opacity compatible with edema and atelectasis.NG tube tip in the stomach.

Output: Pulmonary edema and atelectasis with no acute change.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Reason: eval LIJ placement History: LIJ pulled out by an inch Distal termination of the left IJ line is difficult to assess but likely terminates in the SVC. Cardiac leads are unchanged. Diffuse pulmonary edema, as before. No pneumothorax or focal lung consolidation. Unchanged cardiomegaly.

Output: Distal termination of the left IJ line is difficult to assess but likely terminates in the SVC. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: eval central line Enteric tube terminates with the proximal aspect of the stomach with side port at the gastroesophageal junction. This could be advanced if clinically indicated. Left IJ line terminates at the junction of the left brachiocephalic vein and SVC. Endotracheal tube terminates approximately 6 cm from the carina. Low lung volumes makes detailed cardiopulmonary assessment difficult. No new focal pleural parenchymal opacity. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: Lines and tubes, as above. No pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male 19 years old; Reason: nipple pain, nodules on exam History: nipple pain There is induration of the soft tissues near the nipple. No definite fluid collection.

Output: 1.Induration of the soft tissues near the nipple. A cellulitis is possible or developing abscess. Follow-up to resolution is recommended. If needed, further investigation with a chest MRI can be performed.


Instruction: Generate impression based on medical findings.

Input: 48 years, Female. Reason: eval for obstruction History: abd pain, constipation. Nonobstructive bowel gas pattern. No free air on upright views. Right hip prosthesis is noted. Average stool burden.

Output: Nonobstructive bowel gas pattern. No free air.


Instruction: Generate impression based on medical findings.

Input: 61 year old female with history of cough and shortness of breath. COPD patient participating in Spiration research trial. CHEST:LUNGS AND PLEURA: Severe, diffuse centrilobular emphysema bilaterally. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Aortic valve calcifications.CHEST WALL: No significant abnormality noted. UPPER ABDOMEN: Nonspecific left adrenal nodule.

Output: Severe centrilobular emphysema


Instruction: Generate impression based on medical findings.

Input: Female, 92 years old.Reason: Fever History: Fever Nonspecific left basilar left retrocardiac opacity is nonspecific but favors atelectasis. Superimposed infection cannot be excluded. Cardiac silhouette upper limits normal. Vasculature normal. No pneumothorax or pleural effusion.

Output: Nonspecific left basilar opacity representing atelectasis. Superimposed infection cannot be ruled out.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: s/p cardiac surgery History: s/p cardiac surgery One chest tube with no pneumothorax following cardiac surgery. Mild increase in basilar opacities suggestive of edema and atelectasis.Small pleural effusions.Right jugular catheter, tip in right brachiocephalic.

Output: Slight increase in pulmonary opacities suggestive of edema and atelectasis.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Empyema. Persistent complete opacification of the left hemithorax likely related to a large left pleural effusion with underlying atelectasis/consolidation. Persistent small right pleural effusion. Slight interval increase in right-sided interstitial and airspace opacities suspicious for pulmonary edema.Sternotomy wires and plates in place, right sided chest tubes, and left jugular catheter in place, unchanged.

Output: Slight interval increase in right-sided interstitial and airspace opacities suspicious for pulmonary edema. Persistent complete opacification of the left hemithorax.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, 50 years old.Reason: sob History: above Clear lungs. No pleural effusion or pneumothorax. No acute bony abnormality. Normal heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: 62-year-old male with history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged.There lung apices, right greater then left.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Unchanged T10 vertebral body metastatic focus.ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal nodules, stable.KIDNEYS, 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: Left femoral lymph node is unchanged measuring 1.8 x 1.3 cm on image number on 178 series number 3BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small sclerotic bone metastases are unchanged.OTHER: No significant abnormality noted

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: hx CHF/pleural effusion History: cough/SOB Large right pleural effusion tracking laterally compressing the right lower lung zone.Left lung unremarkable.Moderate cardiomegaly.

Output: Stable large right pleural effusion presumably cardiogenic.


Instruction: Generate impression based on medical findings.

Input: Neutropenic fever, leukemia Interval resolving small bilateral pleural effusions without additional new cardiopulmonary abnormalities. Mild COPDRight jugular catheter extends into the proximal SVC unchanged

Output: Resolving effusions without new abnormalities


Instruction: Generate impression based on medical findings.

Input: Age: 72 yearsGender: FemaleReason for Study: Reason: eval lung fields History: s/p MVR, devaga Mediastinal tubes, enteric tube, and right IJ venous catheter have been removed.Left-sided chest tube and left-sided ICD unchanged.Decreased lung volumes with stable cardiac enlargement.Perihilar/basilar edema and pleural effusions similar to the prior exam.

Output: Stable cardiopulmonary appearance with cardiac enlargement, edema/atelectasis, and pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o pnuemonia History: cough/colds Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Abdominal pain. Low lung volumes with areas of subsegmental atelectasis bilaterally. Patchy interstitial opacities in the left retrocardiac area are nonspecific and are favored to be atelectasis. Cardiomediastinal silhouette is within normal limits.

Output: Patchy retrocardiac interstitial opacities are favored to represent atelectasis. Recommend correlation with signs of infection. This can be conservatively followed with repeat PA/lateral chest radiograph in six weeks.


Instruction: Generate impression based on medical findings.

Input: Male, 56 years old.Reason: evidence of infxn, interval change in effusions History: febrile Diffuse pulmonary opacities and pleural effusions are unchanged consistent with edema and possible pneumonia.A Dobbhoff tube extends below the lower margin of the image.

Output: Extensive pulmonary opacities and pleural effusions, consistent with edema and possible pneumonia, unchanged.


Instruction: Generate impression based on medical findings.

Input: 58-year-old male 22 days status post haplo cord (haplo-identical cord blood blood transplantation) for mds (myelodysplastic syndrome) with new dyspnea. CHEST:LUNGS AND PLEURA: Right basilar pleural and parenchymal scarring as was seen previously. No suspicious nodules, masses, or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size normal without pericardial effusion. Calcifications along left brachiocephalic vein as well as subtle adjacent stranding may represent chronic thrombosis.CHEST WALL: Right jugular central venous catheter with tip near SVC/RA junction. Spinal stabilization hardware.UPPER ABDOMEN: Cholecystectomy clips. IVC filter.

Output: No significant interval change from prior study. No findings to account for patient's dyspnea.


Instruction: Generate impression based on medical findings.

Input: Male, 57 years old.Reason: r/o infection History: cough with yellow sputum x 1 week Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No specific evidence of infection.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 20 years old.Reason: Decreased breath sounds bilateral bases. The cardiac mediastinal silhouette is within normal limits. Questionable patchy right middle lobe opacity. No pleural effusions no pneumothorax

Output: Questionable patchy right middle lobe opacity consistent with pneumonia.


Instruction: Generate impression based on medical findings.

Input: Age: 62 yearsGender: FemaleReason for Study: Reason: SOB History: see above ET tube and NG tube have been removed.Stable cardiomediastinal silhouette.Basilar opacities are compatible with pleural effusions and edema/atelectasis.No new pulmonary opacities noted.

Output: Interval extubation and removal of NG tube. Stable cardiopulmonary appearance with pleural effusions and basilar edema/atelectasis.


Instruction: Generate impression based on medical findings.

Input: evaluate effusionVIEW: Chest AP Endotracheal tube tip is between thoracic inlet and carina. A chest tube is present in each hemithorax. Right neck and mediastinal surgical clips are identified. There are two atrial lines. Epicardial pacer leads remain in place. Cardiomegaly unchanged. There are bilateral small pleural effusions decreased. Bilateral hazy lung opacities unchanged. There is soft tissue edema. There is a catheter at the right axilla. Gastrostomy tube at left upper quadrant.

Output: Right pleural effusion has decreased.


Instruction: Generate impression based on medical findings.

Input: Age: 67 yearsGender: MaleReason for Study: Reason: wheezing, history of DAH, uri symptoms, assess for infiltrate History: see above Stable cardiac enlargement.Mild basilar scarring/subsegmental atelectasis.No focal areas of consolidation.No large pleural effusions.Cervical fusion hardware redemonstrated.

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


Instruction: Generate impression based on medical findings.

Input: 86 year old female with history of metastatic lung cancer CHEST:LUNGS AND PLEURA: Right middle lobe Mass measures 5.5 by 3-cm on image number 59, series number 4, slightly increased in size compared to previous study. Emphysema, unchanged.Previously described right upper lobe solid lesion now has a central cavitation. This lesion measures 2.9 by 1.8 cm in image number 64, series number 4.MEDIASTINUM AND HILA: Unchanged right paraesophageal lymph node.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fracture of T7 vertebral body with more dense 50% loss of height of the vertebral body is unchanged. Scoliosis and degenerative changes are also unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Minimal interval increase in the size of the right middle lobe mass. Interval development of cavitation within the right upper lobe mass.Other findings are unchanged from previous study.


Instruction: Generate impression based on medical findings.

Input: 52-year-old male with neutropenic fever CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: Subcentimeter residual soft tissue cannot be well seen due to noncontrast technique on this study. Reference AP window node lymph nodes can also not be optimally evaluated and accurately measured due to lack of IV contrast.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small amount of residual contrast material in the collecting system of the kidneys, which may be from a previous contrast enhanced study. Left renal parapelvic cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference right mesenteric lymph node is smaller, measuring 8 x 7 mm image number 156, series number 4.There is moderate amount of wall thickening, predominantly involving the small bowel loops in the left upper quadrant, likely representing jejunal segments. Multiple borderline enlarged, mesentery lymph nodes are unchanged.Possible mild wall thickening of the terminal ileum. Ascending colon and cecum and other colon segments appear unremarkable.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: Diffuse wall thickening involving the proximal small bowel segments in the left upper quadrant likely representing jejunum. Differential diagnosis includes infection or graft versus host disease.Mesenteric lymph node is smaller. Neck and mediastinal lymph nodes cannot be optimally measured.


Instruction: Generate impression based on medical findings.

Input: 72 years old Female. Reason: Cardiopulmonary abnormalities History: AMS. There is no evidence for infiltrate in both lung, pleural effusion or pneumothorax. Cardiac silhouette is normal.

Output: Unremarkable examination


Instruction: Generate impression based on medical findings.

Input: Reason: interval change History: interval change Small lung volumes with bilateral airspace opacity and pleural effusions, greater on the right, with underlying atelectasis.Interval removal of a right jugular catheter.No significant change.

Output: Airspace opacity, atelectasis and pleural effusions without significant change.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Coronary artery disease. Tubes, lines and hardware similar in position. Questionable trace air lucency laterally on the right could reflect minimal air layering on pleural fluid, but there is no significant sized pneumothorax.Pleural fluid, atelectasis and edema, about the same. Unchanged cardiomegaly and/or pericardial fluid.

Output: Stable mild to moderate CHF. No significant sized pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 78 years old.Reason: hx of bladder and kidney cancer s/p radical cystectomy and left partial nephrectomy, evaluate for metastatic disease History: see above Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.No evidence of metastases.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 53 years old.Lead placement history of ICD infection. Right jugular catheter terminates at the SVC/RA junction. Right subclavian ICD leads project over the right atrial appendage and right ventricle directed towards the apex. Low lung volumes with basal atelectasis. Blunting of the posterior costophrenic angles may be due to trace pleural fluid. Thickening and opacity posteriorly along the confluence of the fissures may reflect loculated pleural fluid however an adjacent parenchymal opacity cannot be ruled out without follow-up. No pneumothorax.

Output: Right subclavian ICD with leads projecting over the right ventricular apex and right atrial appendage. Probable small fluid collection on the right entering the fissure however follow-up is suggested to exclude the possibility of an adjacent intraparenchymal process, though this is considered less likely.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: s/p AAA repair History: none Bilateral pleural effusions and basilar consolidation with volume loss continues to worsen especially on the right rib and now may be complete right middle and lower lobe atelectasis.Right jugular catheter tip at cavoatrial junction.Left jugular catheter tip in left brachiocephalic vein to the left of midline.

Output: Worsening basilar opacities with near complete atelectasis of the right middle and lower lobes.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with history of ovarian cancer CHEST:LUNGS AND PLEURA: Biapical scarring, unchanged. Scarring in the left upper lobe anteriorly likely from localize radiation to the left breast is unchanged. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Punctate hypodense lesions on image number 18, series number 3 are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hydronephrosis and hydroureter with double-J stent is unchanged.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 9 x 9 mm image number 110, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Soft tissue mass involving the left upper vagina measures 7.1 by 5.1-cm image number 170, series number 3. This mass is slightly increased in size compared to previous study.BLADDER: Thickwalled bladder suggestive of cystitis.LYMPH NODES: Reference right pelvic lymph node abutting the rectum measures 3.5 x 2.8 cm in image number 117, series number 3 enlarged from previous study.Reference right external iliac lymph node measures 19 x 11 mm in image number 1061, series number 3, enlarged from previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Pelvic lesions have increased in size. No other significant change.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Reason: CP History: sob Compared to the prior study there is interval development of a right posterior midlung zone opacity, most likely infectious in etiology considering its rapid development.No effusion. No pneumothorax.Heart size normal.

Output: Rapid interval development of a right posterior midlung zone opacity likely representing pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 63 years old.Shortness of breath. Respiratory distress. Moderate diffuse interstitial abnormalities bilaterally with cardiomegaly are new from prior and compatible with pulmonary edema. No pneumothorax.

Output: Moderate diffuse pulmonary edema, new from prior.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: r/o pna History: sob, posttussive emesis, cough The cardiomediastinal silhouette is unremarkable. Airspace opacity in the superior segment of the left lower lobe as compatible with pneumonia and/or aspiration.The right lung is clear.No pleural effusions.Marked degenerative changes of the thoracic spine

Output: Left lower lobe pneumonia and/or aspiration. Attending physician in the ED (Dr. Helland) was notified by phone at 8:55 a.m.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: FemaleReason for Study: Reason: r/o pneumonia History: cough The cardiomediastinal silhouette is unremarkable.No focal airspace consolidation.Small pulmonary nodules as noted on prior and recent CT exams not well-visualized on this chest radiograph.There are no pleural effusions.Multiple surgical clips in the right upper abdomen.

Output: No specific evidence of acute infection.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Reason: neutropenic fever, positive S pneumo antigen, please evaluate History: see 1 Right port remains accessed. Multiple electrodes are coiled at the thoracic inlet.Reticulonodular opacities in the upper lobes are not completely resolved in the setting of previously documented bronchiolitis. Small bilateral pleural effusions. No associated pulmonary edema. Heart size is normal. No pneumothorax.

Output: Incomplete resolution of upper lobe reticulonodular opacities in the setting of previously documented bronchiolitis. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: 82-year-old female with cirrhosis, hypertension, heart disease, kidney disease. Evaluate for lung and liver disease. Shortness of breath. Ascites. CHEST:LUNGS AND PLEURA: Bibasilar scarring/atelectasis. No suspicious nodules, masses, or pleural effusion.Mosaic attenuation of the lungs is statistically most likely small airway disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size mildly enlarged without pericardial effusion. Coronary and aortic calcifications.CHEST WALL: No significant abnormality noted. ABDOMEN: LIVER, BILIARY TRACT: Cirrhotic morphology without focal hepatic lesions. Patent hepatic and portal vasculature.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys (left greater than right) with simple left renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Peritoneal dialysis catheter. Ascites.

Output: 1. Findings compatible with portal hypertension with ascites and splenomegaly.2. Cirrhotic liver morphology without focal lesions. However, if evaluation for a primary hepatic malignancy is needed, a dedicated liver protocol CT with and without IV contrast is recommended.3. Mosaic attenuation of the lungs is statistically most likely small airway disease.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Cough. Minimal bilateral pleural fluid, with adjacent basilar atelectasis.Small lung volumes.Cardiac silhouette is within normal limits.

Output: Very small bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old.Reason: SOB History: ? edema; HTN and SOB Mild cardiomegaly but no evidence of pulmonary edema or pleural effusion.

Output: Mild cardiomegaly but no evidence of pulmonary edema or pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Male 69 years old Reason: evaluate for pneumonia History: altered mental status, SIRS There is no focal consolidation, pleural effusion or pneumothorax.The cardiomediastinal contours are within normal limits for size.The imaged skeleton and upper abdomen are unremarkable. The left chest wall pacemaker device lead positions are unchanged. The right internal jugular central venous catheter tip terminates in the SVC.

Output: No acute cardiopulmonary abnormality, with no specific radiographic evidence of infection.


Instruction: Generate impression based on medical findings.

Input: 58-year-old female with history of small cell lung carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Index left hilar lymph node is significantly smaller now measuring 16 x 6 mm image number 51, series number 3. Other mediastinal lymph nodes also smaller.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Decrease in size of liver lesions. Index lesion in segment 8 now measures 15 by 14-mm image number 92, series number 3. All other metastatic lesions are also slightly smaller.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonspecific male lesions.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 decrease in the size of the mediastinal, hilar lymph nodes and hepatic metastases.


Instruction: Generate impression based on medical findings.

Input: Male, 0 days old. Reason: eval PCVC placement History: L LegVIEW: Chest and abdomen AP (two views) 10/21/2015, 1553 ET tube tip below thoracic inlet and above the carina. Feeding tube tip in the left lower chest. Umbilical artery catheter tip at the level of T7. Umbilical venous catheter tip at the level of the left portal vein. Left lower extremity PICC tip in the right atrium. New urinary catheter.Multiple loops of bowel and stomach again noted in the left hemithorax, with decreased gaseous distention compared to prior. There is slightly decreased rightward mediastinal shift with mildly improved right lung aeration. The cardiac silhouette size appears normal.No pneumatosis, portal venous gas, or free air.

Output: Left diaphragmatic hernia with decreased distention of the intrathoracic bowel loops, and mildly improved right lung aeration.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: s/p thoracotomy History: s/p thoracotomy Left chest tube unchanged with no significant pneumothorax but mild right chest wall soft tissue emphysema.Small lung volumes.

Output: Right chest tube stable with no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for fluid History: missed HD Venous catheter and ICD lead unchanged.Small lung volumes withChronic interstitial disease, unchanged. No specific evidence of pulmonary edema or pleural effusion.

Output: Chronic interstitial disease with no specific evidence of pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old.Reason: sob and cough x 1 week now with high bg History: hyperglycemia, cough, Median sternotomy for valve replacement with mild cardiomegaly, pulmonary vascular redistribution but no edema.No specific evidence of infection. No pneumothorax. No pleural effusion.

Output: Cardiomegaly with no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 18 years old. PICC line from the left arm extending to the area of the right ventricle. This has been adjusted on the subsequent radiograph.Right jugular catheter tip in the SVC.No significant cardiopulmonary abnormalities.

Output: Catheter tip in the right ventricle. This was discussed with the clinical service by the resident on call.


Instruction: Generate impression based on medical findings.

Input: Age: 64 yearsGender: FemaleReason for Study: Reason: ? PNA History: COPD and SOB Increased lung volumes compatible COPD.The cardiomediastinal silhouette is unremarkable.No focal air space opacities identified.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: CT in place History: CT Stable position of left chest tube.Extensive chronic interstitial lung disease.No obvious change in the degree of massive pneumoperitoneum.

Output: No significant interval change.


Instruction: Generate impression based on medical findings.

Input: Female, 61 years old.ET tube placement. Altered mental status. ET tube is 3 cm above the carina. NG tube in the distal stomach. Lungs are clear. Heart size within normal limits. No pneumothorax.

Output: No acute cardiopulmonary abnormality. ET tube 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Female, 49 years old.Reason: post op double lung transplant History: post op double lung transplant Minimal left apical pneumothorax, left chest tube still in place.Worsening right base consolidation, edema elsewhere stable.Right chest tube removed with no pneumothorax.

Output: Increased right-sided opacity. Minimal left apical pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: pneumonia History: altered, baseline A/Ox3 currently A/Ox1 not following commands Normal heart size with a tortuous aorta.Small calcified nodules in the left upper lobe compatible with previous infection.Mild chronic appearing basilar interstitial opacities.No sign of pneumonia.Calcific opacity in the area of the left hemidiaphragm of uncertain etiology and chronicity but most likely chronic.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Age: 33 yearsGender: MaleReason for Study: Reason: eval for pneumonia and atelectasis History: fever The cardiomediastinal silhouette is unremarkable.Questionable airspace opacity in the right upper lobe may represent infection.No pleural effusions.

Output: Probable right upper lobe infection.


Instruction: Generate impression based on medical findings.

Input: 57-year-old male history CAD, PUD MEN syndrome with previous CT 11/2007 showed abdominal lymphadenopathy now with shortness of breath and anemia with EGD showing multiple gastric polyps concerning for lymphoma. Please evaluate for change and extension lungs. Severe SOB and O2 requirement. CHEST:LUNGS AND PLEURA: There are perihilar infiltrates with air bronchograms which are patchy, diffuse but predominantly perihilar distribution suggestive of pulmonary edema particularly in association with a new large pleural effusions bilaterally. There is no evidence of pericardial fluid. No discrete lung nodules are seen. These findings could represent a combination of edema and a component of new lymphoma involving the parenchyma of the lung given new adenopathy in the mediastinum.MEDIASTINUM AND HILA: Scattered paratracheal hilar and subcarinal nodes are seen which are new. The baseline purposes a high right paratracheal node on image 28 measures 1.4 x 1.4 cm. No axillary nodes. No cardiophrenic or retrocrural nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver unchanged with only a few scattered nonspecific hyperintensities. A no evidence of biliary dilatation.SPLEEN: Spleen surgically absent with accessory right spleen is hypertrophied and a small adjacent lymph node a splenic cyst these findings are unchanged.KIDNEYS, URETERS: The nonspecific small hypodensities in both kidneys unchanged likely cyst.ADRENAL GLANDS: Some nodularity in the adrenal glands particular in the left, unchanged.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered adenopathy is seen in the porta hepatis peripancreatic area. Extent and distribution is approximately unchanged. Measurements of index lesions as follows:The3 portal node on image 100/21 measures 2.5 x 2.2-cm.Gastrohepatic ligament node on image 97 measures 2.1 x 1.8 cm.Atherosclerotic changes aorta with some irregularity suggestive of ulcerated plaques, unchanged. No evidence of aneurysm.BOWEL, MESENTERY: In the anterior gastric wall, air within the lumen of the stomach outlines large polyps as described in the clinical history. See images 99 and 100. No evidence of ascites. The line small fluid density structure in the wall of the third portion of the duodenum seen on image one and 32, unchanged possibly representing a small duplication cyst.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: A diverticulosis. No evidence diverticulitis. No evidence of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral pleural effusions and dense airspace disease in the patchy perihilar distribution in association with new lymphadenopathy in the chest. This may represent a combination of pulmonary edema and/or progression of lymphoma in the chest. Adenopathy in the abdomen is stable. Gastric polyps. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 46 years old.Reason: swan placement History: swan placement Swan-Ganz catheter tip in the right interlobar pulmonary artery. AICD lead position unchanged.Mild interstitial opacities consistent with pulmonary edema, slightly increased from the prior exam. Moderate cardiomegaly unchanged. No pneumothorax.

Output: Some increased basilar interstitial opacities consistent with mild pulmonary edema. Swan-Ganz catheter tip in the right interlobar pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: 54-year-old male with cough and recent pneumonia. Evaluate for pneumonia. Redemonstrated are bilateral nodular densities which are not significantly changed and are consistent with suspected metastatic disease. Right pleural effusion and right basilar mass unchanged.

Output: Bilateral nodular densities consistent with suspected metastatic disease with associated right pleural effusion. No significant change or evidence of superimposed infection. Please see follow up CT report for further details.


Instruction: Generate impression based on medical findings.

Input: Male, 44 years old.Post ablation. Cardiomegaly again present. Left upper lung atelectasis or small consolidation is unchanged from yesterday but more prominent than 2 days ago. Right lung remains clear. No pneumothorax. Left ICD unchanged.

Output: Cardiomegaly with left upper lung opacity which may reflect atelectasis or small consolidation, stable since yesterday.


Instruction: Generate impression based on medical findings.

Input: Female, 59 years old.Reason: infiltrate History: asthma exacerbation Interval basilar volume loss with progressive subsegmental atelectasis. This obscures the previously described nodular opacity projecting over the left heart border. A CT thorax is recommended. Lucency at the right apex may represent small bullae. Heart size is normal.

Output: Progressive lower zone subsegmental atelectasis which obscures the previously described nodule. CT is recommended for further evaluation.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old.Reason: intubated History: see above Moderate cardiomegaly status post sternotomy.No specific evidence of infection or edema.ET tube tip approximately 3 cm above the carina.An NG tube extends below the lower margin of the image.Right jugular introducer unchanged.

Output: Cardiomegaly with no specific evidence of edema or pneumonia. ET tube tip approximately 3 cm above the carina.


Instruction: Generate impression based on medical findings.

Input: Bilateral transplant Persistent mild to moderate bilateral effusions with underlying basilar opacities, likely atelectasis appear similar. No new cardiopulmonary focal abnormality superimposed upon postsurgical staples and changesUnchanged right jugular port. Left subclavian catheter and G-tube projects over left upper quadrant

Output: Stable pleural effusions and basilar nonspecific opacities