Instruction: Generate impression based on medical findings.

Input: Female, 28 years old.Reason: cordis insertion History: above Severe globular cardiomegaly.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.Right jugular introducer noted.

Output: Right jugular Cordis placement. Severe cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: eval lung fields History: O2 req No interval change in pulmonary opacities. Low lung volumes. Heart size unchanged in configuration.Interval extubation.

Output: No change in pulmonary opacities.


Instruction: Generate impression based on medical findings.

Input: Age: 76 yearsGender: MaleReason for Study: Reason: eval pleural effusions History: s/p CABG Chest/mediastinal tubes and right IJ introducer have been removed.No evidence of a pneumothorax.Stable cardiac enlargement.Nonspecific basilar opacities are compatible with atelectasis and effusions similar to the prior exam.No new pulmonary opacities identified.

Output: Interval removal of chest tubes. No pneumothorax identified. Stable cardiopulmonary appearance.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for effusion, PNA History: SOB, CP Heart size but upper normal with a tortuous aorta.Large lung volumes consistent with COPD.Mild lower zone interstitial opacity and blunting of the costophrenic angles, suggestive of small effusions, with thickening of the pleural fissures on the lateral view.

Output: Increased basilar interstitial opacity and small pleural effusions, suggestive of CHF with underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Reason: widened mediastinum, cardiomegaly History: chest pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Worsening PNA, pulmonary congestion History: SOB Bilateral basilar nonspecific opacity compatible with atelectasis and consolidation with pleural effusions.Feeding tube tip in the gastric fundus.Hyperinflated lungs consistent with emphysema.

Output: Pleural effusions, atelectasis and consolidation which may be related to aspiration, without significant interval change.Opacity at the right base is partly due to a large Bochdalek hernia.


Instruction: Generate impression based on medical findings.

Input: Male, 75 years old.Bilateral opacities status post intubation evaluate ET tube placement. ETT tip 4.5 cm above the level of the carina. IABP marker projects over the proximal descending thoracic aorta about 3 cm below the top of the aortic arch. Swan-Ganz catheter from an IVC approach terminates lateral to the main pulmonary artery and may be in a middle lobe branch, suggest slight retraction. Enteric tube unchanged.Large layering pleural fluid collections with extensive dependent opacities consistent with atelectasis as well as consolidation, right greater than left.

Output: ETT 4.5 cm above carina. Large pleural effusions with significant basal/dependent atelectasis and consolidation, correlate for signs of infection.


Instruction: Generate impression based on medical findings.

Input: 40 year-old male with history of non-Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Unremarkable study.


Instruction: Generate impression based on medical findings.

Input: Male, 69 years old.Multiple myeloma pre auto-SCT evaluation. No focal airspace opacities, pleural fluid or pneumothorax. Normal heart size. Atherosclerotic calcification of the thoracic aorta noted. Calcification in the visualized neck in the distribution of the carotid vasculature.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 22 years old.Reason: R/o focal infiltrate History: HIV pt w/ low CD4 count and diarrhea No acute cardiopulmonary abnormality.

Output: No evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath No acute cardiopulmonary abnormality. Moderate tortuosity of the aorta with atherosclerotic changes. Likely age consistent however without prior imaging for comparison this is difficult to confirm. Questionable eventration of the right hemidiaphragm

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Female, 39 years old.Productive cough, evaluate for pneumonia. Large posterior right upper lobe air space opacity which is seen just which seems to be associated with smaller satellite nodules. Minimal opacity which may reflect atelectasis or an additional airspace process at the right base. Normal heart size.No pleural fluid.

Output: Right upper lobe airspace opacity, most likely representing a pneumonia given the patient's age. Presence of satellite nodules raises question of atypical infection, including mycobacteria in the appropriate clinical context, this was discussed with the ED resident at the time of dictation. Recommend follow up PA and lateral chest radiographs in 6 weeks to assess for resolution .


Instruction: Generate impression based on medical findings.

Input: Female, 76 years old. There is been interval advancement of the Swan-Ganz catheter, with tip within the right pulmonary artery.No pneumothorax.Interval improvement in the degree of pulmonary edema. No change in left basilar opacity.

Output: Swan-Ganz catheter tip in right pulmonary artery. No pneumothorax.Interval improvement in pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Reason: eval lung fields History: s/p MVR Interval extubation.Swan-Ganz catheter tip in the right main pulmonary artery.Normal heart size with no significant pulmonary abnormalities.

Output: Interval extubation with no acute change.


Instruction: Generate impression based on medical findings.

Input: Female, 51 years old.Reason: s/p chest tube removal History: SOB Right chest tubes removed with no significant pneumothorax.Mild to moderate cardiomegaly.Stable small right pleural effusion with right-sided subsegmental atelectasis.Status post mitral valve replacement.

Output: No pneumothorax following chest tube removal.


Instruction: Generate impression based on medical findings.

Input: Right-sided empyema LUNGS AND PLEURA: Large right-sided fluid collection (effusion and or empyema) with underlying lung atelectasis and possible necrotizing pneumonia. No loculation are visualized. Left lower lobe air space opacity like atelectasis.MEDIASTINUM AND HILA: Minimal amount of mediastinal fluid most likely reactional.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Right-sided necrotizing pneumonia with large effusion/empyema.Small of, likely reactional mediastinal fluid.Left lower lobe atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 58 years old.Reason: line placement adjusted History: PICC Persistent left pleural effusion and cardiomegaly.Right PICC tip still low, in the right atrium.

Output: Right PICC tip still in the right atrium. Stable left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Age: 53 yearsGender: MaleReason for Study: Reason: s/p lung transplant History: POST-OP LUNG TRANSPLANT; ADMISSION TO ICU Interval removal of apically directed chest tubes with basilar chest tubes still remaining bilaterally.Persistent left apical pneumothorax.Decreased lung volumes with stable cardiac enlargement.Basilar opacities are compatible with pleural effusions and atelectasis.Gaseous distention of the stomach.

Output: Interval removal of apically directed bilateral chest tubes with persistent left apical pneumothorax.Pleural effusions and basilar atelectasis unchanged. Considerable gaseous distention of the stomach noted.


Instruction: Generate impression based on medical findings.

Input: Chest pain and cough is there pneumonia? Chronic bronchial wall thickening, endobronchial debris and mild subsegmental atelectasis, similar to most recent prior study. No pleural fluid or specific signs of pulmonary edema or pneumonia. Normal heart size. Sternal hardware is in alignment.

Output: No signs of pneumonia. Chronic airway abnormalities may be the result of chronic bronchitis and/or chronic recurrent aspiration.


Instruction: Generate impression based on medical findings.

Input: ETT placement Interval increasing pleural effusions greater on the right streaky densities in both bases suggesting atelectasis also greater on the right. Borderline cardiomegaly.ETT remains 5 cm above the carina

Output: Mild CHF and an unchanged ETT


Instruction: Generate impression based on medical findings.

Input: Female, 56 years old.Swan positioning. Complete opacification of the left hemithorax is stable. Right lung remains clear. Left jugular Swan-Ganz catheter tip over the proximal right main pulmonary artery. Right jugular catheter tip over the SVC. No pneumothorax.

Output: Complete left hemithorax opacification, stable. Swan-Ganz catheter tip over the proximal right pulmonary artery.


Instruction: Generate impression based on medical findings.

Input: Male, 62 years old.Altered mental status, schizophrenia. Normal heart size. No pleural fluid or pneumothorax. No specific signs of pneumonia or aspiration.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female 2 days old; Reason: 33wk female w/ gastroschisis, worsening respiratory distress, dec breath sounds, r/o pna vs ptx vs atelectasis History: respiratory distress, asymmetric lung examVIEW: Chest AP (one view) 10:49:18 ET tube tip unchanged. NG tube in the stomach with tip beyond the inferior margin of the image. Interval adjustment of left upper extremity PICC with tip in the left subclavian vein. Cardiothymic silhouette is unremarkable. There has been interval improved aeration in the right middle lobe. There is no pleural effusion or pneumothorax.

Output: 1. Interval improved aeration of the right middle lobe with no new opacities identified. 2. Interval adjustment of left upper extremity PICC with tip in the left subclavian vein.


Instruction: Generate impression based on medical findings.

Input: 76-year-old female with increased d-dimer and history of DVT. Please evaluate for PE. PULMONARY VASCULATURE: No PE. Technically adequate study.LUNGS AND PLEURA: Scattered micronodules bilaterally, some of which are calcified (<4 mm in diameter).MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Bilateral adrenal hyperplasia. Splenule.

Output: 1.No PE.2.Bilateral adrenal hyperplasia.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: s/p CABG; ?PTX History: SOB Interval removal of left chest tubes and subxiphoid drain.Calcified granuloma left lung. Small pleural effusions. No evidence of infection or edema. Heart size is normal. No significant pneumothorax.

Output: Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Shortness of breath. ET tube is been removed. Medium to large loculated bilateral pleural effusions, right greater than left, are stable. Bilateral nonspecific pulmonary parenchymal opacities are again noted although improved at the left base. No pneumothorax..

Output: Interval extubation. Bilateral significant loculated pleural effusions stable. Bilateral pulmonary parenchymal opacities again noted but improved at the left base.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval for causes of SOB History: HD pt miss dialysis due to clotted graft Cardiomegaly with mild basilar edema pattern.No specific evidence of infection.Left jugular catheter, tip at atrial level.Left subclavian pacemaker, leads unchanged in position.

Output: Cardiomegaly with pulmonary edema consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Male 89 years old Reason: eval for PNA History: AMS, weakness Cardiomediastinal silhouette is upper limits of normal with tortuosity of the aorta.No focal opacity, pneumothorax, or significant pleural effusion is identified.

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


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: copd, trach, dyspnea History: see above Tracheostomy tip in place, 6 cm from the carina.Cardiomediastinal silhouette within normal limits.Calcified hilar lymph nodes and a calcified right upper lobe lymph node.Large lung volumes compatible with history of COPD. No acute focal airspace opacity.No pneumothorax or pleural effusion.Mild pectus excavatum.

Output: No acute cardiopulmonary 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: Reason: 48F with CHF and IABP. History: IABP Balloon catheter marker now at the level of the aortic arch.ICD leads unchanged. No significant pulmonary abnormalities.

Output: Balloon catheter marker at the level of the aortic arch with the balloon in the descending aorta.


Instruction: Generate impression based on medical findings.

Input: Female, 70 years old.Reason: evaluate for pneumonia History: fever Interval elevation left hemidiaphragm with persistent mid to lower zone subsegmental atelectasis. Possibility of left lower lobe consolidation cannot be excluded. Recommend follow-up PA and lateral radiograph. Skin fold projects over the thoracic midline. No pneumothorax is present.

Output: PA and lateral radiograph recommended for further evaluation of left lower lobe.


Instruction: Generate impression based on medical findings.

Input: Reason: rule out PE History: tachycardia and low oxygen saturation Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: 70-year-old female with a fever. Evaluate for source. Cardiomediastinal silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.

Output: No acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 73 years old.Reason: r/o pulm edema, PNA History: RLL crackles Median sternotomy for CABG.No specific evidence of infection or edema.Left subclavian ICD, leads unchanged in position.

Output: No specific evidence of infection or edema.


Instruction: Generate impression based on medical findings.

Input: Female, 52 years old.Reason: eval ETT, lung fields History: s/p AVR, MVR Swan-Ganz catheter tip is in the main pulmonary artery or proximal right pulmonary artery. The endotracheal tube tip is at the level of the carina. Low lung volumes and left pleural effusion. No focal pulmonary opacity. Other support devices are unchanged. Redo median sternotomy hardware is intact with new mitral valve replacement.

Output: Swan-Ganz catheter tip in the main pulmonary artery or proximal right pulmonary artery. Endotracheal tube tip is at the level of the carina.


Instruction: Generate impression based on medical findings.

Input: HypoxiaVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube and feeding tube again noted. Lower extremity PICC with tip in the right atrium. There are two chest tubes on the right and one chest tube on the left. There are bilateral small pneumothoraces unchanged. Cardiothymic silhouette normal.

Output: Bilateral pneumothoraces not significantly change.


Instruction: Generate impression based on medical findings.

Input: Male, 54 years old.Reason: pneumothorax, look at stability History: pneumothorax, assess stability Improving left loculated hydropneumothorax with a left chest tube unchanged in position.Right lung unremarkable although underinflated.Tubes and catheters are unchanged.

Output: Slight improvement in loculated left hydropneumothorax with the findings.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Reason: hypotension Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar opacities, likely atelectasis or scarring. No evidence of overt left-sided heart failure. No large pleural effusion or pneumothorax. At least moderate cardiomegaly. Large patient body habitus. Status post cholecystectomy. IVC filter, incompletely visualized.

Output: Low lung volumes makes detailed cardiopulmonary assessment difficult. Basilar opacities, likely atelectasis or scarring. At least moderate cardiomegaly.


Instruction: Generate impression based on medical findings.

Input: 65-year-old female with renal cell carcinoma with metastatic disease now with fever and confusion. On chemotherapy. CHEST:LUNGS AND PLEURA: Stable pulmonary nodules are again identified. The reference 7 x 5 mm lymph node in the right upper lobe (series 5; image 43) is unchanged.Alveolar airspace opacities are now identified in the medial aspects of the right and left lower lobes. Patchy peripheral areas of ground glass opacity and interlobular septal thickening are identified in both upper lobes, right greater than left. Additionally, some faint opacities are seen in the right lower lobe.MEDIASTINUM AND HILA: The right hilar lymph node has increased in size, measuring 3.4 x 2 .4 cm, previously 2.3 x 2.2 cm (series 3; image 49. Pathologically enlarged AP window, paratracheal and subcarinal lymph nodes are now visualized.Stable small left pleural effusion.CHEST WALL: Right-sided port terminates in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Several small new hepatic lesions are seen. However, the majority of the previously seen hepatic lesions have not significantly changed in size. Index lesion in segment 7 measures approximate 2.3 x 1.8 cm (series 3; image 84), previously 2.7 x 1.7 cm. The other index lesion in segment 6 (series 3; image 100), measures 2.8 x 2 .0 cm, previously 2.8 x 1.9 cm.SPLEEN: Parasplenic soft tissue masses have significantly increased in size, with invasion into the posterior aspect of the spleen. PANCREAS: Displaced by the masses in the left renal fossa without definite abnormality.ADRENAL GLANDS: Nonvisualized left adrenal gland.KIDNEYS, URETERS: Conglomerate mass in the left renal fossa has increased in size, measuring 11.8 x 7.6 cm (series 3; image 104), previously 10.3 x 6.4 cm. These lesions demonstrate broad contact with the posterior peritoneumRETROPERITONEUM, LYMPH NODES: Conglomerate mass in the left common iliac region measures 6.3 x 4.1 cm, previously 5.1 x 3.1 cm when remeasured (series 3; image 149). This lesion bulges into the adjacent IVC, causing luminal narrowing. This is most likely related to extrinsic compression rather than invasion. Hypodense filling defect in the left common iliac vein extending to its bifurcation is most likely related to bland thrombus secondary to stasis, given IVC narrowing.Enlarged gastrohepatic/portacaval lymph nodes are again identified.BOWEL, MESENTERY: Small duodenal diverticulum.Numerous mesenteric masses are again identified. Reference parasplenic lesion measures 4.2 x 4.1 cm, previously 3.0 x 2.9 cm (series 3; image 89). Small nodular implants are now seen along the hepatic serosaBONES, SOFT TISSUES: Metastatic lesion involving the upper ventral abdominal wall measures 4.6 x 3.0 cm (series 3; image 105), previously 2.7 x 1.8 cm.OTHER: No significant abnormality.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: Progression of disease.Development of scattered alveolar and groundglass opacities within the lungs. Atypical infection is favored, with possible superimposed foci of aspiration in the lower lobes.Significant compression of the distal IVC due to adjacent adenopathy. Development of thrombus within the left common iliac vein, likely bland thrombus secondary to stasis given IVC compression.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Motion degrades sensitivity with semiupright positioning.Mildly decreased lung volumes with grossly clear lungs other than mild basilar changes suggesting chronic appearing interstitial changes and/or atelectasis. No distinct superimposed focal airspace process. Specifically the left lung is clear. The previously described mid right lung focal nodularity may be partially visualized overlying the right lower peripheral lung, however it is currently not clearly observed. Please consider serial follow-up dedicated imaging if patient can tolerate and/or CT. Appearance may also represent recent procedure and surrounding adjacent edema and/or hemorrhage if biopsied.The cardiac and medial cell contours are within limits. No definite scoliosis and curvature is thought to be positional

Output: Suspected post biopsied left nodular density with current poor appreciation yet no immediate post procedural complication


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.Reason: Hx of sickle cell with fever History: sickle cell with fever Right Port-A-Cath with its tip in the SVC.Stable cardiac mediastinal silhouette.The lungs are clear.No pleural effusions.

Output: No acute cardiopulmonary abnormalities identified without interval change.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: congested History: dyspnea Enteric tube tip in gastric fundus.Diffuse pulmonary opacities are mildly improved compared to the prior exam. Retrocardiac consolidation/atelectasis not significantly changed. Unchanged heart size. No pneumothorax.

Output: Diffuse pulmonary opacities mildly improved compared to the prior exam.


Instruction: Generate impression based on medical findings.

Input: 75 year-old female history of colon cancer. Positive paraneoplastic panel. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Markedly dilated esophagus redemonstrated. Coronary artery calcification. CHEST WALL: Marked rotatory scoliosis redemonstrated. Associated degenerative changes. No lytic or blastic disease.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: 1.3 cm splenic artery aneurysm series study one image 67. This is unchanged from 2005. Spleen is normal but small in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Rotatory scoliosis with associated degenerative changes. Bilateral renal cysts. Also parapelvic cysts. No obvious masses or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta. No evidence of aneurysm. No pathologic size lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked rotatory scoliosis with degenerative changes. Some fatty replacement in the back muscles. Postsurgical changes anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right hemicolectomy. No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: Left hip prosthesis.OTHER: No significant abnormality noted.

Output: No evidence of malignancy. Stable calcified splenic artery aneurysm. Numerous findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: ett History: as above ET tube tip about 7.5 cm above the carina and NG tube tip in the gastric fundus.Large lung volumes suggest COPD with left lower lobe consolidation and atelectasis, slightly increased. Right lower lobe airspace opacity, unchanged, compatible with aspirated secretions.

Output: COPD with basilar consolidation and atelectasis suggestive of aspiration and possible infection, unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Reason: dialysis cath placement, r/o PTX History: dialysis cath placement, r/o PTX Patient had tunneled catheter placed but could not be done under fluoroscopy due to patient size. Catheter tip in SVC. No evidence of pneumothorax. Other findings stable in short interval.

Output: Catheter tip in SVC.


Instruction: Generate impression based on medical findings.

Input: Female, 67 years old.Reason: eval ETT History: s/p intubation Endotracheal tube tip approximately 2 cm above the carina. Enteric tube overlying the proximal stomach and proximalmost side port at the level of the GE junction.Cardiac silhouette is normal in size.Low lung volumes with bibasilar streaky opacities likely atelectasis. Trace left pleural effusion suspected.Partially imaged abdominal skin staples.

Output: 1.Endotracheal tube tip projecting 2 cm superior to the carina. 2.Enteric tube proximalmost side port at the level of the GE junction. Consider further advancement.3.Low lung volumes with mild bibasilar atelectasis and at least small left pleural effusion.


Instruction: Generate impression based on medical findings.

Input: Heart failure LVAD, ICD and Dobbhoff are all unchanged.Moderate pulmonary edema-like pattern with relative sparing of the left lung remains similar. No gross new superimposed focal airspace process

Output: Similar unchanged pulmonary edema-like pattern


Instruction: Generate impression based on medical findings.

Input: Male, 74 years old.Shortness of breath. Interval removal of endotracheal tube. Stable cardiomediastinal silhouette. Low lung volumes with diffuse severe coarse interstitial opacities compatible with atelectasis and fibrosis. No interval change.

Output: Interval removal of endotracheal tube. Severe chronic interstitial and airway disease is unchanged.


Instruction: Generate impression based on medical findings.

Input: Male, 72 years old.Reason: CT in place History: CT in place Support devices are unchanged.Postoperative findings compatible with gastric interposition. Basilar opacities of subsegmental atelectasis. Trace pneumoperitoneum remains. Small pleural effusions. Decreasing right infralateral chest wall emphysema. No significant pneumothorax.

Output: Resolving pneumoperitoneum. Basilar subsegmental atelectasis and small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Male, 31 years old.Reason: eval interval placement of right subclavian line History: subclavian line Right-sided PICC terminates in the SVC. Other lines and tubes, unchanged. Perihilar and retrocardiac opacities, unchanged. Unchanged heart size. No pneumothorax.

Output: Right-sided PICC terminates in the SVC.


Instruction: Generate impression based on medical findings.

Input: Chest pain Persistent and increasing left lower lobe focal opacity both centrally and peripherally. Concern for advancing infection remains high over infarction. Associated small effusion suspected.Overall lung volumes are otherwise decreased, however the right lung otherwise remains essentially clearMild cardiomegaly with moderate tortuosity aorta with atherosclerotic disease.Lower cervical spine fixation essentially unchanged

Output: Increasing left lower lobe mixed and now more confluent in the opacity previously observed and correlates with prior recent CT is. Concern for increasing infection is high with a solitary follow up image.


Instruction: Generate impression based on medical findings.

Input: Female, 42 years old.History of heart failure. Cough. Global cardiomegaly. Status post median sternotomy and CABG. Single lead ICD terminates at the apex of the right ventricle.Signs of pulmonary venous hypertension. Bilateral bronchial wall thickening and vascular indistinctness, associated with minimal right basilar septal lines, suggestive of chronic interstitial pulmonary edema.No pleural effusions or pneumothorax.No osseous lesions are present. Intact sternotomy wires.

Output: 1. Stable cardiomegaly and signs of chronic pulmonary venous hypertension.


Instruction: Generate impression based on medical findings.

Input: Respiratory failure Stable right chest tube with a right pleural effusion with a small insignificant pneumothorax similar to prior. Stable bilateral pleural effusion, with suspected loculation. Unchanged pulmonary interstitial and air space opacities.Embolization coils

Output: Chest tube unchanged


Instruction: Generate impression based on medical findings.

Input: Female, 69 years old.Reason: infiltrate, edema History: dyspnea Interval placement of a left univentricular AICD electrode with the tip projecting at expected location of the apical right ventricle.Heart size is enlarged but stable. Trace pleural effusions and basilar atelectasis without pulmonary edema. No pneumothorax.

Output: No pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Female, 45 years old.Cough, fever, rule out pneumonia There is mild scarring at the mid-lateral aspect of the left lung. The lungs are otherwise clear. No pneumothorax or pleural effusion. The heart size is normal.

Output: Mild scarring without acute cardiopulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p thoracotomy History: chest tube Left chest tubes unchanged with no significant pneumothorax.Small lung volumes with small bilateral pleural effusions.No new findings.

Output: Unremarkable postoperative chest.


Instruction: Generate impression based on medical findings.

Input: 59 years old Female. Reason: history of COPD, evaluate for possible etiology of dyspnea History: new dyspnea, slight wheeze. The cardiac and mediastinal silhouette is enlarged with cephalization of pulmonary veins. There is a mild interstitial changes in both lungs. Linear opacities are noted in the right lung base.

Output: The above findings are consistent with mild CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 34 years old with chest discomfort. Evaluate for pneumonia or other acute process. The cardiomediastinal silhouette is unremarkable. There is no abnormal pulmonary opacity, pleural effusion or pneumothorax.

Output: No acute cardiopulmonary abnormality. No evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Female, 82 years old.Reason: cough History: cough, COPD Large lung volumes suggestive of COPD.No specific evidence of infection or edema.Unremarkable mediastinal contours and cardiac silhouette.

Output: COPD, otherwise unremarkable.


Instruction: Generate impression based on medical findings.

Input: Male, 63 years old.Muscle weakness dyspnea question infiltrate. Normal heart size. Retrocardiac air space opacity in the left lower lobe. No visible pleural fluid or lymphadenopathy.

Output: Left lower lobe airspace opacity may be the result of aspiration or infection in the appropriate clinical context, nonspecific. In an adult patient, follow-up erect PA and lateral chest radiographs are recommended in 6 weeks to assess for clearance and to exclude a non-benign lesion. Recommendation communicated to the ED via Stat Consult Webpage Dialog.


Instruction: Generate impression based on medical findings.

Input: 31 years, Male. Reason: Crohn's disease, eval for free air, abdominal pain History: abdominal pain, dilated colon. Lungs clear. Mediastinal, osseous, and soft tissue structures of the chest are normal.Mild to moderate diffuse colonic dilatation with air-fluid levels seen in the ascending colon. Scattered mildly dilated loops of small bowel is moderately distended distal ileum without evidence for point of obstruction. No intramural air or free air.Surgical clips right upper quadrant.Osseous structures normal.

Output: Diffusely dilated colon. Given history of Crohn's disease this could represent colonic ileus due to rectal disease. No intramural air or free air.


Instruction: Generate impression based on medical findings.

Input: Follow-up of pleural effusion, history of mesothelioma. Small pleural effusions (left greater than right) not appreciably changed. Right sided pleural thickening again noted. Right chest tube remains in place.

Output: Small bilateral pleural effusions not appreciably changed.


Instruction: Generate impression based on medical findings.

Input: Female, 93 years old.Reason: CP, sob History: above Basilar opacities are present suggestive of edema and atelectasis with small pleural effusions.Heart size normal.

Output: New basilar opacities, either CHF or aspiration/infection.


Instruction: Generate impression based on medical findings.

Input: 68-year-old male with metastatic colorectal cancer. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary masses have increased in size. A left upper lobe reference lesion measures 2.1 x 2.6 centimeters on axial image 24/230 which has increased from 2.1 x 2.2 cm on the prior exam. No new lesions. No pleural fluid.MEDIASTINUM AND HILA: Right hilar lymphadenopathy has progressed. A reference lesion measures 2.6 x 2.3 cm on axial image 40/230 which is larger when compared to the prior exam where it measured 2.2 x 1.9 cm. A subcarinal lymph node measures 1.8 x 1.2 cm on axial image 44/230 and is grossly unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. A peripherally enhancing lesion in the dome of the liver measures 1.9 x 2.1 cm on axial image 78/230 and is grossly unchanged in size. No new liver lesions. The portal and hepatic vasculature is patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: A left adrenal nodule measures fat density and most likely represents a benign adenoma.KIDNEYS, URETERS: A hypoattenuating right renal lesion is unchanged and probably represents a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See below.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: Postoperative changes status post rectal resection with a left lower quadrant colostomy. Soft tissue within the operative bed is unchanged and may be postoperative in etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Progression of metastatic disease in the chest.2.Stable liver metastasis.3.No definite evidence of disease progression in the abdomen or pelvis.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Reason: Chest pain History: As above Severe cardiomegaly.No specific evidence of infection or edema.

Output: Severe cardiomegaly without acute edema or pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 35 years old.Reason: is there a pneumothorax History: acute onset chest pain, no trauma Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality. No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: POSTOP right vats blebectomy History: POSTOP Two right-sided chest tubes terminate at the mid and superior mediastinum, respectively.Large lung volumes compatible with bullous emphysema. Staples are noted at the right upper lobe, adjacent to the superior chest tube. Heart size is normal. Subcutaneous emphysema is noted at the chest tube entry site. No significant pneumothorax.

Output: No significant pneumothorax following blebectomy.


Instruction: Generate impression based on medical findings.

Input: Male, 73 years old.Post right thoracentesis evaluate for resolution of effusion and for pneumothorax. No significant change in left pleural fluid, atelectasis and mild pulmonary edema. Right pleural fluid collection remains moderate to large in volume but appears smaller. No pneumothorax.

Output: Decreased volume of pleural fluid on the right, no pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: 65 y/o hx of CLL in remission, here with URI symptoms, r/o PNA History: cough, congestion Unremarkable cardiac and mediastinal silhouette. Minimal basilar scarring, unchanged. No sign of pneumonia or other acute process. Surgical clips in the left axilla.

Output: No acute abnormalities and no change.


Instruction: Generate impression based on medical findings.

Input: Male, 35 years old.New fever. Known ESBL, mycoplasma and CMV pneumonia. Tubes and lines unchanged in position. Linear opacity projecting over the right upper lobe presumably external to the patient. Elevation of the right hemidiaphragm, present previously.Diffuse interstitial and airspace opacities with slight improvement in density probably related to lung volume on the left. No significant change in findings on the right.

Output: Apparent improvement may be the result of improved lung volumes. Overall, there is no significant change in extensive interstitial and airspace opacities bilaterally.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p BiVAD History: na Interval removal of the Dobbhoff tube and otherwise unchanged devices and catheters.Cardiomegaly with diffuse opacity compatible with edema with more focal consolidation in the left upper and lower lobes.No pneumothorax or other acute change.

Output: Edema, consolidation and pleural effusions without significant interval change.


Instruction: Generate impression based on medical findings.

Input: Aortic valve disorder Mediastinal chest tubes appear unchanged with interval removal of the right jugular sheath. No postprocedural complication observed. Underlying lungs otherwise again demonstrate stable cardiomegaly with basilar edema and effusions with suspected left lower lobe atelectasis

Output: Mediastinal chest tubes unchanged


Instruction: Generate impression based on medical findings.

Input: Altered mental status Persistent borderline cardiomegaly with mild vascular prominence and interstitial changes suggestive of fluid overload and/or early edema. No definite effusions. Mild retrocardiac superimposed opacities suggest atelectasis.Unchanged left jugular dialysis catheter

Output: Cardiomegaly with questionable mild early CHF


Instruction: Generate impression based on medical findings.

Input: Female, 40 years old.Rales at the lung bases. Evaluate for infection. Heart size is within normal limits. The pulmonary artery is prominent, suggestive of pulmonary arterial hypertension. Perihilar and bilateral basilar airspace and interstitial opacities consistent with edema. No focal consolidation, large pleural effusions, or pneumothorax.

Output: Findings consistent with edema. No significant evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male, 59 years old.Reason: evaluate R pleural effusion size History: see above Right upper extremity PICC tip terminates at the cavoatrial junction. Right Pleurx catheter in place. Left chest wall AICD pacemaker device lead position unchanged. Coronary arterial stents noted.Layering moderate right pleural effusion with associated atelectasis, similar to prior. No pneumothorax. The cardiac and mediastinal contours are within normal limits for size.

Output: Unchanged moderate layering right pleural effusion and associated atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 21 years old.History of worsening shortness of breath. Port catheter tip is in the SVC. Interval placement of a pericardial drain.The cardiomediastinal silhouette is obscured.Left-sided pleural effusion appears slightly increased from the prior examination. There is adjacent left lower lobe consolidation. Slightly increased streaky opacities in the right lung base are noted.

Output: 1.Interval placement of pericardial drain.2.Slight increase in left pleural effusion.3.Subsegmental right basilar atelectasis.


Instruction: Generate impression based on medical findings.

Input: Reason: r/o edema History: hyponatremia, volume overload Moderate cardiomegaly with a small right pleural effusion and probable mild lower zone interstitial edema, new or increased from previous.Status post median sternotomy with intact sternal fixation devices.

Output: Findings compatible with mild CHF.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.History of cough and shortness of breath. The cardiomediastinal silhouette is normal.There are linear scars in the left lower lobe, otherwise no focal pulmonary opacities or pleural effusions.

Output: No acute cardiopulmonary abnormality or evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Shortness of breath Persistent cardiopulmonary appearance with mixed nonspecific airspace and interstitial abnormalities greater on the right. Concern for edema versus infection. See subsequent report

Output: Nonspecific mixed interstitial airspace opacities most concerning for edema.


Instruction: Generate impression based on medical findings.

Input: 63-year-old male with history of thyroid cancer and metastatic lesions CHEST:LUNGS AND PLEURA: Paramediastinal fibrosis is again seen. Multiple pulmonary nodules and masses are redemonstrated. Index right upper lobe nodule measures 8mm in diameter on image number 149, series number 8. No significant change from previous study. Left lower lobe pulmonary nodule measures 1.1 x 0.9 cm on image number 208, series number 8, again not significantly changed from previous study. Other nodules are also grossly stable.Bilateral nodular pleural thickening with loculation in the left lower lobe pleural effusion and architectural distortion appear unchanged.MEDIASTINUM AND HILA: Multiple heterogeneous mediastinal lymph nodes are again noted. Index aortopulmonary lymph node measures 2.6 x 3.3 cm on image number 39, series number 7, unchanged. Index upper paratracheal lymph node measures 2.9 x 4.1 cm on image number 36, series number 7, unchanged. Other mediastinal lymph nodes are also grossly unchanged.CHEST WALL: Posterior chest wall mass invading the pedicle at the level of T9 through T11 vertebral bodies and extending into the spinal canal is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Innumerable confluent heterogeneous, bilobar parenchymal metastases replacing the entire normal liver parenchyma is again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Heterogeneous left adrenal mass is unchanged.KIDNEYS, URETERS: Left renal cyst is unchanged. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Index retroperitoneal lymph node or left adrenal mass is unchanged measuring 7 x 4 cm on image number 103, series number 7.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes and destruction of the vertebral bodies by metastatic lesions, not significantly changed.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study.


Instruction: Generate impression based on medical findings.

Input: Male, 37 years old.Reason: Question of Influenza complicated by Community Acquired Pneumonia History: Mild perihilar bronchial wall thickening which could be asthma or chronic bronchitis, or even atypical infection.Otherwise, the lungs are unremarkable.Unremarkable mediastinal contours and cardiac silhouette.

Output: Nonspecific bronchial wall thickening.


Instruction: Generate impression based on medical findings.

Input: 67-year-old male with metastatic CRC on chemotherapy CHEST:LUNGS AND PLEURA: Emphysematous changes remain. The reference right apical lesion measures 15 x 11 mm, previously 12 x 12 mm (series 4; image 25). The right lower lobe nodule measures 9 x 6 mm, unchanged (series 4; image 50). A spiculated right middle lobe lesion has not significantly changed, measuring 22 x 19 mm (series 4; image 55), previously 2.3 x 2.0 cm. The remainder of the pulmonary nodules are stable. The right lower lobe pulmonary embolism has improved though there remains residual.MEDIASTINUM AND HILA: 18 x 15 mm right hilar lymph node is not significantly changed (series 3; image 44). Overall, the other prominent mediastinal lymph nodes are not significantly changed.Postsurgical changes of a CABG.CHEST WALL: The right-sided port terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis with minimal stable intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 16 x 16 mm left lower adrenal nodule (series 3; image 14), not significantly changed. The other left adrenal module (series 3; image 99) has minimally increased in size, measuring 20 x 11 mm, measuring 19 x 11 mm when remeasured.Mild right adrenal nodularity is unchanged.KIDNEYS, URETERS: Stable small renal hypodensities bilaterally, too small to definitely characterize but not significantly changed.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 mildly enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild diverticulosis. Left inguinal hernia repair. Small fat containing right inguinal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Diffuse atherosclerotic disease.

Output: Minimal increase in size of the right apical pulmonary nodule. Otherwise, no significant change.


Instruction: Generate impression based on medical findings.

Input: Reason: s/p pleurectomy with air leak on chest tube History: air leak on chest tube Small left apical pneumothorax slightly increased from previous chest tube in place.Underlying opacity compatible with atelectasis and effusion.Diffuse subcutaneous emphysema.

Output: Small left apical pneumothorax, slightly increased.


Instruction: Generate impression based on medical findings.

Input: "Health examination of defined subpopulation" Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 45 years old.Reason: evaluate for aspiration History: impaired swallowing, fever, cough Near complete resolution of bibasilar opacities with resolution of pleural effusions. Left lower lobe cavitary lesion noted, better characterized on previous CT scans. Improvement in heart size, now normal. No pneumothorax.

Output: Near complete resolution of bibasilar opacities with resolution of pleural effusions. Improvement heart size, now normal. Left lower lobe cavitary lesion, better characterized on previous CT scan.


Instruction: Generate impression based on medical findings.

Input: Age: 47 yearsGender: FemaleReason for Study: Reason: eval resp status History: new cough Left IJ venous catheter unchanged with its tip in the left innominate.  Interval improvement in the bilateral air space opacities and left nasal are consolidation/atelectasis.Persistent cardiac enlargement and small left pleural effusion.

Output: Interval improvement in the pulmonary edema and left retrocardiac consolidation/atelectasis.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: eval swan placement History: swan in place Swan-Ganz catheter tip in main pulmonary artery. Other findings stable.

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


Instruction: Generate impression based on medical findings.

Input: Cough No cardiopulmonary abnormality. Midline sternotomy unchanged

Output: No acute disease


Instruction: Generate impression based on medical findings.

Input: Male, 86 years old.Reason: assess placment of temp pacing wire History: as above Interval placement of a pacer wire from the femoral venous approach demonstrates the wire coiled, and projecting over the right heart. A lateral view would be helpful in determining the exact location of the coiled portion of the wire as well as its landing point.Stable cardiomegaly with vascular congestion but no specific evidence of infection or edema.Stable appearance of right subclavian venous catheter. Right subclavian venous stent again noted.No pleural effusion. No pneumothorax.

Output: Pacer wire is seen coiled, overlying the right heart. A lateral view would be helpful in determining the exact location of the coil portion as well as the terminal and. Repositioning will likely be necessary.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: post op CABG History: see above Resolution of prior basilar opacities.Presently, there is no significant abnormality.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 72-year-old female evaluate for metastatic gastric cancer CHEST:LUNGS AND PLEURA: Bilateral trace pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Periportal edema. No focal liver lesion suspicious for metastatic disease in the liver. No evidence of intra-or extrahepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Punctate calcifications in the pancreas consistent with chronic pancreatitis.ADRENAL GLANDS: Adrenal glands are diffusely enlarged bilaterally.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peripancreatic adenopathy. An index lesion measures 18 by 10-mm image number 95, series number 3.BOWEL, MESENTERY: The stomach wall is diffusely thickened, consistent with patient's known history of gastric cancer. Hazy increased density of the small bowel mesentery.Mild wall thickening of the small bowel loops in the lower abdomen and pelvis. The etiology is uncertain. Some of the distal small bowel loops are dilated, measuring up to 5 cm. Proximal small bowel loops are not dilated. Distal small bowel loops and terminal ileum are unremarkable with oral contrast freely passing into the cecum. The wall of the cecum and ascending colon is also slightly thickened.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is not well visualized. There are bilateral adnexal soft tissue densities. These may represent ovaries, however, given the history of gastric cancer. Possibility of peritoneal deposits cannot be excluded.BLADDER: Focal soft tissue density abutting the anterior/superior wall of the bladder measuring 4 by 2.4 cm, image number 84, series number 3. The etiology is unknown. This may represent bladder wall thickening or metastatic deposit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 19 mm, round, soft tissue density in the left lower quadrant pelvic wall. The etiology is unknown. Metastatic disease cannot excluded. Other smaller subcutaneous soft tissue densities are also present.OTHER: No significant abnormality noted.

Output: Diffuse gastric wall thickening and perigastric adenopathy consistent with patient's known history of metastatic gastric cancer.Mild, nonspecific small bowel dilatation of mid small bowel segments. Oral contrast freely extends into the cecum.Wall thickening of the distal small bowel loops and proximal colon. Increased density of the mesenteric fat. These findings may represent peritoneal carcinomatosis versus therapy related (chemotherapy or radiotherapy.) changes.Soft tissue nodules in the pelvic abdominal wall of unknown etiology.Soft tissue density abutting the anterior/superior wall of the bladder. The etiology is unknown. This may represent wall thickening of the bladder versus metastatic lesion.Small amount of ascites and trace amount of bilateral pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.History of aspiration, brown discharge from trach, check for worsening aspiration. Multifocal airspace opacities consistent with pneumonia, some of these appear nodular. Chronic basilar atelectasis consistent with provided history of aspiration. Cardiomegaly, tracheostomy tube and right chest port unchanged.

Output: Persistent airspace opacities consistent with pneumonia or metastases. The appearance is not consistent with aspiration pneumonia however.


Instruction: Generate impression based on medical findings.

Input: Reason: Post-extubation History: As above Interval extubation.Slightly decreased right lung volume with diffuse opacity compatible with edema and aspiration.Pleurx catheter at the right base with a moderate effusion.Complete opacification of the left hemithorax, unchanged.No new findings.

Output: Interval extubation with decreased volume in the right lung and no other significant change.


Instruction: Generate impression based on medical findings.

Input: 51-year-old male with colorectal carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes involving the liver. Previously described fluid collection along the suture lines is smaller. No focal lesions in the residual liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small amount of fluid collection in the anterior abdominal wall along the incision. In its largest axial dimension. The collection measures 5 x 3 cm. fat stranding in the anterior abdominal wall and inflammation.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis.

Output: Postsurgical changes and small amount of collection in the anterior abdominal wall. No evidence of metastatic disease.


Instruction: Generate impression based on medical findings.

Input: 74 years, Female. Reason: OGT placement check History: gastric distention Enteric tube is seen coiled in the region of the stomach fundus. Dilated loops of small bowel are partially visualized. Left lower quadrant skin surgical staples are noted. There is degenerative change at the lower lumbar spine. A left lung base opacity is again seen, better evaluated on the current chest radiograph.

Output: 1.Enteric tube coiled in the region of the stomach fundus.2.Partially visualized dilated loops of bowel compatible with small bowel obstruction.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, 62 years old.Reason: et tube location History: micu Endotracheal tube terminates approximately 3.2 cm from the carina. Right IJ line terminates in the RA. No pneumothorax. Diffuse pulmonary opacities again noted. Right greater than left pleural effusions. Unchanged heart size.

Output: Lines and tubes, as above. Diffuse pulmonary opacity again noted. No change in pleural effusions, right greater than left.


Instruction: Generate impression based on medical findings.

Input: Chest pain, tightness, SOB rule out pneumothorax or pneumonia. Normal heart size. No focal airspace opacities, pleural fluid or pneumothorax.

Output: No acute pulmonary abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 79 years old.Tenderness in left breast, assess pacemaker placement. Left-sided pacemaker device with single lead in distribution of right atrial appendage, unchanged. Right chest port with tip in right atrium.Marked cardiomegaly slightly increased with associated vascular redistribution.No specific evidence of acute infection or edema.

Output: Slightly increased cardiomegaly with unchanged position of single lead pacemaker device.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Fevers and neutropenia evaluate for infection. Low normal lung volumes. Mild basal atelectasis and bronchial wall thickening increased from the prior, but no specific signs of pneumonia.

Output: Mild atelectasis but no convincing evidence of pneumonia.


Instruction: Generate impression based on medical findings.

Input: 56 year old female with history of renal cell carcinoma metastatic to right common ileac node, status post radical nephrectomy in 2005 and radiation therapy to evaluate for recurrence This is a suboptimal examination for soft tissue neck due to lack of contrast. The skull base and cavernous sinuses are unremarkable. Limited view of the brain parenchyma is negative for metastatic lesion.Examination redemonstrates previously described structure without any change. The signal attenuation is inseparable with the adjacent jugular vein. Views of soft tissue neck is negative for discrete mass or pathologic lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. Limited view of lungs is negative for metastatic lesion. Osseous structures within the examination range is unremarkable.

Output: Unremarkable CT examination of the neck with no evidence of pathologic lymphadenopathy or discrete mass.


Instruction: Generate impression based on medical findings.

Input: Hypoxia evaluate for edema. Interval worsening of airspace opacities bilaterally, some areas are now masslike. Moderate pleural fluid and pulmonary edema, increased from prior.Right jugular catheter unchanged in position, no pneumothorax.

Output: Significant worsening of masslike airspace opacities, which may be due to septic emboli, angioinvasive fungal pneumonia and/or infarcts given rapid development. Airspace opacities elsewhere compatible with pneumonia have also progressed as has the CHF pattern, which is now moderate.


Instruction: Generate impression based on medical findings.

Input: Male, 36 years old.Reason: chronic cough, h/o Crohn's with immune suppression History: cough, night sweats Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

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


Instruction: Generate impression based on medical findings.

Input: Male, 50 years old.Altered mental status. Assess for pneumonia. There is prominence of the central pulmonary vasculature which may reflect pulmonary arterial hypertension. Right diaphragm is elevated. Lungs are otherwise clear. Heart size within normal limits.

Output: Clear lungs. Possible PA hypertension.


Instruction: Generate impression based on medical findings.

Input: 46-year-old female with history of renal cell cancer, status post 22 cycles of therapy. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Severe fatty infiltration and postsurgical changes in the liver. Numerous metastatic lesions throughout the liver are again identified. These lesions are high attenuation in comparison to the background fatty replaced liver. Exact number cannot be counted, however, overall, no new lesions appear to have developed. Reference lesion in segment 4 now measures 11 x 11 mm in image number 72, series number 3, unchanged, previously measured 11 x 11. Other numerous metastatic lesions are also grossly stable. Hepatomegaly, stable. Hepatic vessels appear patent. Segmentectomy clips appear intact.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Left renal cyst is stable.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: Status post hysterectomy. 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: No significant change of metastatic disease to the liver.


Instruction: Generate impression based on medical findings.

Input: Age: 59 yearsGender: MaleReason for Study: Reason: eval for infiltrate, ARDS History: dyspnea, hypoxia The cardiomediastinal silhouette is unremarkable.Scarring/discoid atelectasis in the left upper lobe.No focal areas of consolidation.No pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 21 year old male with chest pain Cardiomegaly with diffuse bilateral airspace and interstitial opacities increased from prior study. No pleural effusion or pneumothorax.

Output: Findings most consistent with increasing pulmonary edema, less likely hemorrhage.


Instruction: Generate impression based on medical findings.

Input: Male, 55 years old.Oxygen requirement, pulmonary edema. Mitral disorder. Interval removal of Swan-Ganz catheter, introducer in the right jugular vein is unchanged in position. Superior mediastinal widening unchanged, and may represent hematoma. Layering pleural effusions, atelectasis and left lower lobe consolidation, slightly worse.

Output: Worsening pleural fluid, atelectasis and consolidation. Mediastinal widening may represent hematoma or lymphadenopathy, etiology is unclear in the absence of remote prior radiographs.


Instruction: Generate impression based on medical findings.

Input: 26-year-old man with history of long-standing GERD for which he underwent Nissen fundoplication in 2006, with unremitting current symptoms. He underwent esophagogastrectomy in 2013 for recurrent giant esophageal hernia. He underwent exploratory laparotomy and left thoracotomy for herniation of small bowel into the mediastinum in 2014. He now presents with left upper quadrant pain x2 days. Postsurgical changes from esophagectomy with gastric pull-up, unchanged. Mild blunting of the left costophrenic angle is unchanged, and may reflect a small pleural effusion or basilar atelectasis/scarring. No new pulmonary opacity is seen to suggest pneumonia. No pneumothorax.

Output: No significant change in the contours of the cardiomediastinal silhouette, which includes the gastric pull-up, when compared to the radiograph dated 4/10/2016. Please refer to abdominal/pelvic CT dated 4/10/2016.


Instruction: Generate impression based on medical findings.

Input: Female, 31 years old.Reason: What is etiology of shortness of breath? History: Shortness of breath Low lung volumes. No focal consolidation, effusion, or pneumothorax. Mild bronchial wall thickening.Two posterior orthopedic rods affix the thoracolumbar spine. Extensive skeletal deformities consistent with history of osteogenesis imperfecta again noted.

Output: Mild bronchial wall thickening which can be seen in asthma and chronic bronchitis, but no evidence of infection.


Instruction: Generate impression based on medical findings.

Input: Male 1 day old with congenital diaphragmatic hernia and PCVC placementVIEW: Chest and abdomen AP (two views) 3/10/2016, 1018 Placement of left lower extremity PICC with tip in the IVC at the T11 level. Endotracheal tube tip is at the thoracic inlet. Enteric tube tip is below the left hemidiaphragm. Umbilical venous catheter tip is in the right chest. Umbilical arterial catheter tip is in the aorta at the T6 level and displaced to the left. Urinary catheter in place.Small left cervical rib and tiny right cervical rib noted. Cardiothymic silhouette size cannot be evaluated. Right hemithorax is almost completely opacified. A few gas-filled bowel loops are present in the right lateral lower hemithorax. A crescent-shaped lucency is present in the medial upper portion of the right hemithorax. Leftward mediastinal shift noted. Disorganized bowel gas pattern with very little gas present in the left and right mid abdomen as well as less gas noted in the right hemithorax.

Output: Right diaphragmatic hernia with decreased gas noted within the bowel loops of the right chest.


Instruction: Generate impression based on medical findings.

Input: Female, 55 years old.Reason: pleural effusion History: pleural effusion Low lung volumes with large left and moderate right pleural effusions with associated atelectasis, not significantly changed. Left sided jugular catheter is unchanged. Status post sternotomy.

Output: Low lung volumes with large left and moderate right pleural effusions with associated atelectasis, not significantly changed.


Instruction: Generate impression based on medical findings.

Input: Age: 60 yearsGender: MaleReason for Study: Reason: cause of increase in pulse and respiratory rate s/p pericardiocentesis? 60M lung ca, mediastinal mass, HIV History: as above Stable cardiomediastinal silhouette with tracheal stent and large mediastinal mass unchanged.Right perimediastinal atelectasis similar in appearance the prior exam.No new pulmonary abnormalities identified.No evidence of pneumomediastinum.No large pleural effusions.

Output: No interval change in the tracheal stent and large right mediastinal mass. No acute pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Please evaluate for PE, worsening infiltrates, edema, effusion. History: hypoxia, SOB PULMONARY ARTERIES: Technically adequate examination with no evidence of pulmonary embolism.LUNGS AND PLEURA: Extensive bilateral pulmonary nodular and confluent opacities consistent with metastatic disease with associated emphysema. The extent and severity of disease is very similar to the previous scan though in the apical areas there is evidence of moderate interval progression.MEDIASTINUM AND HILA: Incomplete visualization of the thyroid gland.No significant mediastinal lymphadenopathy.CHEST WALL: Small sclerotic foci in several vertebral bodies, unchanged, compatible with metastases.UPPER ABDOMEN: Limited evaluation due to arterial phase of contrast. No gross abnormalities in the visualized area.

Output: 1. No evidence of pulmonary embolism.2. Extensive pulmonary metastatic disease, slightly progressed in the apical areas, and underlying emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 66 years old.Reason: line placement History: same New right IJ catheter tip at the confluence of the brachiocephalic veins. No pneumothorax.Left PICC tip at the superior cavoatrial junction.No focal pulmonary opacity, significant pleural effusion, or pneumothorax.Stable cardiomediastinal silhouette.

Output: No pneumothorax. Right IJ catheter tip at the confluence of the brachiocephalic veins.


Instruction: Generate impression based on medical findings.

Input: 80 year-old female with left lower quadrant pain and leg swelling; evaluate for diverticulitis CHEST:LUNG BASES: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Wall thickening of the urinary bladder is identified.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Thickened urinary bladder wall may represent cystitis/bladder pathology in the appropriate clinical context


Instruction: Generate impression based on medical findings.

Input: Age: 73 yearsGender: FemaleReason for Study: Reason: evaluate ET tube placement History: intubated ET tube with its tip in the region of the carina and proximal right mainstem bronchus.Left-sided pacemaker unchanged.NG tube with tip in the stomach.This was complete opacification of left hemithorax with marked shift of the mediastinum from right to left compatible with left lung collapse.

Output: ET tube in low position with its tip in proximal right mainstem bronchus. There is subsequent left lung collapse.


Instruction: Generate impression based on medical findings.

Input: 6-day-old male with pneumothorax, evaluate chest tube placement.VIEW: Chest AP (one view) 1/16/2015, 14:21 ET tube tip is below thoracic inlet and above the carina. Three right-sided chest tubes are in place, position unchanged. Umbilical lines are unchanged in position.Cardiothymic silhouette is unchanged. No pleural effusion. Persistent small/moderate right pneumothorax. Diffuse, bilateral pulmonary haziness. Stable left lower lobe opacity.

Output: Persistent small/moderate right pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Age: 52 yearsGender: FemaleReason for Study: Reason: concern for infiltrate History: fevers a week ago, non-productive cough, CP The cardiomediastinal silhouette is unremarkable.The lungs are clear.There are no pleural effusions.

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


Instruction: Generate impression based on medical findings.

Input: 61-year-old male with pancytopenia and lymphoma CHEST:LUNGS AND PLEURA: Moderate to severe emphysematous changes bilaterally are unchanged. Small right-sided pleural effusion is minimally increased compared to previous study. Trace left-sided pleural effusion.MEDIASTINUM AND HILA: Mild cardiomegaly and trace pericardial effusion are unchanged. Index right paratracheal lymph node measures 11 x 11 mm on image number 32, series number 3 not significantly changed compared to previous study.CHEST WALL: Interval increase in the size of the bilateral axillary lymph nodes. Right axillary index node measures 1.9 x 1.1 cm on image number 12, series number 3. Previously it was measuring 12 x 9 mm on image number 15, series number 3.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense lesions representing metastatic disease are again noted. Index lesion in the left lateral segment measures 1.8 x 2.1 cm on image number 109, series number 3, smaller compared to previous study. Most of the other metastatic lesions are also slightly smaller to unchanged. However the more superior lesion in the left lobe is slightly increased in size and now measures 5.2 x 2.7 cm on image number 91, series number 3. Previously this lesion was measuring 4.2 x 2.8 cm on image number 86, series number 3.SPLEEN: Splenomegaly, unchanged. Previously described splenic lesion in the inferior pole of the spleen now measures 1.7 x 1.1 cm on image number 112, series number 3.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: An index gastrohepatic lymph node measures 2.3 x 1.4 cm on image number 95, series number 3, not significantly changed from previous study. Other retroperitoneal enlarged lymph nodes are also grossly unchanged.BOWEL, MESENTERY: Small amount of ascites, not significantly changed from previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Enhancing mass in the right bladder wall is not well visualized today.LYMPH NODES: Bilateral enlarged inguinal lymph nodes have slightly increased in size compared to previous study. Index right inguinal lymph node measures 2.2 by 1.1 cm on image number 212, series number 3. Previously it was measuring 1.6 by 0.8 cm on image number 208, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Slight interval increase in the size of the axillary and inguinal lymph nodes. Mixed changes in hepatic lesions as described above.


Instruction: Generate impression based on medical findings.

Input: Age: 86 yearsGender: FemaleReason for Study: Reason: fluid overload, sepsis, hypoxia History: hypoxia Cardiomegaly with diffuse pulmonary opacities and pleural effusions similar in appearance to the prior exam.Right upper lobe consolidation stable.No new pulmonary opacities identified.

Output: Pleural effusions and extensive pulmonary opacities are unchanged compatible with CHF and possible superimposed right upper lobe infection.


Instruction: Generate impression based on medical findings.

Input: There is stable minimal grade 1 anterolisthesis of L4 on L5 measuring 3 mm. The lumbar spine is otherwise in normal alignment, with slight straightening of the normal lumbar lordosis. The vertebral body and disk heights are not significantly changed, with multilevel disc narrowing, up to moderate in degree at L5-S1. There is multilevel disc desiccation again seen. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level. There is bunching and slight redundancy of the cauda equina nerve roots due to the spinal stenosis detailed below.At T11-T12, sagittal images suggest a minimal disc bulge.At T12-L1, L1-L2, L2-L3, there is no significant disk pathology or stenosis.At L3-L4, there is a stable mild disc bulge with right lateral facet arthropathy and ligamentum flavum thickening resulting in moderate central spinal canal stenosis and moderate right as well as mild-moderate left foraminal narrowing.At L4-L5, previously seen large right paracentral disc extrusion is no longer appreciated. There is a residual mild disc bulge with underlying uncovering of the disc. There is moderate central spinal canal stenosis. Severe bilateral facet arthropathy and ligamentum flavum thickening is seen contributing to overall moderate left and now progressed to moderate-severe right foraminal narrowing.At L5-S1, there is a persistent diffuse posterior osteophyte disk complex indents the ventral thecal sac with moderate left and now slightly progressed moderate-severe right foraminal narrowing. There is bilateral facet arthropathy.

Output: 1. Slight interval progression of lower lumbar spondylotic changes, with stable grade 1 anterolisthesis of L4 on L5. Up to moderate central spinal canal stenosis at L3-L4 and L4-L5. Slight worsened now moderate-severe right foraminal narrowing at L4-L5 and L5-S1.2. Interval resolution of previously noted large right paracentral disc protrusion at L4-L5.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old.Reason: Significant weight loss and fatigue in a former smoker. The cardiomediastinal silhouette is normal. No focal opacity or pneumothorax.

Output: No acute cardiopulmonary process.


Instruction: Generate impression based on medical findings.

Input: Male, 47 years old.Reason: CM s/p OHT, annual evaluation History: CM s/p OHT, annual evaluation Status-post sternotomy for heart transplant, size normal.No specific evidence of infection or edema.No pleural effusions.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with history of tongue cancer status post chemoradiation. Restaging CT. CT with abnormality but clinically (illegible). LUNGS AND PLEURA: New right upper lobe peripheral soft tissue nodule with internal enhancement (series 5 image 41) measuring 16 x 20 mm with adjacent peribronchial nodular opacities.Additional upper lobe nodular opacities with associated traction bronchiectasis, similar to prior. Apical scarring, consistent with radiation change.New right middle lobe and right lower lobe clustered tree-in-bud and nodular opacities, most consistent with bronchiolitis.MEDIASTINUM AND HILA: Marked diffuse esophageal dilatation/thickening with right lateral distal esophageal diverticulum containing fluid and debris, similar to prior.Reference right paratracheal lymph node (series 3 image 39) measures 4 mm, unchanged. Other subcentimeter mediastinal lymph nodes are grossly unchanged.CHEST WALL: Moderate to severe degenerative changes of the spine, similar to prior.UPPER ABDOMEN: Cholelithiasis. Left adrenal prominence, similar to prior. Multiple left renal cystic lesions are not significantly changed in size from prior, however, are now relative high density, which may represent hemorrhage or proteinaceous fluid but are incompletely evaluated by this technique.Moderate vascular plaque in the abdominal aorta and its branches.

Output: 1) New right upper lobe pulmonary nodule; absent clinical signs of infection to suggest the presence of pneumonia, this is suspicious for malignancy. PET scan may be obtained if there is a high level of clinical suspicion. Otherwise, follow-up CT scan may be performed in 6 weeks to assess for resolution. 2) Bronchiolitis in the right middle lobe and right lower lobe which may be secondary to infection or aspiration.3) Indeterminate left renal cysts or nodules; recommend correlation with dedicated renal CT within the next 6 months to confirm benign etiology. This may be performed at the time of the follow-up chest CT but should be ordered as a "dedicated renal protocol with infusion".


Instruction: Generate impression based on medical findings.

Input: Reason: patient wtih swan, intubated, sedated. check placement of swan and ET tube History: heart failure, intubated ET tube, Swan-Ganz catheter, left jugular catheter, right pleural drain and feeding tube unchanged.Lower zone airspace opacities and pleural effusions, not significantly changed.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Reason: ett History: ett ET tube tip approximately 3 cm above the carina. Cardiomegaly with mild basilar atelectasis, not significantly changed.Interval removal of a NG tube.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: 66-year-old female with COPD and COPD exacerbation. LUNGS AND PLEURA: Moderate centrilobular emphysema. No pleural effusions.MEDIASTINUM AND HILA: Coronary arterial calcifications. No pericardial effusion or significant mediastinal lymphadenopathy. Layering debris in the dependent portion of the trachea likely secondary to mucous.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: Moderate emphysema without acute cardiac or pulmonary abnormalities.


Instruction: Generate impression based on medical findings.

Input: Male, 66 years old.Reason: iabp position History: above Cardiomegaly, with nonspecific left basilar subsegmental atelectasis.IABP catheter proximal marker 5 cm below the top of the aortic arch.Right jugular catheter, tip in SVC.Left subclavian ICD, leads unchanged in position.

Output: IABP catheter proximal marker now 5 cm below the top of the aortic arch, advanced since the prior study.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.Reason: CT follow up History: CT follow up, previously reported history of mesothelioma Persistent small right pneumothorax in the setting of two apically directed chest tubes. Surgical staples at the right thoracic inlet, unchanged. Marked elevation right hemidiaphragm. Near complete resolution right inferolateral subcutaneous emphysema. Left lower lobe subsegmental atelectasis.

Output: Persistent small right pneumothorax in the setting of a chest tube. Near complete resolution right inferolateral subcutaneous emphysema.


Instruction: Generate impression based on medical findings.

Input: Female, 71 years old.Reason: CHF History: as above Left subclavian dual-chamber ICD remains unchanged.Partially obscured cardiac silhouette is enlarged.Continued interval worsening of pulmonary opacities suggestive of edema with bibasilar pleural effusions, left greater than right. No pneumothorax.

Output: Interval worsening in pulmonary edema pattern and bibasilar pleural effusions. Correlate with fluid status.


Instruction: Generate impression based on medical findings.

Input: Reason: interval eval for PNA in ICU History: as above The heart size about upper normal.Small lung volumes with no evidence of pneumonia or other acute change.Interval removal of a Swan-Ganz catheter with a catheter sheath in the right jugular vein.

Output: No acute abnormalities.


Instruction: Generate impression based on medical findings.

Input: Reason: Evaluate for pulmonary edema History: DOE Moderate cardiomegaly with ICD leads in place. Interstitial opacity with septal lines compatible with edema and moderate bilateral pleural effusions consistent with CHF.Skin folds bilaterally but no pneumothorax.

Output: Pulmonary edema and pleural effusions consistent with CHF.


Instruction: Generate impression based on medical findings.

Input: Reason: free air History: epigastric pain Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.No free air in the abdomen.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 33 years old.Reason: r/o disease History: productive cough Mild bronchial wall thickening, the lungs otherwise unremarkable.Unremarkable mediastinal contours and cardiac silhouette.No specific evidence of infection or edema.

Output: Mild bronchial wall thickening, which could be the result of asthma or chronic bronchitis.


Instruction: Generate impression based on medical findings.

Input: Male, 49 years old.Reason: swan placement History: as above Swan-Ganz catheter terminates within the most proximal aspect of the interlobar pulmonary artery. Small blebs/bullae are noted at the lung apices. Small amount of right-sided subcutaneous emphysema. No large pleural effusion or pneumothorax. Unchanged cardiomegaly.

Output: Swan-Ganz catheter, as above.


Instruction: Generate impression based on medical findings.

Input: Reason: 51 yo M ex lap LOA for closed loop obstruction, eval for pulmonary edema, effusion, infiltrates History: 51 yo M ex lap LOA for closed loop obstruction, eval for pulmonary edema, effusion, infiltrates ET tube tip at the level of T1-T2 with cuff above the vocal cords.NG tube tip in the stomach.No significant cardiopulmonary abnormalities.

Output: High position of ET tube.


Instruction: Generate impression based on medical findings.

Input: Female, 64 years old.Reason: eval for acute process History: worsening SOB No significant cardiopulmonary abnormality.No specific evidence of infection or edema.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Age: 58 yearsGender: MaleReason for Study: Reason: mailignant pleural effusion on L, s/p chest tube History: see above Left sided chest tube unchanged without evidence of a pneumothorax. Stable cardiac enlargement.Left pleural effusion and interstitial opacities in the left lung slightly increased from the prior exam.The right lung is clear with interval improvement in the right pleural effusion.

Output: Mild increase in left pleural effusion and interstitial edema. Improvement in the right pleural effusion.


Instruction: Generate impression based on medical findings.

Input: 97-year-old female with new lung lesions. Concern for occult malignancy versus infection. CHEST:LUNGS AND PLEURA: Scattered small and large bilateral lung nodules consistent with metastatic disease. For baseline purposes when of the medially located left upper lobe nodules is measured on series 4 image 22/100, 1.2 x 0.9 cm.There are small to moderate sized bilateral pleural effusions. There is atelectasis or consolidation at the right lung base and less so at the left lung base.MEDIASTINUM AND HILA: Cardiomegaly. Atherosclerotic changes aorta. Coronary artery calcifications. Bowel calcifications.CHEST WALL: Enlarged right breast with soft tissue density and fluid or edematous changes throughout the fat. This is suspicious for a breast carcinoma.ABDOMEN: The exam is not sensitive for detecting lesions in the solid organs due to the lack of IV contrast. Given that limitation, the following observations are made.LIVER, BILIARY TRACT: Cholelithiasis. No definite liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypo-and slightly hypoattenuating lesions in the kidneys consistent with a combination of simple and high density cysts likely.RETROPERITONEUM, LYMPH NODES: Extensive left para-aortic adenopathy. For baseline purposes left periaortic nodes seen on series 3 image 113/209 measures 3 x 2.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Generalized anasarca., severeOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes. No definite lytic or blastic disease.OTHER: No significant abnormality noted.

Output: Multifocal lung lesions consistent with metastases. Strong suspicion for right breast mass. Generalized anasarca. Retroperitoneal adenopathy. Typical and atypical renal cyst. Cholelithiasis. Atherosclerotic disease. Other findings as above.


Instruction: Generate impression based on medical findings.

Input: Male, 61 years old.Shortness of breath now status-post ET tube placement. ET tube is located 5 cm superiorly from the carina. There are bilateral patchy predominantly central airspace opacities which may represent multifocal aspirations or edema. The heart size is within normal limits. No pneumothorax.

Output: 1. ET tube is located 5 cm from the carina.2. Bilateral patchy predominantly central opacities may represent aspiration or pulmonary edema.


Instruction: Generate impression based on medical findings.

Input: Male, 77 years old.Reason: Infiltrates History: fever Large partially loculated right pleural effusion with overlying compressive atelectasis and consolidation. The right heart border is obscured. Tortuous aorta.

Output: Large partially loculated right pleural effusion with overlying compressive atelectasis and consolidation.


Instruction: Generate impression based on medical findings.

Input: Fever New streaky densities in both bases representing new atelectasis with decreased volume. No distinct superimposed airspace process observed in this limited evaluationMild nonspecific cardiomegalyGrossly unchanged and incomplete visualization of lower cervical spine fixation

Output: Interval atelectasis without definite superimposed focal findings to suggest infection, however serial imaging will be helpful to confirm and ensure clearance given history


Instruction: Generate impression based on medical findings.

Input: Male, 81 years old.Reason: dyspnea History: dyspnea Stable post surgical changes and volume loss in the left hemithorax.Severe emphysema and large bullae appear similar to prior.Pulmonary nodules observed on recent CT are not well evaluated on this study, but likely unchanged.Normal cardiomediastinal silhouette. New nodular lesions at the left lung base.

Output: Query new left basilar aspiration or pneumonia, which can be re-evaluated on follow up imaging.Stable severe emphysematous changes.


Instruction: Generate impression based on medical findings.

Input: Male, 60 years old.Reason: Pre-Op TRANSPLANT baseline assessment History: Pre-Op TRANSPLANT Unremarkable mediastinal and cardiac silhouette.No significant pulmonary or pleural abnormalities.

Output: No significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Female, 53 years old.Reason: Is there pneumonia? History: Fever Central venous catheter terminates near the cavoatrial junction. No new focal pleural parenchymal opacity. No large pleural effusion or pneumothorax. Unchanged heart size.

Output: No acute cardiopulmonary process on radiography.


Instruction: Generate impression based on medical findings.

Input: Male, 48 years old.Reason: evaluate lung fields, LVAD position History: s/p LVAD, MVR Lines and tubes are unchanged. No substantial change in diffuse pulmonary opacities. Dense left lower lobe opacity, likely atelectasis again noted. Unchanged cardiomegaly. No large pleural effusion or pneumothorax.

Output: No substantial change in pulmonary edema pattern.


Instruction: Generate impression based on medical findings.

Input: Female, 62 years old.Evaluate pneumothorax after lung biopsy. Solitary pulmonary nodule. Pulmonary nodules and masses with mediastinal lymphadenopathy unchanged. No visible pneumothorax.

Output: No visible pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Reason: eval for infiltrate History: shortness of breath Unremarkable cardiac and mediastinal silhouette.No significant pulmonary or pleural disease.

Output: No significant abnormalities.


Instruction: Generate impression based on medical findings.

Input: Female, 43 years old.Dobbhoff placement. Interval placement of enteric tube with tip outside the field of view but likely within the proximal duodenum. A left internal central venous catheter terminates in the SVC. Interval removal of an endotracheal tube.Low lung volumes with basilar opacities and bilateral pleural effusions, right greater than left. Cardiomegaly is unchanged.

Output: Enteric tube tip outside the field of view; see abdominal radiograph. Unchanged edema.


Instruction: Generate impression based on medical findings.

Input: Male, 25 years old.Reason: 25 y/o CHF eval swan History: swan Swan-Ganz catheter has been pulled back terminating over the right hilum. ICD lead is unchanged. Left basilar atelectasis again noted. No new focal pleural parenchymal opacity. Unchanged cardiomegaly.

Output: Lines and tubes, as above. No new focal pleural parenchymal opacity.


Instruction: Generate impression based on medical findings.

Input: Male, 65 years old.Reason: right ij catheter and pacer wire placement History: rij cath and wire Interval insertion of a right internal jugular approach pacer wire, with its projected over the proximal right ventricleIncreased volume loss in the right hemithorax with rightward mediastinal shift, consistent with right middle and lower lobe atelectasis combined with a right pleural effusion.Underlying right partially loculated pleural effusion.No pneumothorax. The left lung is clear.Destructive right first rib lesion.

Output: 1. Progressive opacification of the right hemithorax, consistent with a combination of pleural effusion and atelectasis likely secondary to underlying tumor.2. Transvenous pacing wire projected projected over the right ventricle, proximal to the apex.


Instruction: Generate impression based on medical findings.

Input: 74-year-old female with history of pancreatic cancer. Status post Whipple surgery. Please evaluate. CHEST:LUNGS AND PLEURA: Previous described subcentimeter nodule image number 56 on series number 4 is unchanged.Small bilateral pleural effusions (left greater than right).MEDIASTINUM AND HILA: Small thyroid nodules are not changed substantially since prior exam. Descending aorta mildly prominent 4.4 cm in diameter but unchanged. No significant lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Perfusional variation adjacent the gallbladder fossa may be a normal variant and could be followed.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. Pancreatic head is unremarkable. Hazy increased density in the bed of the pancreatic body and head likely represents postsurgical changes. No definite recurrent or metastatic mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall, unchanged.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: Pelvic ascites.

Output: Pelvic ascites. Small pleural effusions. Perfusional variation in the liver adjacent to the gallbladder fossa that should be followed. No measurable disease identified.


Instruction: Generate impression based on medical findings.

Input: Female, 44 years old.Leukocytosis and tachycardia. Hypotension. Right chest port tip at the SVC/RA junction. Questionable partial obscuration of the right hemidiaphragm which could be due to patient position versus adjacent atelectasis or air space opacity. No conclusive pneumonia is appreciated.

Output: No conclusive evidence of pneumonia. Nonspecific appearance of the right hemidiaphragm which could be due to patient positioning. If there is continued clinical concern for pneumonia, erect PA and lateral chest films may be of use for further characterization.


Instruction: Generate impression based on medical findings.

Input: Male, 79 years old.Reason: assess ETT position, acute abnormalities History: s/p PEA arrest and intubation Interval removal of external defibrillator pads. An external blanket is now present. The remaining support devices are unchanged.Multifocal patchy opacities of pulmonary nodules and edema. No pneumothorax.

Output: Multifocal pulmonary nodules with associated edema. Small pleural effusions.


Instruction: Generate impression based on medical findings.

Input: Reason: eval ett History: ett ET tube tip approximately 4 cm above the carina.Mild left lower lobe opacity compatible with atelectasis.

Output: ET tube in acceptable position.


Instruction: Generate impression based on medical findings.

Input: Male, 68 years old.Perforation of esophagus. SOB. Rule out pneumo or pneumonia. Tubes and lines unchanged in position. Small right apical pneumothorax with 8 mm of pleural separation from the chest wall, slightly smaller.Small volume of loculated pleural fluid on the left, unchanged. Small left pneumothorax seen previously in the deep left costophrenic angle no longer visible though the area is obscured due to overlying chest tubes and only partially included on the film.Basilar atelectasis and airspace opacity, left greater than right. Basal consolidation on the right appears progressed, unable to exclude pneumonia.

Output: Small 8 mm right pneumothorax, previously 14 mm. Small left pneumothorax component seen cannot be accurately assessed, but is not larger. Worsening focal consolidation on the right may indicate pneumonia.


Instruction: Generate impression based on medical findings.

Input: Female, 80 years old.Reason: r/o pneumothorax post thoracentesis History: requiring bipap Small pleural effusions, that on the right located in the fissure.No pneumothorax following thoracentesis.Right jugular catheter, tip in SVC.Descending aortic endograft noted as well as a gastrostomy tube.

Output: No significant pneumothorax.


Instruction: Generate impression based on medical findings.

Input: Male, 58 years old.Reason: pulmonary edema? History: shortness of breath Moderate cardiomegaly unchanged.No specific evidence of infection or edema.Unchanged left brachiocephalic vascular stent.

Output: Cardiomegaly, but no acute abnormality.


Instruction: Generate impression based on medical findings.

Input: Male, 67 years old.IABP placement. IABP marker projects over the proximal descending thoracic aorta approximately 5 cm below the top of the aortic arch.Right jugular Swan-Ganz catheter overlies the proximal right main pulmonary artery.Left subclavian ICD and external pacing leads unchanged. No pneumothorax.Mild basal atelectasis and probable small pleural effusions.

Output: IABP marker about 5 cm below the top of the aortic arch.